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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

A systematic review of pharmacotherapy for diabetic foot infections

Carzoli, Joshua, Thompson, Cody January 2010 (has links)
Class of 2010 Abstract / OBJECTIVES:The main purpose of this study was to review recent and good quality studies of the antimicrobial therapy of for moderate to severe (“limb threatening”) DFI. The analysis of these studies was to conclude with one or two “standard” approach to the routine management of this clinical entity. METHODS: This literature review study consisted of an evaluation of clinical trials that compare two or more active systemic antimicrobial regimens for the treatment of moderate to severe (i.e., “limb-threatening”) diabetic foot infections in human patients. Literature sources were identified primarily from OVID MEDLINE, but also included additional tertiary sources. The primary criteria for the clinical studies were: prospective, controlled, randomized and investigator blinded. Studies had to be published after the year 2003, and be available in full-text in English. RESULTS: Ultimately, only four studies were found that met the criteria for consideration. Trials differed in numerous features. All four studies were sponsored by the manufacturer of one of the comparator drugs. Three of the four were non-inferiority design. Evidence is lacking that any of the suggested regimens are superior. CONCLUSIONS: Instead of meeting our original goal of concluding that one or two regimens could be the “standard” management of DFI, we were limited to commentary on the quality and applicability of the current literature on this clinical entity. Numerous suggestions for improvement in the clinical information provided by DFI studies were offered. We eagerly anticipate the publication of the updated IDSA guideline document on DFI.
2

Microbiology of diabetic foot infections: from Louis Pasteur to 'crime scene investigation'

Spichler, Anne, Hurwitz, Bonnie L., Armstrong, David G., Lipsky, Benjamin A. January 2015 (has links)
Were he alive today, would Louis Pasteur still champion culture methods he pioneered over 150 years ago for identifying bacterial pathogens? Or, might he suggest that new molecular techniques may prove a better way forward for quickly detecting the true microbial diversity of wounds? As modern clinicians faced with treating complex patients with diabetic foot infections (DFI), should we still request venerated and familiar culture and sensitivity methods, or is it time to ask for newer molecular tests, such as 16S rRNA gene sequencing? Or, are molecular techniques as yet too experimental, non-specific and expensive for current clinical use? While molecular techniques help us to identify more microorganisms from a DFI, can they tell us ‘who done it?', that is, which are the causative pathogens and which are merely colonizers? Furthermore, can molecular techniques provide clinically relevant, rapid information on the virulence of wound isolates and their antibiotic sensitivities? We herein review current knowledge on the microbiology of DFI, from standard culture methods to the current era of rapid and comprehensive ‘crime scene investigation' (CSI) techniques.
3

Cost-effectiveness of Intravenous Antibiotics in Moderate to Severe Diabetic Foot Infections and Efficacy as a Function of Resistance Rates in the Case of Methicillan-resistant Staphylococcus Aureus in Diabetic Foot Infections

Marchesano, Romina 22 November 2012 (has links)
Objectives: The objectives of the research were to determine which intravenous (IV) antibiotics were cost-effective in Diabetic Foot Infections (DFIs) and to assess the impact of MRSA prevalence on clinical outcome. Methods: A Cost-effectiveness analysis (CEA) was performed on IV antibiotics used to treat moderate to severe DFIs in hospitalized patients. MRSA prevalence was taken into account by calculating an ‘Adjusted cure rate’ and re-analysing the CEA. Results: In the original CEA, imipenem/cilastatin was the cost-effective agent. When MRSA prevalence was taken into account imipenem/cilastatin, moxifloxacin, cefoxitin and ertapenem were cost-effective antibiotics. Conclusion: MRSA prevalence adjustments changed the results of the CEA and included classes of IV antibiotics that are seen being using in practice, such as fluoroquinolones and cephalosporins. These methods could potentially have an impact on the evaluation of clinical cure rates and resistance when evaluating the literature.
4

Cost-effectiveness of Intravenous Antibiotics in Moderate to Severe Diabetic Foot Infections and Efficacy as a Function of Resistance Rates in the Case of Methicillan-resistant Staphylococcus Aureus in Diabetic Foot Infections

