Mycobacterium abscessus keratitis after LASIK surgery / Ceratite por Mycobacterium abscessus após cirurgia LASIK

ABSTRACT A 33-year-old male presented with unilateral subacute infectious keratitis 4 weeks after surgery. Corneal inflammation was resistant to standard topical antibiotic regimens. During diagnostic flap lifting and sampling, the corneal flap melted and separated. Through flap lifting, corneal scraping, microbiological diagnosis of atypical mycobacteria, and treatment with topical fortified amikacin, clarithromycin, and systemic clarithromycin, clinical improvement was achieved.

RESUMO Paciente do sexo masculino, 33 anos, apresentou ceratite infecciosa subaguda unilateral 4 semanas após a cirurgia. A inflamação da córnea foi resistente aos regimes de antibióticos tópicos padrão. A aba da córnea foi derretida e seccionada durante o levantamento e amostragem para diagnóstico. A melhora clínica só foi alcançada após levantamento do retalho, raspagem e diagnóstico microbiológico de micobactérias atípicas e tratamento com amicacina fortificada tópica, claritromicina e claritromicina sistêmica.

Establishment and application of the physiologically-based pharmacokinetic model of amikacin in elderly patients with renal insufficiency / 中国药房

OBJECTIVE To establish a physiologically-based pharmacokinetic （PBPK） model of amikacin in elderly patients with renal insufficiency. METHODS PK-SIM® software was adopted for model building， optimization and simulation. The physical and chemical properties and pharmacokinetic parameters related to amikacin were collected by literature review. The PBPK model on adults was established and extrapolated to the elderly population based on the built-in human model. Data from clinical PK studies were used to optimize and validate the model. The goodness of fit， relative residual， and mean folding error （MFE） were used to evaluate the performance of forecasting. The final model was employed to simulate the exposure of amikacin in the elderly population with renal insufficiency， and the efficacy and safety of commonly used clinical dosing regimens were evaluated， and the recommended regimens were proposed. RESULTS The established PBPK model of amikacin had good prediction performance in both adult and elderly populations， with the absolute mean of relative residual value of 25%； the MFE of peak concentration （cmax） and area under the plasma concentration curve （AUC0－∞） in all simulation occasions ranged ＞0.5-＜2. The simulation results showed that， compared with healthy adults， no significant clinical difference in cmax was observed in the elderly with renal insufficiency at the same dosing regimen， but the trough concentration increased significantly due to accumulation. Prolonging the administration interval of amikacin rather than reducing the dosage was more helpful to ensure the efficacy and to reduce the occurrence of nephrotoxicity. CONCLUSIONS The PBPK model for amikacin is successfully established in the elderly patient with renal insufficiency， and shows good predictive performance.

Plan de implementación de Dosis Unitaria en el servicio de neonatología en el Hospital Cochabamba / Plan for the Implementation of the Unit Dose in the Neonatology Service of Cochabamba Hospital / Plano de Implementação de Dose Unitária no Serviço de Neonatologia do Hospital Cochabamba

En la actualidad la sepsis neonatal es uno de los principales diagnósticos en el servicio de Neonatología del Hospital Cochabamba, el medicamento de mayor elección para el tratamiento farmacológico de esta infección es la Amicacina, con la probabilidad de causar hipoacusia neonatal, la hipoacusia o disminución de la percepción auditiva, es un problema de especial importancia durante la infancia, ya que el desarrollo intelectual y social del niño está íntimamente ligado a las aferencias auditivas al sistema nervioso central, cuyo potencial discapacitante y minusvalidante depende en gran medida de la precocidad con que se realice el diagnóstico y se instaure el tratamiento y la rehabilitación. Objetivo. Diseñar un plan de implementación de Dosis Unitaria para contribuir a disminuir la hipoacusia en los pacientes neonatos. Materiales y Métodos se realizó un estudio documental basado en los registros de las Historias clínicas de los pacientes, realizándose un estudio descriptivo y retrospectivo. Se utilizaron los métodos empíricos como la encuesta, la entrevista y la observación científica, con el fin de demostrar y obtener un diagnóstico fidedigno, apoyándose con fuentes y estudios sobre la hipoacusia como sustento teórico. Resultados. Ante la evidencia de la existencia de la hipoacusia neonatal, como posible efecto adverso del uso farmacológico de la amicacina, se obtiene como resultado de la investigación la necesidad imperiosa de un plan de implementación en Dosis Unitaria para el servicio de neonatología del Hospital. Conclusiones. Los pacientes neonatos recibirán una atención segura, eficaz y humanizada con base a una implementación de Dosis Unitaria.

At present, neonatal sepsis is one of the main diagnoses in the Neonatology service of the Cochabamba Hospital, the drug of choice for the pharmacological treatment of this infection is Amicacin, with the probability of causing neonatal hypoacusis, the hypoacusis or decrease in auditory perception, is a problem of special importance during childhood, since the intellectual and social development of the child is intimately linked to the auditory afferents to the central nervous system, whose disabling and handicapping potential depends to a great extent on the precocity with which the diagnosis is made and the treatment and rehabilitation are established. Objective. To design a plan for the implementation of Unit Dose to contribute to the reduction of hearing loss in neonatal patients. Materials and Methods. A documentary study was carried out based on the patients' medical records, performing a descriptive and retrospective study. Empirical methods such as survey, interview and scientific observation were used in order to demonstrate and obtain a reliable diagnosis, supported by sources and studies on hypoacusis as theoretical support. Results. In view of the evidence of the existence of neonatal hypoacusis, as a possible adverse effect of the pharmacological use of amikacin, it is obtained as a result of the research the imperative need of an implementation plan in Unit Dose for the neonatology service of the Hospital. Conclusions. Neonatal patients will receive safe, effective and humanized care based on a Unit Dose implementation.

