ABSTRACT
ABSTRACT OBJECTIVE: This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU). METHODS: Data were collected relating to all episodes of GNB infection that occurred in a PICU between January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1) infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment, definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate antibiotic therapy, and the 7- and 30-day mortality. RESULTS: Multivariate logistic regression analyses showed significant relationships between MDR-GNB and hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p = 0.021) and healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p = 0.015). There were significant differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy. CONCLUSIONS: Hematologic malignancy and healthcare-associated infection were significantly associated with MDR-GNB infection in this sample of pediatric oncology patients.
RESUMO OBJETIVO: Este estudo visou a avaliar os preditores e resultados associados às infecções por bactérias gram-negativas multirresistentes (BGN-MR) em uma unidade de terapia intensiva pediátrica oncológica (UTIP). MÉTODOS: Foram coletados dados com relação a todos os episódios de infecção por BGN que ocorreram em uma UTIP entre janeiro de 2009 e dezembro de 2012. As infecções por BGN foram divididas em dois grupos para comparação: 1) infecções atribuídas a BGN-MR e 2) infecções atribuídas a BGN não multirresistente. As variáveis de interesse incluíram idade, sexo, presença de tumor sólido ou malignidade hematológica, câncer, uso de cateter venoso central, infecção anterior por Pseudomonas aeruginosa, infecção hospitalar, neutropenia nos sete dias anteriores, duração da neutropenia, tempo de internação antes da UTI, duração da internação na UTI e uso de quaisquer dos seguintes nos 30 dias anteriores: agentes antimicrobianos, corticosteroides, quimioterapia ou radioterapia. Outras variáveis incluíram: tratamento antimicrobiano inicial adequado, tratamento antimicrobiano definitivo inadequado, duração do uso de antibióticos adequados, tempo de início da terapia antibiótica adequada, mortalidade em sete dias e mortalidade em 30 dias. RESULTADOS: As análises de regressão logística multivariada mostraram relações significativas entre as BGN-MR e as doenças hematológicas (razão de chance (RC) 5,262; intervalo de confiança de 95% (IC de 95%) 1,282-21,594; p = 0,021) e infecções hospitalares (RC 18,360; IC de 95% 1,778-189,560; p = 0,015). Houve diferenças significativas entre os pacientes com BGN-MR e BGN não MR com relação às seguintes variáveis: recebimento de terapia antibiótica empírica inicial inadequada, tempo para início do tratamento antibiótico adequado e recebimento de terapia antibiótica inadequada. CONCLUSÕES: A malignidade hematológica e a infecção hospitalar foram significativamente associadas à infecção por BGN-MR nessa amostra de pacientes pediátricos oncológicos.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/drug effects , Gram-Negative Bacterial Infections/microbiology , Hematologic Neoplasms/microbiology , Pseudomonas Infections/microbiology , Acinetobacter Infections/microbiology , Acinetobacter baumannii/isolation & purification , Anti-Bacterial Agents/therapeutic use , Case-Control Studies , Cross Infection/drug therapy , Cross Infection/mortality , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/mortality , Hematologic Neoplasms/drug therapy , Hematologic Neoplasms/mortality , Intensive Care Units, Pediatric/statistics & numerical data , Length of Stay/statistics & numerical data , Pseudomonas aeruginosa/isolation & purification , Risk Factors , Treatment OutcomeABSTRACT
El propósito del presente trabajo fue determinar la potencia antimicrobiana de extractos alcohólicos de plantas utilizadas popularmente en Argentina como antisépticos y antiinflamatorios: Dasyphyllum diaconthoides, Erythrina cristagalli, Larrea cuneifolia, Larrea divaricata, Phytolacca dioica, Pithecoctenium cynanchoides, Prosopanche americana, Schinus molle, Schkuhria pinnata, Senna aphylla y Solidago chilensis. La inhibición del crecimiento bacteriano se determinó a través de ensayos de difusión en agar, macrodilución en medio sólido y microdilución en medio líquido frente a 47 aislamientos clínicos multirresistentes a antibióticos, obtenidos de pacientes de un hospital de Tucumán, Argentina: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter cloacae, Serratia marcescens, Morganella morganii, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia. De acuerdo con los valores de concentración inhibitoria mínima (CIM), tres de las once especies ensayadas fueron las más activas: L. divaricata, L. cuneifolia, y S. aphylla (CIM de 25 a 200 µg/mL). P. mirabilis, A. baumanni y S. maltophilia fueron las cepas más susceptibles con valores de CIM entre 25 y 50 µg/mL seguido por P. aeruginosa con valores de CIM de 50 a 100 µg/mL. Los valores de concentración bactericida mínima (CBM) fueron semejantes o dos veces superiores a los valores de CIM. Mediante ensayos bioautográficos se comprobó que los extractos más activos presentaban al menos dos principios antimicrobianos. Análisis fitoquímicos indican que estos compuestos son de naturaleza fenólica. Los resultados obtenidos justificarían el uso de estos extractos para el tratamiento de infecciones bacterianas, especialmente aquellas de origen dérmico.
The present study was conducted to investigate antimicrobial activity of alcoholic extracts of Argentine medicinal plant species (Dasyphyllum diacanthoides, Erythrina cristagalli, Larrea cuneifolia, Larrea divaricata, Phytolacca dioica, Pithecoctenium cynanchoides, Prosopanche americana, Schinus molle, Schkuhria pinnata, Senna aphylla and Solidago chilensis) against multidrug resistant human pathogen gram negative bacteria isolated from a Hospital in Tucumán, Argentina. Inhibition of bacterial growth was investigated using disc diffusion, agar macrodilution and broth microdilution methods against multiresistant clinical isolates of nine different specie of gram negative bacteria: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter cloacae, Serratia marcescens, Morganella morganii, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia. A significant antimicrobial activity was found in three of the eleven plant species studied. Based on minimal inhibitory concentration (MIC) values, three plant species, L. divaricata, L. cuneifolia, and S. aphylla were the most potent ones with MIC values between 25-200 µg/mL. Overall, P. mirabilis, M. morganii and P. aeruginosa isolates were the most susceptible to these extracts with MIC values of 25 to 50 µg/mL. All extracts showed significant inhibitory activities on bacteria growth in a dose phenolic compound-dependent fashion. The minimal bactericidal concentration (MBC) values were identical to the MIC values or twofold higher than the corresponding MIC. Contact bioautography indicated that crude extracts possess several major antibacterial components. Phytochemical screening showed that the bioactive compounds correspond to polyphenols. Investigations are in progress to purify the bioactive principles.