Doxycycline modify the cytokine storm in patients with dengue and dengue hemorrhagic fever

Doxycycline modify the cytokine storm in patients with dengue and dengue hemorrhagic fever

e44 14th International Congress on Infectious Diseases (ICID) Abstracts Conclusion: Our data show that after the inclusion of ertapenem, the use of ...

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e44

14th International Congress on Infectious Diseases (ICID) Abstracts

Conclusion: Our data show that after the inclusion of ertapenem, the use of other carbapenems and ceftriaxone significantly decreased, however the use of antipseudomonal cephalosporins significantly increased; of note, there was a slight decrease in the susceptibility to carbapenems and broad-spectrum cephalosporins during the POST-period, which could be attributed to the intensive use of both, ceftriaxone and antipseudomonal cephalosporins.

Conclusion: Carbapenem-resistant A. baumannii infections were associated with severe morbidity, requiring prolonged hospitalization and ICU admissions, and also resulted in increased mortality.

doi:10.1016/j.ijid.2010.02.1584

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Doxycycline modify the cytokine storm in patients with dengue and dengue hemorrhagic fever

Clinical characterization of patients with carbapenemresistant versus carbapenemsusceptible Acinetobacter baumannii infections

J. Zavala Castro 1,∗ , T. Fredeking 2



I. Tyagi , J. Koirala Southern Illinois University School of Medicine, Springfield, IL, USA Background: Steady rise in carbapenem resistance in Acinetobacter baumannii has become a major challenge for clinicians. The objective of this study is to characterize clinical features of infections secondary to carbapenemresistant organisms compared to carbapenemsusceptible organisms. Methods: We conducted a retrospective analysis of data for 39 patients from two tertiary care medical centers who had positive cultures for A. baumannii. Collected data included clinical presentations, underlying illnesses, treatment course, clinical outcome, microbiological data and other laboratory data. Statistical comparisons were done between patients infected with carbapenem-resistant (CRAB) and carbapenem-susceptible (CSAB) isolates using Fisher’s exact test and Student’s T-test. Multidrug resistance (MDR) was defined as resistance to more than two classes of antibiotics generally active against A. baumannii. Results: Total 17 (44%) patients had carbapenemresistant (CRAB) and 24 (62%) had multidrug resistant (MDR) A. baumannii. Mean age (53 ± 5.7 years) and male predominance (70%) were comparable in both groups. Predisposing factors included diabetes mellitus (15), pressure ulcers (12), malignancy (8), paraplegia (7), burn (5), peripheral vascular disease (5), and chronic renal failure (5). Majority of the infections involved wound (13) and bone (10) followed by sputum (8), urine (5) and bloodstream (3). Mean duration for first positive A. baumannii cultures after admission to the hospital was 6.6 (±3.4) days. Patients infected with CRAB had significantly higher rates of respiratory or other organ failures (47% vs. 14%, p < 0.05), and were more frequently admitted to the intensive care unit (53% vs. 18%, p < 0.05), compared to the patients with CSAB. Patients with CRAB were also more likely to be admitted for prolonged durations in the hospital (mean = 31.5 vs. 8.5 days, p < 0.01) and in the intensive care unit (mean = 25.9 vs. 1.2 days, p < 0.05). Mortality was significantly higher among patients with CRAB compared to those with CSAB (29% vs. 4.5%, p < 0.01). A. baumannii infections were treated for an average duration of 24 (±7) days. Antibiotics used for treatment included carbapenems, ampicillin-sulbactam, tigecycline, aminoglycosides, colistin and polymyxin B.

doi:10.1016/j.ijid.2010.02.1585

Arboviruses (Poster Presentation)

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Universidad Autonoma de Yucatan, Merida, Yucatán, Mexico 2 Antibody Systems Inc., Hurst, TX, USA Background: Dengue virus infection is an acute febrile disease caused by a virus of the genus Flavivirus, family Flaviridae. Usually is a mild self-limiting acute illness, but may evolve to a hemorrhagic form characterized by plasma leakage and hemorrhagic manifestations. The treatment of both forms has been limited to the management of the signs and symptoms, and sometimes a retroviral treatment has been used. The cytokine cascade has a crucial role in the pathogenesis of dengue (DF) and dengue hemorrhagic fever (DHF), and the presence of the Th1 and Th2 cytokines are responsible to cross-regulate the disease from a mild illness (DF; Th1-type response), to a severe illness (DHF; Th2-type response). Recently, doxycycline was show to inhibit the cytokine storm caused by Staphylococcal exotoxins, specifically the cytokines involved in the Th2-type response. In this work, we use the doxycycline and tetracycline treatment in patients with dengue and dengue hemorrhagic fever, in order to regulate the Th1 and Th2 cytokines. Methods: Thirty patients were included in the work. The patients were divided in groups of 5 each: DF, DF+ doxycycline, DF+ tetracycline, DHF, DHF+ doxycycline, DHF+ tetracycline. The doxycycline groups were treated with oral doxycycline 200 mg/day/7 days, the tetracycline groups were treated with oral tetracycline 1.5 g/day/7 days. The patients were bleeding in days 0, 3 and 7. Serum concentrations of IL-6, IL-1␤, IL-1ra, TNF-␣, and sTNF-R1 were determined by ELISA. Clinical laboratory were performed with each bleeding, and a clinical control of signs and symptoms were carry out every day. Results: Doxycycline groups shows the higher immuneregulation of cytokines IL-6, IL-1␤, and TNF-␣, with an increase in the levels of IL-1ra and sTNF-R1, followed by the tetracycline groups which presents an slightly higher regulation than the control group without treatment. The improvement of the patients was better in the doxycycline groups, with a faster remission of the symptoms than the other groups. Conclusion: The use of doxycycline in the treatment of dengue and dengue hemorrhagic fever patients could regulate the cytokine cascade and improve the recovery of the patients with dengue and dengue hemorrhagic fever. doi:10.1016/j.ijid.2010.02.1586