Application and evaluation of management mode for the use of antimicrobial drugs in county-level medical communities led by anti-infective clinical pharmacists / 中国药房

OBJECTIVE To provide reference for improving the rational use of antimicrobial drugs in primary township medical institutions. METHODS Based on the county prescription pre-review center， a team led by anti-infective clinical pharmacists constructed the management mode for the use of antimicrobial drugs in county-level medical communities with clinical pharmacists as the main team by finding out the main problems in the use of antimicrobial drugs in primary township medical institutions， providing feedback on the problems， organizing relevant training for the problems， improving the customization rules of the prescription pre-review software， implementing the automatic interception and pharmacist online prescription review and other measures. Data on the use of antimicrobial drugs were collected and compared in the 15 primary township medical institutions between January-June in 2022 （before the implementation of the mode） and January-June in 2023 （after the implementation of the mode）. RESULTS Compared with before the implementation of the mode， the utilization rate of antimicrobial drugs in outpatients of primary township medical institutions decreased from 24.97% before the implementation of the mode to 19.39% after the implementation of the mode； the utilization rate of antimicrobial injection in outpatients decreased from 66.10% to 46.80%； the utilization rate of intravenous drip of antimicrobial drugs in outpatients decreased from 52.33% to 40.35%； the rates of combined use of antimicrobial drugs in outpatients decreased from 12.70% to 8.19%； the reasonable rate of antimicrobial prescribing in outpatients increased from 55.28% to 73.93%. After the implementation of the mode， the proportion of antimicrobial prescriptions for each diagnosis was basically the same as before； the defined daily dose system （DDDs） and proportion of a few antimicrobial drugs changed compared with before according to the anatomical therapeutic chemical classification of drugs， among which DDDs of lincomycin， gentamicin and other drugs declined significantly； DDDs of antimicrobial drugs for each classification was basically the same as before according to AWaRe classification. CONCLUSIONS The management mode of the use of antimicrobial drugs led by anti-infective clinical pharmacists is constructed in the prescription pre-reviewing center of county-level medical communities， which can effectively improve the rational use of antimicrobial drugs in the primary township medical institutions.

The pattern of adverse effects related to antimicrobial therapy in a tertiary care hospital

Background: Antimicrobial drugs are life-saving drugs but they come with their own share of adverse drug reactions (ADRs). Institutional drug policy helps in the rational use of the antimicrobial for the given clinical condition. This helps in controlling the development of resistance as well as minimizing adverse events. Aims and Objectives: This study aims to share the pattern of adverse reactions seen to the commonly prescribed antimicrobials. Materials and Methods: This is a retrospective, observational study. The data of patients, admitted to a tertiary care center in North Kerala who reported adverse effects related to antimicrobial treatment, were obtained from the case files from the medical record library. ADRs with antimicrobials reported during the period from November 2018 to November 2019 were obtained and the data were expressed as percentages in Microsoft excel. Causality assessment was done using the world health organization casualty scale. Results: 92 case reports were analyzed. Among the different antimicrobials used, Ciprofloxacin was the most commonly prescribed antimicrobial (18.5%) followed by ceftriaxone (12%). 13 different patterns of ADRs were obtained following the use of these drugs, among which allergic reactions to drugs were the most common (71.7%) with a causality assessment showing it to be the probable cause. Conclusion: The monitoring of ADRs to antimicrobials is the need of the hour. This study helped in determining the different patterns of ADRs with antimicrobials. Active surveillance and complete reporting help in identifying these and reporting and managing them to prevent such occurrences in the future.

Current Research on Epidemiology of Helicobacter pylori Antimicrobial Resistance / 胃肠病学

The resistance rate of Helicobacter pylori (Hp) to antimicrobial drugs increases year by year, which is the key factor for the decreased Hp eradication rate. Formulating an empirical regimen for Hp eradication based on an understanding of the dynamic epidemiology of antimicrobial resistance of Hp in the region will improve the eradication rate of Hp efficiently. The resistance rates of Hp to antimicrobial drugs are diversified in different geographic regions, population and time. This article reviewed the resistance rates of Hp to seven currently most frequently used antimicrobial drugs.

