Browsing by Subject "antibiotics"

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  • Kurra, Henrietta (Helsingin yliopisto, 2018)
    Lasten hammashoidossa antibiootteja käytetään vain harvoin, mutta lääkkeiden hyvä tuntemus on hammaslääkärin työssä tärkeää. Tavallisimmat antibiootit lasten hammaslääketieteessä ovat V-penisilliini, amoksisilliini, kefaleksiini, klindamysiini, metronidatsoli ja doksisykliini. Lasten vesipitoisuus ja aineenvaihdunta ovat erilaiset, kuin aikuisilla, joten antibioottien annostus määritellään lapsen painon mukaan. Tässä syventävässä tutkielmassa tarkoitus on käsitellä lasten hammashoidossa käytettäviä antibiootteja, niiden käyttö- ja vasta-aiheita päivystystapauksissa ja profylaktisesti sekä potilasryhmiä, joille antibiootteja suositellaan. Lisäksi käsitellään akuutin hammasperäisen infektion syntyä ja kulkua sekä vertaillaan antibioottihoidon hyöty- ja haittapuolia lapsipotilailla. Syventävä tutkielma on kirjoitettu kirjallisuuskatsauksen muotoon. Aineisto kerättiin pääasiassa PubMed-tietokannasta, alan oppikirjallisuudesta ja Käypä hoito suosituksesta. Hammashoidossa antibiootteja käytetään mikrobilääkehoitona infektion ollessa jo läsnä tai profylaktisesti, jolloin pyritään ehkäisemään infektion syntyminen tai sen vaikeutuminen. Hammaslääketieteessä yleisin indikaatio mikrobilääkehoidolle on akuutin hammasperäisen infektion hoito. Antibioottisuoja annetaan ennen toimenpidettä niille potilaille, joilla vastustuskyky on heikompi tai joilla on suurentunut riski saada sydämen sisäkalvon tulehdus. Hammastraumoissa antibiootteja käytetään silloin, kun hammaskuopastaan irronnut pysyvä hammas asetetaan takaisin paikoilleen. Kuten kaikilla lääkkeillä, myös antibiooteilla on sivuvaikutuksia. Antibiootteja ei tulisikaan koskaan käyttää yksinään, vaan aina muun hammaslääketieteellisen hoidon tukena. Yleisimmät haittavaikutukset liittyvät maha-suolikanavan oireiluihin, mutta pahimmillaan antibiootit voivat aiheuttaa hengenvaarallisen anafylaktisen reaktion. Antibioottien vastuullinen käyttö on tärkeää, sillä antibioottiresistenssi on maailmanlaajuisesti kasvava ongelma.
  • Turner, Dan; Bishai, Jason; Reshef, Leah; Abitbol, Guila; Focht, Gili; Marcus, Dana; Ledder, Oren; Lev-Tzion, Raffi; Orlanski-Meyer, Esther; Yerushalmi, Baruch; Aloi, Marina; Griffiths, Anne M.; Albenberg, Lindsey; Kolho, Kaija-Leena; Assa, Amit; Cohen, Shlomi; Gophna, Uri; Vlamakis, Hera; Lurz, Eberhard; Levine, Arie (2020)
    Background: Alterations in the microbiome have been postulated to drive inflammation in IBD. In this pilot randomized controlled trial, we evaluated the effectiveness of quadruple antibiotic cocktail in addition to intravenous-corticosteroids (IVCSs) in acute severe colitis (ASC). Methods: Hospitalized children with ASC (pediatric ulcerative colitis activity index [PUCAI] >= 65) were randomized into 2 arms: the first received antibiotics in addition to IVCS (amoxicillin, vancomycin, metronidazole, doxycycline/ciprofloxacin [IVCS+AB]), whereas the other received only IVCS for 14 days. The primary outcome was disease activity (PUCAI) at day 5. Microbiome was analyzed using 16S rRNA gene and metagenome. Results: Twenty-eight children were included: 16 in the AB + IVCS arm and 12 in the IVCS arm (mean age 13.9 +/- 4.1 years and 23 [82%] with extensive colitis). The mean day-5 PUCAI was 25 +/- 16.7 vs 40.4 +/- 20.4, respectively (P = 0.037). Only 3 and 2 children, respectively, required colectomy during 1-year follow-up (P = 0.89). Microbiome data at time of admission were analyzed for 25 children, of whom 17 (68%) had a predominant bacterial species (>33% abundance); response was not associated with the specific species, whereas decreased microbiome diversity at admission was associated with day-5 response in the IVCS arm. Conclusion: Patients with ASC have alterations in the microbiome characterized by loss of diversity and presence of predominant bacterial species. Quadruple therapy in addition to IVCS improved disease activity on day 5, but larger studies are needed to determine whether this is associated with improved long-term outcomes.
