ß-lactamasas de espectro extendido y factores de virulencia en Escherichia coli uropatógenas en asilos de ancianos en Lima, Perú / ß-lactamases and virulence factors in uropathogenic Escherichia coli in nursing homes in Lima, Peru

RESUMEN Los asilos de ancianos son instituciones con una alta prevalencia de infecciones del tracto urinario ocasionado por Escherichia coli productoras de ß-lactamasas de espectro extendido (BLEE), con diversos factores de virulencia. El objetivo del estudio fue determinar la frecuencia del gen bla CTX-M y de ocho genes de virulencia en 35 E. coli uropatógenas productoras de BLEE provenientes de seis asilos en Perú, durante el 2018. El 57,1% (20/35) de las E. coli fueron portadores del gen bla CTX-M. Además, se obtuvo una frecuencia del 46% (15/35) y 37% (13/35) de hly-alfa y cnf-1, respectivamente; elevada presencia de los genes iucC (63%, 22/35), aer (94%, 33/35) y chuA (94%, 33/34) y una frecuencia del 46% (16/35) y del 91% (32/34) de los genes pap GII y nanA, respectivamente. Existe predominancia en la distribución del gen bla CTX-M, además de una alta frecuencia de exotoxinas que le confieren una ventaja competitiva para diseminarse hacia el torrente sanguíneo.

ABSTRACT Nursing homes are institutions with high prevalence of urinary tract infections caused by ESBL-producing E. coli with several virulence factors. The aim of this study was to determine the frequency of the bla CTX-M gene and eight virulence genes in 35 ESBL-producing uropathogenic E. coli from six nursing homes in Peru during 2018. Of the E. coli samples, 57.1% (20/35) were carriers of the bla CTX-M gene. Furthermore, we obtained frequencies of 46% (15/35) and 37% (13/35) for hly-alpha and cnf-1, respectively; we also found high presence of the iucC (63%, 22/35), aer (94%, 33/35) and chuA genes (94%, 33/34) as well as a frequency of 46% (16/35) and 91% (32/34) for the pap GII and nanA genes, respectively. The bla CTX-M gene is predominant and a high frequency of exotoxins gives it a competitive advantage for spreading into the bloodstream.

Gastos com antibacterianos de uso sistêmico e seus determinantes: uma análise de 2010 a 2015 no Estado de Minas Gerais / Expenditure on antibacterials for systemic use and its drivers: analysis between 2010 and 2015 in Minas Gerais State, Brazil

Resumo Introdução Antibacterianos sistêmicos são medicamentos amplamente utilizados e os gastos públicos com este grupo têm aumentado consideravelmente. Objetivo Avaliar os gastos com antibacterianos sistêmicos e seus determinantes, entre 2010 e 2015, no Estado de Minas Gerais. Método Estudo de Utilização de Medicamentos (EUM), longitudinal, com dados do banco de administração pública do Sistema Integrado de Administração de Materiais e Serviços de Minas Gerais (SIAD-MG). Foram estimados gastos e volumes totais por ano, bem como por subgrupo terapêutico. Os antibacterianos responsáveis pelo maior gasto foram identificados pelo método Drug Cost 90%. Análise de decomposição foi utilizada para avaliar os determinantes dos gastos, preço, volume ou escolha terapêutica. Resultados No período analisado houve uma redução de 22,2% nas despesas e de 25,5% no volume adquirido. As penicilinas corresponderam a 42% do total adquirido, sendo a amoxicilina, isolada ou em associação, o fármaco mais consumido. A redução das despesas, entre 2010 e 2015, foi determinada principalmente pela redução do volume (queda de 25%) e preços (queda de 5%). Conclusão A redução de volume no período pode ter impacto negativo na cobertura populacional. O investimento em agentes de amplo espectro, em fármacos de segunda linha de tratamento ou com pouca evidência clínica requerem a criação de protocolos clínicos universais que orientem a prescrição mais adequada.

Abstract Background Antibacterials for systemic use are widely used and public spending on these drugs has increased considerably. Objective To evaluate the expenditures with Antibacterials for systemic use and its drivers in the state of Minas Gerais, between 2010 and 2015. Method Longitudinal Drug Utilization Study, based on data from the public administration database SIAD-MG. Total expenditures and volumes were estimated per year and per therapeutic subgroup. Drug Cost 90% method was used to identify antibacterials responsible for the highest expenditure. Decomposition analysis was used to evaluate the determinants of expenditures (price, volume, or drug mix). Results There was a reduction in expenditure (22.2%) and in volume (25.5%) from 2010 to 2015. Penicillins corresponded to 42% of the total volume. Amoxicillin plain or in combination was responsible for consuming more than one-third of the budget. The reduction in expenditure between 2010 and 2015 was mainly determined by the reduction in volume (25%) and prices (5%). Conclusion Volume reduction in the period may harm population coverage. The investment in broad-spectrum agents, drugs considered the second line of treatment, or with little clinical evidence raises the need to create universal clinical protocols that guide the appropriate prescription.

Caracterización de la sepsis en pacientes adultos del Hospital Nacional

RESUMEN Introducción: la sepsis es una patología que afecta a un gran número de personas en todo el mundo, sigue siendo un problema de salud importante debido a su alta mortalidad. Objetivos: describir las características de la sepsis en pacientes adultos del Hospital Nacional, Itauguá, Paraguay. Métodos: estudio observacional, retrospectivo, descriptivo, de corte trasversal en el que se incluyó a todos los pacientes adultos, de ambos sexos, del periodo 2020-2021. La investigación fue aprobada por el Comité de Ética de la Universidad Nacional de Itapúa. Resultados: la muestra estuvo compuesta de 92 pacientes, la edad media fue de 59 ± 18 años, 56,5% correspondió al sexo masculino, 52,2% procedió de zonas urbanas, predominó la escolaridad primaria (46,8%). El 84,8% presentó alguna comorbilidad: la hipertensión arterial y la diabetes mellitus fueron las más frecuentes. El foco más frecuente de la sepsis fue pulmonar (35,9%), seguido de piel y partes blandas (26,1%). Los antibióticos más usados fueron cefalosporinas (22,8%), derivados de penicilina (17,4%) y combinación de quinolona y lincosamida (17,4%). En 38% la antibioticoterapia se inició posterior a 4 horas, en 31,5% entre 3 y 4 horas y en 30,4% antes de las 2 horas. Se aislaron gérmenes en 53,2% de los casos. El 65,2% requirió internación en terapia intensiva, de los cuales 70% falleció. Conclusión: la edad media fue 59 años y predominó el sexo masculino. La comorbilidad más frecuente fue la hipertensión arterial. El principal foco de origen fue el pulmonar. Los antibióticos más frecuentemente utilizados fueron cefalosporinas. Solamente en 30,4% de los casos se inició antibióticos antes de las 2 horas del diagnóstico. La mortalidad global fue de 45,65%.