The clinical and bacteriological analysis of the diabetic with oral and maxillofacial space infections / 口腔疾病防治

Objective@#To analyze the clinical characteristics of oral and maxillofacial space infection between the diabetic and non-diabetic patients and to explore the common pathogenic bacteria and antibiotic sensitivity of diabetic patients, to guide the clinical medication. @*Methods @# A retrospective study was conducted on 61 patients who received treatment in Qingdao municipal hospital affiliated to Qingdao university, between December 2014 and December 2016 with Oral and maxillofacial space infection. The 61 patients were divided into diabetic group and non-diabetic group. The research contented the patients'age, sex, source of infection, pathogenic bacteria, antibacterial drugs sensitivity, fasting blood glucose levels, white blood cell total and neutrophils percentage, and days of hospitalization. T test and chi-square test in SASS.19.0 software was used. @*Results @#In the 2 groups of patients, the most common etiological factor was odontogenic infection; the most easiest affected space was submandibular space. The most common pathogenic bacteria were streptococcus. Vancomycin was the most sensitive drug, then levofloxacin and cefotaxime. In addition, the diabetes patients'age, fasting blood glucose levels and hospitalization days were significantly higher than non-diabetic patients'.@*Conclusion @#For the diabetic patients with maxillofacial space infection, levofloxacin and cefotaxime was first used for the conservative treatments when the results of the bacterial culture and drug susceptibility test are not obtained. Meanwhile, according to the oral and maxillofacial anatomy, combination of anti-anaerobic agents such as Tinidazole is also suggested. But the final situation of medication is based on the result of the drug susceptibility test.

Novel berberine derivatives: Design, synthesis, antimicrobial effects, and molecular docking studies / 中国天然药物

A series of berberine derivatives were synthesized by introducing substituted benzyl groups at C-9. All these synthesized compounds (4a-4m) were screened for their in vitro antibacterial activity against four Gram-positive bacteria and four Gram-negative bacteria and evaluated for their antifungal activity against three pathogenic fungal strains. All these compounds displayed good antibacterial and antifungal activities, compared to reference drugs including Ciprofloxacin and Fluconazole; Compounds 4f, 4g, and 4l showed the highest antibacterial and antifungal activities. Moreover, all the synthesized compounds were docked into topoisomerase II-DNA complex, which is a crucial drug target for the treatment of microbial infections. Docking results showed that H-bond, π-π stacked, π-cationic, and π-anionic interactions were responsible for the strong binding of the compounds with the target protein-DNA complex.

Novel berberine derivatives: Design, synthesis, antimicrobial effects, and molecular docking studies / 中国天然药物

A series of berberine derivatives were synthesized by introducing substituted benzyl groups at C-9. All these synthesized compounds (4a-4m) were screened for their in vitro antibacterial activity against four Gram-positive bacteria and four Gram-negative bacteria and evaluated for their antifungal activity against three pathogenic fungal strains. All these compounds displayed good antibacterial and antifungal activities, compared to reference drugs including Ciprofloxacin and Fluconazole; Compounds 4f, 4g, and 4l showed the highest antibacterial and antifungal activities. Moreover, all the synthesized compounds were docked into topoisomerase II-DNA complex, which is a crucial drug target for the treatment of microbial infections. Docking results showed that H-bond, π-π stacked, π-cationic, and π-anionic interactions were responsible for the strong binding of the compounds with the target protein-DNA complex.

Analysis of the antibiotics prescriptions in outpatient and emergency departments through system of rational drug administration / 中国生化药物杂志

Objective To improve the quality of antibiotics prescriptions in outpatient and emergency departments, to reduce the irrational use of antimicrobial drugs and to improve the quality of pharmacy service through system of rational drug administration.MethodsAnalyzing and evaluating the data of irrational administration of antimicrobial drugs between 2014 and 2015.The data was collected by the system of rational drug administration.ResultsFrom 2014 to 2015, the qualified rate of antibiotics prescriptions increased from 95.40% to 98.71%.Different types of irrational use of antimicrobial agents significantly reduced.ConclusionThe application of system of rational drug administration can improve the qualified rate of antibiotics prescriptions in outpatient and emergency departments and can promote pharmacy service.

A review of global initiatives to fight antibiotic resistance and recent antibiotics׳ discovery

Data from across the world have shown an overall decline in the antibiotic pipeline and continually rising resistance to all first-line and last-resort antibiotics. The gaps in our knowledge of existing prevalence and mechanisms of antibiotic resistance (ABR) are all too well known. Several decades of antibiotic abuse in humans, animals, and agricultural practices have created health emergency situations and huge socio-economic impact. This paper discusses key findings of the studies conducted by several national and international collaborative organizations on the current state of affairs in ABR. Alongside, a brief overview of the antibacterial agents׳ discovery in recent years approved by the US FDA is discussed.

