Clinical application value of a predictive model for the efficacy of third-generation cephalosporin in treatment of community-acquired spontaneous bacterial peritonitis / 临床肝胆病杂志

ObjectiveTo investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis （CASBP）. MethodsThis prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsAll patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.0% vs 60.0%， χ2=5.094， P=0.024）， while there was no significant difference in the cure rate on day 5 between the two groups （80.0% vs 56.6%， χ2=3.309， P=0.069）. As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.9% vs 60.0%， χ2=4.341， P=0.037）， while there was no significant difference in the cure rate on day 5 between the two groups （83.3% vs 56.0%， χ2=2.425， P=0.119）. There was no significant difference in 30-day mortality rate between the two groups （8.0% vs 20.0%， χ2=0.664， P=0.415）. For all patients， there was a significant association between response of initial treatment and cure on day 5 （odds ratio ［OR］=9.643， 95% confidence interval ［CI］： 2.292‍ — ‍40.564） and between cure on day 5 and 30-day mortality （OR=0.138， 95%CI： 0.023‍ — ‍0.813）. ConclusionThis predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP.

Mioclonías positivas y negativas en paciente con enfermedad renal crónica / Positive and negative myoclonus in a patient with end stage renal disease

Introducción: Las mioclonías son contracciones musculares paroxísticas de corta duración o pérdida abrupta del tono muscular, denominadas mioclonías positivas y negativas, respectivamente. Se presenta un caso clínico de mioclonías positivas y negativas generalizadas y se pretende describir los múltiples mecanismos fisiopatológicos y etiologías que lo desencadenan. Presentación del caso: Hombre de 35 años, con diabetes mellitus tipo 1 complicada con enfermedad renal diabética en hemodiálisis, desarrolló una bacteriemia asociada a catéter por Staphylococcus aureus y presentó mioclonías positivas y negativas. Se identificaron como posibles desencadenantes la uremia, la infección y los fármacos con potencial promioclónico; el hallazgo incidental de una lesión isquémica en núcleo caudado no explicaba la semiología encontrada en el paciente. Se hizo el control y retiro de todos los factores promioclónicos enunciados, junto a manejo farmacológico con levetiracetam, y con ello se logró el control de los síntomas. Discusión: Los pacientes con enfermedad renal crónica son susceptibles a la acumulación de productos tóxicos de tipo guanidinas, que tienen potencial para producir mioclonías. Además, las infecciones, el uso de fármacos con potencial promioclónico y lesiones estructurales como las isquemias corticales son etiologías que deben considerarse en el diagnóstico diferencial. El mayor impacto en los síntomas se observa con el control del factor desencadenante, y, en caso de persistir, la terapia farmacológica proporciona buenos resultados. Conclusión: Las mioclonías son trastornos del movimiento relativamente comunes en la enfermedad renal crónica. La identificación del desencadenante es crucial para su manejo junto al uso de fármacos con actividad antimioclónica.

Introduction: Myoclonus are paroxysmal muscle contractions of short duration or abrupt loss of muscle tone, called positive and negative myoclonus respectively. A clinical case of generalized positive and negative myoclonus is presented and the aim is to describe the multiple pathophysiological mechanisms and etiologies that trigger it. Case presentation: A 35-year-old man with type 1 diabetes mellitus complicated by diabetic kidney disease on hemodialysis developed catheter-associated bacteremia due to Staphylococcus aureus and presented positive and negative myoclonus. Uremia, infection, and drugs with pro-myoclonic potential were identified as possible triggers; The incidental finding of an ischemic lesion in the caudate nucleus did not explain the semiology found in the patient. The control and removal of all the pro-myoclonic factors mentioned was carried out, along with pharmacological management with levetiracetam, thus achieving control of the symptoms. Discussion: Patients with chronic kidney disease are susceptible to the accumulation of guanidine-type toxic products, which have the potential to produce myoclonus. Furthermore, infections, the use of drugs with pro-myoclonic potential and structural lesions such as cortical ischemia are etiologies that should be considered in the differential diagnosis. The greatest impact on symptoms is observed with the control of the triggering factor and if it persists, pharmacological therapy provides good results. Conclusion: Myoclonus are relatively common movement disorders in chronic kidney disease. Identification of the trigger is crucial for its management along with the use of drugs with anti-myoclonic activity.

Dermatosis por IgA lineal de la infancia inducida por cefalosporina

Introducción: La dermatosis por IgA lineal es un trastorno ampollar raro, que afecta sobre todo a niños menores de 5 años y se caracteriza por depósitos de IgA en la membrana basal dermoepidérmica. Se presenta con ampollas tensas que suelen localizarse en la zona peribucal y perineal. Objetivo: Describir una dermatosis por IgA lineal en la infancia inducida por cefalosporinas. Presentación de caso: Niño de 2 años de edad, fototipo III, que presentó una erupción vesículo-ampollar después de tratamiento con cefalosporinas por una infección en la piel. Por su presentación clínica característica y los hallazgos en la histopatología e inmunofluorescencia directa se diagnostica como dermatosis IgA lineal. Conclusiones: La dermatosis por IgA lineal es una enfermedad rara. Se conoce que en los últimos 20 años se han diagnosticado solo 4 casos en Cuba, por lo que es importante tener este hecho presente en el momento de plantear posibles causas de dermatosis ampollosas, para su intervención precoz. Es importante tener en cuenta que se puede manifestar por la exposición a fármacos como ocurrió en este caso.