ABSTRACT Introduction: Sepsis is a pathology that affects a large number of people around the world, and it continues to be a major health problem due to its high mortality. Objectives: To describe the characteristics of sepsis in adult patients of the Hospital Nacional Hospital, Itauguá, Paraguay. Methods: Observational, retrospective, descriptive, cross-sectional study in which all adult men and women from the 2020-2021 period were included. The research was approved by the Ethics Committee of the National University of Itapúa. Results: The sample consisted of 92 patients, the mean age was 59±18 years, 56.5% were male, 52.2% came from urban areas, primary schooling prevailed (46.8%). Comorbidities were present in 84.8%: arterial hypertension and diabetes mellitus were the most frequent. The most frequent focus of sepsis was pulmonary (35.9%), followed by skin and soft tissues (26.1%). The most used antibiotics were cephalosporins (22.8%), penicillin derivatives (17.4%) and a combination of quinolone and lincosamide (17.4%). In 38%, antibiotic therapy was started after 4 hours, in 31.5% between 3 and 4 hours and in 30.4% before 2 hours. Germs were isolated in 53.2% of the cases, 65.2% required hospitalization in intensive care, of which 70% died. Conclusion: The mean age was 59 years and male sex predominated. The most frequent comorbidity was arterial hypertension. The main source of origin was the lung. The most frequently used antibiotics were cephalosporins. Only in 30.4% of cases, antibiotics started within 2 hours of diagnosis. Overall mortality was 45.65%.

Actividad antibacteriana in vitro del extracto hidroetanólico de Myrciaria dubia (Kunth) McVaugh (camu camu) sobre Streptococcus mutans / In vitro antibacterial activity of hydroethanolic extract from Myrciaria dubia (Kunth) McVaugh (camu camu) against Streptococcus mutans

Introducción: Streptococcus mutans participa en el origen y progreso de la caries dental, una de las enfermedades más prevalentes a nivel mundial. Su control requiere métodos seguros y accesibles para la población. Myrciaria dubia (Kunth) McVaugh (Myrtaceae) (camu camu) es un árbol nativo de la amazonía peruana. La capacidad antimicrobiana de los componentes de su fruto ya se ha comprobado. Objetivo: Evaluar la actividad antibacteriana in vitro del extracto hidroetanólico de M. dubia contra S. mutans ATCC 35658. Métodos: Investigación experimental con posprueba y grupos controles. El extracto de la pulpa del fruto de M. dubia se obtuvo mediante maceración hidroetanólica. Las concentraciones evaluadas fueron 25 mg/mL, 50 mg/mL y 75 mg/mL. La capacidad antibacteriana se determinó mediante el método de difusión en disco. Gluconato de clorhexidina 0,12 por ciento fue el control positivo y el dimetilsulfóxido al 1 por ciento el control negativo. Resultados: La actividad antibacteriana se incrementó de manera directamente proporcional a la concentración del extracto. La concentración de 75 mg/mL mostró una media de inhibición de 18,2 ± 0,774 mm, seguido de la concentración de 50 mg/mL con una media de inhibición de 14,6 ± 1,055 mm y la concentración de 25 mg/mL con un halo de inhibición promedio de 10,1± 0,833 mm. La zona de inhibición del control positivo fue de 16,5 ± 0,516 mm. Existe diferencia estadísticamente significativa entre la concentración de 75 mg/mL y el control positivo (p< 0,05). Conclusiones: El extracto hidroetanólico de M. dubia muestra actividad antibacteriana in vitro de tipo bactericida sobre S. mutans ATCC 35668(AU)

Introduction: Streptococcus mutans is involved in the genesis and progress of dental caries, one of the most prevalent diseases worldwide, whose control requires safe methods accessible to the population. Myrciaria dubia (Kunth) McVaugh (Myrtaceae) (camu camu) is a tree native to the Peruvian Amazon. The antimicrobial capacity of the components of its fruit has already been verified. Objective: Evaluate the in vitro antibacterial activity of M. dubia hydroethanolic extract against S. mutans ATCC 35658. Methods: An experimental study was conducted with post-test analysis and control groups. The extract from the pulp of the fruit of M. dubia was obtained by hydroethanolic maceration. The concentrations evaluated were 25 mg/mL, 50 mg/mL and 75 mg/mL. Antibacterial capacity was determined by the disc diffusion method. The positive control was 0.12 percent chlorhexidine gluconate, whereas the negative control was 1 percent dimethyl sulfoxide. Results: The antibacterial activity increased directly proportional to the concentration of the extract. The concentration of 75 mg/mL showed a mean inhibition of 18.2 ± 0.774 mm, followed by the concentration of 50 mg/mL with a mean inhibition of 14.6 ± 1.055 mm and the concentration of 25 mg/mL with an average inhibition halo of 10.1 ± 0.833 mm. The zone of inhibition of the positive control was 16.5 ± 0.516 mm. There is a statistically significant difference between the concentration of 75 mg / mL and the positive control (p< 0.05). Conclusions: The M. dubia hydroethanolic extract displays in vitro antibacterial bactericidal activity against S. mutans ATCC 35668(AU)

O uso da lock terapia na prevenção e tratamento de infecção relacionada ao cateter venoso central de longa permanência: revisão integrativa / Using lock therapy to prevent and treat long-term central venous catheter-related infections: an integrative review

Introdução: A lock terapia, ou terapia de bloqueio, consiste na administração e manutenção de uma solução, em concentração supra terapêutica, nos cateteres venosos centrais. Estas soluções combinam antimicrobianos altamente concentrados com um anticoagulante, sendo aplicáveis tanto para a prevenção, quanto para o tratamento da infecção relacionada ao cateter. Objetivo: Sintetizar o conhecimento sobre o uso da lock terapia na prevenção e tratamento de infecção relacionada ao cateter intravascular de inserção central. Método: Revisão integrativa da literatura, sendo a busca realizada nas seguintes bases de dados CINAHL, Cochrane Central, Embase, LILACS, PubMed, Scopus e Web of Science, abrangendo o período de 1 janeiro de 2010 a 3 de março de 2020, sem restrições de idioma. As referências foram exportadas para o gerenciador EndNote e para o Rayyan, para a seleção dos estudos. As etapas de amostragem, categorização dos estudos, avaliação dos estudos incluídos, interpretação dos resultados e síntese do conhecimento foram realizadas por dois revisores de forma independente. Em seguida, foi realizada uma busca manual nas referências dos estudos incluídos. Os dados foram analisados de forma descritiva. Resultados: A amostra compilou 15 estudos. Seis estudos (40%) abordaram o uso da lock terapia como prevenção de infecção relacionada ao cateter venoso central, e nove artigos (60%) abordaram tal terapia como tratamento. Os artigos incluídos nessa revisão que abordaram a prevenção relatam o uso de soluções antimicrobianas não antibióticas (taurolidina (n=2), etanol (n=2), citrato trissódico (n=1) e nitroglicerina (n=1)). Dentre os nove estudos que abordaram a lock terapia como tratamento para a infecção, a maioria (n=7) utilizou soluções antibióticas, (dois estudos avaliaram a eficácia da daptomicina e os outros cinco utilizaram soluções antibióticas variadas). Os outros dois estudos utilizaram soluções antimicrobianas (ácido clorídrico e taurolidina) associadas com antibioticoterapia sistêmica. Dentre os 15 estudos, em apenas um não foi possível especificar a duração da intervenção. Dois avaliaram a eficácia da lock terapia em curta duração (de três a quatro dias) e seis avaliaram em maior duração (entre 10 e 14 dias). Cada estudo especificou uma técnica de intervenção e o tempo de permanência da solução intraluminal. Em relação ao risco de viés, foram avaliados cinco ensaios clínicos randomizados pela ferramenta da Cochrane Risk of Bias (RoB 2), sendo todos de baixo risco. Dois ensaios clínicos sem randomização avaliados pela ferramenta proposta pelo Joanna Briggs Institute (JBI) resultaram em risco de viés baixo. Dentre os oito estudos observacionais, a ferramenta AXIS avaliou sete como sendo de baixo risco e um como risco moderado. Conclusões: Na prevenção identificou-se o uso de antimicrobianos não antibióticos como o etanol. A taurolidina também foi utilizada em um estudo relacionado ao tratamento, em associação com antibioticoterapia sistêmica. Em três estudos sintetizados para as situações de tratamento da infecção relacionada ao cateter, o antibiótico utilizado foi a daptomicina endovenosa. Tais antibióticos sistêmicos, utilizados concomitantemente na maioria dos estudos de tratamento, foram selecionados em conformidade com o resultado da hemocultura e antibiograma