Atualmente, a sepse neonatal é um dos principais diagnósticos no serviço de Neonatologia do Hospital de Cochabamba. O medicamento de escolha para o tratamento farmacológico desta infecção é a Amicacina, com a probabilidade de causar hipoacusia neonatal, hipoacusia ou diminuição da percepção auditiva, é um problema de especial importância durante a infância, já que o desenvolvimento intelectual e social da criança está intimamente ligado aos aferentes auditivos do sistema nervoso central, cujo potencial incapacitante e deficiente depende em grande parte de quão cedo o diagnóstico é feito e como o tratamento e a reabilitação são estabelecidos. Objetivo. Elaborar um plano para a implementação da Unidade Dose para contribuir para a redução da perda auditiva em pacientes neonatais. Materiais e Métodos. Foi realizado um estudo documental baseado nos registros das histórias clínicas dos pacientes, realizando um estudo descritivo e retrospectivo. Métodos empíricos como pesquisa, entrevista e observação científica foram utilizados para demonstrar e obter um diagnóstico confiável, apoiado por fontes e estudos sobre hipoacusia como suporte teórico. Resultados. Dada a evidência da existência de hipoacusia neonatal, como um possível efeito adverso do uso farmacológico do amikacin, os resultados da pesquisa mostram a necessidade imperativa de um plano de implementação na Unidade Dose para o serviço de neonatologia do Hospital. Conclusões. Os pacientes neonatais receberão um cuidado seguro, eficaz e humanizado com base na implementação de uma dose unitária.

Comparison of different endophthalmitis prophylactic measures in cataract surgery - An analysis of 2.4 lakh cases

Purpose: To compare different endophthalmitis prophylaxis methods adopted in cataract surgery (manual small-incision cataract surgery and phacoemulsification) between the years 2013 and 2021 in the community eye care section of a tertiary eye care hospital in South India and report their outcomes. Methods: All cataract surgeries performed from January 2013 to December 2021 (2,46,874 surgeries) at a single center were included in this retrospective study. The different endophthalmitis rates with each regimen were analyzed and evaluated. Results: 70,081 surgeries were performed from January 2013 to February 2015, where Tobramycin was added to Balanced Salt Solution (BSS) (Group A). From March 2015 to January 2017, 63,245 surgeries were performed when intracameral Moxifloxacin was given (Group B). From February 2017 to December 2021, 1,13,548 surgeries were performed were Amikacin was added to BSS (Group C). In total, 42 cases of postoperative endophthalmitis were reported during the study period (0.02%). There was no significant difference in the endophthalmitis rates between groups A and B (P = 0.4152); however, there was a significant decrease in endophthalmitis rates in group C when compared with group A (P = 0.04) and group B (P = 0.006). Conclusion: There was a significant reduction in the rates of endophthalmitis following the addition of amikacin in irrigating BSS. Nocardia was one of the predominant organisms isolated from these endophthalmitis patients. This is the first single-center study to report a comparative analysis of different endophthalmitis prophylactic measures in a community eye care set up with a high incidence of Nocardia endophthalmitis prevented with amikacin in BSS irrigating solution.

Protective effect of creatine on amikacin-induced ototoxicity / Efeito protetor da creatina na ototoxicidade induzida por amicacina

Abstract Introduction Aminoglycosides are widely known for their ototoxic side effects. Nevertheless, they are potent antibiotics used in the treatment of life-threatening conditions because of the current concern for antibiotic resistance. We hypothesized that creatine supplements which are believed to improve mitochondrial antioxidant defense system and maintain optimal energy homeostasis may improve the ototoxic side effects. Objective This study aimed to investigate the protective effects of creatine monohydrate against ototoxicity induced by amikacin in rats in an experimental animal model, using distortion product otoacoustic emissions and auditory brainstem response. Methods Twenty healthy rats were assigned to four groups (5 rats in each): the control group, the creatine monohydrate group, the amikacin group and the amikacin + creatine monohydrate group. The creatine monohydrate group received creatine at a dose of 2 g/kg once daily via gastric gavage for 21 days. The amikacin group received amikacin at a dose of 600 mg/kg by intramuscular injections once daily for 21 days. The amikacin + creatine monohydrate group received intramuscular injections of amikacin (600 mg/kg) once daily for 21 days and creatine monohydrate (2 g/kg) once daily via gastric gavage for 21 days. The control group received nothing. The distortion product otoacoustic emissions and auditory brainstem response measurements were performed on all rats on days 0, 7, 21. Results Regarding auditory brainstem response values, a significant increase in the auditory threshold was observed in the amikacin group on day 21 (p < 0.001). The amikacin+creatine monohydrate group showed significantly lower levels of auditory brainstem response auditory thresholds on day 21 in comparison to the amikacin group (p < 0.001). Additionally, the control group and the amikacin+creatine monohydrate group did not differ significantly with respect to auditory brainstem response thresholds on treatment day 21 (p > 0.05). When we compare distortion product otoacoustic emissions values, there was no significant difference between the amikacin and amikacin+creatine monohydrate groups on day 7 (p > 0.05), However significantly greater distortion product otoacoustic emissions values were observed in the amikacin+creatine monohydrate group on day 21 compared to the amikacin group (p < 0.001). Conclusion Our findings demonstrate that creatine treatment protects against amikacin ototoxicity when given at a sufficient dose and for an adequate time period.