  • Galarza, Juan A.; Murphy, Liam; Mappes, Johanna (2021)
    Antibiotics have long been used in the raising of animals for agricultural, industrial or laboratory use. The use of subtherapeutic doses in diets of terrestrial and aquatic animals to promote growth is common and highly debated. Despite their vast application in animal husbandry, knowledge about the mechanisms behind growth promotion is minimal, particularly at the molecular level. Evidence from evolutionary research shows that immunocompetence is resource-limited, and hence expected to trade off with other resource-demanding processes, such as growth. Here, we ask if accelerated growth caused by antibiotics can be explained by genome-wide trade-offs between growth and costly immunocompetence. We explored this idea by injecting broad-spectrum antibiotics into wood tiger moth (Arctia plantaginis) larvae during development. We follow several life-history traits and analyse gene expression (RNA-seq) and bacterial (r16S) profiles. Moths treated with antibiotics show a substantial depletion of bacterial taxa, faster growth rate, a significant downregulation of genes involved in immunity and significant upregulation of growth-related genes. These results suggest that the presence of antibiotics may aid in up-keeping the immune system. Hence, by reducing the resource load of this costly process, bodily resources may be reallocated to other key processes such as growth.
  • Allen, John; Zheng, Bang-Xiao (2021)
    Parks and other green spaces are important parts of the urban landscape, providing residents with valuable ecosystem services. Many urban residents visit parks or other types of green space with their dogs on a daily basis, and dog waste is a common problem in these areas. The environmental and health impacts of dogs' left-behind solid waste has been and continues to be studied. However, the impacts of dog urine have received essentially no close attention, and its effects in urban areas are not well understood. Dogs are required to be kept on leashes in public spaces in Finland, and most of their urine has been found to be concentrated along walking paths. Since dogs are commonly treated for infections and other illnesses, these same areas are likely receiving sporadic, low-level doses of antibiotics. This highly localized and chronic deposition of residual antibiotics in areas used for human recreation and leisure represents a uniquely urban phenomenon. In this study we have analysed soil DNA extracts from Helsinki and Lahti greenspaces using SmartChip qPCR Analysis. We found elevated numbers of ARG copies in areas impacted by dog urine versus control sites. Further analysis will be needed to determine the significance of this effect, but the results suggest that dogs are contributing to the development of antibiotic resistance urban park soil bacteria.
  • PASTURE EFRAIM Study Grp; Metzler, Stefanie; Frei, Remo; Schmausser-Hechfellner, Elisabeth; Pekkanen, Juha; Karvonen, Anne M.; Kirjavainen, Pirkka V.; Roduit, Caroline (2019)
    Background: Allergies are a serious public health issue, and prevalences are rising worldwide. The role of antibiotics in the development of allergies has repeatedly been discussed, as results remain inconsistent. The aim of this study was to investigate the association between pre-and post-natal antibiotic exposure and subsequent development of allergies (atopic dermatitis, food allergy, asthma, atopic sensitization and allergic rhinitis). Methods: A total of 1080 children who participated in a European birth cohort study (PASTURE) were included in this analysis. Data on antibiotic exposure during pregnancy and/or first year of life and allergic diseases were collected by questionnaires from pregnancy up to 6 years of age and analysed by performing logistic regressions. To take into account reverse causation, we included models, where children with diagnosis or symptoms of the respective disease in the first year of life were excluded. Results: Antibiotic exposure in utero was significantly and positively associated with atopic dermatitis and food allergy. The strongest effect was on diseases with onset within the first year of life (for atopic dermatitis: aOR 1.66, 95% CI 1.11-2.48 and for food allergy: aOR 3.01, 95% CI 1.22-7.47). Antibiotics in the first year of life were positively associated with atopic dermatitis up to 4 years (aOR 2.73, 95% CI 1.66-4.49) and also suggested a dose-response relationship. A tendency was observed with asthma between 3 and 6 years (aOR 1.65, 95% CI 0.95-2.86). Conclusions: Our findings show positive associations between exposure to antibiotics and allergies, mainly atopic dermatitis and food allergy within the first year of life, after prenatal exposure, and atopic dermatitis and asthma after post-natal exposure to antibiotics in children born in rural settings.