Introduction: Lock therapy, or blockade therapy, is the administration and maintenance of a solution, at a dosage higher than the therapeutic one, in central venous catheters. Blockade solutions combine highly concentrated antimicrobials with an anticoagulant. They can be applied to both prevent and treat catheter-related infections. Objective: To summarize the knowledge about use of lock therapy to prevent and treat intravascular catheter-related infections. Methods: Integrative literature review, whose search was carried out in the databases CINAHL, Cochrane Central, Embase, LILACS, PubMed, Scopus and Web of Science, considering the period from January 1, 2010 to March 3, 2020, without any languages restriction. The references were exported to EndNote and subsequently to Rayyan, so studies could be selected. Sampling, study categorization, study evaluation, interpretation of results, and synthesis of knowledge were executed by two researchers independently and blindly. A manual search was then carried out in the references of the included articles. The data were analyzed descriptively. Results: The final sample was composed of 15 studies. Six studies (40%) addressed the use of lock therapy to prevent central venous catheter-related infections and nine publications (60%) addressed this therapy as a form of treatment. The articles included in this review that addressed prevention reported use of nonantibiotic antimicrobial solutions (taurolidine (n=2), ethanol (n=2), trisodium citrate (n=1), and nitroglycerin (n=1)). Among the nine studies that evaluated lock therapy as a treatment alternative, most (n=7) described the use of antibiotic solutions (two evaluated the effects of daptomycin and five reported the application of varied antibiotic solutions). The other two articles described use of antimicrobial solutions (hydrochloric acid and taurolidine) associated with systemic antibiotic therapy. Among all 15 studies, one did not specify the intervention duration, two assessed the efficacy of lock therapy in the short term (from three to four days), and six assessed it within a longer duration (between 10 and 14 days). Each study specified an intervention technique and length of permanence of the intraluminal solution. Regarding risk of bias, five randomized clinical trials were evaluated with the tool Cochrane Risk of Bias (RoB 2), which indicated all as low risk of bias. Two nonrandomized clinical trials were assessed through the tool proposed by the Joanna Briggs Institute, and resulted in low risk of bias. Among all eight observational studies, the AXIS tool evaluated seven as showing low risk of bias and one as moderate risk of bias. Conclusions: Regarding prevention, the studies reported the use of non-antibiotic antimicrobials such as ethanol. The taurolidine was also mentioned in a study describing therapeutic applications, in combination with systemic antibiotic therapy. In three studies addressing treatment of catheterrelated infections, the antibiotic used were Daptomycin. These systemic antibiotics, which were concomitantly used in most treatment studies, were chosen according to the results of blood culture with antibiogram

In silico and in vitro assay of Hexagamavunon-6 analogs, Dibenzilyden-N-Methyl-4-piperidone as antibacterial agents

A new series of analogs Hexagamavunon-6 (HGV-6) was prepared and screened for antibacterial activity againstStreptococcus mutans (ATCC 25175), Escherichia coli (ATCC 25922), Bacillus subtilis (ATCC 6633), Psedomonasaeruginosa (ATCC 27853), Klebsiella pneumoniae, and Enterococcus faecalis (ATCC 29212) using disk diffusionmethod. The antibacterial results showed that 3,5-Bis-(2',4'-dichlorobenzilyden)-N-methyl-4-piperidone (1c)compound display significant inhibition and broad-spectrum antibacterial activity. This is in accordance with the insilico evaluation showing that compound 1c has a lower docking score than both compounds 1a and 1b. None of thetested compounds were as active as the reference standard drug Amoxicillin.

An evaluation of safety and efficacy of nadifloxacin 1% ointment versus mupirocin 1% ointment in Indian children with skin and soft tissue infection

Background: Although nadifloxacin has been shown to be effective in the treatment of skin & soft tissue infections (SSTI), there is a paucity of data comparing its efficacy and safety with other antibacterials, especially in Indian paediatric population. Therefore, objective of this study was to compare the safety and efficacy of nadifloxacin with mupirocin in children with SSTI.Methods: This was a single-centre, open label, randomized, parallel group, comparative study in 60 children of <12 years of age with SSTI. Test group (n=30) received nadifloxacin 1% ointment and reference group (n=30) received mupirocin 1% ointment, to be applied twice daily. Patients were followed up at day 4, 8 and 15. Efficacy of the study drugs was evaluated by clinical and bacteriological cure rate. Safety was assessed by reporting of adverse events.Results: Baseline characteristics of enrolled patients were comparable between treatment groups and all 60 patients completed the study. At Day 15, 100.0% cases among nadifloxacin group and 96.7% cases among mupirocin group achieved clinical cure (p=0.313). The most common bacteria found in culture were Gram positive cocci in both the groups (86.7% in nadifloxacin and 58.8% in mupirocin group). None of the cases in any of the groups showed bacteriological presence at day 15. No adverse event was reported in any of the treatment groups during the study duration.Conclusions: Nadifloxacin was found to be equally efficacious and safe to mupirocin in the treatment of SSTI in Indian pediatric population.

Isolamento e identificação de bactérias presentes em superfícies inanimadas de uma unidade básica de saúde no interior de São Paulo / Isolation and identification bacteria present in inanimate surfaces of a basic health units in the state of São Paulo

Objetivo ­ Identificar e isolar bactérias em superfícies inanimadas de uma Unidade Básica de Saúde no interior de São Paulo e verificar a suscetibilidade bacteriana frente aos antibióticos testados. Métodos ­ Foram coletadas 60 amostras de superfícies inanimadas de uma Unidade Básica de Saúde realizado um esfregaço da superfície utilizando um swab umidificado em solução salina estéril e inoculado em caldo BHI. Após foram semeadas em meio de cultura não seletivo e identificadas através de coloração de gram, catalase, crescimento no manitol, coagulase, DNAse, fermentação da lactose, EPM, Mili e Citrato. O teste de suscetibilidade antimicrobiana por difusão de disco foi aplicado. Resultados ­ Das 60 superfícies inanimadas analisadas, 59 (98,3%) estavam contaminadas, sendo 29% (17) contaminadas por Staphylococcus aureus, 71,1% (41) por Staphylococcus coagulase negativa e 72,9% por enterobactérias (20,9% Escherichia coli, 16,3% Citrobacter freundii, 13,9% Serratia marcescens, 13,9% Serratia liquefaciens, 7% Salmonella paratyphi, 7% Klebsiella pneumoniae, 4,6% Shigella sp., 4,6% Yersinia enterocolitica, 2,3% Klebsiella oxytoca, 2,3% Serratia odorifera, 2,3% Providencia sp. e 2,3% Enterobacter sp.). Foi observada uma multirresistência dessas bactérias frente aos antibióticos testados. Conclusão ­ A contaminação em superfícies inanimadas, assim como o perfil de resistência microbiana, foram evidentes na UBS analisada, resultados estes que demonstram a necessidade de uma maior vigilância no que diz respeito ao controle de infecções, assim ao que se refere a reavaliação das estratégias de limpeza e desinfecção dessas superfícies inanimadas

