5 research outputs found
Assessment of an intervention aimed at early discontinuation of intravenous antimicrobial therapy in a Brazilian University hospital
Many interventions demonstrate success in adapting the duration of intravenous antibiotic therapy, but few studies have been conducted in developing countries. The aim of this study was to evaluate the effectiveness of an intervention in the induction of early discontinuation of intravenous antimicrobial therapy and/or its switch to oral therapy. The study employed a beforeâafter intervention design that consisted of displaying a message in the computerized prescription on the third day and suspension of the prescription on the fifth day of intravenous antimicrobial therapy. A total of 465 patients were followed during the control period (CP) and 440 in the intervention period (IP). The intravenous therapy was switched to oral therapy for 11 (2.4%) patients during the CP and 25 (5.7%) in the IP (p = 0.011), and was discontinued for 82 (17.6%) patients during the CP and 106 (24.1%) in the IP (p = 0.017). During the IP there was a significant increase of patients who had their antimicrobial treatment discontinued before the seventh day of intravenous treatment, 37.40% (49/131) in the IP and 16.13% (15/93) in the CP (p = 0.0005). The duration of intravenous antimicrobial therapy decreased by one day, but it was not significant (p = 0.136). It is concluded that the proposed intervention is effective in promoting the early discontinuation of antimicrobial treatment and/or switch to oral therapy. As long as a computerized system for prescription already exists, it is easy and inexpensive to be implemented, especially in hospitals in developing countries. Keywords: Antibiotics, Intravenous administration, Oral administration, Inappropriate prescribin
You Talking to Me? Says the Enteric Nervous System (ENS) to the Microbe. How Intestinal Microbes Interact with the ENS
Mammalian organisms form intimate interfaces with commensal and pathogenic gut microorganisms. Increasing evidence suggests a close interaction between gut microorganisms and the enteric nervous system (ENS), as the first interface to the central nervous system. Each microorganism can exert a different effect on the ENS, including phenotypical neuronal changes or the induction of chemical transmitters that interact with ENS neurons. Some pathogenic bacteria take advantage of the ENS to create a more suitable environment for their growth or to promote the effects of their toxins. In addition, some commensal bacteria can affect the central nervous system (CNS) by locally interacting with the ENS. From the current knowledge emerges an interesting field that may shape future concepts on the pathogen\u2013host synergic interaction. The aim of this narrative review is to report the current findings regarding the inter-relationships between bacteria, viruses, and parasites and the ENS
Cellular and Genetic Mechanisms Involved in the Generation of Protective and Pathogenic Immune Responses in Human Chagas Disease
Perhaps one of the most intriguing aspects of human Chagas disease is
the complex network of events that underlie the generation of
protective versus pathogenic immune responses during the chronic phase
of the disease. While most individuals do not develop patent disease, a
large percentage may develop severe forms that eventually lead to
death. Although many efforts have been devoted to deciphering these
mechanisms, there is still much to be learned before we can fully
understand the pathogenesis of Chagas disease. It is clear that the
hostâs immune response is decisive in this process. While
characteristics of the parasite influence the immune response, it is
becoming evident that the host genetic background plays a fundamental
role in the establishment of pathogenic versus protective responses.
The involvement of three complex organisms, host, parasite and vector,
is certainly one of the key aspects that calls for multidisciplinary
approaches towards the understanding of Chagas disease. We believe that
now, one hundred years after the discovery of Chagas disease, it is
imperative to continue with highly interactive research in order to
elucidate the immune response associated with disease evolution, which
will be essential in designing prophylactic or therapeutic
interventions