Resumo Introdução Os aminoglicosídeos são amplamente conhecidos por seus efeitos colaterais ototóxicos. No entanto, eles são antibióticos potentes usados no tratamento de doenças potencialmente fatais devido à atual preocupação com a resistência aos antimicrobianos. Nossa hipótese é que os suplementos de creatina, aos quais atribui-se um efeito benéfico sobre o sistema de defesa antioxidante mitocondrial e manutenção da homeostase energética ideal, possam melhorar os efeitos colaterais ototóxicos. Objetivo Investigar os efeitos protetores da creatina mono-hidratada contra a ototoxicidade induzida pela amicacina em ratos em um modelo experimental animal com o uso das emissões otoacústicas por produto de distorção e o potencial evocado auditivo de tronco encefálico. Método Vinte ratos saudáveis foram divididos em quatro grupos (5 ratos em cada): o grupo controle, o grupo creatina mono-hidratada, o grupo amicacina e o grupo amicacina + creatina mono-hidratada. O grupo creatina mono-hidratada recebeu creatina na dose de 2 g / kg uma vez ao dia por gavagem gástrica por 21 dias. O grupo amicacina recebeu amicacina na dose de 600 mg/kg por injeção intramuscular uma vez ao dia por 21 dias. O grupo amicacina + creatina mono-hidratada recebeu injeções intramusculares de amicacina (600 mg/kg) uma vez ao dia por 21 dias e creatina mono-hidratada (2 g/kg) uma vez ao dia por gavagem gástrica por 21 dias. O grupo controle nada recebeu. As medidas de emissões otoacústicas por produto de distorção e potencial evocado auditivo de tronco encefálico foram feitas em todos os ratos nos dias 0, 7, e 21. Resultados Em relação aos valores do potencial evocado auditivo de tronco encefálico, foi observado aumento significante dos limiares auditivos no grupo amicacina no 21° dia (p < 0,001). O grupo amicacina + creatina mono-hidratada apresentou níveis significantemente mais baixos de limiares auditivos de potencial evocado auditivo de tronco encefálico no dia 21 em comparação com o grupo amicacina (p < 0,001). Além disso, o grupo controle e o grupo amicacina + creatina mono-hidratada não diferiram significantemente em relação aos limiares de potencial evocado auditivo de tronco encefálico no 21° dia de tratamento (p > 0,05). Quando comparamos os valores de emissões otoacústicas por produto de distorção, não houve diferença significante entre os grupos amicacina e amicacina + creatina mono-hidratada no 7° dia (p > 0,05). No entanto, valores significantemente mais altos de emissões otoacústicas por produto de distorção foram observados no grupo amicacina + creatina mono-hidratada no 21° dia em comparação com o grupo amicacina p < 0,001). Conclusão O tratamento com creatina mono-hidratada protege contra a ototoxicidade da amicacina quando administrado em dose suficiente e por um período de tempo adequado.

Antibiotic susceptibility patterns of bacterial isolates of patients with upper respiratory tract infections

Abstract To evaluate the antibiotic susceptibility patterns in URTIs reporting to tertiary hospitals of Lahore. A cross-sectional study employing 259 culture sensitivity reports obtained from tertiary care hospitals of Lahore. Using SPSS, descriptive statistics were used to estimate frequencies and percentages. In URTIs, S. aureus (5%) was the frequent gram-positive isolate followed by MRSA (1.5%) and MSSA (1.5%), while P. aeruginosa (15.8%) was the prevalent gram-negative isolate followed by Klebsiella (13.1%) and E. coli (6.9%). Against P. aeruginosa, ceftazidime (7.7%), cefuroxime/ceftriaxone (4.6%), amoxicillin (4.3%) and ciprofloxacin (4.2%), were tested resistant, while imipenem (11.2%), ciprofloxacin (9.2%), amikacin (9.2%), meropenem/ levofloxacin/gentamicin (8.1%) and piptaz (6.9%) were found sensitive. Against Klebsiella, carbepenems (7.3%), amikacin (6.5%), ciprofloxacin (5.4%) and gentamicin (5%) were tested sensitive, whereas, ceftazidime (8.5%), ceftriaxone (5.8%), cefaclor (5.5%), ampicillin (4.6%), co-amoxiclave (4.2%) and ciftazidime/ciprofloxacin (3.8%) were found resistant. Overall, imipenem (35%), meropenem (30.8%) and amikacin (31.9%) were the three most sensitive antibiotics, while ceftazidime (25.4%), ceftriaxone (19.2%) and ampicillin (18.5%) were the three most resistant antibiotics. Data suggested that P.aeruginosa and Klebsiella, were the most frequent bacterial isolates in URTIs of Lahore. These isolates were resistant to ampicillin, cefuroxime and ceftazidime, but were sensitive to carbapenem and aminoglycosides

Impacto del monitoreo terapéutico de vancomicina y amikacina en la optimización de dosis de antimicrobianos en pacientes pediátricos / Impact of the vancomycin and amikacin therapeutic monitoring in the optimization of antimicrobial dose in pediatric patients