Objective ­ Identify and bacteria isolates on inanimate surfaces of a Basic Health Unit in the interior of São Paulo and to verify the bacterial susceptibility against the tested antibiotics. Methods ­ Sixty samples of inanimate surfaces from a Basic Health Unit were collected by swabbing the surface using a swab humidified in sterile saline and inoculated into BHI broth. After sowing in non-selective culture medium and identified by staining of gram, catalase, growth in mannitol, coagulase, DNAse, fermentation of lactose, EPM, Mili, Citrate. The antimicrobial susceptibility test by disk diffusion were applied. Results ­ Of the 60 inanimate surfaces analyzed, 59 (98.3%) were contaminated, with 28.9% (17) being contaminated by Staphylococcus aureus, 71.1% (42) Staphylococcus coagulase negative and 72.9% by enterobacteria (20.9% Escherichia coli, 16.3% Citrobacter freundii, 13.9% Serratia marcescens, 13.9% Serratia liquefaciens, 7% Salmonella paratyphi, 7% Klebsiella pneumoniae, 4.6% Shigella sp., 4.6% Yersinia enterocolitica, 2.3% Klebsiella oxytoca, 2.3% Serratia odorifera, 2.3% Providencia sp. e 2.3% Enterobacter sp.) A multiresistance of these bacteria was observed against the tested antibiotics. Conclusions ­ The contamination on inanimate surfaces, as well as the microbial resistance profile, were evident in the Basic Health Unit analyzed, which results demonstrate the need for greater vigilance with regard to infection control, as well as the reevaluation of strategies for cleaning and disinfecting these inanimate surfaces.

Antibiotics for appendicectomy in children and adolescents during the perioperative period: an integrative review / Antibióticos para apendicectomia em crianças e adolescentes no perioperatório: uma revisão integrativa

ABSTRACT Objective: To analyze the preoperative use of antibiotics in children and adolescents requiring appendectomy. Data source: Integrative review was performed in the MEDLINE, Latin American and Caribbean Health Sciences (LILACS) and Cochrane databases and the PubMed portal, with no time limit. The keywords used were: appendicitis, child, adolescent and antibacterial with Boolean AND. The articles included were published in Portuguese, English or Spanish and whose participants were under 18 years of age. Review articles and guidelines were excluded. The studies were classified according to their level of evidence and 24 papers were selected. Data collection and analysis: Seven randomized clinical trial studies (level of evidence II), eight cohorts (level III), seven retrospective observational studies (level V) and two historical documentary analysis (level IV) were selected. The studies addressed antibiotics used in acute appendicitis in both uncomplicated and complicated cases. Antibiotics initiated in the preoperative period showed a decrease in the rates of surgical wound infections. First-line (empiric) regimens were tested for sensitivity to microorganisms in peritoneal material cultures, however the results were controversial. Broad-spectrum antibiotics have been suggested in some studies because they have good coverage, but in others they have not been recommended because of the risk of developing bacterial resistance. Shorter administration time and earlier change to the oral route reduced hospitalization time. Conclusions: There are several clinical protocols with different antibiotics. However, there is no standardization concerning the type of antibiotic drug, time of use, or route.

RESUMO Objetivo: Analisar o uso de antibióticos em crianças e adolescentes no perioperatório de apendicectomia. Fonte de dados: Realizou-se uma revisão integrativa, nas bases de dados MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Cochrane e no portal PubMed, sem limite de tempo. As palavras-chave utilizadas foram: apendicite, criança, adolescente e antibacterianos com booleano AND. Os artigos incluídos foram publicados nos idiomas português, inglês ou espanhol e cujos participantes tivessem idade inferior a 18 anos. Os artigos de revisão e diretrizes foram excluídos. A qualidade da evidência foi analisada, e foram selecionados 24 artigos. Síntese dos dados: Sobre os estudos selecionados, sete foram ensaios clínicos randomizados (nível de evidência II), oito coortes (nível III), sete observacionais retrospectivos (nível V) e duas análises documentais históricas (nível IV). Os estudos abordaram antibióticos usados na apendicite aguda em suas formas não complicada e complicada. Os antibióticos iniciados no pré-operatório evidenciaram diminuição nas taxas de infecção da ferida cirúrgica. Os esquemas de primeira linha (empíricos) foram testados em relação à sensibilidade dos microrganismos nas culturas de material peritoneal, no entanto os resultados foram controversos. Sugeriram-se antibióticos de amplo espectro em alguns estudos por apresentar boa cobertura, no entanto em outros eles não foram recomendados, pelo risco de desenvolver resistência bacteriana. O menor tempo de administração e a mudança mais precoce para a via oral reduziram o tempo de internação. Conclusões: Existe um grande número de protocolos clínicos com antibióticos diversos, no entanto não existe padronização em relação ao tipo de antibiótico, tempo de uso nem via.

Análise da confiabilidade de fórmulas para o cálculo de dose de antibacterianos em odontopediatria / Analysis of the reliability of formulas for calculating antibacterial doses in pediatric dentistry

Objetivo: avaliar a confiabilidade de fórmulas para o cálculo da dose dos principais antibacterianos em crianças de diferentes idades e pesos, tendo como padrão-ouro as dosagens fornecidas em bulas. Sujeitos e método: 45 crianças, com idades de 3, 6 e 9 anos, constituíram três grupos independentes. Os dados antropométricos foram obtidos por meio da análise de prontuários da Clínica de Odontologia Infantil da Faculdade Integrada de Pernambuco. As dosagens foram calculadas através das fórmulas estabelecidas a partir de parâmetros de peso, idade e superfície corporal. Os antibacterianos selecionados para a análise foram: Amoxicilina, Amoxicilina com clavulonato de potássio, Clindamicina, Claritromicina, Eritromicina e Azitromicina. Os dados foram submetidos ao teste paramétrico de análise de variância. Para verificar se houve diferença entre as dosagens estabelecidas por fórmulas e a dose estabelecida pela bula (padrão-ouro), foi aplicado o teste post-hoc de Tukey. Os testes estatísticos foram realizados com uma margem de erro de 5%. Resultados: nenhuma fórmula foi válida para todos os antibacterianos quando se comparou com a dose padrão estabelecida em bula. Os resultados apresentaram maiores variabilidades no grupo de crianças com menor idade, podendo ser considerado um risco clínico. Conclusão: as dosagens pediátricas dos antibacterianos obtidas por meio de fórmulas não são confiáveis para os grupos etários analisados e, portanto, não devem ser utilizadas para fins de prescrição medicamentosa. (AU)

