Gastrointestinal tract and viral pathogens

Introduction: Acinetobacter baumannii (AB) is a multidrug-resistant pathogen commonly associated with nosocomial infections. The resistance profile and ability to produce biofilm make it a complicated organism to treat effectively. Cefoperazone sulbactam (CS) is commonly used to treat AB, but the associated data are scarce. Methods: We conducted a systematic review of articles downloaded from Cochrane, Embase, PubMed, Scopus, and Web of Science (through June 2022) to study the efficacy of CS in treating AB infections. Our review evaluated patients treated with CS alone and CS in combination with other antibiotics separately. The following outcomes were studied: clinical cure, microbiological cure, and mortality from any cause. Results: We included 16 studies where CS was used for the treatment of AB infections. This included 11 studies where CS was used alone and 10 studies where CS was used in combination. The outcomes were similar in both groups. We found that the pooled clinical cure, microbiological cure, and mortality with CS alone for AB were 70%, 44%, and 20%, respectively. The pooled clinical cure, microbiological cure, and mortality when CS was used in combination with other antibiotics were 72%, 43%, and 21%, respectively. Conclusions: CS alone or in combination needs to be further explored for the treatment of AB infections. There is a need for randomized controlled trials with comparator drugs to evaluate the drug’s effectiveness.

Introduction: Glucagon-like Peptide-1 (GLP-1) agonists cause delayed gastric emptying by acting on vagal afferent nerves. Retained Gastric Contents (RGC) increase the risk of pulmonary aspiration, particularly under anesthesia in endoscopic procedures. This systematic review and meta-analysis summarize the current evidence on pulmonary aspiration in patients receiving GLP-1 agonists who undergo endoscopy. Methods: A systematic review of the literature was conducted using Cochrane, Embase, and PubMed from inception to May 2024, including studies and case reports on GLP-1 agonists and pulmonary aspiration. Data on study characteristics, demographics, and GLP-1 agonist use were collected. A pooled analysis of retrospective studies was conducted using RevMan version 5.4.1. The study protocol was registered in the PROSPERO international database (ID CRD42024595241). Results: We identified five case reports involving six patients and twelve studies, including 210,216 patients. A total of 143/87691 (0.16%) in the GLP-1 agonist and 149/122525 (0.12%) in the placebo group had pulmonary aspiration. In the case reports, three patients had aspiration despite stopping medication >6 days prior to the procedure and fasting for >8 hours. Meta-analysis showed that GLP-1 agonists were associated with an odds ratio of 1.23 for pulmonary aspiration (P = 0.59; 95% CI, 0.58 to 2.60), which was not statistically significant. Conclusion: Our analysis found no statistically significant association between GLP-1 agonist use and the risk of pulmonary aspiration during endoscopic procedures. Further research is needed to determine optimal fasting protocols and peri-procedural management strategies.