Introduction: Linear IgA dermatosis is a rare blistering disorder, which mainly affects children under 5 years of age and is characterized by IgA deposits in the dermoepidermal basement membrane. It presents with tense blisters that are usually located in the perioral and perineal area. Objective: To describe linear IgA dermatosis in childhood induced by cephalosporins. Case Presentation: 2-year-old boy, phototype III, who developed a vesicle-blister rash after treatment with cephalosporins for a skin infection. Due to its characteristic clinical presentation and findings in histopathology and direct immunofluorescence it is diagnosed as linear IgA dermatosis. Conclusions: Linear IgA dermatosis is a rare disease. It is known that in the last 20 years only 4 cases have been diagnosed in Cuba, so it is important to have this fact present at the time of raising possible causes of bullous dermatoses, for early intervention. It is important to note that it can be manifested by exposure to drugs as happened in this case.

A study on evaluation of prescription pattern of drugs in upper respiratory tract infections in children at a tertiary care hospital

Background: Acute respiratory tract infections (ARTIs) are a major burden to child health in developing countries like India. Preschool children have 4–8 episodes of the upper respiratory tract infection (URTI) per year on average, while school-aged children experience 2–6 episodes per year. They are the most prevalent reason for visits to the outpatient section of a hospital and general practice. Aim and Objective: The aim of this study was to evaluate the prescribing patterns in patients aged 1–18 years with URTIs. Materials and Methods: A prospective study conducted in the department of pharmacology at a tertiary health care center. Two hundred and fifty patients with URTI visiting pediatric and ENT department of tertiary health care center during December 2014–June 2015 were studied. Data included detailed history, physical examination, investigations, antimicrobial treatment given, and other treatment given were noted. This data was gathered from the records of Pediatric and ENT department. Statistical tests were used to analyze the data. Results: The most common clinical presentation was fever and cough. The common diagnosis noted in the study were non-specific URTI, tonsillitis, and sinusitis. Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Amoxicillin-clavulanic acid and cephalosporins were the common antibitoics prescribed. Beta-hemolytic streptococci were the common microbe isolated among the patients tested to know the etiology. Conclusion: Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Antibiotics were prescribed in most of the non-specific URTI and pharyngitis which is a matter of concern.

Reatividade cruzada entre betalactâmicos: uma abordagem prática / Cross-reactivity among beta-lactams: a practical approach

Os betalactâmicos são a classe de drogas que mais causam reações de hipersensibilidade envolvendo um mecanismo imunológico específico, e são os principais desencadeantes entre os antimicrobianos. São representados pelas penicilinas, cefalosporinas, carbapenêmicos, monobactâmicos e inibidores da betalactamase. A estrutura química básica destes fármacos consiste na presença dos seguintes componentes: anel betalactâmico, anel adjacente e cadeias laterais, sendo todos potenciais epítopos. Os anticorpos da classe IgE e linfócitos T estão frequentemente envolvidos no reconhecimento desses epítopos. A reatividade cruzada depende da estabilidade dos produtos intermediários (determinantes antigênicos) derivados da degradação dos anéis betalactâmicos, anéis adicionais e da semelhança estrutural das cadeias laterais entre as drogas. Classicamente acreditava-se num grande potencial de reatividade cruzada dentro de cada classe e até entre as classes, mas estudos da última década mostraram que indivíduos alérgicos à penicilina (com testes cutâneos positivos) reagiam às cefalosporinas em aproximadamente 3% dos casos, aos carbapenêmicos em cerca de 1%, e praticamente não reagiam aos monobactâmicos. Essa reatividade ou tolerância parece estar vinculada ao grau de similaridade entre as cadeias laterais desses antibióticos. Nesta revisão, ressaltamos a importância da investigação sistematizada na confirmação ou exclusão de alergia aos betalactâmicos, descrevemos a prevalência da reatividade cruzada entre estes fármacos e sugerimos um algoritmo de abordagem desses pacientes baseados em sua estrutura química e nos dados publicados na literatura.

Beta-lactams are the drugs most commonly involved in hypersensitivity reactions mediated by a specific immune mechanism and are the main triggers among antibiotics. They include penicillins, cephalosporins, carbapenems, monobactams and beta-lactam inhibitors. The basic chemical structure of these drugs consist on the presence of the following components: betalactam ring, an adjacent ring and side chains, all of which are potential epitopes. IgE antibodies and T lymphocytes are often involved in recognizing those epitopes. Cross-reactivity depends on the stability of intermediate products (antigenic determinants) derived from the degradation of the beta-lactam ring, on the adjacent rings, and on the structural similarity of the side chains between drugs. Classically, it was believed that there was a great potential for cross-reactivity within each class and even between classes, but studies from the last decade showed that individuals allergic to penicillin (with positive skin tests) reacted to cephalosporins in approximately 3% of cases, to carbapenems in about 1%, and rarely reacted to monobactams. This reactivity or tolerance seems to be linked to the degree of similarity between the side chains of these antibiotics. In this review, we emphasize the importance of systematic investigation to confirm or exclude allergy to beta-lactams, we describe the prevalence of crossreactivity between these drugs and we suggest an algorithm for approaching these patients based on their chemical structure and on data published in the literature.

