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- Adamsson, Inger, et al.
(författare)
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Comparative effects of omeprazole, amoxycillin plus metronidazole versus omeprazole, clarithromycin plus metronidazole on the oral, gastric and intestinal microflora in Helicobacter pylori-infected patients
- 1999
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Ingår i: Journal of Antimicrobial Chemotherapy. - : Nature Publishing Group. - 0305-7453 .- 1460-2091. ; 45, s. A8-A8
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Tidskriftsartikel (refereegranskat)abstract
- Fourteen patients with Helicobacter pylori infection were treated with 20 mg omeprazole, 1 g amoxycillin and 400 mg metronidazole bd for 7 days (OAM), and 16 patients were treated with 20 mg omeprazole, 250 mg clarithromycin and 400 mg metronidazole bd for 7 days (OCM). Saliva, gastric biopsies and faecal samples were collected before, during (day 7) and 4 weeks after treatment in order to analyse alterations of the normal microflora and to determine antimicrobial susceptibility. Both treatment regimens resulted in marked quantitative and qualitative alterations. A selection of resistant streptococcal strains were noticed in both treatment groups, most apparent in the OCM group where a shift from susceptible to resistant strains was recorded. In the OAM group, six patients had overgrowth of resistant Enterobacteriaceae during treatment compared with none in the OCM group, in the gastric microflora. The MICs for Enterococcus spp. and Enterobacteriaceae in faeces increased significantly during treatment in both groups. Nine patients in the OAM group became intestinally colonized by yeasts during treatment. The total anaerobic microflora was strongly suppressed in both treatment groups, although most pronounced in the OCM group, where the frequency of clarithromycin-resistant bacteroides strains increased from 2 to 76% during treatment, and remained at 59% 4 weeks post-treatment. Even if the treatment outcome was better in the OCM group (100%) than in the OAM group (71%), the amoxycillin-based treatment might be preferable from an ecological point of view, since the qualitative alterations in terms of emergence and persistence of resistant strains seemed to be most pronounced in the clarithromycin-treated group.
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| 2. |
- Adamsson, I, et al.
(författare)
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Microbial ecology and treatment of Helicobacter pylori infections : Review
- 2000
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Ingår i: Journal of chemotherapy. - 1120-009X .- 1973-9478. ; 12:1, s. 5-16
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Forskningsöversikt (refereegranskat)abstract
- The aims of the present study were to investigate the ecological disturbances caused by four different anti-H. pylori regimens, to compare different methods for diagnosing H. pylori, and to study the genetic variability of H. pylori. The patients included in the study were all treated at the Center of Gastroenterology, Huddinge University Hospital, Karolinska Institute. All patients were H. pylori-positive before entering the study, confirmed by rapid urease test, histology, culture and urea breath test or PCR. Treatment regimens included in the study were omeprazole alone (OP), in combination with amoxicillin (OA), in combination with amoxicillin and metronidazole (OAM) and in combination with clarithromycin and metronidazole (OCM). Samples from the mouth (saliva and dental plaque), stomach (biopsies from the gastric mucosa in the corpus and in the antrum) and the intestine (feces) were collected before, during and after treatment. The oral microflora was challenged by the three treatment regimens including antimicrobial agents, with the emergence of resistant streptococci and staphylococci in the OCM group. Bacterial strains in the gastric mucosa increased in numbers during treatment in all treatment groups, probably due to the pH rise, which provides a better environment for the commensal microflora. This overgrowth was especially pronounced during treatment with omeprazole alone (OP), possibly due to the fact that a concomitant suppression exerted by the antimicrobial agents occurred in the other treatment groups. H. pylori was, on the other hand, suppressed during treatment in all treatment groups, possibly due to a direct effect of omeprazole and to the colonization resistance expressed by the normal microflora, An emergence of resistant commensal strains in the gastric mucosa was seen in the OCM and the OAM groups. The intestinal microflora was most altered in the OAM and the OCM groups, with persistent disturbances in the OCM group 4 weeks after treatment. The frequency of resistant Enterococcus spp, (OCM), Enterobacteriaceae spp, (OA and OAM) and Bacteroides spp, (OCM) was increased during and after treatment. Different detection methods for H. pylori were compared and PCR was shown to have higher sensitivity than other routine diagnostic tests. The patients in the present study seemed to be colonized with a single strain of H. pylori. Treatment failures in patients treated with OAM were caused by recrudescence. These four patients with relapsing H. pylori infection, were shown to be reinfected with the original H. pylori strain, indicating that H. pylori escapes treatment by a thus far unknown mechanism.