Marchesano, Romina 22 November 2012 (has links)
Objectives: The objectives of the research were to determine which intravenous (IV) antibiotics were cost-effective in Diabetic Foot Infections (DFIs) and to assess the impact of MRSA prevalence on clinical outcome. Methods: A Cost-effectiveness analysis (CEA) was performed on IV antibiotics used to treat moderate to severe DFIs in hospitalized patients. MRSA prevalence was taken into account by calculating an ‘Adjusted cure rate’ and re-analysing the CEA. Results: In the original CEA, imipenem/cilastatin was the cost-effective agent. When MRSA prevalence was taken into account imipenem/cilastatin, moxifloxacin, cefoxitin and ertapenem were cost-effective antibiotics. Conclusion: MRSA prevalence adjustments changed the results of the CEA and included classes of IV antibiotics that are seen being using in practice, such as fluoroquinolones and cephalosporins. These methods could potentially have an impact on the evaluation of clinical cure rates and resistance when evaluating the literature.
5

Atividade antibacteriana e ensaio time kill com extratos etanólicos vegetais do cerrado tocantinense contra bactérias resistentes à múltiplos fármacos isoladas de lesões de pés diabéticos

Gatinho, Michele Cezimbra Perim 05 March 2018 (has links)
O desenvolvimento de cepas bacterianas multirresistentes tornou-se uma preocupação global. As plantas medicinais têm sido exploradas como uma fonte potencial terapêutica para o tratamento de várias doenças e para o desenvolvimento de medicamentos mais eficazes contra infecções bacterianas. Assim, o objetivo deste estudo foi avaliar a atividade antibacteriana do extrato de cascas e folhas de Anacardium humile (St.) Hil, extrato de cascas de Davilla nítida (Vahl.) Kubitski, e extrato de folhas de Kalanchoe pinnata (Lam.) Pers. contra bactérias resistentes a múltiplos fármacos isoladas de infecções do pé diabético, e também contra cepas de referência da American Type Culture Collection (ATCC). A atividade antibacteriana foi avaliada pelos métodos de Ágar Disco-Difusão (DD), Microdiluição em Caldo (MC), Ensaio “Checkerboard” e Ensaio “Time-Kill”. O extrato das cascas de Davilla nitida (Vahl.) Kubitski mostrou atividade antibacteriana expressiva contra todos os grupos de bactérias testadas. O método de microdiluição em caldo foi mais sensível que o método disco-difusão para determinar a atividade antibacteriana presente no extrato das cascas. O extrato de cascas inibiu o crescimento de bactérias com altos níveis de resistência aos antibióticos, como Pseudomonas spp. (100,00%), Enterobacter spp. (88,89%), Staphylococcus aureus (54,55%), Streptococcus pneumoniae (75,00%), Staphylococcus saprophyticus (92,86%). A combinação do extrato das cascas com antibióticos resultou em efeito aditivo contra a maioria das cepas testadas. O perfil cinético de tempo de morte do extrato de cascas mostrou propriedades bactericidas tempo-dependentes. Nossos resultados sugerem a presença de compostos bioativos nesta planta que podem ser utilizados para o desenvolvimento de novos agentes antibacterianos. O extrato de folhas de Kalanchoe pinnata (Lam.) Pers. mostrou atividade antibacteriana contra Citrobacter spp. (100,00%), Citrobacter youngae (ATCC-29935) (100,00%), Enterobacter spp. (33,33%), Pseumodonas spp. (66,67%), Pseudomonas aeruginosa (ATCC-27853) (100,00%). O extrato de folhas quando associado com antibiótico amoxicilina/ácido clavulânico ou cefoxitina não evidenciou qualquer potencialização da atividade antibacteriana contra as bactérias Gram-positivas e Gram-negativas, sugerindo que extrato e antibióticos possuem mecanismos independentes relacionados à inibição do crescimento bacteriano. Nossos resultados mostraram que o extrato etanólico das folhas de Kalanchoe pinnata (Lam.) Pers. teve uma boa atividade antimicrobiana contra algumas bactérias resistentes a múltiplos fármacos. Entretanto, estudos adicionais e mais específicos são recomendados para determinar a eficácia deste extrato no tratamento de infecções bacterianas. O extrato das cascas e folhas de Anacardium humile (St.) Hil, tanto no método Disco-difusão quanto em microdiluição em caldo, inibiu significantemente o crescimento das bactérias Gram-positivas e Gram-negativas, como também o crescimento das bactérias comumente encontradas em lesões de pés diabéticos. Pelo método “Checkerboard”, a combinação do extrato das cascas (35,00%) e folhas (40,00%) sobre as bactérias Gram-negativas apresentaram efeitos sinérgicos