Uso ambulatorio de cefalosporinas en una población colombiana: estudio de prescripción-indicación / Outpatient cephalosporin use in a Colombian population: prescription-indication study

INTRODUCCIÓN: El uso indebido de cefalosporinas puede provocar resistencia de las bacterias. OBJETIVO: Determinar el perfil de prescripción e indicación de cefalosporinas en un grupo de pacientes afiliados al Sistema de Salud de Colombia. MÉTODOS: Estudio transversal. A partir de una base de datos poblacional se obtuvo una muestra aleatoria de pacientes atendidos en consulta ambulatoria para identificar las indicaciones de cefalosporinas en registros clínicos. Se evaluaron variables farmacológicas relacionadas con formulación no indicada según guías de práctica clínica. RESULTADOS: En 381 pacientes, con edad media 41,2 ± 15,4 años, el 61,4% (n = 234) eran mujeres. Cefalexina fue la más utilizada (n=318; 83,5%), con duración media del tratamiento de 7,3 ± 3,2 días, seguida de cefradina (n = 43, 11,3%) y ceftriaxona (n = 20, 5,2%). Se prescribieron para infecciones de piel y tejidos blandos (n = 177; 46,4%, de las cuales 47,5% eran purulentas), del tracto urinario (n = 70; 18,4%), de vías respiratorias superiores (n = 57; 15,0%), e infecciones de transmisión sexual (n = 21; 5,5%). Estaban indicadas en 169 pacientes (44,4%), pero sólo 103 (60,9%) tenían prescripciones que cumplían las recomendaciones de dosificación. CONCLUSIONES: Más de la mitad de pacientes prescritos con cefalosporinas en un contexto ambulatorio tenían prescripciones consideradas no indicadas, en particular por su uso en infecciones de piel y tejidos blandos purulentas.

BACKGROUND: Misuse of cephalosporins can lead to bacterial resistance. Aim: To determine the prescription profile and indication of cephalosporins in the patients affiliated to the Colombian Health System. METHODS: Cross-sectional study. From a population database, a random sample of patients treated in an outpatient consultation was obtained, to identify the indications of the prescribed cephalosporins in their clinical record. Pharmacological variables, and those related to non-indicated formulations were evaluated according to the clinical practice guidelines. RESULTS: In 381 patients, the mean age was 41.2 ± 15.4 years, and 61.4% (n = 234) were women. Cefalexin was the most widely used (n=318; 83.5%), with a mean duration of treatment of 7.3 ± 3.2 days; followed by cefradine (n = 43; 11.3%), and ceftriaxone (n = 20; 5.2%). The most common uses were for skin and soft tissue infections (n = 177; 46.4% of which 47.5% were purulent), urinary tract infections (n = 70; 18.4%), upper respiratory airway infections (n = 57; 15.0%) and sexually transmitted diseases (n = 21; 5.5%). The use was considered indicated in 169 patients (44.4%), but only 103 (60.9%) had prescriptions that met the dosage recommendations from the clinical practice guidelines. CONCLUSIONS: More than half of the patients prescribed with cephalosporins in the outpatient setting had prescriptions considered not indicated, particularly for their use in purulent skin and soft tissue infections.

Restricción programada de cefalosporinas de tercera generación en contexto de un brote de bacilos gramnegativos productores de beta-lactamasas tipo AmpC en unidades críticas: una experiencia de la vida real / Third-generation cephalosporins programmed restriction in the context of an outbreak of AmpC beta-lactamase-producing gram-negative bacilli in critical units: a real-life experience

INTRODUCCIÓN: La restricción programada (RP) de antimicrobianos puede disminuir selectivamente la tasa de infecciones por determinados microorganismos. En este sentido, los bacilos gramnegativos productores de beta-lactamasas AmpC (BGN-blaAmpC) son seleccionados por el sobreuso de cefalosporinas de tercera generación (C3G). Estas bacterias, también adquieren genes y co-producen otras beta-lactamasas, como las de Nueva Delhi (BGN-blaNDM). OBJETIVOS: Disminuir la tasa de aislamiento de BGN-blaAmpC y BGN-blaNDM en cultivos de pacientes de la UCI luego de una RP de C3G en el marco de un brote nosocomial por estos microrganismos. MATERIALES Y MÉTODOS: Estudio cuasi-experimental, previo (P1= 12 meses) y posterior (P2= 12 meses) a una RP de C3G en un hospital de adultos, donde, en el contexto de brote mencionado, se aplicaron medidas de control de infecciones generales. El uso de antimicrobianos se expresó como "porcentaje de los días de tratamiento (%DDT)"/100 camas ocupadas al día (100-COD). Se compararon las tasas de aislamiento de BGN-blaAmpC y BGN-blaNDM en hemocultivos (HC), mini-lavados bronquio-alveolares (mB) y urocultivos (UC) en la UCI. RESULTADOS: En P2 el consumo de C3G fue 2,5% DDT/100-COD. Hubo un descenso en los aislamientos de BGN-blaAmpC en HC (RR 0,48 [0,2-0,9] p < 0,02) y mB (RR 0,52 [0,3-0,9] p < 0,02), así como también de BGN-blaNDM en HC (RR 8,1 [1,6-39,4] p < 0,00). Conclusiones: La RP de C3G se asoció con la reducción de los BGN-blaAmpC y BGN-blaNDM en HC, así como de los BGN-blaAmpC mB.