  • Peltonen, Henna (Helsingin yliopisto, 2021)
    Background: Preschoolers suffer frequently from infections. Large group sizes and varying hygiene practices may enhance pathogen transmission within preschool settings. Preschool-attributable infections cause economic consequences for society, which is why identifying the related risk factors is of importance. One such may be diet. Appropriate immune defence requires sufficient intakes of energy, protein, polyunsaturated fat, dietary fibre, and numerous micronutrients, whereas excess sugar and saturated fat may be harmful. However, previous nutritional research examining preschoolers’ infections has mainly focused on probiotics. Little research has been done on the role of whole-diet in preschoolers’ susceptibility to infections. Aim: The present study aimed to investigate the associations of dietary patterns with common colds, gastroenteritis, and antibiotic courses among Finnish preschoolers. Methods: The study sample included 721 children aged 3-6 years attending the cross-sectional DAGIS survey. The parents reported retrospectively how many common colds, gastroenteritis, and antibiotic courses their children had experienced during the past year. Children’s food consumption was recorded using a 47-item food frequency questionnaire filled in by the parents. The parents also reported background factors of their children and family. The following three dietary patterns were identified based on the food consumption frequencies using principal component analysis: 1) sweets-and-treats pattern (high loadings of e.g. biscuits, chocolate, and ice cream); 2) health-conscious pattern (high loadings of e.g. nuts, natural yoghurt, and berries); and 3) vegetables-and-processed meats pattern (high loadings of e.g. vegetables, colds cuts, and fruits). Dietary pattern scores were calculated for each child to describe the strength of adherence to each identified dietary pattern. The distributions of the dietary pattern scores were divided into thirds that were labelled low, moderate, and high adherence groups. Negative binomial regression analysis was used to examine the associations between thirds of the dietary pattern scores and the prevalence of common colds and antibiotic courses. Logistic regression analysis was used to investigate the associations between thirds of the dietary pattern scores and a chance of experiencing at least one gastroenteritis. Results: Prevalence of common colds was lower in moderate and high adherences to the sweets-and-treats pattern compared to low adherence (PR=0.89, 95% CI=0.80-1.00; and PR=0.88, 95% CI=0.79-0.99, respectively) and higher in high adherence to the health-conscious pattern compared to low adherence (PR=1.13, 95% CI=1.01-1.27) after adjusting for age, sex, number of children living in the same household, frequency of preschool attendance, probiotic use, and the highest educational level in the family. Moderate adherence to the sweets-and-treats pattern was associated with a lower chance of at least one gastroenteritis (OR=0.63, 95% CI=0.44-0.92) and lower prevalence of antibiotic courses (PR=0.77, 95% CI= 0.59-1.00) compared to low adherence. No significant associations were observed between the vegetables-and-processed meats pattern and the infectious outcomes. Adjustments for the background factors did not modify the associations. Conclusion: The results were unexpected. The associations observed would suggest that favouring unhealthier foods but avoiding healthier foods was linked to better immunity, which is difficult to accept as true. Parents who were most health-conscious of their children’s diet might also have been more conscious of their children’s illness conditions than less health-conscious parents, which may explain the results. Further research with longitudinal designs is needed to determine whether dietary habits play a role in preschoolers’ susceptibility to infections.
  • Chabok, A; Thorisson, A; Nikberg, M; Schultz, JK; Sallinen, V (2021)
    Left-sided colonic diverticulitis is a common condition with significant morbidity and health care costs in Western countries. Acute uncomplicated diverticulitis which is characterized by the absence of organ dysfunction, abscesses, fistula, or perforations accounts for around 80% of the cases. In the last decades, several traditional paradigms in the management of acute uncomplicated diverticulitis have been replaced by evidence-based routines. This review provides a comprehensive evidence-based and clinical-oriented overview of up-to-date diagnostics with computer tomography, non-antibiotic treatment, outpatient treatment, and surgical strategies as well as follow-up of patients with acute uncomplicated diverticulitis.