Synergistic effects of sulbactam in multi-drug-resistant Acinetobacter baumannii

Abstract Acinetobacter baumannii is a frequently isolated etiologic agent of nosocomial infections, especially in intensive care units. With the increase in multi-drug resistance of A. baumannii isolates, finding appropriate treatment alternatives for infections caused by these bacteria has become more difficult, and available alternate treatments include the use of older antibiotics such as colistin or a combination of antibiotics. The current study aimed to evaluate the in vitro efficacy of various antibiotic combinations against multi-drug resistant A. baumannii strains. Thirty multi-drug and carbapenem resistant A. baumannii strains isolated at the Ankara Training and Research Hospital between June 2011 and June 2012 were used in the study. Antibiotic susceptibility tests and species-level identification were performed using conventional methods and the VITEK 2 system. The effects of meropenem, ciprofloxacin, amikacin, tigecycline, and colistin alone and in combination with sulbactam against the isolates were studied using Etest (bioMérieux) in Mueller-Hinton agar medium. Fractional inhibitory concentration index (FIC) was used to determine the efficacy of the various combinations. While all combinations showed a predominant indifferent effect, a synergistic effect was also observed in 4 of the 5 combinations. Synergy was demonstrated in 43% of the isolates with the meropenem-sulbactam combination, in 27% of the isolates with tigecycline-sulbactam, and in 17% of the isolates with colistin-sulbactam and amikacin-sulbactam. No synergy was detected with the sulbactam-ciprofloxacin combination and antagonism was detected only in the sulbactam-colistin combination (6.66% of the isolates). Antibiotic combinations can be used as an alternative treatment approach in multi-drug resistant A. baumannii infections.

Systematic Review of Clinical Efficacy and Safety of Macrolide Antimicrobial Drugs in the Adjuvant Treat-ment of Lung Infection of Pseudomonas aeruginosa / 中国药房

OBJECTIVE:To systematically review the clinical efficacy and safety of macrolide antimicrobial drugs in the adju-vant treatment of lung infection of Pseudomonas aeruginosa (PA) and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from PubMed,Ovid,CJFD,VIP,CBM and Wangfang database,randomized controlled trials(RCT)about sensitive antimicrobial drugs of PA combined with macrolide antimicrobial drugs (test group) vs. sensitive antimicrobial drugs of PA alone(control group)in the treatment of lung infection of PA were included and comprehensively evaluated using Jadad scale. The homogeneity results were analyzed by Rev Man 5.2 software. RESULTS:13 RCTs were included,involving 872 patients. Me-ta-analysis showed that the effective rate [OR=6.42,95%CI(4.23,9.74),P<0.001] and PA clearance rate[OR=6.10,95%CI(4.10, 9.09),P<0.001] in test group were significantly higher than control group;the time of body temperature returned to normal[MD=-1.14,95%CI(-1.35,-0.94),P<0.001],time of cough sputum disappearance [MD=-1.70,95%CI (-1.97,-1.44),P<0.001] and time of the blood returned to normal[MD=-1.24,95%CI(-2.04,-0.43),P<0.001] were significantly shorter than control group,there were significant difference between 2 groups. There was no significant difference in the incidence of adverse re-action [OR=1.30,95%CI(0.73,2.31),P=0.37]. CONCLUSIONS:Macrolide antimicrobial drugs have good efficacy and safety in the adjuvant treatment of PA infection. Duo to the limit of research methodology quality,it remains to be further verified by large-sample and high-quality RCT.

Analysis on Application Rationality of Anti-fungal Agents for Deep Fungal Infection in Inpatients in a Top Three Hospital / 中国药师

Objective:To investigate the rationality of anti-fungal agents for deep fungal infection used in one hospital and the effects of national rectification of antimicrobial drugs. Methods: The retrospective analysis method was used to survey the inpatients administrated anti-fungal agents for deep fungal infection from April 2010 to Mard 2012, and assessed the rationality. Results:The ir-rational utilization of anti-fungal agents for deep fungal infection included loading dosage lack during the treatment,inappropriate loading dosage and administration frequency. The irrational utilization of anti-fungal agents for deep fungal infection was decreased significantly (P<0. 05)after the national rectification of antimicrobial drugs. Conclusion:After the national rectification of antimicrobial drugs, the hospital can amtrol the irrational use of anti-fungal agents to some extent, while still needs more management and education.