BACKGROUND: Programmed restriction (PR) of antimicrobials can selectively decrease the rate of infections by certain microorganisms. In this sense, AmpC beta-lactamase-producing gram-negative bacilli (GNB-blaAmpC) are selected for the overuse of third generation cephalosporins (3GC). These bacteria also acquire genes and co-produce other β-lactamases, such as New Delhi ones (GNB-blaNDM). AIM: To decrease the isolation rate of GNB- blaAmpC and GNB- blaNDM in cultures from ICU patients after a PR of 3GC. METHODS: Quasi-experimental study, before (P1= 12 months) and after (P2= 12 months) a PR of 3GC in an adults' hospital. The use of antibiotics was expressed as "percentage days of treatment (%DOT)" /100 beds occupied per day (100-BOD). The rates of GNB-blaAmpC and GNB-blaNDM were compared in blood cultures (BC), mini-bronchio alveolar lavages (mB) and urine cultures (UC) in the ICU. RESULTS: In P2, 3GC consumption was 2.5% DOT/100-COD. There was a decrease in GNB-blaAmpC from BC (RR 0.48 [0.2-0.9] p < 0.02) and mB (RR 0.52 [0.3-0.9] p < 0.02), as well as of GNB-blaNDM from BC (RR 8.1 [1.6-39.4] p < 0.00). Conclusions: PR of 3GC was linked to the reduction of GNB-blaAmpC and GNB-blaNDM in BC, as well as GNB-blaAmpC in mB from ICU patients.

Anaphylactic Reaction Following Injection Cefotaxime Sodium

This is a case study of anaphylactic reaction to cefotaxime sodium in a 23-year-old female who underwent a lower segment cesarean section under spinal anesthesia. Cefotaxime sodium, an antibiotic belonging to the class of cephalosporins, was administered intravenously postoperatively for prevention of infection. The patient complained of breathlessness, swelling around both eyes, and pruritus and urticarial rash over her abdomen, legs, and forehead. The case was successfully managed by withholding the medication and treatment of symptoms. According to the WHO-Uppsala Monitoring Centre causality assessment scale, a probable causal relationship between the suspected drug (cefotaxime sodium) and anaphylactic reaction was made. The severity was found to be moderate (Level 3). Although cefotaxime has well established place in surgical prophylaxis, this case study emphasizes on constant observation and meticulous follow-up of patients receiving it in clinical practice as there is possibility of an adverse drug reaction (ADR) which can be life-threatening. Such happenings can add to challenges faced by the treating physician in the present COVID-19 era. Recognizing ADR helps reduce morbidity and mortality. Reporting ADR helps in documentation and education of healthcare professionals.

Laboratory-based surveillance of Shigella spp. from human clinical cases in Colombia, 1997-2018 / Vigilancia por el laboratorio de Shigella spp. aislada de casos clínicos humanos en Colombia, 1997-2018

Abstract | Introduction: Shigellosis is endemic in low-and middle-income countries, causing approximately 125 million episodes of diarrhea and leading to approximately 160.000 deaths annually one-third of which is associated with children. Objective: To describe the characteristics and antimicrobial resistance profiles of Shigella species recovered in Colombia from 1997 to 2018. Materials and methods: We received isolates from laboratories in 29 Colombian departments. We serotyped with specific antiserum and determined antimicrobial resistance and minimal inhibitory concentrations for ten antibiotics with Kirby-Bauer tests following the Clinical and Laboratory Standards Institute recommendations. Results: We analyzed 5,251 isolates of Shigella spp., most of them obtained from stools (96.4%); 2,511 (47.8%) were from children under five years of age. The two most common species were S. sonnei (55.1%) and S. fbxneri (41.7%). The highest resistance rate was that of tetracycline (88.1%) followed by trimethoprim-sulfamethoxazole (79.3%) and ampicillin (65.5%); 50.8% of isolates were resistant to chloramphenicol, 43.6% to amoxicillin/clavulanic acid, and less than 1% to cefotaxime, ceftazidime, gentamicin, and ciprofloxacin. In S. sonnei, the most common resistance profile corresponded to trimethoprim-sulfamethoxazole (92%) whereas in S. fbxneri the most common antibiotic profiles were multidrug resistance. Conclusions. In Colombia, children under five years are affected by all Shigella species. These findings should guide funders and public health officials to make evidence-based decisions for protection and prevention measures. The antimicrobial resistance characteristics found in this study underline the importance of combating the dissemination of the most frequently isolated species, S. sonnei and S. ftexneri.