INTRODUCCIÓN: La monitorización de antimicrobianos mediante sus concentraciones plasmáticas permite determinar la posología óptima de éstos, conducta esencial en pediatría. OBJETIVOS: Describir la monitorización de concentraciones plasmáticas de antimicrobianos y el ajuste de dosis en población pediátrica para determinar si las dosis utilizadas alcanzan rangos terapéuticos. PACIENTES Y MÉTODOS: Estudio descriptivo, retrospectivo, utilizando una base de datos con medición de concentraciones plasmáticas de amikacina y vancomicina en pacientes pediátricos del Hospital San Borja Arriarán, entre 2015-2018. Se determinó el número de pacientes que alcanzó rango terapéutico con dosis inicial, cuántos requirieron ajuste y sus características. RESULTADOS: Se monitorizó 104 concentraciones totales. Para vancomicina 65 concentraciones plasmáticas eran basales encontrándose fuera de rango terapéutico 56,5%; de los que requirieron ajuste, 25% fueron neonatos con mayor probabilidad de estar fuera de rango versus otros (p = 0,022). Para amikacina la Cpeak estuvo en rango en 60% de mediciones; 15,4% requirió ajuste incluyendo pacientes con fibrosis quística y oncológicos. No fue necesario efectuar ajustes en pacientes sin co-morbilidad. CONCLUSIÓN: La medición de concentraciones plasmáticas es necesaria para ajustar de forma individualizada la dosis, especialmente en pacientes pediátricos con fibrosis quística, oncológicos y en neonatología, donde es más probable no alcanzar rango terapéutico con las dosis iniciales.

BACKGROUND: The monitoring of antimicrobial therapy through plasma levels makes it possible to determine the optimal dosage of antimicrobials, an essential approach in pediatrics. AIM: To describe the monitoring of plasma antimicrobial levels and dose adjustment in the pediatric population to determine if the doses used reach therapeutic ranges. METHODS: Retrospective, descriptive study using a database with measurement of plasma levels of amikacin and vancomycin in pediatric patients at San Borja Arriarán Hospital between 2015-2018. The number of patients who reached the therapeutic range with the initial dose, how many required adjustment and their characteristics were determined. RESULTS: 104 total levels were monitored. For vancomycin 65 plasmatic levels were baseline, being outside the therapeutic range 56.5%; 25% of those requiring adjustment were neonates with a higher probability of being out of range versus others (p = 0.022). For amikacin, Cpeak was in range in 60% of measurements; 15.4% required adjustment, including patients with cystic fibrosis and cancer, without adjustments in patients without comorbidity. CONCLUSION: Measurement of plasma levels is necessary to individually adjust the dose, especially in pediatric patients with cystic fibrosis, oncology and in neonatology where it is more likely not to reach a therapeutic range with initial doses.

Pharmaceutical strategies to extend pulmonary exposure of inhaled medicines

Pulmonary administration route has been extensively exploited for the treatment of local lung diseases such as asthma, chronic obstructive pulmonary diseases and respiratory infections, and systemic diseases such as diabetes. Most inhaled medicines could be cleared rapidly from the lungs and their therapeutic effects are transit. The inhaled medicines with extended pulmonary exposure may not only improve the patient compliance by reducing the frequency of drug administration, but also enhance the clinical benefits to the patients with improved therapeutic outcomes. This article systematically reviews the physical and chemical strategies to extend the pulmonary exposure of the inhaled medicines. It starts with an introduction of various physiological and pathophysiological barriers for designing inhaled medicines with extended lung exposure, which is followed by recent advances in various strategies to overcome these barriers. Finally, the applications of the inhaled medicines with extended lung exposure for the treatment of various diseases and the safety concerns associated to various strategies to extend the pulmonary exposure of the inhaled medicines are summarized.

Gentamicin and amikacin adversely affect male infertility indicated by pharmacological, andrological and pathological evidence

Background: Many drugs are implicated in male infertility and screening for medication history is an important for diagnosis and treatment of the problem. The aim is to study amikacin effect on male reproductive system in comparison to gentamicin.Methods: Twenty-five male wister rats weighted 220±20 gm and aged 8 weeks were randomly divided into five groups of five. The first group received gentamicin in dose 18.25 mg/kg/day once daily (OD) (therapeutic dose). The second group received gentamicin with double dose of the first group. The third group received amikacin in dose 54.75 mg/kg/day OD (therapeutic dose). The Fourth group received amikacin with double dose of the third group. However, the fifth group served as a control and received normal saline (NS) OD. All treatments were administered intraperitoneally (IP) for 14 days. On the 15th day, blood samples and reproductive organs were obtained from all animals. Testicular tissues were prepared for genetic testing and chemical and microscopical examination.Results: Amikacin and gentamicin negatively affected reproductive organs weights, sperm parameters, serum follicle stimulating hormone and luteinizing hormone (LH) level relative to control (p<0.05). However, serum testosterone level was only affected with gentamicin (p<0.05). A significant difference between gentamicin and amikacin was found in sperm count, testis and epididymis weights and serum testosterone and LH level (p<0.05). Testicular histopathological changes were also found with the two drugs with different degrees. Effects of both gentamicin and amikacin were dose-dependent.Conclusions: Both gentamicin and amikacin adversely affect andrological function that should be monitored and controlled during application of these drugs.

