Filogenia y resistencia de cepas de Escherichia coli productoras de betalactamasas de espectro extendido a los antibióticos en pacientes con cáncer hospitalizados en Perú / Phylogeny and antimicrobial resistance of extended-spectrum beta-lactamase- producing Escherichia coli from hospitalized oncology patients in Perú

Introducción. Las infecciones asociadas con la atención en salud constituyen un problema de salud pública porque aumentan la morbimortalidad de los pacientes, sobre todo de aquellos con factores de riesgo, como la inmunosupresión debida a enfermedades oncológicas. Es importante conocer la diversidad genética de los principales microorganimos causantes de infecciones hospitalarias mediante la vigilancia epidemiológica tradicional y la epidemiología molecular, para hacer un mejor seguimiento y detectar brotes tempranamente. Objetivo. Determinar el grupo filogenético y la resistencia a antibióticos de las cepas de Escherichia coli aisladas de pacientes con cáncer hospitalizados. Materiales y métodos. Se hizo un estudio de tipo transversal que incluyó 67 cepas de Escherichia coli productoras de betalactamasas de espectro extendido (BLEE). Se determinó el grupo filogenético, el perfil de resistencia a los antibióticos, los genes de resistencia a betalactámicos, el tipo de las muestras y los servicios de hospitalización de donde fueron recuperadas. Resultados. El grupo filogenético más frecuente fue el B2 (36 %). El 57 % de las cepas B2 fueron aisladas de muestras de orina y el 33 % provenía del servicio de urología. La resistencia a ciprofloxacino y gentamicina fue de 91 y 53 %, respectivamente, y el 79 % de las cepas tenía el gen blaCTX-M. Se encontró una relación significativa (p<0,05) entre los grupos filogenéticos y la resistencia a ciprofloxacina, así como a la edad del paciente. Conclusión. El filogrupo de E. coli predominante fue el B2. Se evidenció una gran resistencia a ciprofloxacina y gentamicina, una proporción elevada de cepas BLEE con el blaCTX-M, y una relación entre el grupo filogenético y la resistencia a ciprofloxacino.

Introduction: Healthcare-associated infections are a public health problem due to the increased morbimortality of patients, especially those with risk factors such as immunosuppression due to oncological diseases. It is essential to determine the genetic diversity of the main microorganisms causing healthcare infections by combining traditional epidemiological surveillance and molecular epidemiology for better outbreak follow-up and early detection. Objective: To determine the phylogenetic group and antibiotic resistance of Escherichia coliisolated from hospitalized oncologic patients. Materials and methods: We conducted a cross-sectional study of 67 strains of ESBL-producing Escherichia coli to determine their phylogenetic group and described their antibiotic resistance profile, beta-lactam resistance genes, as well as the type of sample and the hospitalization areas from which they were recovered. Results: The most frequent phylogenetic group was B2 (36%); 57% of B2 strains were isolated from urine and 33% came from the urology department. Resistance to ciprofloxacin and gentamicin was 92% and 53%, respectively, and 79% of the strains had the blaCTX-Mgene. A significant association (p<0.05) was found between the phylogenetic groups, ciprofloxacin resistance, and the age of the patients. Conclusion: The predominant E. coli phylogroup was B2. We evidenced high resistance to ciprofloxacin and gentamicin, a high proportion of ESBL strains with the blaCTX-M gene, and a significant association between the phylogenetic group and the resistance to ciprofloxacin.

Comparación de antibióticoterapia en la apendicitis complicada en pediatría / Comparison of antibiotic therapy in complicated appendicitis in pediatrics

INTRODUCCIÓN. La apendicitis aguda es una patología pediátrica quirúrgica que en su fase complicada requiere uso de antibióticos en el postoperatorio; encontrar la mejor opción como experiencia local, fue necesario. OBJETIVO. Comparar un esquema de antibioticoterapia triple vs un doble respecto a variables: demográficas, clínicas y de costos en pacientes pediátricos con apendicitis complicada. MATERIALES y MÉTODOS. Estudio analítico transversal. Población de 133 pacientes y una muestra de 93, operados por apendicitis complicada; 58 recibieron ampicilina + metronidazol + gentamicina y 35 ceftriaxona + metronidazol. Se comparó las variables: estadía hospitalaria, complicaciones y costo monetario de cada esquema. Se realizó en la Unidad de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, en el periodo enero de 2017 a octubre de 2018. Los datos fueron analizados con R-Studio 1.8.366 para Windows. RESULTADOS. No hubo diferencia estadística con respecto a: estadía hospitalaria (p=0,261); complicaciones como infección del sitio quirúrgico (p=0,196), re-intervención quirúrgica (p=0,653) y costo (p=0,059). CONCLUSIÓN. Se comparó el esquema de antibioticoterapia triple vs un doble, utilizados en apendicitis complicada en pediatría. No se encontró diferencias estadísticamente significativas en este reporte preliminar, con la diferencia de que con el esquema doble la frecuencia de administración fue menor y se evitó la exposición a los efectos colaterales de los aminoglicósidos.