  • Danielsson, Rebecca; Lucas, Jane; Dahlberg, Josef; Ramin, Mohammad; Agenas, Sigrid; Bayat, Ali-Reza; Tapio, Ilma; Hammer, Tobin; Roslin, Tomas (2019)
    The use of antibiotics in livestock production may trigger ecosystem disservices, including increased emissions of greenhouse gases. To evaluate this, we conducted two separate animal experiments, administering two widely used antibiotic compounds (benzylpenicillin and tetracycline) to dairy cows over a 4- or 5-day period locally and/or systemically. We then recorded enteric methane production, total gas production from dung decomposing under aerobic versus anaerobic conditions, prokaryotic community composition in rumen and dung, and accompanying changes in nutrient intake, rumen fermentation, and digestibility resulting from antibiotic administration. The focal antibiotics had no detectable effect on gas emissions from enteric fermentation or dung in aerobic conditions, while they decreased total gas production from anaerobic dung. Microbiome-level effects of benzylpenicillin proved markedly different from those previously recorded for tetracycline in dung, and did not differ by the mode of administration (local or systemic). Antibiotic effects on gas production differed substantially between dung maintained under aerobic versus anaerobic conditions and between compounds. These findings demonstrate compound- and context-dependent impacts of antibiotics on methane emissions and underlying processes, and highlight the need for a global synthesis of data on agricultural antibiotic use before understanding their climatic impacts.
  • Spruit, Cindy; Wicklund, Anu; Wan, Xing; Skurnik, Mikael; Pajunen, Maria (2020)
    The lytic phage, fHe-Kpn01 was isolated from sewage water using an extended-spectrum beta-lactamase-producing strain of Klebsiella pneumoniae as a host. The genome is 43,329 bp in size and contains direct terminal repeats of 222 bp. The genome contains 56 predicted genes, of which proteomics analysis detected 29 different proteins in purified phage particles. Comparison of fHe-Kpn01 to other phages, both morphologically and genetically, indicated that the phage belongs to the family Podoviridae and genus Drulisvirus. Because fHe-Kpn01 is strictly lytic and does not carry any known resistance or virulence genes, it is suitable for phage therapy. It has, however, a narrow host range since it infected only three of the 72 tested K. pneumoniae strains, two of which were of capsule type KL62. After annotation of the predicted genes based on the similarity to genes of known function and proteomics results on the virion-associated proteins, 22 gene products remained annotated as hypothetical proteins of unknown function (HPUF). These fHe-Kpn01 HPUFs were screened for their toxicity in Escherichia coli. Three of the HPUFs, encoded by the genes g10, g22, and g38, were confirmed to be toxic.
  • Cruz, CD; Esteve, P.; Tammela, Päivi (2021)
    Minimal inhibitory concentration of antimicrobials, determined by the broth microdilution method, requires visual assessment or absorbance measurement using a spectrophotometer. Both procedures are usually performed manually, requiring the presence of an operator to assess the plates at specific time point. To increase the throughput of antimicrobial susceptibility testing, and concurrently convert into an automatic assay, the Biolog OmniLog(R) system was validated for a new, label-free application using standard 96-well microplates. OmniLog was evaluated for its signal strength to ensure that the signal intensity, detected and measured by the system's camera, was satisfactory. Variability due to the plate location inside the OmniLog incubator, as well as variation between wells, was investigated. Then the system was validated by determining the minimal inhibitory concentration of ciprofloxacin, piperacillin and linezolid against a selected Gram-negative and Gram-positive strains. No significant difference was observed in relation to position of the plates within the system. Plate edge effects were noticeable, thus the edge wells were not included in further experiments. Minimal inhibitory concentration results were comparable to those obtained by conventional protocol as well as to values defined by the Clinical Laboratory Standards Institute or published in the literature.