Prevalence of Klebsiella pneumoniae carbapenemase - and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option

Abstract INTRODUCTION: Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon. METHODS: In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, bla GES, bla NDM, bla SPM, bla IMP, bla VIM, and bla OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. RESULTS: Seventy-four (50.3%) isolates were positive for bla NDM, eight (5.4%) for bla KPC, and one (1.2%) for both bla NDM and bla KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response. CONCLUSIONS: Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.

Impacto en el consumo de amikacina y ceftriaxone en una unidad de emergencias de adultos, luego de la implementación de una guía para el tratamiento de la infección urinaria alta / Impact on the consumption of ceftriaxone and amikacin in an adult emergency unit, after the implementation of a guide for the treatment of pyelonephritis

Introducción: los programas de optimización del uso de antimicrobianos son fundamentales para mejorar los resultados clínicos de los pacientes. Objetivos: determinar el impacto en el consumo de amikacina y ceftriaxona, además de cambios de sensibilidad de las principales bacterias en la unidad de emergencias del hospital Carlos van Buren de Valparaíso, Chile, luego de la implementación de una guía para el tratamiento de la ITU alta. Materiales y método: estudio cuasi-experimental antes/después. Se implementó una guía de tratamiento para la ITU alta, la cual fue enviada vía WhatsApp a los médicos de la unidad. Luego se midieron las dosis diarias definidas (DDD) de amikacina y ceftriaxona y se compararon con las DDD de los mismos meses del año anterior. Además se extrajo la sensibilidad de E.coli, K. pneumonia y P.mirabilis aisladas de urocultivos. Resultados: posterior a la intervención hubo un aumento de las DDD de amikacina y una disminución de las de ceftriaxona. K.pneumoniae mantuvo su sensibilidad a amikacina y la aumentó para cefotaxima, ertapenem y meropenem. Conclusiones: la implementación de una guía de tratamiento de la ITU alta aumentó el consumo de amikacina y disminuyó el de ceftriaxona. K.pneumoniae aumentó su sensibilidad a cefotaxima, ertapenem y meropenem.

Introduction: different antimicrobial stewardship programs are fundamental to improve clinical results in patients. Objectives: to determine the impact on amikacin and ceftriaxone consumption, in addition to knowing changes in sensitivity of the main agents in the emergency unit of the Carlos van Buren Hospital in Valparaíso, Chile, after the implementation of a treatment guide for pyelonephritis. Materials and methods: quasi-experimental before/after study. A treatment guide was implemented for pyelonephritis. The guide was sent by WhatsApp to all clinicians in the emergency unit. Following the intervention, amikacin and ceftriaxone defined daily dose (DDD) were measured and compared with the DDD for the same months of the previous year. In addition, the sensitivity of E.coli, K. pneumonia and P.mirabilis isolated from urine cultures was extracted. Results: after the intervention there was a sustained increase of the DDD of amikacin and a decrease in the DDD of ceftriaxone in the months studied period. K. pneumoniae maintained its sensitivity to amikacin and increased it to cefotaxime, ertapenem, and meropenem. Conclusions: The guide's implementation for treatment of high UTI in the emergency unit of the Carlos van Buren hospital increased the consumption of amikacin and decreased that of ceftriaxone. K. pneumoniae increased its sensitivity to cefotaxime, ertapenem and meropenem.

Urinary tract Infection among type 2 diabetic patients admitted in a multispecialty hospital in South Chennai, Tamil Nadu

Background: Diabetes mellitus (DM) is a chronic and potentially disabling disease which is reaching an epidemic proportion in many parts of the world. UTI is a common infection observed in diabetic patients. The objectives of this study was to determine the prevalence of UTI among hospitalized type 2 diabetic patients, the frequent bacteria responsible for UTI and most susceptible antibiotics among the diabetic patients.Methods: A hospital-based study involving type 2 diabetes patients admitted with diagnosis of UTI between 2017- 2018 (July - June). The study was a cross sectional study and was approved by the Ethics Committee of the hospital. Patients fitting study inclusion and exclusion criteria took part in the study with informed written consent obtained. A validated pilot-tested questionnaire was used as a tool for data collection.Results: Total of 126 subjects were identified. Prevalence of UTI was around 25% higher in women with type 2 diabetes than in men. UTI was found to be significantly associated with age, creatinine (p<0.05) and Escherichia coli was the commonly isolated micro-organism. The gram negative pathogens were highly sensitive to cefoperazone-sulbactum and amikacin was found to be the most sensitive antibiotic for both gram positive and gram negative pathogens.Conclusions: UTIs are frequent in diabetic patients. Improved glycemic control in diabetics may help in controlling the UTIs. Accurate screening for UTI in diabetic patients is also critical to enable the appropriate treatment and avoiding related complications.

Evaluation of a Carbapenem-Saving Strategy Using Empirical Combination Regimen of Piperacillin-Tazobactam and Amikacin in Hemato-Oncology Patients

We implemented a carbapenem-saving strategy in hemato-oncology patients from 2013, using an empirical combination of piperacillin-tazobactam and amikacin for high-risk hemato-oncology patients with febrile neutropenia, who remain hemodynamically unstable > 72 hours despite initial cefepime treatment. All-cause mortality was not different between the two periods (6.54 and 6.57 deaths per 1,000 person-day, P = 0.926). Group 2 carbapenem use significantly decreased after strategy implementation (78.43 vs. 67.43 monthly days of therapy, P = 0.018), while carbapenem-resistant gram-negative bacilli did not show meaningful changes during the study period. Our carbapenem-saving strategy could effectively suppress carbapenem use without an increase of overall mortality.