INTRODUCTION. Acute appendicitis is a pediatric surgical pathology that in its complicated phase requires the use of antibiotics during the postoperative period; finding the best option as local experience was a must. OBJECTIVE. Compare a triple vs a double antibiotic therapy scheme respect demographic, clinical and cost variables in pediatric patients whit complicated apendicitis. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 133 patients and sample of 93, with complicated appendicitis; 58 received ampicillin + metronidazole + gentamicin and 35 ceftriaxone + metronidazole. The following variables were compared; hospital stay, complications and monetary cost of each scheme. It was performed in the Pediatric Surgery Unit of the Hospital of Specialties Carlos Andrade Marin, during january 2017, through october 2018. The data were analyzed with R-Studio 1.8.366 for Windows. RESULTS. There was no statistical difference regarding hospital stay (p=0.261); complications such as surgical site infection (p=0.196), re-surgical intervention (p=0.653); nor cost (p=0.059). CONCLUSION. Triple vs. Double antibiotic therapy scheme used in complicated appendicitis in pediatrics was compared. No statistically significant differences were found in this preliminary report, how ever with the double scheme the frequency of administration was lower and exposure to side effects of aminoglycosides was avoided.

Infecção do sítio cirúrgico após cesariana em uma maternidade de Manaus, Brasil: a importância do uso racional da antibioticoterapia / Surgical site infection after cesarean section in a maternity hospital in Manaus, Brazil: the importance of rational antibiotic therapy

Objetivo: Descrever o perfil epidemiológico e microbiológico das puérperas com diagnóstico de infecção após cesárea, caracterizando as infecções de sítio cirúrgico e o tratamento. Métodos: Coorte prospectiva de parturientes submetidas a parto cesáreo em maternidade pública de Manaus, Amazonas, Brasil, com diagnóstico de infecção de sítio cirúrgico, entre 1º de julho de 2019 e 30 de abril de 2020. Foram coletados dados epidemiológicos. Para a investigação do perfil microbiológico, foi realizada a identificação da cultura a partir da secreção da infecção do sítio cirúrgico e do antibiograma das culturas. Resultados: Um total de 81 pacientes foi diagnosticado com infecção de sítio cirúrgico durante o período de estudo. A taxa de infecção de sítio cirúrgico na maternidade em estudo foi de 6,0%. As pacientes possuíam baixa escolaridade e baixa renda mensal, com ocupações que requerem menor qualificação, sendo a maioria solteira. Entre as pacientes, 70,4% eram obesas e 28,4% apresentaram sobrepeso; 45,6% delas tiveram parto cesáreo de emergência e 29,6% não usaram antibióticos profiláticos. Staphylococcus aureus foi a cultura identificada mais frequentemente e apresentou resistência ao antibiótico mais prescrito: a gentamicina. Conclusão: A taxa de infecção do sítio cirúrgico foi alta durante o período do estudo. Ressaltamos a necessidade de um protocolo eficaz de identificação bacteriana e acompanhamento da puérpera. O conhecimento das características epidemiológicas e microbiológicas pode auxiliar no planejamento dos cuidados realizados pelas instituições de saúde para minimizar os casos de infecção de sítio cirúrgico e suas consequências.(AU)

Objective: To describe the epidemiological and microbiological profiles of puerperal women diagnosed with the infection after cesarean sections, characterizing the surgical site infections and treatment. Methods: Prospective cohort of parturients underwent cesarean delivery at a public maternity hospital in Manaus, Amazonas, Brazil, diagnosed with surgical site infection between July 1, 2019, and April 30, 2020. Epidemiological data were collected. To investigate the microbiological profile, both culture identification from surgical site infection secretion and antibiogram for the cultures were performed. Results: A total of 81 patients were confirmed to have surgical site infection during this study period; The surgical site infection rate in the maternity hospital under study was 6.0%. The patients presented a low level of education and monthly income, with occupations that require lower qualification, and most of them are single. Seventy point four percent of the patients were obese, and 28.4% were overweight. Forty-five point six percent of patients had an emergency cesarean delivery, and 29.6% did not use prophylactic antibiotics. Staphylococcus aureus was the most frequent culture identified from surgical site infection secretion and presented resistance to the most prescribed antibiotic, Gentamicin. Conclusion: The rate of surgical site infection was high during the study period. We highlight the need for an effective bacterial identification protocol and monitoring of puerperal women. Knowledge of epidemiological and microbiological characteristics can assist in the planning of care performed by the health institutions to minimize cases of surgical site infection and its consequences.(AU)