semelhantes, enquanto que para as bactérias Gram-positivas, os extratos das folhas (45,00%) apresentaram um efeito sinérgico mais efetivo do que os extratos das cascas (17,50%). O perfil cinético “Time-Kill” apresentou atividade bactericida com propriedades dose e tempo dependente, sugerindo que os extratos das cascas e folhas podem potencializar os efeitos dos antibióticos, o que sugere que os extratos de Anacardium humile (St.) Hil podem ser usados com uma fonte alternativa de pesquisa para agentes antibacterianos com ação em bactérias Gram-positivas e Gram-negativas resistentes a multidrogas. No entanto, o isolamento dos compostos bioativos e estudos adicionais devem ser realizados para entender os mecanismos de ação bactericida, para definir a real eficácia e os efeitos tóxicos. / Development of multidrug resistant bacterial strains has become a global concern. Medicinal plants have been explored as a source of molecules with therapeutic potential for the treatment of various diseases and to the development of better drug against bacterial infections. Thus, the aim of this study was to evaluate the antibacterial activity of the bark and leaves extracts of Anacardium humile (St.) Hil, bark extract of Davilla nitida (Vahl.) kubitski, of leaf extract of Kalanchoe pinnata (Lam.) Pers. and against multidrug resistant bacteria isolated from diabetic foot infections, and also of reference strains from the American Type Culture Collection (ATCC). Antibacterial activity of the bark extract was evaluated by agar Disk-Diffusion (DD), Broth Dilution (BD), “Checkerboard” and “Time-Kill” methods. The bark extract of Davilla nitida (Vahl.) kubistki showed a significant antibacterial activity against all groups of bacteria tested. Broth dilution was more sensitive for determining the antibacterial activity of the bark extract than the Disk-Difusion method. The bark extract inhibited the growth of bacteria with high-levels of antibiotic-resistance, such as Pseudomonas spp. (100,00%), Enterobacer spp. (88,89%), Staphylococcus aureus (54,55%), Streptococcus pneumoniae (75,00%), Staphylococcus saprophyticus (92,86%). The combination of extract with antibiotics resulted in an additive effect against most of the strains tested. “Time-Kill” kinetics profiles of bark extract showed bactericidal and time-dependent properties. Our results suggest the presence of bioactive compounds in this plant that could be useful for the development of new antibacterial agents. The leaf extract of Kalanchoe pinnata (Lam.) Pers. showed antibacterial activity against Citrobacter spp. (100,00%), Citrobacter youngae (ATCC-29935) (100,00%), Enterobacer spp. (33.33%), Pseumodonas spp. (66.67%), Pseudomonas aeruginosa (ATCC-27853) (100.00%). Extract of leaf associated with amoxicillin/clavulanic acid or cefoxitin antibiotics did not show any potentiation of antibacterial activity against both Gram-positive and Gram-negative bacteria, suggesting that extract and antibiotics have independent mechanisms related to inhibition of bacterial growth. Our results showed that the ethanolic leaf extract of Kalanchoe pinnata (Lam.) Pers. had a good antimicrobial activity against some multidrug resistant bacteria. However, further and more specific studies, are recommended to determine the efficacy of this extract in the treatment of bacterial infections. Barks and leaves extracts of Anacardium humile (St.) Hil, both in the Disk-Difusion and Broth Dilution methods, inhibited the growth of Gram-positive and Gram-negative bacteria, as well as the growth of bacteria commonly found in diabetic foot lesions. By the “Checkerboard” method, the combination of bark extract (35,00%) and leaves (40,00%) on Gram-negative bacteria had similar synergistic effects, while for Gram-positive bacteria, leaf extracts (45,00%) presented a synergistic effect more effective than the bark extracts (17,50%). The “Time-Kill” kinetic profile showed bactericidal activity with dose and time-dependent properties, suggesting that bark and leaf extracts may potentiate the effects of antibiotics, suggesting that Anacardium humile (St.) Hil extracts can be used with an alternative source of research for antibacterial agents acting on multidrug resistant Gram- positive and Gram- negative bacteria. However, the isolation of bioactive compounds and additional studies should be performed to understand the mechanisms of bactericidal action, to define real efficacy and toxic effects.

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