Objective: This cross-sectional study evaluated the reliability of formulas for calculating the dose of the main antibacterials in children of different ages and weight, and the gold standard were the dosages provided in package inserts. Subjects and method: Forty-five children aged 3, 6, and 9 years constituted three independent groups. The anthropometric data were obtained through the analysis of medical records of the Child Dentistry Clinic of Faculdade Integrada de Pernambuco, Brazil. The dosages were calculated using the formulas established from parameters of weight, age, and body surface. The antibacterials selected for this analysis were amoxicillin, amoxicillin with potassium clavulanate, clindamycin, clarithromycin, erythromycin, and azithromycin. The data were subjected to parametric analysis of variance. In order to verify whether there was a difference between the dosages established in the formulas and the dose established in the package insert (gold standard), Tukey's post-hoc test was applied. The statistical tests were performed with a 5% margin of error. Results: No formula was valid for all antibacterials when compared to the standard dose established in package inserts. The results showed greater variability in the group of younger children, which may be considered a clinical risk. Conclusion: The pediatric dosages of antibacterials obtained in formulas are not reliable for the age groups analyzed and therefore should not be used for drug prescription purposes. (AU)

Etiología y perfil de resistencia antimicrobiana en pacientes con infección urinaria / Etiology and antimicrobial resistance profile in patients with urinary infection

Introducción: La infección de vías urinarias (IVU) es una de las enfermedades más prevalentes en la práctica clínica Objetivo: Identificar los principales agentes etiológicos y la frecuencia de resistencia a antibióticos por parte de microorganismos aislados por urocultivos en pa cientes con IVU en un hospital de primer nivel de atención. Materiales y Métodos: Estudio descriptivo de corte transversal, a partir de una muestra aleatoria de pacientes con IVU en La Virginia, Risaralda, entre el 1 de abril de 2014 a 31 de marzo de 2015. Se evaluaron las bacterias aisladas en la totalidad de urocultivos procesados y los resultados de los antibiogramas. Se establecieron frecuencias y proporciones. Para el análisis de datos, se utilizó SPSS Statistics 22. Se hizo análisis multivariado. Resultados: Se realizaron 1563 urocultivos en el periodo de estudio, de los cuales 329 (21,0%) mostraron crecimiento mayor a 100.000 UFC. Las frecuencias más altas de resistencia para E. coli se observaron para cefalotina (75,8%), ampicilina (72,6%) y trimetoprim/sulfametoxazol (55,3%). De 296 pacientes seleccionados aleatoriamente se halló que la cistitis era la IVU más frecuente (70,3%) y al 50,7% no se les prescribió ningún antimicrobiano. El uso de antiulcerosos se asoció con mayor probabilidad de uso inadecuado del antibiótico (OR:4,28; IC95%:1,070-17,153; p=0,04). Conclusiones: Existe una elevada resistencia bacteriana a los antibióticos de primera línea para el tratamiento de las IVUs, lo que sugiere la importancia de identi ficar los microorganismos y sus perfiles de sensibilidad a antimicrobianos para seleccionar con mejor criterio cual emplear.

Introduction: Urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. Objective: To identify the main etiologic agents and the frequency of antibiotic resistance by microorganisms isolated from urine culture and sensitivity in patients with IVU in a hospital primary care. Materials and Methods. Descriptive cross-sectional study, from a random sample of patients with UTI in La Virginia, Risaralda, from April 1, 2014 to March 31, 2015. Bacteria isolated from all processed urine cultures and the results of susceptibility were evaluated. Frequencies and proportions were established. For data analysis was used SPSS Statistics 22. Results: A total of 1563 urine cultures were performed in the study period, of which 329 (21.0%) showed further growth to 100,000 UFC. Higher frequencies of resis tance were observed for E. coli to cephalothin (75.8%), ampicillin (72.6%) and trimethoprim/sulfamethoxazole (55.3%). In the 296 randomized patients it was found that the most common UTI was cystitis (70.3%) and 50.7% were not prescribed any antimicrobial. The use of anti-ulcer is associated with increased probability of inappropriate use of antibiotics (OR:4.28; 95% CI:1.070-17.153; p=0.04). Conclusions: There is a high bacterial resistance to first-line antibiotics for treatment of UTIs, suggesting the importance of identifying microorganisms and their antimicrobial susceptibility profiles to select which use better approach.

Prevalencia de injuria renal aguda en pacientes tratados con colistina

RESUMEN Introducción: la colistina es un antibiótico eficaz para tratar infecciones causadas por bacterias Gram negativas multirresistentes pero tiende a producir injuria renal aguda. Objetivos: determinar la frecuencia de injuria renal aguda en pacientes adultos tratados con colistina e identificar la presencia de afecciones comórbidas asociadas. Metodología: estudio observacional retrospectivo de pacientes tratados con colistina en el Hospital Nacional, Paraguay, en 2016-2017. Resultados: se estudiaron 80 pacientes, siendo 64% del sexo masculino. La edad media fue 50±17 años. La prevalencia de injuria renal aguda fue 70%. Según los criterios RIFLE hubo lesión en 45% de los casos, riesgo de lesión en 25% y no riesgo/no lesión en 30%. Las afecciones comórbidas más frecuentes fueron la hipertensión arterial (61%) y diabetes mellitus (31%). El germen aislado con mayor frecuencia fue Acinetobacter baumannii (57%), Pseudomonas aeruginosa (24%) y Klebsiella pneumoniae (19%). Los antibióticos más utilizados en forma combinada con la colistina fueron la vancomicina (46%) y los carbapenémicos (43%). Conclusiones: la prevalencia de injuria renal aguda fue 70%. Según los criterios RIFLE predominó la lesión. Las afecciones comórbidas más frecuentes fueron la hipertensión arterial y la diabetes mellitus.

ABSTRACT Introduction: Colistin is an effective antibiotic to treat infections caused by multiresistant Gram-negative bacteria but tends to produce acute renal injury. Objectives: To determine the frequency of acute renal injury in adult patients treated with colistin and to identify the presence of associated comorbid conditions. Methodology: Retrospective observational study of patients treated with colistin in the National Hospital, Paraguay in 2016-2017. Results: Eighty patients were studied and 64% of them were male. The mean age was 50±17 years. The prevalence of acute renal injury was 70%. According to the RIFLE criteria there was an injury in 45% of the cases, risk of injury in 25% and no risk/no injury in 30%. The most common comorbid conditions were hypertension (61%) and diabetes mellitus (31%). The most frequently isolated germs were Acinetobacter baumannii (57%), Pseudomonas aeruginosa (24%) and Klebsiella pneumoniae (19%). The most commonly used antibiotics in combination with colistin were vancomycin (46%) and carbapenems (43%). Conclusions: The prevalence of acute renal injury was 70%. According to the RIFLE criteria, the injury predominated. The most common comorbid conditions were hypertension and diabetes mellitus.