Diabetes Mellitus: fator de risco para toxicidade de medicamentos / Diabetes Mellitus: factor de riesgo para toxicidad de fármacos / Diabetes Mellitus: a risk factor for drug toxicity

RESUMO Objetivo Avaliar o efeito do antibiótico gentamicina em modelo experimental na presença de Diabetes Mellitus por meio da função renal e perfil oxidativo. Método Ratos Wistar, adultos, machos, foram distribuídos nos grupos: Citrato; Gentamicina (Genta), (gentamicina 100 mg/kg de peso corporal, 1 vez ao dia, intraperitoneal, i.p., 5 dias); DM (60 mg/kg de STZ, intravenosa, i.v., dose única, diluída em tampão citrato) e DM+Genta. Foram avaliados os parâmetros fisiológicos, a função renal (clearance de creatinina), a lesão oxidativa (peróxidos e substâncias reativas ao ácido tiobarbitúrico − TBARS urinários) e a hemodinâmica renal. Resultados O grupo Diabetes Mellitus apresentou hiperglicemia crônica, associada à perda de peso corporal, polifagia, polidipsia e poliúria, além de redução da função renal, com aumento na excreção de metabólitos oxidativos. A administração de gentamicina induziu a redução do fluxo sanguíneo renal e o aumento da resistência vascular renal em ratos saudáveis. A associação do Diabetes Mellitus com gentamicina resultou em redução adicional na função renal e elevação de metabólitos oxidativos, com aumento de resistência vascular renal. Conclusão A existência de Diabetes Mellitus determinou a elevação da nefrotoxicidade da gentamicina e se confirmou como fator de risco para nefrotoxicidade de medicamentos.

RESUMEN Objetivo Evaluar el efecto del antibiótico gentamicina en modelo experimental en la presencia de Diabetes Mellitus mediante la función renal y el perfil oxidativo. Método Ratas Wistar, adultas, machos, fueron distribuidas en los grupos: Citrato; Gentamicina (Genta), (gentamicina 100 mg/kg de peso corporal, 1 vez al día, intraperitoneal, i.p., 5 días); DM (60 mg/kg de STZ, intravenosa, i.v., dosis única, diluida en tampón citrato) y DM+Genta. Fueron evaluados los parámetros fisiológicos, la función renal (aclaramiento de creatinina), la lesión oxidativa (peróxidos y sustancias reactivas al ácido tiobarbitúrico - TBARS urinarios) y la hemodinámica renal. Resultados El grupo Diabetes Mellitus presentó hiperglucemia crónica, asociada con pérdida de peso corporal, polifagia, polidipsia y poliuria, además de reducción de la función renal, con aumento en la secreción de metabolitos oxidativos. La administración de gentamicina indujo a la reducción del flujo sanguíneo renal y al incremento de la resistencia vascular renal en ratas sanas. La asociación del Diabetes Mellitus con gentamicina resultó en reducción adicional en la función renal y elevación de metabolitos oxidativos, con aumento de resistencia vascular renal. Conclusión La existencia de Diabetes Mellitus determinó la elevación de la nefrotoxicidad de la gentamicina y se confirmó como factor de riesgo para nefrotoxicidad de fármacos.

ABSTRACT Objective To assess the effect of the antibiotic Gentamicin in an experimental model in the presence of Diabetes Mellitus through renal function and oxidative profile. Method Adult male Wistar rats were distributed into groups: Citrate; Gentamicin (Genta), (intraperitoneal, i.p. gentamicin, 100 mg/kg of body weight, once a day,5 days); DM (60 mg/kg of STZ (Streptozotocin), single dose, intravenously, i.v., diluted in citrate buffer); and DM+Genta. Physiological parameters, renal function (creatinine clearance), oxidative damage (peroxides and thiobarbituric acid reactive substances - urinary TBARS) and renal hemodynamics were evaluated. Results The Diabetes Mellitus group presented chronic hyperglycemia associated with loss of body weight, polyphagia, polydipsia and polyuria, in addition to reduced renal function and with an increase in oxidative metabolite excretion. Administration of gentamicin induced a reduction in renal blood flow and increased renal vascular resistance in healthy rats. The association of Diabetes Mellitus with gentamicin resulted in an additional reduction in renal function and elevation of oxidative metabolites, with increased renal vascular resistance. Conclusion The existence of Diabetes Mellitus resulted in an elevation of gentamicin nephrotoxicity, thus confirming the risk factor for drug nephrotoxicity.