Changes in drug resistance and distribution of Streptococcus pneumonia infection from 2001 to 2011 in Shenyang area / 中国小儿急救医学

Objective To investigate the dynamic changes of infectious distribution,current resistant situation of Streptococcus pneumoniae(SP) and resistant to penicillin and other 10 kinds of antibiotics for the guidance of clinical therapy of SP.Methods Bacteria were identified by French BioMerieux API identification system,VITEK 2-COMPACT identification system and Optochin test,bile solubility test.In vitro,drug susceptibility test to penicillin,cefotaxime,and other 10 kinds of antibiotics were conducted with K-B disk diffusion method combined with the concentration gradient method.Drug susceptibility results were analyzed from 2001 to 2011.Results In recent 11 years,SP antimicrobial resistance rate had increased year after year,especially rates of penicillin-resistant and penicillin not-sensitive had increased significantly,rising from 8.3％( in 2001 ) to 72.7％ ( in 2011 ) ( meningitis 86.4％,non-meningitis 59.0％ ).Resistance rate of cefotaxime,belonging to third-generation cephalosporin had already accounted for 54.0％ ( meningitis 64.0％,non-meningitis 44.0％ ) ;and the resistance rate of macrolide antimicrobial was 100％ ; vancomycin-resistant strains and linezolid-resistant strains had not been detected.Conclusion Penicillin non-susceptible SP has accounted for a high percentage,antimicrobial resistance of Streptococcus pneumoniae penicillin,cephalosporins,macrolides are in serious condition.Vancomycin and linezolid should be preferred or the right antibiotics be chosen according to vitro susceptibility results of isolates in clinical treatment of severe infections caused by SP.

Cost of antimicrobial treatment in patients infected with multidrug-resistant organisms in the Intensive Care Unit / Costo de la terapia antimicrobiana en pacientes infectados con microorganismos multirresistentes en la Unidad de Cuidados Intensivos

This study aims to compare the costs of antimicrobial drugs used in the treatment of patients infected with multidrug-resistant organisms (MDRO) or those not infected with this type of organisms in an intensive care unit (ICU). It is a retrospective comparative case-control study, performed in a public hospital in the capital city of Brazil, comprising the years 2007, 2008 and 2009. Information on age, sex, length of hospitalization, clinical outcome, antimicrobial drugs, microorganisms and microbial sensitivity to antibiotics was collected. Spearman and Mann-Whitney tests were used for statistical analysis. The level of significance was set at p < 0.05. The sample consisted of 401 patients with a mean age of 51.36 years (± 19.68) being 226 (56.4%) male. As for the length of stay, 32.9% of the patients remained more than 20 days, with 195 discharged and 206 deaths. Global cost of antimicrobial treatment was US$ 1113 221.55 during the three year period. Treatment cost for patients with MDRO was higher than for those without (p = 0.010). At least one MDR strain was isolated in 54.6% of the patients. According to these results, nosocomial infections due to MDRO and the high costs involved may endanger the effectiveness of antimicrobial therapy in ICU and Health Centers.

El presente estudio tuvo como objetivo comparar los costos del tratamiento con fármacos antimicrobianos para las infecciones debidas a organismos multirresistentes (OMDR) versus aquellas debidas a gérmenes no multirresistentes, en la Unidad de Cuidados Intensivos (UCI) de un hospital público de Brasilia, Distrito Federal. Fue un estudio retrospectivo, de casos y controles y abarcó un período de tres años (2007, 2008, 2009). Se recolectó información sobre edad, sexo, tiempo de internación, resultados clínicos, antimicrobianos usados, microorganismos aislados y su sensibilidad a los antibióticos. Se utilizaron en el análisis estadístico las pruebas de Spearman y de Mann-Whitney, con p < 0.05. La muestra consistió en 401 pacientes con media de edad de 51.36 años (± 19.68), siendo 226 varones (56.4%). En cuanto al tiempo de internación, un 32.9% de los pacientes permanecieron más de 20 días, con 195 altas y 206 óbitos. El tratamiento antimicrobiano costó US$ 1113 221.55 en los tres años, siendo éste mayor para los que presentaron OMDR que para los que no los presentaron (p = 0.01). Se comprobó la presencia de, por lo menos, un microorganismo multirresistente en el 54.6% de los pacientes. La infección intrahospitalaria con OMDR y el elevado costo del tratamiento de los pacientes infectados con estos microorganismos puede comprometer la efectividad de la terapia antimicrobiana en estas Unidades y Centros de Salud.