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| 3. |
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| 4. |
- Agvald-Öhman, C, et al.
(författare)
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Anaerobic bacteria commonly colonize the lower airways of intubated ICU patients
- 2003
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Ingår i: Clinical Microbiology and Infection. - : Elsevier BV. - 1198-743X .- 1469-0691. ; 9:5, s. 397-405
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate respiratory tract colonization by aerobic and anaerobic bacteria in mechanically ventilated patients. Methods Bacterial colonization of the stomach and the respiratory tract was qualitatively and quantitatively analyzed over time in 41 consecutive mechanically ventilated patients in a Swedish intensive care unit (ICU), with special emphasis on elucidation of the role of anaerobic bacteria in the lower respiratory tract. Samples were taken from the oropharynx, gastric juice, subglottic space and trachea within 24 h (median 14 h) of intubation, and then every third day until day 18 and every fifth day until day 33. Results The patients were often heavily colonized with microorganisms not considered to belong to a healthy normal oropharyngeal and gastric flora on admission to the ICU. A majority harbored enterococci, coagulase-negative staphylococci and Candida spp. in at least one site on day 1. Anaerobic bacteria, mainly peptostreptococci and Prevotella spp., were isolated from subglottic and/or tracheal secretions in 59% of the patients. Different routes of tracheal colonization for different groups of microorganisms were found. Primary or concomitant colonization of the oropharynx with staphylococci, enterococci, enterobacteria and Candida was often seen, while Pseudomonas spp., other non-fermenting Gram-negative rods and several anaerobic species often primarily colonized the trachea, indicating exogenous or direct gastrointestinal routes of colonization. Conclusions Mechanically ventilated patients were heavily colonized in their lower airways by potential pathogenic microorganisms, including a high load of anaerobic bacteria. Different routes of colonization were shown for different species.
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| 5. |
- Agvald-Öhman, C, et al.
(författare)
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Multiresistant coagulase-negative staphylococci disseminate frequently between intubated patients in a multidisciplinary intensive care unit
- 2004
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 8:1, s. R42-R47
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The intensive care unit is burdened with a high frequency of nosocomial infections often caused by multiresistant nosocomial pathogens. Coagulase-negative staphylococci (CoNS) are reported to be the third causative agent of nosocomial infections and the most frequent cause of nosocomial bloodstream infections. CoNS are a part of the normal microflora of skin but can also colonize the nasal mucosa, the lower airways and invasive devices. The main aim of the present study was to investigate colonization and the rate of cross-transmissions of CoNS between intubated patients in a multidisciplinary intensive care unit. Materials and methods Twenty consecutive patients, ventilated for at least 3 days, were included. Samples were collected from the upper and lower airways. All samples were cultured quantitatively and CoNS were identified by morphology and biochemical tests. A total of 199 CoNS isolates from 17 patients were genetically fingerprinted by pulsed-field gel electrophoresis in order to identify clones and to monitor dissemination within and between patients. Results An unexpected high number of transmission events were detected. Five genotypes were each isolated from two or more patients, and 14/20 patients were involved in at least one and up to eight probable transmission events. Conclusions A frequent transmission of CoNS was found between patients in the intensive care unit. Although transmission of bacteria does not necessarily lead to infection, it is nevertheless an indication that infection control measures can be improved.
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| 6. |
- Alvan, Gunnar, et al.