Simultaneous Quantification of Ethambutol and Amikacin in Human Sputum by HPLC-MS/MS / 中国药学杂志

OBJECTIVE: To develop an LC-MS method for simultaneously quantifying two anti-tuberculosis drugs (ethambuto land amikacin) in human sputum thus to help guide clinical medication. METHODS: The drugs in sputum were extracted by acetonitrile precipitation, and separated on ACQUITY UPLC HSS T3 column(2.1 mm×100 mm, 1.8μm) with mobile phase consisting of 0.1% formic acid aqueous solution and acetonitrile (containing 0.1% formic acid) (80∶20) at a flow rate of 0.35 mL•min-1. Multiple reaction monitoring (MRM) was performed in positive ionization mode with electrospray ionization source. RESULTS: The liner calibration curves of ethambutol and amikacin were obtained in the concentration ranges of 48-12 000(r=0.997 8) and 320-80 000(r=0.999 5)ng•mL-1, respectively. The intra- and inter-day precision RSD was less than 9.2% and the absolute recovery was between 96.65% and 106.35%. This method was successfully applied to analyze the drugs in sputum from five clinical samples, the concentration of ethambutol was 148.5 to 919 ng•mL-1, and no amikacin was detected. CONCLUSION: The method is rapid, simple, sensitive and accurate, and can be applied to the therapeutic drug monitoring of ethambutol and amikacin.

Pharmacoeconomic Evaluation of Cefoperazone/sulbactam Combined with Moxifloxacin and Amikacin versus Cefoperazone/ sulbactam Combined with Tigecycline in the Treatment of Pneumonia with Multidrug-resistant Acinetobacter baumannii Pneumonia / 中国药房

OBJECTIVE： To study the efficacy and economics of cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with multidrug-resistant Acinetobacter baumannii （MDRAB）. METHODS： By prospective study， 150 MDRAB pneumonia patients were selected from Jingmen Second People’s Hospital during Jan. 1st， 2016-Aug. 31st， 2019， and then randomly divided into control group and observation group， with 75 cases in each group. Control group was given Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Tigecycline for injection （first dose 100 mg， maintenance dose 50 mg， q12 h， ivgtt）. Observation group  was give Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Moxifloxacin hydrochloride and sodium chloride injection （400 mg， qd， ivgtt） and Amikacin sulfate injection （0.6 g， qd， ivgtt）. The treatment lasted for 14 days in both groups. The time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal， clinical efficacy， bacterial clearance rate and the occurrence of ADR were compared between 2 groups. Cost-effectiveness analysis was used to evaluate the cost- effectiveness ratio （C/E） and incremental cost-effectiveness ratio （ΔC/ΔE） of 2 groups using antibiotics cost as cost. Sensitivity analysis was performed by reducing drug cost by 15％. RESULTS： There was no statistical significance in the time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal between control group and observation group （P＞0.05）. Clinical response rates of 2 groups were 85.33％ and 81.33％， and bacterial clearance rate were 89.33％ and 82.67％， with statistical significance （P＞0.05）. No serious ADR occurred in either group. The antibacterial cost of control group and observation group were 32 371.49 yuan/person and 9 367.82 yuan/person. C/E of clinical response rate were 379.37 and 115.18， and C/E of bacterial clearance rate were 362.38 and 113.32 in 2 groups， respectively. ΔC/ΔE of clinical response rate and bacterial clearance rate between control group and observation group were 5 750.92 and 3 454.00. Sensitivity analysis supported cost-effectiveness analysis results. CONCLUSIONS： Cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with MDRAB has similar efficacy， but cefoperazone/sulbactam combined with moxifloxacin and amikacin has economic and social benefits.

Prevalence and molecular characteristics of 16s rRNA methylase gene rmtB in amikacin resistant Escherichia coli isolated from South Korea / 대한수의학회지

The production of rmtB-encoded 16S rRNA methylases has emerged as a novel mechanism promoting high-level resistance toward aminoglycosides in Gram-negative bacteria. Between 2015 and 2017, 636 distinct commensal Escherichia (E.) coli isolates were collected from different farms in South Korea to determine the prevalence and molecular characteristics of rmtB. The positive rates of rmtB between all the isolates and amikacin-resistant isolates were 1.1 and 100%, respectively. High-level aminoglycoside resistance could be transferred by conjugation from rmtB-positive donors to higher amikacin-resistance efficacies. This is the first report of 16S rRNA methylase-encoding genes in E. coli isolated from food-producing animals in Korea.

Uso de la amikacina como profilaxis en pacientes sometidos a prostatectomía / Use of amikacin as prophylaxis in patients undergoing prostatectomy / Uso de amicacina como profilaxia em pacientes submetidos à prostatectomia