Etiologia e terapia das endocardites bacterianas em cães - revisão / Etiología y terapia de endocarditis bacterianas en perros - revisón / Etiology and therapy of bacterial endocarditis in dogs - review

A endocardite bacteriana é uma doença caracterizada pela infecção do endocárdio valvular ou mural. Os sinais clínicos inespecíficos, somados a grande variedade de agentes que podem estar implicados na etiologia da doença e as diferenças em relação à suscetibilidade aos antimicrobianos fazem do diagnóstico e tratamento um desafio para o clínico. O objetivo desta revisão é abordar os principais micro-organismos envolvidos e possibilidades terapêuticas da endocardite em cães.

Bacterial endocarditis is a disease characterized by the infection of the valvular or mural endocardium. The unspecific clinical signs, the wide variety of agents that may be implicated in the etiology and the differences in antimicrobial susceptibility make the diagnosis and treatment a challenge to clinicians. The purpose of this review is to discuss the main microorganisms involved in canine endocarditis and its therapeutic possibilities.

Endocarditis bacteriana es una enfermedad caracterizada por la infección del endocardio valvular o mural. Los señales clínicos inespecíficos, sumados a una gran variedad de agentes que pueden estar implicados en la etiología de la enfermedad y las diferencias en relación a la susceptibilidad a los antimicrobianos, hacen del diagnóstico y tratamiento un reto para el clínico. El objetivo de esta revisión es abordar los principales microorganismos implicados y posibilidades terapéuticas de endocarditis en perros.

Antimicrobial activity of autoclaved and non autoclaved copaiba oil on Listeria monocytogenes / Atividade antimicrobiana de óleo de copaíba autoclavado e não autoclavado sobre Listeria monocytogenes

The aim of this study was to evaluate the antimicrobial effect of different copaiba oil concentrations against the growth of Listeria monocytogenes, and analyze differences in inhibition of microorganisms with autoclaved and non autoclaved oil. This study provided an agar diffusion test with six isolates of bacteria and six different concentrations of autoclaved or non autoclaved copaiba oil and a negative control. The results showed sensitivity of five L. monocytogenes isolates related to the 10 percent autoclaved solution of copaiba oil. Four strains also showed sensitivity to the 5 percent autoclaved solution and one to 2.5 percent autoclaved solution. The 10 percent non autoclaved oil solution showed growth inhibition only for two strains. These results had pointed the 10 percent autoclaved solution of copaiba oil with higher inhibition as all other solutions and concentrations tested (P<0.05). For the other concentrations of both solutions, the 5 and 2.5 percent autoclaved and 10 percent non autoclaved solutions had presented statistically equal. All other concentrations of both copaiba solutions and the negative control did not presented any bacteria inhibition. In conclusion, the results of this study suggest that the autoclaved copaiba oil may be a potential new agent source for infection control or for food preservation, inhibiting the growth of food-borne bacteria such as L. monocytogenes.

Os objetivos deste estudo foram avaliar o efeito antimicrobiano de diferentes concentrações de óleo de copaíba contra o crescimento de Listeria monocytogenes e analisar as diferenças na inibição do microorganismo com soluções do óleo autoclavadas e não autoclavadas. Para tanto, foi realizado um teste de difusão em ágar, com seis isolados do microrganismo originários de produtos cárneos, seis concentrações de ambas as soluções e um controle negativo. Os resultados mostraram sensibilidade de cinco cepas de L. monocytogenes em relação à solução 10 por cento de óleo de copaíba autoclavada. Quatro isolados também apresentaram sensibilidade para a solução de 5 por cento autoclavada e apenas um foi sensível à solução de 2,5 por cento autoclavada. A solução 10 por cento não autoclavada apresentou inibição do crescimento de apenas dois isolados. Esses resultados apontaram a solução autoclavada de 10 por cento do óleo de copaíba com maior inibição em relação a todas as outras soluções e concentrações testadas (P<0,05). As soluções 5 e 2,5 por cento autoclavadas e a solução 10 por cento não autoclavada apresentaram-se estatisticamente iguais. Todas as outras concentrações das soluções de copaíba e o controle negativo não apresentaram inibição das bactérias. Os resultados deste estudo sugerem que o óleo de copaíba autoclavado pode ser uma potencial fonte de novos agentes para o controle de infecção ou para a conservação dos alimentos, inibindo o crescimento de bactérias de origem alimentar como L. monocytogenes.

