ABSTRACT
Introduction: Urinary tract infection (UTI) has a high incidence and recurrence, therefore, treatment is empirical in the majority of cases. Objectives: The aim of this study was to analyze the urine cultures performed at a secondary hospital, during two periods, 2005-2006 and 2010-2011, and to estimate the microbial resistance. Patients and methods: We analyzed 11,943 aerobic urine cultures according to basic demographic data and susceptibility to antibiotics in accordance with the Clinical and Laboratory Standards Institute (CLSI) for Vitek 1 and 2. Results: Most of our cohort consisted of young adult females that were seen at the Emergency Department. E. coli was the most frequent (70.2%) among the 75 species isolated. Resistance of all isolates was ≥ 20% for trimethoprim/sulfamethoxazole (TMP/SMX), norfloxacin, nitrofurantoin, cefazolin and nalidixic acid. Although E. coli was more susceptible (resistance ≥ 20% for TMP/SMX and nalidixic acid) among all of the isolates, when classified by the number and percentage of antibiotic resistance. Global resistance to fluoroquinolones was approximately 12%. Risk factors for E. coli were female gender and an age less than 65 years. Men and patients older than 65 years of age, presented more resistant isolates. Extended spectrum beta-lactamases (ESBL) were identified in 173 out of 5,722 Gram-negative isolates (3.0%) between 2010 and 2011. Conclusion: E. coli was the most frequent microbe isolated in the urine cultures analyzed in this study. There was a significant evolution of bacterial resistance between the two periods studied. In particular, the rise of bacterial resistance to fluoroquinolones was concerning.
Introdução: A infecção do trato urinário (ITU) tem alta incidência e recorrência, e o tratamento é empírico na maioria dos casos. Objetivos: O objetivo deste estudo foi analisar as culturas de urina realizadas em um hospital secundário, durante dois períodos: 2005-2006 e 2010-2011, para estimar a resistência microbiana. Pacientes e métodos: Foram analisadas 11.943 culturas aeróbicas de urina de acordo com um conjunto de dados demográficos básicos e susceptibilidade aos antibióticos, obedecendo às normas do Clinical and Laboratory Standards Institute (CLSI) para Vitek 1 e 2. Resultados: A maioria dos participantes era adulta e jovem atendida no Serviço de Emergência. E. coli foi a mais freqüente (70,2%) entre as 75 espécies isoladas. Resistência de todos os isolados foi ≥ 20% para sulfametoxazol/trimetoprim (SMX/TMP), norfloxacina, nitrofurantoína, cefazolina e ácido nalidíxico, apesar de E. coli ter sido mais suscetível (resistência ≥ 20% apenas para SMX/TMP e ácido nalidíxico) entre todos os isolados, levando em conta a porcentagem de resistência e o número de antibióticos testados. Resistência às fluoroquinolonas foi de 12%. Fatores de risco para E. coli: sexo feminino e idade < 65 anos. Homens e pacientes com mais de 65 anos apresentaram isolados mais resistentes. Beta-lactamases de espectro estendido (ESBL) foram identificadas em 173 de 5.722 isolados Gram-negativos (3,0%), 2010-2011. Conclusões: E. coli foi o isolado mais sensível a antibióticos. Houve uma evolução significativa da resistência antimicrobiana entre os dois períodos. Foi preocupante o aumento da resistência às fluoroquinolonas.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/pharmacology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Urinary Tract Infections/microbiology , Brazil , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/classification , Gram-Positive Bacteria/isolation & purification , Microbial Sensitivity Tests , Secondary CareABSTRACT
OBJECTIVES: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. METHODS: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors ± raltegravir ± enfuvirtide ± maraviroc) after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. RESULTS: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6). The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2). At week 48, 83% (95% CI: 75-90%) had an HIV RNA level <50 copies/mL and the median CD4 cell count was 301 (interquartile range 224-445) cells/mm³. Baseline HIV RNA >100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p = 0.028). CONCLUSIONS: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , HIV-1 , Anti-HIV Agents/therapeutic use , Drug Resistance, Viral/genetics , HIV Infections/drug therapy , Mutation/genetics , Ritonavir/therapeutic use , Sulfonamides/therapeutic use , HIV-1 , Antiretroviral Therapy, Highly Active , Brazil , Cohort Studies , Drug Therapy, Combination/methods , Genotype , HIV Infections/virology , Prospective Studies , Time Factors , Viral LoadABSTRACT
Sarcoidosis has been rarely described in literature as a cause of interstitial pulmonary disease associated with AIDS. This study reports a case of immune reconstitution inflammatory syndrome associated with pulmonary sarcoidosis in a patient with a history of previous pulmonary tuberculosis concomitant with HIV infection. Results of the immunohistochemical study of samples from the resected right lower lobe are described. Pathological findings suggest a role of Th1, Th2 and Th17 response in IRIS associated sarcoidosis.
Subject(s)
Adult , Humans , Male , AIDS-Related Opportunistic Infections/pathology , Immune Reconstitution Inflammatory Syndrome/pathology , Sarcoidosis, Pulmonary/pathology , ImmunohistochemistrySubject(s)
Humans , Male , Middle Aged , AIDS-Related Opportunistic Infections/microbiology , Lung Diseases, Fungal/microbiology , Nontuberculous Mycobacteria/isolation & purification , Mycobacterium Infections, Nontuberculous/microbiology , Paracoccidioidomycosis/diagnosis , AIDS-Related Opportunistic Infections/diagnosis , Chronic Disease , Lung Diseases, Fungal/diagnosis , Mycobacterium Infections, Nontuberculous/diagnosis , Paracoccidioides/isolation & purification , Paracoccidioidomycosis/drug therapy , Sputum/microbiologyABSTRACT
JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi rever a saúde ocupacional em unidade de terapia intensiva (UTI), bem como avaliar os aspectos para abordagem educacional da equipe multidisciplinar de forma integral. CONTEÚDO: Revisão da literatura realizada no período de 1997-2007, acerca de questões relevantes da saúde de profissionais da equipe multidisciplinar de UTI, na base de dados da Biblioteca Regional de Medicina (Bireme). Foram utilizados os termos "UTI", "educação em saúde" e "saúde ocupacional", sem haver seleção por desenho de estudo. CONCLUSÕES: Todos os estudos observados demonstraram que o ambiente de UTI é insalubre. Contudo entre os fatores que contribuem para tal insalubridade estão atitudes e hábitos dos profissionais de saúde da UTI, os quais são perfeitamente passíveis de mudança, razões pela qual uma abordagem de educação em saúde seria benéfica para diminuir o problema. As estratégias de educação continuada são adequadas na prevenção, tanto de riscos ocupacionais quanto ambientais nas UTI.
BACKGROUND AND OBJECTIVES: In this study we discuss about risks to health of intensive care unity staff and suggest a proposal of integral approach of health. CONTENTS: Literature review, from 1997 to 2007, at Bireme database about "health education", "intensive care unity", "nursing" and "occupational health", regardless of design of study. CONCLUSIONS: All studies show that the environment of intensive care unity is unhealthy, which is also due to habits and attitudes of ICU health professionals. An approach to health education would be beneficial to minimize the problem. Strategies for continuing education are appropriate both in the prevention of occupational and environmental risks in intensive care units.