Resumen | Introducción. La shigelosis es endémica en los países de ingresos bajos y medios y ocasiona aproximadamente 125 millones de episodios de diarrea y 160.000 muertes al año, un tercio de los cuales se presenta en niños. Objetivo. Describir las características y los perfiles de resistencia antimicrobiana en aislamientos de Shigella spp. recuperados en Colombia entre 1997 y 2018. Materiales y métodos. Los aislamientos provenían de laboratorios en 29 departamentos de Colombia. La serotipificación se hizo con antisueros específicos de Shigella spp. y, la determinación de los perfiles de resistencia y la concentración inhibitoria mínima de diez antibióticos, por Kirby-Bauer. Resultados. Se estudiaron 5.251 aislamientos de Shigella spp. obtenidos de materia fecal (96,4 %); el 47,8 % de ellos correspondía a niños menores de cinco años. Las especies más frecuentes fueron S. sonnei (55,1 %) y S. ftexneri (41,7 %). Se presentó resistencia a tetraciclina (88,1 %), trimetoprim-sulfametoxasol (79,3 %), ampicilina (65,5 %), cloranfenicol (50,8 %) y amoxicilina-acido clavulánico (43,6 %). La resistencia no superó el 1 % contra cefotaxime, ceftazidima, gentamicina y ciprofloxacina. Para S. sonnei, el perfil de resistencia más frecuente correspondió a trimetoprim-sulfametoxasol, en contraste con S. ftexneri, cuyos perfiles fueron todos multirresistentes. Conclusiones. Los niños menores de cinco años se vieron afectados por todas las especies de Shigella spp., aspecto que los legisladores en salud pública deben considerar a la hora de tomar decisiones en torno a las medidas de prevención y protección frente a esta enfermedad. Las características de resistencia antimicrobiana de los aislamientos de Shigella spp. en Colombia ponen de manifiesto la importancia de combatir la diseminación de las dos especies más frecuentes en casos clínicos, S. sonnei y S. ftexneri.

Actividad antimicrobiana de ceftolozano-tazobactam y ceftazidima-avibactam contra bacilos gramnegativos clínicamente relevantes aislados en México / Ceftolozane/tazobactam and ceftazidime/avibactam antimicrobial activity against clinically relevant gram-negative bacilli isolated in Mexico

Resumen Introducción: Existe poca información acerca de la efectividad de las combinaciones ceftolozano/tazobactam y ceftazidima/avibactam en cepas clínicamente relevantes aisladas en México. Objetivo: Determinar el perfil antimicrobiano de ambos antibióticos en nuestra comunidad. Método: El presente estudio de investigación fue prospectivo, descriptivo y transversal. Se incluyeron cepas clínicamente relevantes aisladas a partir de cultivos de cepa pura durante el periodo de agosto de 2018 a enero de 2019 en Mexicali, Baja California, México. Resultados: Se analizaron 74 cepas de enterobacterias y 19 cepas de Pseudomonas aeruginosa; el porcentaje de sensibilidad de ceftazidima/avibactam fue de 100 % contra enterobacterias y de 72.7 % contra Pseudomonas aeruginosa; el porcentaje de sensibilidad de ceftolozano/tazobactam fue de 90.5 % para enterobacterias y de 72.7 % para Pseudomonas aeruginosa. Conclusiones: Las combinaciones ceftolozano/tazobactam y ceftazidima/avibactam ofrecen buena sensibilidad antimicrobiana in vitro, tanto contra enterobacterias productoras de betalactamasas de espectro extendido como contra Pseudomonas aeruginosa. Se requieren más datos para valorar la respuesta clínica en pacientes que reciben esas combinaciones de antibióticos.

Abstract Introduction: There is limited information on the effectiveness of ceftolozane/tazobactam and ceftazidime/avibactam combinations on clinically relevant strains isolated in Mexico. Objective: To determine the antimicrobial profile of both antibiotic combinations in our community. Method: The present research study was prospective, descriptive and cross-sectional. Clinically relevant strains isolated from pure-strain cultures were included during the period from August 2018 to January 2019 in Mexicali, Baja California, Mexico. Results: 74 enterobacteriaceae and 19 Pseudomonas aeruginosa strains were analyzed; the percentage of sensitivity of ceftazidime/avibactam was 100 % for enterobacteriaceae and 72.7 % for Pseudomonas aeruginosa; the percentage of sensitivity of ceftolozane/tazobactam for enterobacteriaceae was 90.5 % and 72.7 % for Pseudomonas aeruginosa. Conclusions: The ceftolozane/tazobactam and ceftazidime/avibactam combinations offer good antimicrobial sensitivity in vitro, both for ESBL-producing enterobacteriaceae and Pseudomonas aeruginosa. More data are required to assess clinical response in patients receiving these antibiotic combinations.

Analysis of drug resistance pattern and genes of Salmonella.spp isolated from human infections in Anhui Province / 中华预防医学杂志