Prevalence and antimicrobial susceptibility profile of microorganisms in a university hospital from Vitória (ES), Brazil / Prevalência de microrganismos e perfil de suscetibilidade antimicrobiana em um hospital universitário de Vitória (ES), Brasil

ABSTRACT INTRODUCTION: Healthcare associated infections (HAIs) occur during the hospital stay as a result of underlying morbidity, invasive procedures, acute pathology or medical treatment. They lead prolonged stay and, consequently, to an increase in financial charges. The main tool to control these infections is the use of antimicrobials. However, the increase in resistance and the low frequency of discovery of new drugs justify the research that evaluates the resistance profile of microorganisms to antimicrobials. OBJECTIVE: To evaluate the prevalence and antimicrobial susceptibility profile of HAIs at a philanthropic reference hospital in Espírito Santo, Brazil. METHODS: Observational, retrospective and cross-sectional study, between July 2014 and June 2016. Data on blood, urine and corporal secretions culture were collected from the data base of the Hospital Infection Control Commission. RESULTS: There was a high prevalence of HAIs in patients older than 60 years. Two hundred and forty three (47.55%) patients were female. The four most prevalent bacteria were: Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Polymyxin was the drug which presented the best antimicrobial effects. CONCLUSION: Polymyxin was active in vitro against all isolates of Acinetobacter spp. Regarding K. pneumoniae, both polymyxin and amikacin showed a significant effectiveness. Regarding Pseudomonas aeruginosa, polymyxin was effective in all samples. Regarding S. aureus, teicoplanin, daptomycin and vancomycin were effective in all samples. Polymyxin showed a good overall in vitro activity.

RESUMO INTRODUÇÃO: As infecções relacionadas com a assistência à saúde (IRAS) ocorrem durante a internação como resultado de morbidade subjacente, procedimentos invasivos, patologia aguda ou tratamento médico. Elas levam à prolongada permanência e, consequentemente, à carga econômica. A principal ferramenta para conter essas infecções são os antimicrobianos. No entanto, o aumento da resistência e a baixa taxa de descoberta de novos medicamentos justificam a pesquisa que avalia o perfil de resistência de microrganismos aos antimicrobianos. OBJETIVO: Avaliar a prevalência e o perfil de suscetibilidade antimicrobiana das IRAS ocorridas em um hospital filantrópico de referência do Espírito Santo, Brasil. MÉTODOS: Estudo observacional, retrospectivo e transversal, entre julho de 2014 e junho de 2016. Os dados sobre cultura de sangue, urina e secreções corporais foram coletados da base de dados do Centro de Controle de Infecção Hospitalar. RESULTADOS: Houve alta prevalência de IRAS em pacientes com mais de 60 anos. Duzentos e quarenta e três (47.55%) pacientes eram do sexo feminino. As quatro bactérias mais prevalentes foram: Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa e Staphylococcus aureus. A polimixina foi a droga que apresentou os melhores efeitos antimicrobianos. CONCLUSÃO: A polimixina foi ativa in vitro contra todos os isolados de Acinetobacter spp. Quanto à K. pneumoniae, tanto a polimixina quanto a amicacina apresentaram eficácia significativa. Em relação à Pseudomonas aeruginosa, a polimixina foi efetiva em todas as amostras. Já em relação ao S. aureus, teicoplanina, daptomicina e vancomicina foram efetivas em todas as amostras. A polimixina demonstrou um bom desempenho geral in vitro.

Synthesis Evaluation of the Effect of Antibacterials Management in 10 Third Grade General Hospitals of Xi'an by TOPSIS Method from 2012 to 2016 / 中国药房

OBJECTIVE: To provide scientific evidence for the further improvement of hospital antibacterial management, the formulation of related management decisions and long-acting mechanism. METHODS: Technique for order preference by similarity to ideal solution (TOPSIS) was used to select 8 evaluation indexes as utilization rate of antibiotics in the inpatients to synthetically evaluate the effect of antibacterial management in 10 third grade general hospitals of Xi'an from 2012 to 2016. RESULTS: Results of synthesis evaluation by TOPSIS method showed that the least effect was in 2012 [coefficient of proximity from the object of evaluation to the optimal value (Ci) =0]; the effect of antibacterials management was improved gradually during 2013-2015, and there was the best effect in 2015 (Ci=0. 918 3); but declined in 2016 (Ci=0. 838 5). Only one evaluation index (the rate of microbial examination in the inpatient receiving special use of antibacterials) was improved significantly in the 5 years(P＜0. 01), but there was no statistical significance in the data of other 7 indexes (P＞0. 01). CONCLUSIONS: The effect of antibacterials management in 10 third grade general hospitals of Xi'an was on the rise from 2012 to 2015, but was declined in 2016. It might be slack. A long-acting management mechanism of antibacterial management is needed to be established, in order to consolidate the achievements from "special rectification for clinical antibacterial use" and further improve the normal and dynamic operation of antibacterial management measure. TOPSIS method is objective and comprehensive method for synthesis evaluation of the effect of antibacterial management, and is of significance to antibacterial supervision and use.

Association of outcomes with comprehension, adherence and behavioral characteristics of tuberculosis patients using fixed-dose combination therapy in Contagem, Minas Gerais, Brazil

ABSTRACT The present study aimed to assess the association of outcomes with comprehension, adherence and behavioral characteristics of tuberculosis (TB) patients using fixed-dose combination (FDC) therapy in the city of Contagem, MG, Brazil. This study used standardized questionnaires to collect data. Outcomes included cure in 77.2% (64/ 83), noncompliance with treatment in 20.4% (17/ 83), and absence of organ failure or death cases. The rate of adherence to treatment was high (71.1% - 59/ 83), while the level of comprehension of the treatment was insufficient for the majority of patients (72.3% - 60/ 83). When a greater number of medicines was used, the chance of noncompliance with treatment increased exponentially (p = 0.00 - OR 1.72). Light-skinned black patients, alcoholics and those who live with HIV/ AIDS showed a significant association with noncompliance with treatment (p=0.039 - OR 3.38, p=0.002 - OR 4.68, and p=0.001 - OR 9.68, respectively). Comprehension also presented a significant association with noncompliance with treatment (p=0.01 and OR 5.76 and CI 1.49-22.29). The probability of noncompliance with treatment in the first few months was greater than in the subsequent months. This study demonstrates that if the TB patients had a better understanding of the treatment, the outcome would have been more favorable as regards a proper cure.

Peptídeos catiônicos e flavonoides como alternativas biológicas para aplicação em odontologia: efeito antimicrobiano, citotóxico e na indução de mineralização / Cationic peptides and flavonoids as biological alternatives in dentistry: antimicrobial, cytotoxic and mineralization induction effects