Resumen 17. El objetivo de este artículo es presentar la mejor evidencia científica disponible sobre el uso de la amikacina como profilaxis en pacientes sometidos a prostatectomía. La indicación de amikacina en cirugías tipo prostatectomías se remite al uso profiláctico, razón por la cual surge la inquietud sobre el beneficio de la administración del medicamento en estos pacientes tomando en cuenta que, entre los efectos adversos, se evidencia nefrotoxicidad y ototoxicidad principalmente en personas adultas mayores o con problemas renales previos. Se utilizó la metodología de práctica clínica basada en la evidencia (PCBE), partiendo de una pregunta clínica para posteriormente hacer las búsquedas electrónicas en bases de datos como: MEDLINE, Google académico y Cochrane Library Plus. Después de establecer los criterios de inclusión y exclusión y análisis crítico, se seleccionó cuatro documentos que se relacionan con la respuesta a la pregunta planteada. Los resultados para el análisis crítico fueron revisados minuciosamente a través de la plataforma informática FCL 2.0 con las plantillas correspondientes. La evidencia señala que ningún estudio respondió directamente a la pregunta clínica planteada, las investigaciones analizadas no demuestran evidencia que confirme que el uso profiláctico de la amikacina sea beneficioso en pacientes intervenidos quirúrgicamente. Se concluye que no se encuentró evidencia significativa que respalde el uso profiláctico de la amikacina para disminuir las infecciones. La profilaxis se enfoca en administrar en pacientes sometidos a procedimientos quirúrgicos urológicos como primera elección un antibiótico de menor espectro, ya que para administrar amikacina hay que cumplir con los lineamientos institucionales establecidos según la condición de cada usuario, tomando en cuenta los resultados de las pruebas de función renal pre y post administración.

Abstract 21. The aim of this article is to present the best available scientific evidence on the use of amikacin as prophylaxis in patients undergoing prostatectomy. The indication of amikacin in prostatectomy-type surgeries refers to prophylactic use, which is why the concern about the benefit of administering the drug in these patients arises, taking into account that, among the adverse effects, nephrotoxicity and ototoxicity are evidenced mainly in people older adults or with previous kidney problems. We used the evidence-based clinical practice methodology (PCBE), based on a clinical question to later perform the electronic searches in databases such as: MEDLINE, Google academic and Cochrane Library Plus. After establishing the inclusion and exclusion criteria and critical analysis, four documents were selected that relate to the answer to the question posed. The results for the critical analysis were thoroughly reviewed through the FCL 2.0 computer platform with the corresponding templates. The evidence indicates that no study directly responded to the clinical question posed, the investigations analyzed do not demonstrate evidence confirming that the prophylactic use of amikacin is beneficial in patients undergoing surgery. It was concluded that no significant evidence was found to support the prophylactic use of amikacin to reduce infections. Prophylaxis focuses on administering patients with urological surgical procedures as first choice a lower spectrum antibiotic, since to administer amikacin it is necessary to comply with established institutional guidelines according to the condition of each user, taking into account the results of the tests of renal function pre and post administration.

Resumo 25. O objetivo deste artigo é apresentar as melhores provas disponíveis sobre o uso da doença como profilaxia em pacientes com uma prostatectomia. A indicação de amicacina em cirugias tipo prostatectomia é remediada com o uso de profiláctico, a razão pela investigação surge sobre o benefício da administração do medicamento em estágios, a tomada de controle, entre os efetivos adversos, a evidência nefrotoxicidad e ototoxicidad principalmente em personas adultas mayores o com problemas renales previos. Use a metodologia de prática clínica baseada na evidência (PCBE), partindo de uma clínica pré-existente para o futuro sobre as bússulas electrónicas em bases de dados como: MEDLINE, Google académico e Biblioteca Cochrane Plus. Depois de estabelecer os critérios de inclusão e exclusão e análise crítica, selecione o documento que se relaciona com a resposta à pregunta plantada. Os resultados para a análise crítica foram revisados ​​minuciosamente através da plataforma informática FCL 2.0 com os plantillas correspondentes. A evidência é que o exame é respondido diretamente à consulta clínica plantada, as investigações não demonstram evidências que confirmam o uso profiláctico da amidação do mar em pacientes intervencionados quirúrgicamente. Se concluye que não há provas de que são importantes o uso do termo profiláctico da amicina para disminuir as infecciones. A profilaxia do enfarte na administração de doentes é um procedimento quirúrgico urológico como a primeira eleição do antibiótico de menor espectro, o que ajuda a administrar o feno que cumplir com os lineamentos institucionais estabelecidos segundo a condição de cada um, tomando os resultados dos exames de función renal pré y pós administración.

Clinico-Bacteriological Profile of Chronic Suppurative Otitis Media in a Teaching Hospital of Uttar Pradesh

Background: Chronic suppurative otitis media (CSOM) is a commonly encountered infection of the middle ear. It cancause extra cranial and intracranial complications and involves considerable morbidity. Although it is a global disease, its incidence has remained relatively higher in resource-constrained countries. Due to its recurrent nature and the development of resistant pathogenic organisms, control of infection poses a greatest therapeutic challenge. Knowledge of the local microbial flora in CSOM is essential for initiating empirical therapy. The objective of our study was to examine the current bacteriological profile and antibiotic sensitivity pattern to locally available antibiotics in CSOM. Methods: A total of 157 patients clinically diagnosed of CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and were processed as per standard microbiological techniques. Antibiotic sensitivity to ten locally available antibiotics was analyzed. Antibiotic susceptibility testing for bacterial isolates was conducted using Kirby-Bauer disc diffusion method. Results: Out of total 157 swabs bacterial growth was seen in 144 (91.72%) with Pseudomonas aeruginosa (28.5%) and Staphylococcus aureus (22.9%) being the most common bacterial isolates. Among the antibiotics tested amikacin (88.3%), ciprofloxacin (78.9%) and cotrimoxazole (78.2%) were found to be most active against all the isolates, whereas maximum resistance was seen for ampicillin (45.8%). Poor hygiene 79 (50.3%) and pond/river bath 51 (32.5%) were the two most common predisposing factors associated with CSOM. Conclusion: In the era of continuously increasing drug resistance among bacteria, periodic monitoring of the bacterial isolates causing CSOM and their antibiogram with clinical correlation is very important. Local antimicrobial susceptibility data should be utilized for formulating antibiotic policy for every institution. Our results will surely help in the modification of hospital’s current antibiotic policy and also will optimize the therapy to patients.