Objective@#To investigate the drug resistance pattern and drug resistance genotypes of Salmonella. spp isolated from fecal specimens and anal swabs of diarrhea cases in Anhui Province.@*Methods@#The 149 strains of Salmonella.spp isolated from feces and anal swabs of diarrhea cases in Anhui Province from April to October 2017 were selected. The serotypes of Salmonella.spp were identified by slide agglutination. The susceptibility of all strains to 14 antibiotics were determined by micro-broth dilution method. Sixty of the cephalosporin-resistant antibiotics were selected. The β-lactamase encoding genes blaTEM, blaSHV, blaOXA-1, blaOXA-2, blaPER, blaCMY, blaCTX-M, and colistin resistance genes mcr-1 and mcr-2 were performed using the multi-PCR method.@*Results@#Of the 149 diarrhea cases, the median (P25, P75) of the age was 5.0 (1.1, 38.5). The 92 of them were male and 54.4% were children. Of the 149 strains of Salmonella.spp, 105 strains had different degrees of resistance to 13 antibiotics other than imipenem. The resistance rate of ampicillin was 55.0% (82/149), which was the highest. 53.0% strains (79 strains) were multidrug resistant, main of which were Salmonella typhimurium and Salmonella enteritidis. A total of 53 resistance patterns were detected, and 10 strains were resistant to ampicillin-ampicillin/sulbactam-tetracycline-chloramphenicol-cefazolin-trimethoprim/sulfamethoxazole, which was the most common resistance pattern. Among the 60 cephalosporin resistant strains, 45 strains carried blaTEM-1, 6 of which also carried blaCTX-M-14 and 3 of which also carried blaCTX-M-65. All the 32 strains carried only blaTEM-1 show resistance to ampicillin and 31 of them show resistance to cefazolin. There were 2 strains showing negative results of gene detection. mcr-1 was detected in a multidrug resistant strain.@*Conclusion@#The resistance of Salmonella.spp to ampicillin shows a serious situation in this region, and there were a number of multidrug resistant strains. The blaTEM-1 was the major drug resistance gene detected in this research. Detection of the mcr-1 suggests the emergence of surveillance to colistin resistance of Salmonella.spp in this area.

Analysis of drug resistance pattern and genes of Salmonella.spp isolated from human infections in Anhui Province / 中华预防医学杂志

To investigate the drug resistance pattern and drug resistance genotypes of Salmonella. spp isolated from fecal specimens and anal swabs of diarrhea cases in Anhui Province. The 149 strains of Salmonella.spp isolated from feces and anal swabs of diarrhea cases in Anhui Province from April to October 2017 were selected. The serotypes of Salmonella.spp were identified by slide agglutination. The susceptibility of all strains to 14 antibiotics were determined by micro-broth dilution method. Sixty of the cephalosporin-resistant antibiotics were selected. The β-lactamase encoding genes , , (1), (2), , , , and colistin resistance genes 1 and 2 were performed using the multi-PCR method. Of the 149 diarrhea cases, the median ((25), (75)) of the age was 5.0 (1.1, 38.5). The 92 of them were male and 54.4% were children. Of the 149 strains of Salmonella.spp, 105 strains had different degrees of resistance to 13 antibiotics other than imipenem. The resistance rate of ampicillin was 55.0% (82/149), which was the highest. 53.0% strains (79 strains) were multidrug resistant, main of which were Salmonella typhimurium and Salmonella enteritidis. A total of 53 resistance patterns were detected, and 10 strains were resistant to ampicillin-ampicillin/sulbactam-tetracycline-chloramphenicol-cefazolin-trimethoprim/sulfamethoxazole, which was the most common resistance pattern. Among the 60 cephalosporin resistant strains, 45 strains carried (1), 6 of which also carried (14) and 3 of which also carried (65). All the 32 strains carried only (1) show resistance to ampicillin and 31 of them show resistance to cefazolin. There were 2 strains showing negative results of gene detection. 1 was detected in a multidrug resistant strain. The resistance of Salmonella.spp to ampicillin shows a serious situation in this region, and there were a number of multidrug resistant strains. The (1) was the major drug resistance gene detected in this research. Detection of the 1 suggests the emergence of surveillance to colistin resistance of Salmonella.spp in this area.

Análise da eficácia entre as cefalosporinas da 1. e 4. geração em cepas de Pseudomonas aeruginosa / Analysis of the efficacy enters the cephalosporins of 1st and 4th generation in strains of Pseudomonas aeruginosa

Objetivo ­ Verificar a resistência antibacteriana em cepas de Pseudomonas aeruginosa das Unidades de Tratamento Intensio (UTI's) do Hospital 28 de agosto, Hospital Universitário Francisca Mendes e Hospital e Pronto Socorro João Lúcio Pereira Machado. Métodos ­ A partir de 12 cepas de Pseudomonas aeruginosa foi realizado o teste de Concentração Inibitória Mínima (CIM), para verificar a suscetibilidade as cefalosporinas, de acordo com Clinical and Laboratory Standards Institute ­ CLSI. Resultados ­ Dentre os 12 isolados, 8 (67%) apresentaram resistência na concentração superior a 256 µg/mL na cefalosporina da 1ª geração (cefalotina); quanto a cefalosporina da 4ª geração (cefepima), cerca de 4 (33%) das amostras isoladas foram sensíveis ao antibiótico. Conclusão ­ Elevadas amostras foram resistentes a cefalotina, enquanto na cefepima, mostraram sensibilidade.