(författare)
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The global need for effective antibiotics : a summary of plenary presentations
- 2011
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Ingår i: Drug resistance updates. - : Elsevier BV. - 1368-7646 .- 1532-2084. ; 14:2, s. 70-76
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Forskningsöversikt (refereegranskat)abstract
- To highlight the global need for effective antibiotics and explore possible concerted actions for change, cross-cutting plenary sessions served to frame the program of the conference. These sessions contained presentations on the present state of antibacterial resistance and the availability, the use and misuse of antibiotics. A number of possible actions were discussed, such as rational use of and access to antibiotics from various perspectives. The roles of vaccines and diagnostics were touched upon and followed by in depth discussions on supply-side bottlenecks with their scientific, regulatory and financial challenges. The value chain for research and development (R&D) of antibiotics has to be reengineered if we are to realize the development of much needed new antibiotics. This challenge will require a multitude of actions, some of which are related to changing the financial realities of antibiotics and interventions by global and regional institutions.
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| 7. |
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| 8. |
- Edlund, Charlotta, et al.
(författare)
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Comparative effects of moxifloxacin and clarithromycin on the normal intestinal microflora
- 2000
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 32:1, s. 81-85
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Tidskriftsartikel (refereegranskat)abstract
- Twelve healthy male subjects age range 24-40 y participated in the investigation. The trial was divided into 2 35-d periods. The 2 treatment regimens were: (i) 1 x 400 mg moxifloxacin tablet in the morning and 1 placebo tablet in the evening for 7 d; and (ii) 1 x 500 mg clarithromycin tablet in the morning and 1 x 500 mg clarithromycin tablet in the evening for 7 d. Each subject received firstly 1 treatment regimen and secondly the other treatment regimen. The wash-out period was 6 weeks between the two treatment regimens. Moxifloxacin caused significant decreases of enterococci and enterobacteria during the administration period while the numbers of staphylococci, streptococci, Bacillus and Candida were not affected. No impact on peptostreptococci, lactobacilli, Veillonella, Bacteroides or fusobacteria was observed, while bifidobacteria and clostridia decreased during moxifloxacin administration. The microflora was normalized after 35 d. Clarithromycin caused significant reduction of Escherichia coli while the numbers of enterococci, Enterobacter, Citrobacter, Klebsiella and Pseudomonas increased markedly. No significant changes in the numbers of staphylococci, streptococci, Bacillus and Candida were noticed. In the anaerobic microflora bifidobacteria, lactobacilli and clostridia were suppressed, while no changes in peptostreptococci, Veillonella, Bacteroides and fusobacteria were found. The microflora was normalized in all volunteers after 35 d.
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| 9. |
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| 10. |
- Edlund, Charlotta, et al.
(författare)
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Effect on the human normal microflora of oral antibiotics for treatment of urinary tract infections
- 2000
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Ingår i: Journal of Antimicrobial Chemotherapy. - : Oxford University Press (OUP). - 0305-7453 .- 1460-2091. ; 46, s. 41-48
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Tidskriftsartikel (refereegranskat)abstract
- Oral administration of antibiotics for treatment of urinary tract infections (UTIs) can cause ecological disturbances in the normal intestinal microflora. Poorly absorbed drugs can reach the colon in active form, suppress susceptible microorganisms and disturb the ecological balance. Suppression of the normal microflora may lead to reduced colonization resistance with subsequent overgrowth of pre-existing, naturally resistant microorganisms, such as yeasts and Clostridium difficile. New colonization by resistant potential pathogens may also occur and may spread within the body or to other patients and cause severe infections. It is therefore important to learn more about the ecological effects of antibacterial agents on the human microflora. The impact on intestinal microorganisms of oral antibiotics used for the treatment of UTIs is reviewed here. Ampicillin, amoxycillin and co-amoxiclav suppress both the aerobic and anaerobic intestinal microflora with overgrowth of ampicillin-resistant Enterobacteriaceae. Pivmecillinam also affects the intestinal microflora, suppressing Escherichia coli, but does not have a major effect on the anaerobic microflora. Several orally administered cephalosporins, such as cefixime, cefpodoxime, cefprozil and ceftibuten, reduce the number of Enterobacteriaceae and increase the number of enterococci. Colonization with C. difficile has also been observed. Fluoroquinolones eliminate or strongly suppress intestinal Enterobacteriaceae, but affect enterococci and anaerobic bacteria only slightly. When antimicrobial agents are prescribed for the treatment of UTIs, not only the antimicrobial spectrum of the agent but also the potential ecological disturbances, including the risk of emergence of resistant strains, should be considered.
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