Fabrication and biological effect investigation of the antibacterial drug delivery system with PEG-hydrogel and gentamicin-loaded-CSt on titanium surface / 中华骨科杂志

Objective To fabricate an antibacterial controlled drug delivery system with PEG-hydrogel and gentamicin-loaded-CSt on titanium surface,and to investigate its surface characteristics,swelling behavior,drug release behavior in vitro,antiinfection performance in vivo,and tissue biocompatibility.Methods Cross-linked starch (CSt) was synthesized first and then CSt was loaded with gentamicin (GEN) as a carrier (GEN@CSt),then 4-arm-polyethylene glycol (PEG) was added to it which was mixed by ultrasound.The surface of titanium (Ti) was covered with a layer of poly dopamine (PDA).The drug-loaded hydrogel was fixed to the titanium surface,subsequently capped by poly lactic-co-glycolic acid (PLGA) membranes,and then the Ti-PDA-PEG (GEN@CSt)-PLGA composite coating was fabricated finally.Surface morphology of the system was observed,while the swelling behavior was characterized;release behavior of the composite coating was detected;the bacteriostatic experiments were carried out with staphylococcus aureus (SAU),staphylococcus epidermidis (SEP) and escherichia coli (ECO) in vitro.The animal models of infected bone defect was established in 36 New Zealand white rabbits.These animals were randomly divided into three groups.Group 1 animals were implanted with drug-loaded composite coatings.Group 2 animals were implanted with drug-free composite coatings.Group 3 animals were implanted with bare titanium rods.The infection data were collected periodically to carry out antiinfection experiments in vivo.Another 12 rabbits were divided into the experimental group and the control group randomly.Biocompatibility of the materials was observed by histopathology after implantation of the corresponding materials into the femoral condyle.Results The composite coating adhered to the titanium surface firmly,presenting a smooth and translucent shape.The ratio of CSt/PEG affects swelling behavior varied,starch-free gels maintained an equilibrium swelling of 7.4,after the ratio reached 1 ∶ 1,the equilibrium swelling ratio remained at 3.0.In-vitro the release rate of the first 8 h was fast,and the cumulative release amount accounted for 83％ of the total in the first 7 days,lasting more than 13 d.In vitro antibacterial test,the average diameter of the inhibition ring was 3.6±0.13 cm (SAU),3.4±0.11 cm (SEP),3.7±0.10 cm (ECO).In-vivo anti-infection experiment,the infection situation of the group 1 was better than the control groups 2 and 3.The pathological results indicated that inflammatory reaction in the experimental group was basically the same as the control group.Conclusion The study successfully fabricated the antibacterial controlled drug delivery system with PEG-hydrogel and gentamicin-loaded-CSt on titanium surface.The system has a reasonable drug release behavior,and effectively inhibited the growth of bacteria in vivo and in vitro.It also has good biocompatibility to stand a promising strategy to improve the orthopedics anti-infection.

Priming previne a insuficiência renal aguda nefrotóxica através da estimulação do mecanismo de defesa antioxidante / Priming prevent nephrotoxic acute renal failure through stimulation of antioxidant defense mechanism

RESUMO Introdução: Priming é um mecanismo de proteção induzida pela exposição anterior de uma célula ou órgão a baixas ou mesmas concentrações de uma substância tóxica. Objetivo: analisar o mecanismo de priming induzido pela exposição a gentamicina em células tubulares proximais humanas e na insuficiência renal aguda (IRA). Métodos: Células tubulares foram expostos a 2 mM de gentamicina durante 24 horas, enquanto ratos Wistar foram expostas a 40 mg/kg durante 3 dias. Depois de uma semana, as células foram expostas à mesma concentração durante 24h e os ratos durante dez dias. Os animais condicionados foram comparados com ratos controle e tratados com gentamicina durante 10 dias. Foram analisados parâmetros bioquímicos, o estresse oxidativo foi analisado por hidroperóxidos e proteínas carboniladas urinárias, enquanto a defesa antioxidante foi estudada pela atividade antioxidante do plasma e imunomarcação e atividade da catalase, superóxido dismutase, heme oxigenase-1 (HO-1) nos rins. Necrose, apoptose, proliferação e expressão da endotelina-1 (ET-1) e HO-1 foram estudadas em células. Resultados: o condicionamento dos animais inibiu o aumento da creatinina, ureia, excreção urinária de sódio e de proteína induzida por gentamicina. Bosentana, antagonista do receptor ET-1, e hemin, indutor de HO-1, potencializaram a inibição. O mecanismo de proteção foi mediado pela indução de enzimas antioxidantes HO-1, catalase e SOD atividade e redução do estresse oxidativo. O condicionamento inibiu a morte celular e induziu a proliferação via produção de ET-1. Conclusão: o mecanismo de condicionamento é persistente e multifactorial, o estímulo da defesa antioxidante poderia mimetizar o processo de condicionamento e impedir a IRA.