  • Kuula, Laura S. M.; Backman, Janne T.; Blom, Marja L. (2021)
    Y The aim of this study was to assess costs and health service use associated with tendon injuries after the use of fluoroquinolone antimicrobialsin Finland during 2002-2012. This retrospective observational study included data from the Finnish Pharmaceutical Insurance Pool's pharmaceutical injury claims. In total, 145 compensated claimants aged >= 18 years presenting tendon injuries after the use of fluoroquinolones (FQs) were included in the study. Outcomes of interest were the number of outpatient visits to primary, secondary, tertiary, and private healthcare services, hospital days, rehabilitation and their costs. Regression models were used to analyze the impact of patient characteristics on hospital days, as well as the relationship between patient characteristics and tendon ruptures. Direct costs of a tendon injury averaged 14,800euro and indirect costs were estimated to be 9,077euro for employed claimants. Fifty-one percent of the claimants were hospitalized, with an average duration of 21 days. Hospitalization was the costliest form of health service use with an average of 9,915euro per hospital episode. Hospital days and direct costs increased with the severity of the injury. Tendon ruptures, in particular bilateral ruptures, required substantially more hospital days and their direct costs were significantly higher than those of uncomplicated tendinitis. Concurrent use of oral corticosteroids and increasing age were associated with a higher likelihood of tendon ruptures. Although rare, FQ-related tendon injuries can result in considerable costs and health service use. Medical staff should remain vigilant when prescribing FQs, especially in groups at increased risk for tendon injuries.
  • Kuula, Laura S.M.; Backman, Janne; Blom, Marja (2022)
    The aim of this study was to estimate healthcare costs and mortality associated with serious fluoroquinolone-related adverse reactions in Finland from 2008 to 2019. Serious adverse reaction types were identified from the Finnish Pharmaceutical Insurance Pool's pharmaceutical injury claims and the Finnish Medicines Agency's Adverse Reaction Register. A decision tree model was built to predict costs and mortality associated with serious adverse drug reactions (ADR). Severe clostridioides difficile infections, severe cutaneous adverse reactions, tendon ruptures, aortic ruptures, and liver injuries were included as serious adverse drug reactions in the model. Direct healthcare costs of a serious ADR were based on the number of reimbursed fluoroquinolone prescriptions from the Social Insurance Institution of Finland's database. Sensitivity analyses were conducted to address parameter uncertainty. A total of 1 831 537 fluoroquinolone prescriptions were filled between 2008 and 2019 in Finland, with prescription numbers declining 40% in recent years. Serious ADRs associated with fluoroquinolones lead to estimated direct healthcare costs of 501 938 402 (sic), including 11 405 ADRs and 3,884 deaths between 2008 and 2019. The average mortality risk associated with the use of fluoroquinolones was 0.21%. Severe clostridioides difficile infections were the most frequent, fatal, and costly serious ADRs associated with the use of fluoroquinolones. Although fluoroquinolones continue to be generally well-tolerated antimicrobials, serious adverse reactions cause long-term impairment to patients and high healthcare costs. Therefore, the risks and benefits should be weighed carefully in antibiotic prescription policies, as well as with individual patients.
  • Townsend, Eleanor M; Kelly, Lucy; Gannon, Lucy; Muscatt, George; Dunstan, Rhys; Michniewski, Slawomir; Sapkota, Hari; Kiljunen, Saija J; Kolsi, Anna; Skurnik, Mikael; Lithgow, Trevor; Millard, Andrew D; Jameson, Eleanor (2021)
    Introduction: Klebsiella is a clinically important pathogen causing a variety of antimicrobial resistant infections in both community and nosocomial settings, particularly pneumonia, urinary tract infection, and sepsis. Bacteriophage (phage) therapy is being considered a primary option for the treatment of drug-resistant infections of these types. Methods: We report the successful isolation and characterization of 30 novel, genetically diverse Klebsiella phages. Results: The isolated phages span six different phage families and nine genera, representing both lysogenic and lytic lifestyles. Individual Klebsiella phage isolates infected up to 11 of the 18 Klebsiella capsule types tested, and all 18 capsule-types were infected by at least one of the phages. Conclusions: Of the Klebsiella-infecting phages presented in this study, the lytic phages are most suitable for phage therapy, based on their broad host range, high virulence, short lysis period and given that they encode no known toxin or antimicrobial resistance genes. Phage isolates belonging to the Sugarlandvirus and Slopekvirus genera were deemed most suitable for phage therapy based on our characterization. Importantly, when applied alone, none of the characterized phages were able to suppress the growth of Klebsiella for more than 12 h, likely due to the inherent ease of Klebsiella to generate spontaneous phage-resistant mutants. This indicates that for successful phage therapy, a cocktail of multiple phages would be necessary to treat Klebsiella infections.