Análise epidemiológica de isolados clínicos de Pseudomonas aeruginosa provenientes de hospital universitário / Epidemiologic analysis of clinical isolates of Pseudomonas aeruginosa from an university hospital

OBJETIVOS: A Pseudomonas aeruginosa é um patógeno oportunista que tem se destacado quanto à prevalência em casos de infecções hospitalares. Sua ampla resistência aos diversos grupos de antimicrobianos garante a este microrganismo um papel de destaque entre as bactérias mais prevalentes associadas à infecção nosocomial. O objetivo deste estudo foi realizar um levantamento epidemiológico da P. aeruginosa, bem como do seu perfil de susceptibilidade aos antimicrobianos no Hospital das Clínicas da Universidade Federal de Pernambuco. MÉTODOS: Foi realizado um estudo retrospectivo baseado no livro de registro de secreções diversas do laboratório de bacteriologia do Hospital das Clínicas no período compreendido entre janeiro a junho de 2008. Entre os registros, identificamos aqueles que foram positivos para a P. aeruginosa, analisando sua origem e perfil de susceptibilidade aos antimicrobianos utilizados na rotina daquele laboratório. RESULTADOS: As bactérias mais freqüentes, isoladas das secreções diversas, foram P. aeruginosa (26 por cento) e S. aureus (25 por cento). Quanto à origem, a P. aeruginosa foi isolada principalmente de infecções respiratórias, pois 33 por cento das amostras positivas para esta bactéria foram provinientes de secreções traqueais e 21 por cento nasais. Os antimicrobianos mais eficazes contra a P. aeruginosa foram: amicacina, imipenem, meropenem e aztreonam. CONCLUSÕES: Estes resultados mostram uma alta prevalência de P. aeruginosa, no Hospital das Clínicas da Universidade Federal de Pernambuco. Apesar de apresentar grande resistência a antimicrobianos mais antigos como as cefalosporinas de primeira e segunda geração, assim como cloranfenicol, em geral, este patógeno demonstrou boa sensibilidade às drogas utilizadas na rotina deste hospital.

OBJECTIVES: Pseudomonas aeruginosa is an increasingly prevalent opportunistic pathogen in hospital infection cases. Its high resistance rates to many antimicrobials has given this microorganism a relevant role among other highly prevalent bacteria involved in nosocomial infections. This study aimed to analyze epidemiologic characteristics of P. aeruginosa and to evaluate its susceptibility to antimicrobial agents at Hospital das Clínicas of the Universidade Federal de Pernambuco METHODS: A retrospective study was performed based on the registry book of miscellaneous secretions from the bacteriology laboratory of the Hospital das Clínicas involving the period between January and June 2008. Among the secretions registered, were identified the positives samples for P. aeruginosa, whose origin was analyzed, as well as its susceptibility profile to routinely used in our laboratory antimicrobials. RESULTS: The bacteria most frequently isolated from miscellaneous secretions bacteria were P. aeruginosa (26 percent) and S. aureus (25 percent). P. aeruginosa was mainly isolated from respiratory infections, with 33 percent of positive samples for this organism from tracheal secretions and 21 percent from nasal. The most effective antimicrobials against P. aeruginosa were: amikacin, imipenem, meropenem and aztreonam. CONCLUSIONS: These results show a high prevalence of P. aeruginosa in the Hospital das Clínicas of the Universidade Federal de Pernambuco. Despite featuring high resistance rates to older antimicrobials, as cephalosporins first and second generations and chloramphenicol, this pathogen showed good susceptibility to agents routinely used in this hospital.

Sinergismo entre óleos essenciais e drogas antimicrobianas sobre linhagens de Staphylococcus aureus e Escherichia coli isoladas de casos clínicos humanos / Synergism between essential oils and antimicrobial drugs against Staphylooccus aureus and Escherichia coli strains from human infections

Estudos com plantas e utilização em terapias combinatórias têm sido estimulados. Verificou-se as possíveis interações entre óleos essenciais de plantas [canela (Cinnamomum zeylanicum Blume Lauraceae), capim-cidreira (Cymbopogon citratus (DC.) Stapf, Poaceae), hortelã-pimenta (Mentha piperita L. Lamiaceae), gengibre (Zingiber officinale Roscoe Zingiberaceae), cravo-da-índia (Caryophillus aromaticus L. Myrtaceae) e alecrim (Rosmarinus officinalis L. Lamiaceae)] combinados a oito drogas antimicrobianas frente a doze linhagens de Staphylococcus aureus e doze de Escherichia coli isoladas de humanos. Após determinação da Concentração Inibitória Mínima (CIM) para os óleos pelo método da diluição foram realizados ensaios para verificação de sinergismo entre os óleos essenciais e os antimicrobianos pela metodologia de Kirby & Bauer. S. aureus foi mais suscetível às interações óleos e drogas, tendo o óleo de capim cidreira apresentado sinergismo com as oito drogas testadas, seguido pelo óleo de hortelã com sete drogas. Nos ensaios com E. coli, houve sinergismo apenas para os óleos de alecrim (três drogas) e capim-cidreira (duas drogas). Não ocorreram casos de antagonismo e os resultados de sinergismo foram influenciados pelos microrganismos estudados.