To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre

Background: Surgical site infection is a common cause of morbidity for the operated patients. Hence a cost effective and simple method was formulated and studied on cases of laparotomy and appendicectomy patients which can be categorized as dirty and contaminated wounds. Materials and methods: 25 cases and adequately matched controls were selected from patients who underwent laparotomy or appendicectomy which can be categorized as dirty or contaminated wounds. Cases were given local application Inj. Amikacin over the subcutaneous plane preoperatively and for the subsequent three post-operative days through a subcutaneously placed feeding tube along with systemic iv antibiotics. The control patients only received systemic IV antibiotics. ASEPSIS scoring was used to grade the post-operative surgical site infection in the cases and the corresponding controls, at the end of the first and second week after surgery. Various criterions were specifically evaluated such as the isolation of microbe from the wound site or the requirement of change of antibiotic at the end of the 1st or 2nd week and the tendency of prolonged stay in the hospital for more than 2 weeks. Results: It was observed that the cases that received the local Amikacin application as an adjuvant to systemic antibiotic showed significantly lesser incidence and/ or grading of SSIs in the first week and A.K. Rajendran, C. Arun Babu, Gnana Sezhian. To evaluate efficacy of local Amikacin therapy as an adjuvant to parenteral antibiotics in control of surgical site infection compared to parenteral antibiotic alone in a tertiary care centre. IAIM, 2018; 5(2): 64-71. Page 65 also lesser, but not statistically significant reduction of SSIs in the second week. The incidence of antibiotic change, hospital stay and isolation of microbe from the wound site was statistically found be to lesser in the study group compared to their controls. Conclusion: It is observed that the local therapy as an adjuvant is cost effective and without any significant local or systemic adverse effects in the prevention of SSIs in dirty and contaminated patients. But it was also observed that it did not have sustained effect for prolonged period beyond its time of administration (as evidenced by its lesser effect in the second week after surgery). It may be suggested that a further combination of suction drainage of the subcutaneous DT along with local antibiotic treatment may have added advantage in further preventing SSIs.

Prevalencia de infección de la vía urinaria y perfil microbiológico en mujeres que finalizaron el embarazo en una clínica privada de Lima, Perú / Prevalence of urinary tract infection and microbiological profile in women who end their pregnancy in a private clinic in Lima, Peru

Resumen Objetivo: Describir la prevalencia de infección de la vía urinaria en mujeres que finalizaron el embarazo en una clínica privada (nivel II-2) de Lima, Perú, además de conocer el perfil microbiológico e identificar la resistencia a los antibióticos. Materiales y métodos: Estudio retrospectivo, observacional y transversal efectuado en pacientes que finalizaron el embarazo en la Clínica Jesús del Norte del distrito de Independencia de Lima, Perú, entre enero de 2016 y diciembre del 2017. Criterio de inclusión: pacientes con al menos seis citas médicas de control prenatal en la clínica. Se obtuvo el resultado de los urocultivos y el de resistencia a los antibióticos. Se buscaron medidas de tendencia central como promedios, desviación estándar y frecuencias. Resultados: Se registraron 1455 pacientes que cumplieron con el criterio de inclusión; de éstas 108 (7.4%) tuvieron infección de la vía urinaria con urocultivo positivo. El microorganismo aislado con más frecuencia fue Escherichia coli en 70 (63.6%) casos, con resistencia a ampicilina (60.8%), ciprofloxacina (34.7%) y norfloxacina (34.7%), y sensibilidad a amikacina, nitrofurantoína y cefuroxima. En 13 (11.8%) pacientes también se identificó Escherichia coli y enterobacterias productoras de betalactamasas de espectro extendido resistentes a cefalosporinas. Conclusión: La prevalencia de infección de la vía urinaria estuvo dentro del valor de referencia expresado en los reportes internacionales (7.4%). Los microorganismos aislados con mayor frecuencia fueron E. coli y E. coli productora de betalactamasas de espectro extendido.

Abstract Objective: To describe the prevalence of urinary tract infections (UTI) and their microbiological profile in pregnant women attended in a private clinic of level II-2 of Lima, Peru. Materials and methods: An analytical cross-sectional observational study was conducted, in women they had their delivery in a private clinic during January 2016 to December 2017. Inclusion criteria were those who had at least 06 prenatal care. Results of urocultures and their respective antibiotic resistance were obtained. In the statistical analysis, central tendency measures such as averages, standard deviation and frequencies were found. Results: 1455 met the selection criteria. We found 108 patients (7.4%) with UTI with a positive urine culture. The 70 cases (63.6%) were Escherichia coli resistant to antibiotics such as: ampicillin (57.6%), ciprofloxacin (30.7%) and norfloxacin (30.7%), and sensitive to: amikacin, nitrofurantoin and cefuroxime. However, was is found that 13 (11.8%) had Escherichia coli BLEE resistant to cephalosporins. Conclusion: The prevalence of urinary infection was within what was expected in relation to international reports. The most commonly isolated uropathogen was Escherichia coli, followed by Escherichia coli BLEE.