ABSTRACT Introduction: Priming is the mechanism of protection induced by a previous exposition of a cell or organ to low or equal concentrations of a toxic substance. Objective: To analyze the mechanism of priming induced by the previous exposition to gentamicin in human proximal tubular cells and nephrotoxic acute renal failure (ARF). Methods: Wistar rats and tubular cells were exposed to gentamicin 2mM during 24h or 40 mg/kg during 3 days and after one rest week were exposed to the same concentration during 24h in cells and additional ten days in rats. The primed animals were compared to control rats receiving vehicle and GENTA animals treated with the gentamicin during the same period. Biochemical parameters were analyzed. The oxidative stress was analyzed by urinary hydroperoxides and carbonylated protein while antioxidant defense was studied by antioxidant activity of the plasma (FRAP), catalase, superoxide dismutase, heme-oxygenase 1 (HO-1) immunostaining and enzymatic activity in kidney. Necrosis, apoptosis, proliferation, endothelin 1 (ET-1) and HO-1 expression were studied in cells. Results: Priming of the animals inhibited the increase in creatinine, urea, sodium excretion and urinary protein induced by gentamicin. Bosentan, ET-1 receptor antagonist, and hemin, HO-1 inducer, potentiate the inhibition. The mechanism of protection was mediated by induction of the antioxidant enzymes HO-1, catalase and SOD activity and oxidative stress reduction. Priming inhibited cell death and induced proliferation through ET-1 production. Conclusion: Priming is a persistent and multifactorial mechanism, the stimulation of the antioxidant defense could mimics partially the priming process and prevent the ARF.

Study of Renal enzymuria and albuminuria activity in the Petals of Pink Nelumbo nucifera Gaertn.

Aim: The aim of the present study was to assess the activity of Nelumbo nucifera Gaertn. Petal extract (NNPE) in tubular enzymes and in urinary albumin of Gentamicin (GM) induced renotoxic rats. Material and methods: The study was conducted for fourteen days in twenty-four rats in four groups and the study was designed as ,Group I: Control group received 0.5% CMC; Group II: GM 100mg/kg/day i.p. Group III: NNPE extract (200mg/kg/day p.o.) + GM (100mg/kg/day i.p.); Group IV: NNPE extract (400mg/kg/day p. o) + GM (100mg/kg/day i.p.).After the last injection of GM, 24-hour urine samples were collected from all the groups to analyze the levels of tubular marker enzymes N-acetyl-β-D-glusosaminidase (NAG), Gama Glutamyl transpeptidase (GGT), Alkaline phosphatase (ALP) and Lactate dehydrogenase (LDH) and Albumin in urine to determine the extent of renal tubular damage by measuring renal enzymuria and albuminuria in toxic rats induced by Gentamicin. Results: Levels of tubular marker enzymes and albumin were increased in Group-II and in treatment with N. nucifera Gaertn. Petal extract with different doses brought back to normal levels in tubular marker enzymes as well as albumin in urine for Group- III and Group- IV. Conclusions: The present study revealed that N. nucifera Gaertn. Petal extract possess potent protective effect in both doses due to its high antioxidant property against renal enzymuria and albuminuria.

Study of variables involved in hospital-acquired urinary tract infections at a university hospital / Estudo de variáveis envolvidas em infecção do trato urinário nosocomiais em um hospital universitário

OBJECTIVE: Analyze bacteria involved in urinary tract nosocomial infections (UTIs), their sensitivity profile, and other correlated clinical variables. METHODS: This was a retrospective study, based on the analysis of positive urine culture reports (from100,000CFU/ml) for nosocomial infection covering the years 2009, 2010 and 2011, and on medical records. Statistical analysis was performed through SPSS 19.0 software, using chi-square tests with Yates correction and Pearson's correlation coefficient. p<0.05 was considered statistically significant. RESULTS: The sample consisted of 74 positive urine cultures, 64.9% of which from females, and 58.1% of which from patients above 50 years of age. Medical conditions accounted for 87.8% of cases, and nervous and gastrointestinal problems were the most prevalent. Hospital stay ranged from 56.7±35.7 days; 51.4% of the patients used indwelling urinary catheter, 54% of whom over a 30 day period. Klebsielle pneumoniae and Escherichia coli together accounted for 60.8% of cases. Amikacin, Gentamicin, Cefoxitin, Piperacillin-tazobactam, Imipem, Meropenem and Ertapenem showed ≥50% sensitivity. There were correlations between symptoms associated to UTI and antibiotic use after urine culture (p=0.02), and catheter use and duration of hospital stay (p=0.04). CONCLUSIONS: Female patients over 50 years of age with underlying clinical conditions originated in the nervous system or the gastrointestinal apparatus making use of indwelling urinary catheters for over 30 days and a hospital stay period of 56.7±35.7 days are more likely to develop nosocomial UTIs. Amikacin, Gentamycin and Cefoxitin are feasible options for empirical antibiotic therapy against the two most prevalent bacteria.