The studies with plants and combinatory therapy have been stimulated. The interactions between cinnamon (Cinnamomun zeylanicum Blume Lauraceae), lemon grass (Cymbopogon citratus (DC.) Stapf, Poaceae), mint (Mentha piperita L. Lamiaceae), ginger (Zingiber officinale Roscoe Zingiberaceae), clove (Caryophillus aromaticus L. Myrtaceae) and rosemary (Rosmarinus officinalis L. Lamiaceae) and eight antimicrobial drug was carried. It was made against twelve S. aureus and twelve E.coli strains isolated from human specimens. After minimal inhibitory concentration (MIC) values determination of essential oils by dilution agar method, the synergism assays were performed by Kirby and Bauer method. The S. aureus was susceptible to oils and drugs interactions, and the lemon grass oils showed synergism with all drugs tested followed by mint with seven drugs. E.coli assays, synergism was observed only with rosemary (three drugs) and lemon grass (two drugs). No antagonism between drugs and oils tested was observed and the results were variable according to microorganism used.

Sensibilidade antimicrobiana de bactérias isoladas de Jundiá (Rhamdia quelen) / Antimicrobial sensibility of bacterial isolates from Jundiá (Rhamdia quelen)

Objetivando o delineamento do perfil de sensibilidade dos agentes bacterianos causadores de enfermidades em peixes, 51 isolados bacterianos provenientes de Jundiá e pertencentes aos gêneros Acinetobacter spp. (8), Aeromonas spp. (15), Edwardsiella spp. (2), Enterobacter spp. (2), Klebsiella spp. (1), Plesiomonas spp. (5), Pseudomonas spp. (1), Staphylococcus spp.(11) e Vibrio spp. (6) foram testados frente aos antimicrobianos utilizados no tratamento de enfermidades em peixes. Dos 51 isolados bacterianos obtidos de exemplares de Jundiá (Rhamdia quelen) 51 (100 por cento) foram sensíveis a gentamicina, 49 (96,08 por cento) ao sulfazotrim, 47 (92,16 por cento) ao cloranfenicol, 43 (84,31 por cento), a tetraciclina, 43 (84,31 por cento) ao ácido nalidíxico, 31 (60,78 por cento) à nitrofurantoina, 22 (43,14 por cento) à eritromicina, 22 (43,14 por cento) à ampicilina, 15 (29,41 por cento) à espiramicina, 13 (25,50 por cento) à colistina e 5 (3 por cento) foram sensíveis a penicilina G. Com exceção de um isolado do gênero Staphylococcus spp., as bactérias analisadas no presente estudo foram resistentes a um ou mais agentes antimicrobianos testados. O conhecimento do perfil de sensibilidade das bactérias envolvidas em processos infecciosos nos peixes permitirá aos técnicos à adoção de uma antimicrobianoterapia racional, que contribuirá para o controle das enfermidades em Rhamdia quelen, sem causar grandes riscos à saúde pública e ao meio ambiente.(AU)

Aiming the evaluation of sensitivity profiles of pathogen bacteria responsible for fish diseases, 51 bacterial isolates from Jundiá (Rhamdia quelen) belonging to the genus Acinetobacter spp. (8), Aeromonas spp. (15), Edwardsiella spp. (2), Enterobacter spp. (2), Klebsiella spp. (1), Plesiomonas spp. (5), Pseudomonas spp. (1), Staphylococcus spp. (11), and Vibrio spp. (6), were tested against antimicrobial agents used for treatment of bacterial fish diseases. All samples were processed at the Laboratory of Bacteriology, Department of Preventive Veterinary Medicine, UFSM. From 51 bacteria isolated from jundiá fishes (Rhamdia quelen) 51 (100 percent) were sensitive to gentamycin, 49 (96,08 percent) to sulphazotrin, 47(92,16 percent) to chloramphenicol, 43 (84,31 percent) to tetracylin, 43 (84,31 percent) to naldixic acid, 31 (60,78 percent) to nitrofurantoin, 22 (43,14 percent) to erytromycin, 22 (43,14 percent) to ampicillin, 15 (29,41 percent) spiramycin, 13 (25,50 percent) to cholystin, and 5 (3 percent) to penicillin G. With exception of an isolate of Staphylococcus spp., the bacteria analyzed in the present study were resistant to one or more antimicrobial agents tested. Knowledge of the sensitivity profile of bacteria involved in infectious processes in fish will allow rational antimicrobial treatment that will contribute to the control of fish diseases in Rhamdia quelen without causing great risks to public health and the environment.(AU)

