amphotericin-b and Helicobacter-Infections

Topics: Amphotericin B; Bismuth; Clarithromycin; Drug Resistance, Microbial; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer; Tetracyclines

The prevalence of Helicobacter pylori is increased in healthcare workers and in intensive care nurses. Exposure to H. pylori from gastric secretions and faeces are probably the main sources of transmission to healthcare workers. Routine use of selective decontamination of digestive tract (SDD) in an intensive care unit suppresses H. pylori in critically ill patients. It was questioned whether this suppression and the subsequent decreased exposure to H. pylori for intensive care nurses would lead to a lower prevalence of H. pylori infection. Helicobacter pylori infection prevalence in intensive care nurses from a unit routinely using SDD (group I) was compared to that of nurses from a unit not using SDD (group II). Heathcare workers from other departments of the hospital where no SDD was used (group III) served as a control group. Persons using proton pump inhibitors were excluded. Helicobacter pylori was detected by Laser Assisted Ratio Analyser(13)C-urea breath test (UBT) and serology. This could not be performed in three out of 64 in group I, five out of 55 in group II and five out of 55 in group III (total UBTs = 169). The prevalence of H. pylori infection was 11% (7/61) in group I and 25.5% (14/50) in group II (P= 0.027). In group III, the prevalence of H. pylori infection was 16% (8/45), which was not significantly different from both group I and II. Sero-prevalence in group I was 18.6%, 27% in group II (ns) and 24% in group III. Mean age in the three groups was 35.9, 37.8 and 36.6 years, respectively (ns). In conclusion, the prevalence of H. pylori infection among intensive care nurses is lower in nurses from a unit using SDD compared to a non SDD-using unit. Acquisition of H. pylori by transmission from critically ill patients appears to be diminished through SDD use.

Topics: Adult; Amphotericin B; Breath Tests; Colistin; Critical Care; Critical Illness; Cross Infection; Cross-Sectional Studies; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Nursing Staff, Hospital; Prevalence; Stomach Diseases; Tobramycin

A woman of 75 years old was admitted at our hospital for evaluation of worsening and weakness in inferior limbs. Several vertebral fractures by crushing, one doubtful discitis, an infiltrate with cavitation in the right superior lobe and one infiltrate in the left superior lobe were detected. In the biopsy of the consolidation a filamentous fungus was watched and in the bronchial washing specimen culture grew Aspergillus terreus. The infiltrates disappeared with liposomal Amphotericin B remaining with oral Itraconazol during three months more. The clinical and analytical data demonstrate the existence of a Overlap syndrome associate to antiphospholipid-antibody syndrome. We comment the peculiarity of the infection by Aspergillus terreus in patients who have not been in critical care and the good response at treatment with liposomal Amphotericin B. It contrasts with the high mortality referred in a recent review. Other aspects to comment are the coexistence with a collagen vascular and an antiphospholipid-antibody syndrome with the higher titles of IgM ACA that we have found in literature.

Topics: Aged; Amphotericin B; Antifungal Agents; Antiphospholipid Syndrome; Aspergillosis; Aspergillus; Autoimmune Diseases; Drug Therapy, Combination; Female; Gastritis, Atrophic; Helicobacter Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Liposomes; Lung Diseases, Fungal; Opportunistic Infections; Prednisone; Purpura, Thrombocytopenic, Idiopathic

The incidence of bleeding related to stress ulcers is reduced in critically ill patients in whom gut decontamination has been performed; this may be a result of suppression of Helicobacter pylori infection. We determined the susceptibility of H. pylori to the applied antibiotics. In nine of 10 critically ill patients (using intravenous cefotaxime and topical polymyxin, tobramycin and amphotericin B (PTA) given by nasogastric tube) and all six volunteers (using PTA alone), H. pylori was suppressed as long as the topical antibiotics were ingested. The in vitro studies revealed that all strains were susceptible to cefotaxime and tobramycin. The strains were not susceptible to polymyxin or amphotericin B.

Topics: Administration, Topical; Amphotericin B; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Decontamination; Digestive System; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Microbial Sensitivity Tests; Polymyxins; Tobramycin