OBJETIVO: Analisar as bactérias envolvidas nas infecções do trato urinário (ITUs) nosocomiais, perfil de sensibilidade, e outras variáveis clínicas correlacionadas. MÉTODOS: Estudo retrospectivo, com base na análise dos laudos de urocultura positiva (a partir de 100 mil UFC/ml) para infecção nosocomial abrangendo os anos 2009, 2010 e 2011, em prontuários médicos. A análise estatística foi realizada no SPSS 19.0, utilizando os testes do qui-quadrado com correção de Yates e coeficiente de correlação de Pearson. Considerou-se estatisticamente significativo p<0,05. RESULTADOS: A amostra constitui-se de 74 uroculturas positivas, sendo 64,9% do sexo feminino, com 58,1% acima de 50 anos. As patologias clínicas corresponderam a 87,8% dos casos, sendo sistema nervoso e gastrointestinal os de maiores prevalências. Tempo de permanência hospitalar foi de 56,7±35,7 dias, 51,4% fizeram uso de SVD, sendo 54% destes com uso acima de 30 dias. As bactérias Klebsielle pneumoniae e Escherichia coli representaram juntas 60,8% dos casos. Os antibióticos Amicacina, Gentamicina, Cefoxitina, Piperaciclina-tazobactam, Imipem, Meropenem e Ertapenem apresentaram sensibilidade ≥50%. Houve correlação entre sintomas associados à ITU e uso de antibiótico após urocultura (p=0,02); tempo de uso de sonda e tempo de permanência hospitalar (p=0,04). CONCLUSÕES: Pacientes femininos com mais de 50 anos e doença de base clínica, de origem no sistema nervoso ou gastrointestinal, em uso de SVD por mais de 30 dias e tempo de permanência hospitalar de 56,7±35,7 dias, estão entre as mais propensas a desenvolverem ITU nosocomial. A Amicacina, Gentamicina e Cefoxitina apresentaram opções factíveis para a antibioticoterapia empírica as duas bactérias mais prevalentes.

Resposta à Triagem Auditiva em Neonatos do Projeto Canguru Usuários de Medicamentos Ototóxicos / Hearing Screening Response in Neonates of the Kangaroo Project Using Ototoxic Medicines

Avaliar a resposta à triagem auditiva em recémnascidosque participaram do projeto Mãe Canguru eutilizaram medicamentos ototóxico. Material e métodos:Estudo do tipo transversal observacional quantitativo, comamostra de 66 pacientes. Foram incluídos na pesquisa recémnascidosque utilizaram pelo menos um medicamentoototóxico (Gentamicina, Vancomicina, e Furosemida)participantes do Projeto Canguru da Maternidade CândidaVargas em João Pessoa - PB no período de Novembro de2012 a Março de 2013. As variáveis quantitativas foramexpressas em média e desvio-padrão, e as variáveisqualitativas foram expressas por frequências absolutas erelativas. O resultado do teste de EOA e de outras variáveisfoi feito utilizando-se o teste qui-quadrado e calculada pelosoftware SPSS versão 21.0. Adotou-se o nível designificância (p) de 5%. Resultados: Dos 66 pacientesincluídos na pesquisa, 45 pacientes (68,2%) utilizaramototóxicos, e 21 (31,8%) não. A Gentamicina foi usada por43 neonatos, a Furosemida por 8 e a Vancomicina por 6.Entre os pacientes que fizeram uso de medicamento ototóxico,95,2% tinham o teste da orelhinha normal e 2 apresentaramresposta ausente (4,8%) (p=0,4). Conclusão: Resultadospositivos e negativos na triagem auditiva foram encontradostanto em recém-nascidos que usaram como naqueles quenão usaram drogas ototóxicas. Não sendo significativo ouso isolado do medicamento nos neonatos que tiveramresposta ausente no teste de EOA...

To evaluate the hearing screening response innewborns who participated in Kangaroo Mother Project andused ototoxic drugs. Material and methods: This is a crosssectional,quantitative study including a sample of 66newborns who made use of at least one ototoxic drug(gentamicin, vancomycin, and furosemide) participating ofthe Kangaroo project at the Candida Vargas Hospital in JoãoPessoa, PB, Brazil, from November 2012 to March 2013.Quantitative variables were expressed as mean and standarddeviation, and qualitative variables were expressed asabsolute and relative frequencies. The correlation betweenthe results of the OAE test and other variables was performedusing the chi-square test and calculated by SPSS softwareversion 21.0, with a significance level (p) of 5%. Results: Ofthe 66 patients included in the study, 45 (68.2%) had usedototoxic drugs and 21 (31.8%) had not. Gentamicin wasused for 43 neonates, furosemide by 8 and vancomycin by6. Among the patients who made use of ototoxic medication,95.2% had normal OAE test and 2 had absent response(4.8%) (p = 0.4). Conclusion: Positive and negative resultsin the hearing screening were found both in newborns whoused or did not use ototoxic drugs. The isolated use of drugby newborns with absent response in the OAE test was notsignificant...