Erros de administração de antimicrobianos identificados em estudo multicêntrico brasileiro / Antimicrobial drug administration errors identified in Brazilian multicentric study

Erros de administração de antimicrobianos são relevantes, pois podem interferir na segurança do paciente e no desenvolvimento de resistência microbiana. O objetivo desse estudo foi identificar os antimicrobianos associados a erros de administração de medicamentos. Estudo multicêntrico, descritivo e exploratório, realizado em unidades de clínica médica de cinco hospitais por meio de técnica observacional, durante 30 dias. Os erros foram classificados em categorias: dose, medicamento não prescrito, via, paciente e horário. A classificação farmacológica dos antimicrobianos foi realizada segundo o Sistema Anatômico Terapêutico Químico (ATC). Os fármacos de intervalo terapêutico estreito foram identificados. A análise estatística descritiva foi realizada no software SPSS 11.5. Foram identificados 1500 erros, sendo 277 (18,5 por cento) com antimicrobianos. Os tipos de erros foram: de horário 87,7 por cento; de dose 6,9 por cento; de medicamento não autorizado 3,2 por cento, de via 1,5 por cento e de paciente 0,7 por cento. Foram identificados 36 antimicrobianos e as classes ATC mais freqüentes foram: fluorquinolonas 13,9 por cento, combinações de penicilinas 13,9 por cento, macrolídeos 8,3 por cento e cefalosporina de terceira geração 5,6 por cento. Os fármacos de intervalo terapêutico estreito corresponderam a 16,7 por cento dos antimicrobianos. Os erros com antimicrobianos analisados podem ser fontes de estudo e melhoria no processo de utilização racional de medicamentos e segurança do paciente.

Medication administration errors (MAE) are the most frequent kind of medication errors. Errors with antimicrobial drugs (AD) are relevant because they may interfere in patient safety and in the development of microbial resistance. The aim of this study is to analyze the AD errors detected in a Brazilian multicentric study of MAE. It was a descriptive and exploratory study carried out in clinical units in five Brazilian teaching hospitals. The hospitals were investigated during 30 days. MAE were detected by observation technique. MAE were classified in categories: wrong route(WR), wrong patient(WP), wrong dose(WD) wrong time (WT) and unordered drug (UD). AD with MAE were classified by Anatomical-Therapeutical-Chemical Classification System. AD with narrow therapeutic index (NTI) were identified. A descriptive statistical analysis was performed using SPSS version 11.5 software. A total of 1500 errors were observed, 277 (18.5 percent) of them were errors with AD. The types of AD error were: WT 87.7 percent, WD 6.9 percent, WR 1.5 percent, UD 3.2 percent and WP 0.7 percent. The number of AD found was 36. The mostly ATC class were fluoroquinolones 13.9 percent, combinations of penicillin 13.9 percent, macrolides 8.3 percent and third-generation cephalosporins 5.6 percent. The parenteral drug dosage form was associated with 55.6 percent of AD. 16.7 percent of AD were NTI. 47.4 percent of WD and 21.8 percent WT were with NTI drugs. This study shows that these errors should be considered potential areas for improvement in the medication process and patient safety plus there is requirement to develop rational drug use of AD.

Anti-coagulase-negative Staphylococcus activity of ethanolic extracts of propolis from two Brazilian regions and synergism with antimicrobial drugs by the E-test method

Propolis is a natural resinous substance collected by bees from vegetal sources and its therapeutic properties have been investigated. In this work, we evaluated the inhibitory activity of ethanolic extracts of propolis (EEP) from the Southeast and South of Brazil on coagulase-negative Staphylococcus (CNS) growth as well as the EEP in vitro synergism with antimicrobial drugs by using the diffusion method (E-test). The EEP chemical characteristics (dry weight, pH, flavonoid and phenolic compounds) were determined. Seven drugs were tested, and synergism was observed between three drugs and Southeast EEP, six drugs and South EEP, and one drug and ethanol control. Ethanolic extracts of propolis from the South of Brazil presented the greatest flavonoid content and synergism rate, while EEP from the Southeast presented the greatest anti-CNS activity and phenolic compound content. Results showed the correlation among anti-CNS activity, synergism rate and chemical characteristics of propolis.