  • Freitag, Tobias L.; Hartikainen, Anna; Jouhten, Hanne; Sahl, Cecilia; Meri, Seppo; Anttila, Veli-Jukka; Mattila, Eero; Arkkila, Perttu; Jalanka, Jonna; Satokari, Reetta (2019)
    Fecal microbiota transplantation (FMT) is an effective therapy for recurrent Clostridioides difficile infection (rCDI) and is also considered a potential treatment for a wide range of intestinal and systemic diseases. FMT corrects the microbial dysbiosis associated with rCDI, and the engraftment of donor microbiota is likely to play a key role in treatment efficacy. For disease indications other than rCDI, FMT treatment efficacy has been moderate. This may be partly due to stronger resilience of resident host microbiota in patients who do not suffer from rCDI. In rCDI, patients typically have undergone several antibiotic treatments prior to FMT, depleting the microbiota. In this study, we addressed the effect of broad-spectrum antibiotics (Ab) as a pre-treatment to FMT on the engraftment of donor microbiota in recipients. We conducted a pre-clinical study of FMT between two healthy mouse strains, Balb/c as donors and C57BL/6 as recipients, to perform FMT within the same species and to mimic interindividual FMT between human donors and patients. Microbiota composition was assessed with high-throughput 16S rDNA amplicon sequencing. The microbiota of Balb/c and C57BL/6 mice differed significantly, which allowed for the assessment of microbiota transplantation from the donor strain to the recipient. Our results showed that Ab-treatment depleted microbiota in C57BL/6 recipient mice prior to FMT. The diversity of microbiota did not recover spontaneously to baseline levels during 8 weeks after Ab-treatment, but was restored already at 2 weeks in mice receiving FMT. Interestingly, pre-treatment with antibiotics prior to FMT did not increase the overall similarity of the recipient's microbiota to that of the donor's, as compared with mice receiving FMT without Ab-treatment. Pre-treatment with Ab improved the establishment of only a few donor-derived taxa, such as Bifidobacterium, in the recipients, thus having a minor effect on the engraftment of donor microbiota in FMT. In conclusion, pre-treatment with broad-spectrum antibiotics did not improve the overall engraftment of donor microbiota, but did improve the engraftment of specific taxa. These results may inform future therapeutic studies of FMT.
  • Kopra, Elisa; Lahdentausta, Laura; Pietiäinen, Milla; Buhlin, Kåre; Mäntylä, Päivi; Hörkkö, Sohvi; Persson, Rutger; Paju, Susanna; Sinisalo, Juha; Salminen, Aino; Pussinen, Pirkko J. (2021)
    The use of systemic antibiotics may influence the oral microbiota composition. Our aim was to investigate in this retrospective study whether the use of prescribed antibiotics associate with periodontal status, oral microbiota, and antibodies against the periodontal pathogens. The Social Insurance Institution of Finland Data provided the data on the use of systemic antibiotics by record linkage to purchased medications and entitled reimbursements up to 1 year before the oral examination and sampling. Six different classes of antibiotics were considered. The Parogene cohort included 505 subjects undergoing coronary angiography with the mean (SD) age of 63.4 (9.2) years and 65% of males. Subgingival plaque samples were analysed using the checkerboard DNA-DNA hybridisation. Serum and saliva antibody levels to periodontal pathogens were analysed with immunoassays and lipopolysaccharide (LPS) activity with the LAL assay. Systemic antibiotics were prescribed for 261 (51.7%) patients during the preceding year. The mean number of prescriptions among them was 2.13 (range 1-12), and 29.4% of the prescriptions were cephalosporins, 25.7% penicillins, 14.3% quinolones, 12.7% macrolides or lincomycin, 12.0% tetracycline, and 5.8% trimethoprim or sulphonamides. In linear regression models adjusted for age, sex, current smoking, and diabetes, number of antibiotic courses associated significantly with low periodontal inflammation burden index (PIBI, p < 0.001), bleeding on probing (BOP, p = 0.006), and alveolar bone loss (ABL, p = 0.042). Cephalosporins associated with all the parameters. The phyla mainly affected by the antibiotics were Bacteroidetes and Spirochaetes. Their levels were inversely associated with the number of prescriptions (p = 0.010 and p < 0.001) and directly associated with the time since the last prescription (p = 0.019 and p < 0.001). Significant inverse associations were observed between the number of prescriptions and saliva concentrations of Prevotella intermedia, Tannerella forsythia, and Treponema denticola and subgingival bacterial amounts of Porphyromonas gingivalis, P. intermedia, T. forsythia, and T. denticola. Saliva or serum antibody levels did not present an association with the use of antibiotics. Both serum (p = 0.031) and saliva (p = 0.032) LPS activity was lower in patients having any antibiotic course less than 1 month before sampling. Systemic antibiotics have effects on periodontal inflammation and oral microbiota composition, whereas the effects on host immune responses against the periodontal biomarker species seem unchanged.