The effect of high concentration of magnesium with ropivacaine, gentamicin, rocuronium, and their combination on neuromuscular blockade / 대한마취과학회지

BACKGROUND: Magnesium, ropivacaine, gentamicin, and rocuronium block neuromuscular (NM) transmission by different mechanisms. Therefore, concurrent administration of these agents may induce prolonged muscle paralysis via synergistic interaction. This study investigated the efficacy and safety of NM block caused by the administration of high concentrations of magnesium in combination with ropivacaine, gentamicin, and rocuronium. METHODS: Eighty-three left phrenic nerve-hemidiaphragms from male SD rats (150-250 g) were hung in Krebs solution. Three consecutive single twitch tension (ST, 0.1 Hz) and one tetanic tension (TT, 50 Hz for 1.9 s) were obtained before drug application and at each new drug concentration. The concentration of MgCl2 and MgSO4 in Krebs solution was increased until an 80 to 90% reduction in ST was reached. To test the effects of combinations of NM agents, a Krebs solution was premixed with MgCl2 alone, MgCl2 and ropivacaine, or MgCl2, ropivacaine, and gentamicin. The concentration of ropivacaine, gentamicin, or rocuronium was then progressively increased until an 80 to 90% reduction in ST was reached. The effective concentrations were estimated with a probit model. RESULTS: The potency of MgCl2 was greater than that of MgSO4, and pretreatment with MgCl2 increased the potency of gentamicin and rocuronium. Unexpectedly, MgCl2 did not potentiate ropivacaine, and the potency of gentamicin and rocuronium failed to show an increase when premixed with 0.5 microM ropivacaine. CONCLUSIONS: The concomitant administration of high concentrations of magnesium and ropivacaine together with clinically relevant concentrations of gentamicin or rocuronium potentiated NM blockade but not with clinically relevant concentrations of ropivacaine.

Severe scleral dellen as an early complication of pterygium excision with simple conjunctival closure and review of the literature / "Dellen" escleral grave como complicação precoce de excisão de pterígio com fechamento conjuntival simples e revisão da literatura

We describe a patient with acute scleral dellen (SD) after pterygium excision with simple conjunctival closure. In addition, we present a PUBMED review on the medical literature on early SD after pterygium surgery. This case describes a 45-year-old man who presented with severe SD, 7 days after pterygium surgery with minimal cauterization of episcleral vessels and simple conjunctival closure. No other adjunctive therapy was used intraoperatively. The patient refused conjunctival flap coverage of the lesion. Therefore, medical treatment consisted of antibiotic ointment, patching, and daily follow-up. After 7 days, the patching was changed for intensive ocular lubrication. Five weeks later, the surrounding conjunctiva had completely covered the affected sclera. To the best of our knowledge, this is the first report of early SD following pterygium excision and simple conjunctival closure with no other adjunctive therapy. When performing pterygium excision with conjunctival coverage of the sclera, a close follow-up is recommended to rule out wound dehiscence and SD, even when surgical wound closure is considered to prevent SD. If this complication is detected, the treatment can be conservative.

Descrevemos um paciente com "dellen" escleral agudo (SD) após excisão de pterígio com fechamento conjuntival simples. Uma revisão adicional da literatura médica sobre SD precoce após a cirurgia de pterígio também é realizada. Este caso descreve um homem de 45 anos de idade, que apresentou SD grave, sete dias após a cirurgia de pterígio com cauterização mínima de vasos episclerais e fechamento conjuntival simples. Nenhuma outra terapia adjuvante foi utilizada no intraoperatório. O paciente recusou-se à cobertura de retalho conjuntival da lesão. Portanto, o tratamento médico consistiu em pomada antibiótica, oclusão e acompanhamento diário. Após sete dias, a oclusão foi mudada para a lubrificação ocular intensiva. Cinco semanas após, a conjuntiva cobriu completamente a esclera afetada. Ao melhor de nosso conhecimento, este é o primeiro relato de SD precoce após a excisão do pterígio e fechamento conjuntival simples com nenhuma outra terapia adjuvante. Ao realizar a excisão do pterígio com cobertura conjuntival da esclera, um acompanhamento frequente é recomendado para descartar a deiscência da ferida e SD. Se esta complicação for detectada, o tratamento pode ser conservador.