Objective ­ To verify the antibacterial resistance in Pseudomonas aeruginosa strains of the Intensive Care Units (ICUs) of Hospital 28 de agosto, Hospital Universitário Francisca Mendes and Hospital e Pronto Socorro João Lúcio Pereira Machado. Methods ­ From 12 strains of Pseudomonas aeruginosa, the Minimum Inhibitory Concentration (MIC) test was performed to verify the susceptibility of cephalosporins, according to the Clinical and Laboratory Standards Institute - CLSI. Results ­ Among the 12 isolates, 8 (67%) presented resistance in the concentration above 256 µg/mL in cephalosporin of the first generation (cephalothin); for cephalosporin of the 4th generation (cefepime), about 4 (33%) of the isolated samples were sensitive to the antibiotic, at the concentration of 4 µg/mL. Conclusion ­ High samples were resistant to cephalothin, whereas in cefepime, they showed sensitivity

Study of Antibiotic Utilization Pattern and Cost of Antibiotic Therapy in Patients Undergoing Cholecystectomy in a Tertiary Care Hospital of Eastern India

Cholecystectomy, one of the most common operative procedures done in our institution. In a developing country like India, choice of antibiotics should be rational to reduce the burden of cost. There are no standard treatment guidelines to follow regarding antibiotic usage causing indiscriminate use of this antibiotic. Methods: An observational, prospective analytical study by collection of data without intervention was done. Ethical committee’s approval was duly taken. Data were collected in the department of general surgery from the bed side tickets of the patients after taking a short history and informed consent from the patient. Cost of the therapy was calculated from CIMS (Current Index of Medical Specialities) and institutional pharmacy. Results: More commonly single antibiotic (190/320) prescribe followed by two antibiotic (80/320) and three antibiotic (50/320). Piperacillin + Tazobactum most commonly prescribe antibiotic as a single agent and overall. Ceftriaxone / Tazobactum + Metronidazole preferred combination when two antibiotic use at a time. Mean hospital stay 3.78 days. Average duration for prescribing of antibiotic 3.25 days. Mean cost for antibiotic in 984 INR, with a range 115-2700 INR. The average duration of stay in open Cholecystectomy was 7 days whereas the mean duration of stay in cases of laparoscopic Cholecystectomy was reduced to 3.07 days. Average antibiotic prescribing duration was 4.75 days significantly higher than Lap. Cholecystectomy (1.4 days). Conclusion: As there is no standard treatment protocol and antibiotic policy to follow antibiotics are used as pick and choose method due to lack of standard treatment protocol.

Encefalopatía por cefepima en paciente renal: una reacción adversa a medicamento / Cefepime encephalopathy in a kidney patient: an adverse reaction to the drug

RESUMEN La reacción adversa a medicamentos es un problema importante para la salud de pacientes en manejo hospitalario, encontrado de manera regular durante la práctica médica y cuya asociación no identificamos de forma oportuna, pero que aumentan la morbimortalidad y la estancia hospitalaria; en este artículo presentamos el caso clínico de un paciente con encefalopatía severa asociada al uso de cefepima, el deterioro clínico evidenciado durante su proceso de hospitalización y el razonamiento a través del cual se identificó una reacción adversa tipo A como causa de encefalopatía.

SUMMARY The adverse reaction to medications represents a major problem for the health of patients in hospital management, which we encounter on a regular basis during medical practice and whose association we do not identify in a timely manner, but increase morbidity and mortality and hospital stay; In this article we present the clinical case of a patient with severe encephalopathy associated with the use of cefepima, the clinical deterioration evidenced during the hospitalization process and the reasoning through which an adverse type A reaction was identified as a cause of encephalopathy.

Antibiotics sensitivity and resistant pattern in tribal region of Chhattisgarh, India: a retrospective observational study

Background: Antimicrobial resistance (AMR) is the biggest health care problem globally, it is responsible for the high rate of mortality worldwide which was commonly observed in developing countries. We tried to find the incidence of antimicrobial resistance in the tribal region of Chhattisgarh, India.Methods: It was an institutional based retrospective observational study. Out of 3389 samples from inpatient and outpatient department, a total number of 1676 cultured proven micro-organism were isolated from Jan 2017 to Dec 2018. SPSS v23 was used for descriptive analysis.Results: More than 75% of the samples collected from the inpatient department in which surgical IPD were significantly higher. The commonest isolated were Staphylococcus aureus followed by Escherichia coli, then Klebsiella species. Amoxycillin-clavulanic acid was resistant to the majority of microorganism followed by 3rd generation cephalosporins then Co-trimoxazole.Conclusions: Antimicrobial resistance was higher even in the tribal region. The incidence of AMR is increasing at an alarming rate. Microorganism targeted antimicrobial therapy with the use of narrow-spectrum antibiotics and avoidance of broad-spectrum antibiotics will possibly overcome the antimicrobial resistance. There is also a need to strengthen laboratory or microbiology department to produce an accurate report to combat antimicrobial resistance.