O presente estudo avaliou o efeito antimicrobiano, citotóxico e na indução de mineralização de peptídeos catiônicos e flavonoides para aplicação em Odontologia. Para isso, foram realizados 7 estudos que neste trabalho foram divididos em capítulos. Os capítulos 1 e 2 tiveram por objetivo avaliar a toxicidade em células epiteliais (linhagens HaCat e OBA-9) e o efeito de fragmentos de peptídeos catiônicos sobre bactérias cariogênicas em condições planctônicas e sobre biofilme e posteriormente inserir o fragmento peptídico com melhor efeito antimicrobiano em um sistema líquido cristalino (SLC), previamente caracterizado por microscopia de luz polarizada, reologia e ensaio de bioadesão, e avaliar seu efeito sobre biofilme de Streptococcus mutans. Os capítulos 3 e 4 avaliaram a toxicidade em fibroblastos (linhagem 1929) e a atividade antimicrobiana/antibiofilme de análogos de peptídeos catiônicos sobre microrganismos de interesse endodôntico e seu efeito sobre os marcadores de mineralização dentinária: atividade da fosfatase alcalina (ALP), formação de nódulos de mineralização (NM) e expressão dos genes DSPP ­ sialofosfoproteína dentinária e DMP-I ­ fosfoproteína da matriz dentinária) em células semelhantes a odontoblastos da linhagem MDPC-23. O capítulo 5 teve por objetivo avaliar a atividade antimicrobiana/antibiofilme dos flavonoides: taxifolina, galangina, pinocembrina e crisina e sua toxicidade sobre fibroblastos L929. Na sequência, os capítulos 6 e 7 avaliaram o potencial da taxifolina sobre a indução de marcadores de mineralização dentinária (ALP, NM, expressão dos genes DSPP e DMP-I) nas células MDPC-23 e óssea (ALP, NM e expressão dos genes ALP e COL-I ­ colagenase 1) nas células semelhantes a osteoblastos da linhagem Saos-2, utilizando tratamentos de 24, 72h e contínuo. Os resultados dos capítulos 1 e 2 mostraram que, dentre os peptídeos testados, DI-23, fragmento da porção N-teminal do Defb14-1CV (ortólogo do hBD-3), apresentou o melhor efeito sobre cultura de S. mutans, S. mitis and S. salivarius e potente ação contra biofilme de cepas padrão e clínicas de S. mutans, além de baixa toxicidade em células epiteliais. Na presença de saliva, o SLC demonstrou alta viscosidade e altos valores de bioadesão. O SLC contendo DI-23 apresentou melhor efeito antibiofilme após 24h quando comparado à 4h de tratamento e não apresentou citoxicidade, nas condições testadas. Os resultados dos capítulos 3 e 4 mostraram que os peptídeos afetaram o metabolismo de L929 em concentrações acima de 500 gg/mL. KR-12-a5 inibiu o crescimento de todos os microrganismos testados, em baixas concentrações, e reduziu significativamente os biofilmes de S. mutans e Enterococcus faecalis formados nos túbulos dentinários. KR-12-a5 também estimulou a deposição inicial de NM, similar aos outros peptídeos, entretanto, em concentrações mais baixas e minimamente tóxicas. Nenhum peptídeo influenciou a expressão de DMP-I e DSPP nas células MDPC-23, nas concentrações testadas. No capítulo 5, a taxifolina não causou toxicidade sobre 1929 em nenhuma concentração testada e apresentou o melhor efeito inibitório sobre cultura de E. faecalis, S. mutans e Actinomyces israelii. Esse flavonoide também foi capaz de eliminar biofilmes de E. faecalis e S. mutans e reduzir significativamente biofilme de A. israelii em placas de poliestireno, além de reduzir substanciamente biofilme de E. faecalis no interior dos túbulos dentinários. No capítulo 6, o tratamento com taxifolina a 10gM por 72h estimulou a atividade de ALP, a formação de NM e a expressão de DMP-I. Taxifolina a 5gM por 24h estimulou a expressão de DSPP nas células MDPC-23. No capítulo 7, taxifolina a 10gM por 24h estimulou a atividade e a expressão de ALP e COL-I e taxifolina a 10gM a por 72h estimulou a formação de NM e também a expressão de COL-I. Conclui-se que os peptídeos DI-23 e KR-12-a5 são potentes agentes antimicrobianos e antibiofilme. A taxifolina, além da ação antimicrobiana/antibiofilme, também demonstrou capacidade de indução de marcadores fenotípicos e genotípicos de mineralização dentinária e óssea, indicando seu potencial uso em Odontologia(AU)

The present study evaluated the antimicrobial, cytotoxic and mineralization induction effects of cationic peptides and flavonoids for application in Dentistry. Seven studies were carried out and divided into chapters for this work. Chapters 1 and 2 aimed to evaluate the toxicity in epithelial cells (HaCat and OBA-9 lines) and the effect of cationic peptide fragments on cariogenic bacteria under planktonic and biofilm conditions and the peptide fragment with the best effect was incorporated in a crystalline liquid system (SLC) previously characterized by polarized light microscopy, rheology and bioadhesion assay, and to evaluate its effect on biofilm of clinical and standard strains of S. mutans. Chapters 3 and 4 evaluated the toxicity on fibroblasts (line L929) and the antimicrobial/antibiofilm activity of analogs of cationic peptides on microorganisms of endodontic interest and their effect on the markers of dentin mineralization: alkaline phosphatase activity (ALP), formation of mineralization nodules (MN) and expression of DSPP dentin sialophosphoprotein and DMP-I - dentin matrix phosphoprotein genes) in MDPC-23 odontoblasts-like cells. The objective of chapter 5 was to evaluate the antimicrobial/antibiofilm activity of the flavonoids: taxifolin, galangin, pinocembrin and chrysin and their toxicity on L929 fibroblasts. In addition, chapters 6 and 7 evaluated the potential of taxifolin on the induction of dentin mineralization markers (ALP, MN, DSPP and DMP-I gene expression) in MDPC-23 and bone mineralization markers (ALP, MN, ALP and COL-1-collagenase 1 gene expression) in the osteoblast-like cells of Saos-2 line, using 24h, 72h and continuous treatments. The results of chapters 1 and 2 showed that, among the peptides tested, DI-23, fragment of the N-terminal portion of Defb14-1CV (hBD-3 ortholog), showed the best effect on culture of S. mutans, S. mitis and S. salivarius and potent biofilm action on standard and clinical strains of S. mutans, as well as low toxicity in epithelial cells. In the presence of saliva, SLC demonstrated high viscosity and high bioadhesion values. SLC containing DI-23 presented better antibiofilm effect after 24h when compared to 4h of treatment and did not present cytotoxicity under the conditions tested. The results of chapters 3 and 4 showed that peptides affected the metabolism of L929 at concentrations above 500 gg/mL. KR-12-a5 inhibited the growth of all tested microorganisms at low concentrations and significantly reduced the biofilms of S. mutans and E. faecalis formed in dentin tubules. KR-12-a5 also stimulated the initial deposition of MN, similar to the other peptides, however, in lower and minimally toxic concentrations. No peptide influenced the expression of DMP-I and DSPP in MDPC-23 cells. In Chapter 5, taxifolin no cause toxicity on L929 at any tested concentration and it had the best effect against culture of Actinomyces israelii, S. mutans and E. faecalis. This flavonoid was also able to eliminate biofilms of E. faecalis and S. mutans and significantly reduce A. israelii biofilm on polystyrene plates, besides substantially reducing E. faecalis biofilms within dentinal tubules. In chapter 6, treatment with taxifolin at IOgM for 72h stimulated ALP activity, MN formation and DMP-I expression. Taxifolin at 51.1Mfo r 24h stimulated DSPP expression in MDPC-23 cells. In chapter 7, taxifolin at 10gM for 24h stimulated the activity and expression of ALP and COL-I and taxifolin at 10gM for 72h stimulated MN formation and also expression of COL-I. It is concluded that peptides DI-23 and KR-12-a5 are potent antimicrobial and antibiofilm agents. Taxifolin, besides the antimicrobial/antibiofilm action, also demonstrated the capacity for induction of phenotypic and genotypic markers of dentin and bone mineralization, indicating their potential use in Dentistry(AU)