  • Teräväinen, Inga (Helsingin yliopisto, 2019)
    Keisarinleikkaus eli sektio on yksi yleisimmistä leikkauksista naisille maailmanlaajuisesti. Jopa 10% naisista, jotka synnyttävät sektiolla, saa myöhemmin leikkausalueen infektion. Infektioita pyritään ehkäisemään paitsi leikkausalueen antiseptisellä valmistelulla, myös profylaktisella eli ennaltaehkäisevällä antibiootilla. Tässä tutkimuksessa arvioimme antibioottien käyttöä sektioihin liittyen sekä infektioprofylaksiassa että infektioiden hoidossa. Käytännöt vaihtelevat maailmanlaajuisesti huomattavan paljon. Tässä retrospektiivisessä tapaus-verrokkitutkimuksessa aineisto koostuu naisista, jotka synnyttivät sektiolla Naistenklinikalla tai Kätilöopistolla helmikuun 2016 ja helmikuun 2018 välillä ja joille myöhemmin kehittyi haavainfektio. Jokaiselle infektiopotilaalle etsittiin verrokkipotilas, joka synnytti samassa sairaalassa samalla kiireellisyysluokituksella mutta joka ei saanut haavainfektiota. Haavainfektion riskitekijöiksi tunnistettiin korkeampi BMI ennen raskautta, korionamnioniitti, pidempi aika kalvojen repeämisestä leikkaukseen, pidempi leikkausaika sekä suurempi leikkausvuoto. Kaikki potilaat ja verrokit saivat profylaktisen antibiootin ennen leikkausta. Ensisijaisesti profylaksiana käytettiin kefuroksiimia, pensilliiniallergisille klindamysiinia. Infektiopotilaat saivat verrokkeja useammin metronidatsolia, yleensä kefuroksiimiin yhdistettynä. Osa potilaista sai synnytyksen aikana antibiootteja esimerkiksi vaginan GBS-kolonisaation vuoksi tai korionamnioniitin hoitona. Antibioottien käyttö synnytyksen aikana ei merkittävästi vaikuttanut myöhempään haavainfektion kehittymiseen. Verrokkeihin verrattuna antibioottihoidon kesto infektiopotilailla välittömästi sektion jälkeen oli merkittävästi pidempi. Potilaat, joilla oli pinnallinen infektio, saivat ensioireensa myöhemmin ja tarvitsivat lyhyemmän hoidon kuin ne potilaat, joille kehittyi syvä infektio. Potilailla, joiden kohdalla päädyttiin lopulta hysterektomiaan eli kohdun poistoon, antibioottihoidon kesto oli pisin. CRP ensimmäisten oireiden ilmetessä sekä korkein CRP- ja leukosyyttiarvo olivat suuremmat potilailla, joilla oli syvä infektio. Haavainfektioiden riskitekijöiden tunnistaminen on erinomaisen tärkeää antibioottiprofylaksian suunnittelun kannalta. Antibioottiprofylaksia pitäisi myös optimoida niin, että valinta kohdistuu todennäköisimpiä patogeeneja vastaan.
  • Pieters, R. J; Slotved, H. C; Møller Mortensen, H.; Arler, L; Finne, J; Haataja, Sauli; Joosten, J. A. F; Branderhorst, H. M; Krogfelt, K. A (2013)