Evaluation of cephalosporins utilization and compliance with reference to the hospital antibiotic policy of an Indian tertiary care hospital

Background: Emergence of bacterial resistance in hospital settings due to the liberal use of antibiotics which led to an altered impact on its therapeutic efficacy and outcome, thereby increasing the treatment costs in patients. In this regard the study aims to evaluate the cephalosporins utilization and compliance to the hospital antibiotic policy in general medicine ward.Methods: A prospective observational study was carried out over an eleven-month period in patients prescribed with cephalosporins. Clinical data of inpatients were collected and evaluated by using World Health Organization (WHO) core prescribing indicators and defined daily dose per 100 bed-days. The comparison between the cephalosporins prescribed in the chart records to the recommendations mentioned in the institutional antibiotic policy v.2.0, help to determine the deviations in their usage pattern.Results: A total of 370 patients were enrolled in the study, of which 54.6% were females. Cephalosporins were empirically prescribed in 240 (64.9%) cases. The average number of total antibiotics and cephalosporins per encounter was 1.6 and 1 respectively. Among the total antibiotics, 63.7% were cephalosporins. Third generation cephalosporins (98.4%) were commonly prescribed, with ceftriaxone (93%) in parenteral form for respiratory tract infections (31.9%). Total parenteral antibiotics prescribed were found to be 68.8% of which 88.6% were cephalosporins. Utilization pattern of cephalosporins amounted to be 4.95 DDD/100 bed-days. Overall compliance was achieved in 191 (51.6%) prescriptions.Conclusions: The rate of prescribing of cephalosporins was marginally high. There was a low rate of compliance towards policy which reflects the urgent need for repetitive intervention to comply antibiotic policy.

Estudio teórico de compuestos derivados de cefalosporinas con potencial actividad inhibitoria frente a proteína de unión a penicilina (PBP) y resistencia a enzimas betalactamasa de espectro extendido (BLEE) producidas por Escherichia coli / Theoretical study of compounds derived from cephalosporins with inhibitory activity potential front to penicillin binding proteins (PBP) and resistance to Extended spectrum Beta-lactamase (ESBL) produced by Escherichia coli

RESUMEN Se han utilizado herramientas computacionales para proponer moléculas derivadas de cefalosporinas con potencial actividad antibacteriana, frente a cepas de Escherichia Coli, con mayor afinidad como inhibidores de enzimas de unión a penicilinas y que a su vez disminuyan o no tengan afinidad por betalactamasas de espectro extendido. Se diseñaron 20 moléculas con base en la estructura molecular de la cefalosporina, las estructuras fueron optimizadas utilizando la teoría del funcional de la densidad, se calcularon descriptores moleculares de reactividad, de forma paralela se sometieron a acoplamiento molecular con las enzimas antes mencionadas. Las moléculas presentaron valores de energía de unión negativos, doce moléculas mostraron una orientación e interacciones favorables en el sitio activo de la enzima de unión a penicilinas y trece moléculas presentaron menor afinidad que el ligando nativo (cefotaxima) por la betalactamasa. Tres moléculas pueden considerarse como potenciales inhibidores de enzimas de unión a penicilinas resistentes y betalactamasas.

SUMMARY Computational tools have been used to propose molecules derived from cephalosporins with potential antibacterial activity, against strains of Escherichia Coli, with higher affinity as inhibitors of penicillin-binding enzymes and which in turn decrease or do not have affinity for extended-spectrum beta-lactamases. 20 molecules were designed based on the molecular structure of the cephalosporin, the structures were optimized using the density functional theory, molecular descriptors of reactivity were calculated, and in parallel form they were subjected to molecular docking with the enzymes mentioned above. The molecules showed negative binding energy values, 12 molecules showed an orientation and favorable interactions in the active site of the penicillin binding enzyme and thirteen molecules had lower affinity than the native ligand (Cefotaxime) for betalactamase. Three molecules can be considered as potential inhibitors of binding enzymes to resistant penicillins and betalactamases.

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.

Predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis / 临床肝胆病杂志

ObjectiveTo investigate the predictive factors for third-generation cephalosporin-resistant spontaneous bacterial peritonitis (SBP). MethodsA retrospective analysis was performed for the clinical data of 206 patients with liver cirrhosis who were hospitalized in the Ninth Hospital of Nanchang from January 2010 to December 2018, and all patients had SBP with positive bacteria based on ascites culture. According to drug susceptibility results, the patients were divided into third-generation cephalosporin-resistant SBP group (101 patients with third-generation cephalosporin-resistant pathogenic bacteria in ascites) and control group (105 patients with pathogenic bacteria sensitive to third-generation cephalosporin). Electronic medical records were reviewed to collect related information. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of data with skewed distribution between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. A dichotomous logistic regression analysis was used for multivariate analysis, and the Forward: LR method was used for the screening of independent variables. ResultsThere was a significant difference in the composition of pathogenic bacteria between the two groups (P＜0.001). The univariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months (χ2=12.351, P＜0001), non-first-time onset of SBP (χ2=14.427, P＜0.001), blood creatinine (χ2=-2.537, P=0.011), and blood bicarbonate (χ2=-4.592, P＜0.001) were candidate predictive factors with statistical significance between the two groups, and further multivariate analysis showed that a history of broad-spectrum antibiotic exposure in the past three months (odds ratio ［OR］=2.376, 95% confidence interval ［CI］: 1.009-5.598, P=0.048), non-first-time onset of SBP (OR=2.841, 95%CI: 1.133-7.122, P=0.026), and blood bicarbonate (OR=0.892, 95%CI: 0.818-0.973, P=0.010) had an independent predictive value for third-generation cephalosporin-resistant SBP. ConclusionA history of broad-spectrum antibiotic exposure in the past three months, non-first-time onset of SBP, and a low level of blood bicarbonate are independent predictive factors for third-generation cephalosporin-resistant SBP, and third-generation cephalosporins should be used with caution in SBP patients with these features.