Distribution and Resistance of Bacterial Isolated from Blood of Malignant Tumour Patients / 医药导报

Objective To investigate the distribution and susceptibility of isolated organisms from blood of malignant tumour patients.Methods Isolates from blood culture in patients with cancer during January 2013 to December 2015 were analyzed.Results were analyzed according to the breakpoints of CLSI 2014.Results Total of 498 isolates from blood culture,gram-negative bacilli accounted for 58.0% and gram-positive cocci accounted for 42.0%.The most common pathogens were E.coli,Coagulase-negative Staphylococcus,Klebsiella spp, S.aureus and Enterococcus spp.Drug resistance of E.coli strains to piperacillin-tazobactam,amikacin and imipenem were low,and drug resistance of E.coli strains to ampicillin-sulbactam,gentamicin,ciprofloxacin,levofloxacin and compound sulfamethoxazole were high.The prevalence of ESBL-producing strains was 70.7% in E.coli and 22.8% in Klebsiella spp.The E.coli and Klebsiella spp.strains isolated from ICU showed higher resistance than the strains from surgery and medicine department.The E.faecium strains were highly susceptible to gentamicin (high level) and lower susceptible to most of the antibiotics tested.The E.faecalis strains were more susceptible than E.faecium to these agents.No vancomycin-resistant strains were found in Enterococcus spp.Conclusion Among gram-negative pathogen isolates from blood culture in cancer patients,E.coli and Klebsiella spp.are the most frequent.Staphylococcus and Enterococcus are the most frequently isolated species of gram-positive cocci.The percentage of Acinetobacter spp.strains is relatively higher in ICU.Surveillance of antimicrobial resistance can provide the basis for rational use of antibiotics.

Relationship Between Improvement on Antibacterials Use and Lowered Incidence of Drug-induced Hyperthermia / 医药导报

Objective To conduct a retrospective study about drug-induced hyperthermia (DIH) based on DIH data obtained in medical practice,and elucidate the relationship between DIH incidence and antibacterials overuse.Methods To investigate successively the medical records of inpatients from orthopaedics department in Fudan university affiliated Jinshan hospital at two different periods,and data of DIH cases were extracted to perform a comparative study.The period for 229 effective cases of group Ⅰ was from Feb.1 to Apr.30,2011,before significant improvement on antibacterials use.The period for 342 effective cases of group Ⅱ was from Jul.1 to Sep.30,2012,after the effective enforcements of regulation on antibacterials use.Inclusion criteria for DIH were:①an oral temperature ≥37.6 ℃ since postoperative day 4,②no evidence of infection,③a time relationship between fever and the administration of causative drugs:a fever occurring with drug administration and disappearing after drug cessation within 3 days,④no other causes for the fever,⑤oral temperature ≤ 37.6 ℃ until leaving hospital.Exclusion criteria for DIH were listed below:①possible pathological fever,e.g.,in cancer,②hospitalization within 3 days,③no surgery,④severe trauma,for example,visceral or central nervous system injury.Results All causative drugs were for injection.By comparison,duration of antibacterial administration is significantly shorter in group Ⅱ than in group Ⅰ (1.7 ± 1.7 vs.4.6-± 1.8days,P ＜ 0.01),and total DIH incidence and antibacterials related DIH incidence were significantly lower in group Ⅱ than in group Ⅰ (7.3％ vs.30.1％,1.5％ vs.25.3％,both P ＜0.01).Conclusion DIH incidence is related with drug type especially with antibacterials overuse,and changed with drug program.DIH was more serious for injection of antibacterials than injection of traditional Chinese medicine.Decrease of antibacterials usage is positively associated with the decreased DIH incidence.Safe medication should begin from safe usage of antibacterials.

Analysis on biological characteristics and drug resistance situation of Klebsiella pneumoniae liver abscess / 国际检验医学杂志

Objective To analyzed the clinical characteristics of Klebsiella pneumoniae liver abscess as well as the characteristics and drug resistance situationof Klebsiella pneumoniae .Methods The clinical data in 110 cases of Klebsiella pneumoniae liver ab-scess were collected and divided into the other liver diseases group and non-other liver diseases group for conducting the study .The slime test was adopted to determine the high mucus character of Klebsiella pneumoniae .The PCR amplification was used to detect the virulence genes and capsular type and the drug susceptibility test was performed by using the disk diffusion method .Then the results were statistically analyzed .Results Klebsiella pneumoniae liver abscess was common in 40 -80 years old middle aged and elderly males .50 .00% patients had the diabetes base .In 110 strains of Klebsiella pneumoniae ,86 .36% strains had the high mucus phenotype ,the capsular types were dominated by serotype K1 and K2 .The detection rats of phenotype strains ,carrying virulence gene rmpA and aerocin in the non-other liver disease group were significantly higher than those in other liver diseases group ,the difference was statistically significant (P<0 .01) .The resistance rats of Klebsiella pneumoniae to 12 kinds of common antibacterials were lower .Conclusion Klebsiella pneumoniae liver abscess is common in middle aged and elderly males .High mucus and high vir-ulence Klebsiella pneumoniae carrying virulence gene empA and aerocin is main pathogenic bacterium of liver abscess ,w hich has lower resistance rate to common antibacterials .

Simultaneous determination of amoxicillin and clavulanic acid in pharmaceutical preparations by capillary zone electrophoresis

ABSTRACT Clavulanic acid enhances the antibacterial spectrum of amoxicillin by rendering most β-lactamase producing isolates susceptible to the drug. A fast, simple and efficient capillary electrophoresis method was developed for the simultaneous determination of amoxicillin and clavulanic acid from complex mixtures. Using a 25 mM sodium tetraborate as background electrolyte at a pH of 9.30, + 25 kV applied voltage, 25 °C system temperature, UV determination at 230 nm; we succeeded in simultaneous separation of amoxicillin and clavulanic acid in approximately 2 minutes. The analytical performance of the method was evaluated in terms of reproducibility, precision, accuracy, and linearity. The optimized analytical method was applied for the determination of the two analytes from combined commercial pharmaceutical preparations. This CE method is fast, inexpensive, efficient, and environmentally friendly when compared with the more frequently used high performance liquid chromatography methods described in the literature.

RESUMO O ácido clavulânico acentua o espectro antibacteriano de amoxicilina, tornando a maioria dos isolados produtores de β-lactamase sensíveis ao fármaco. Desenvolveu-se um método rápido, simples e eficiente de electroforese capilar (EC) para a determinação simultânea de amoxicilina e de ácido clavulânico a partir de misturas complexas. Usando tetraborato de sódio 25 mM como electrólito em pH de 9,30, voltagem aplicada de + 25 kV, em sistema a 25 ° C e determinação por UV a 230 nm, a foi bem-sucedida a separação simultânea de amoxicilina e ácido clavulânico em, aproximadamente, 2 minutos. O desempenho analítico do método foi avaliado em termos de reprodutibilidade, precisão, exatidão e linearidade. O método analítico otimizado foi aplicado para a determinação dos dois analitos em associação, a partir de preparações farmacêuticas comerciais. Este método de EC é rápido, barato, eficiente e ecologicamente correto, quando comparado aos métodos de cromatografia líquida de alta eficiência mais frequentemente descritos na literatura.