Expression of Rac1 in normal and gentamicin-induced ototoxic damaged cochlea of guinea pigs / 中国医师杂志

Objective To investigate the expression of Rac 1 in the guinea pig cochlea of gentamicin-induced ototoxic damage and prevention with antioxidant sodium salicylate , and to explore the roles of Rac 1 in the ototoxic mechanism of aminoglycoside antibi-otics.Methods Thirty healthy male guinea pigs were involved in this study .All the guinea pigs were randomly divided into 3 groups and received intraperitoneal injections according to their arranged group .Group I (control) was treated with normal saline for 7 days. Group II [Gentamicin (GM)] was treated with gentamicin alone for 7 days.Group III [GM+sodium salicylate(SA)] was treated with gentamicin in combination with sodium salicylate for 7 days.Paraffin-embedded cochlear section with immunohistochemical stai-ning was used for evaluation of Rac 1 expression in the cochlea .The protein was extracted from the cochlea tissues , and Rac1 protein levels in the cochlea were detected by Western blot assay .Results Immunohistochemistry showed a slightly positive reaction for Rac 1 staining found in the cochlea of the control group was mainly shown in the cytoplasm and cytomembrane of ganglion and organ of Corti ;a highly positive expression was shown in GM group;and the extent of Rac 1 expression of GM+SA group was between the control and GM groups.Image analysis showed that the differences in Rac1 expression between each two groups were statistically significant ( P <0.05).Western blot assay showed that expression of Rac 1 protein was highest in GM group and decreased in GM +SA group, while the intensity of Rac1 protein expression in GM +SA group was between the control and GM group .Statistics analysis showed that the expression between each two groups had significant difference ( P <0.05 ) .Conclusions A slightly positive reaction for Rac 1 stai-ning was found in the cochlea of guinea pigs , and mainly observed in the cytoplasm and cytomembrane of spiral ganglion and organ of Corti.With the administration of gentamicin , Rac1 protein expression was upregulated in the cochlea .Simultaneous administration of antioxidant sodium salicylate could significantly decrease the expression of Rac 1 protein.These results indicated that Rac1 might play an important role in the processes of gentamicin-induced oxidative damage of cochlea .

Protective Effect of Metformin on Gentamicin-Induced Vestibulotoxicity in Rat Primary Cell Culture

OBJECTIVES: One of the antidiabetic drugs, metformin, have shown that it prevented oxidative stress-induced death in several cell types through a mechanism involving the opening of the permeability transition pore and cytochrome c release. Thus, it is possible that the antioxidative effect of metformin can also serve as protection against gentamicin-induced cytotoxicity related to reactive oxygen species (ROS). The aim of this study was to examine the protective effect of metformin on gentamicin-induced vestibulotoxicity in primary cell culture derived from rat utricle. METHODS: For vestibular primary cell culture, rat utricles were dissected and incubated. Gentamicin-induced cytotoxicity was measured in both the auditory and vestibular cells. To examine the effects of metformin on gentamicin-induced cytotoxicity in the primary cell culture, the cells were pretreated with metformin at a concentration of 1 mM for 24 hours, and then exposed to 2.5 mM gentamicin for 48 hours. The intracellular ROS level was measured using a fluorescent dye, and also measured using a FACScan flow cytometer. Intracellular calcium levels in the vestibular cells were measured with calcium imaging using Fura-2 AM. RESULTS: Vestibular cells were more sensitive to gentamicin-induced cytotoxicity than auditory hair cells. Metformin protects against gentamicin-induced cytotoxicity in vestibular cells. Metformin significantly reduced a gentamicin-induced increase in ROS, and also reduced an increase in intracellular calcium concentrations in gentamicin-induced cytotoxicity. CONCLUSION: Metformin significantly reduced a gentamicin-induced increase in ROS, stabilized the intracellular calcium concentration, and inhibited gentamicin-induced apoptosis. Thus, Metformin showed protective effect on gentamicin-induced cytotoxicity in vestibular primary cell culture.

Establishment of New Zealand rabbit BMSCs-gentamicin-calcium alginate 3D sustained-release system and in vitro evaluation / 第二军医大学学报

Objective To establish a New Zealand rabbit bone marrow mesenchymal stem cells (BMSCs)-gentamicin- calcium alginate 3D sustained-release culture system and to study the growth and differentiation of BMSCs. Methods BMSCs- calcium alginate 3D culture system (W group) and BMSCs-gentamicin-calcium alginate 3D sustained-release culture system (U group) were constructed and were cultured with HG-DMEM (15% FBS, 10 ng/mL TGF-fh) under saturated humidity, 37°C and at 5% CO2, with the culture medium changed on a daily basis, and the cell morphology and microsphere morphology changes were observed. H-E staining, toluidine blue staining and type H collagen staining were performed for the microspheres on week 2,4, and 6. Results Cell clusterswere formed locally in the two groups after the 3D microspheres were cultured for 10 days. A large number of cell clusters were formed after 21 days, and BMSCs maintained a spherical or approximate spherical shape. There was no significant difference in cell proliferation or growth between the two groups (P>0. 05). After a 2-week culture, toluidine blue staining of microspheres showed positive staining in both groups, but with no obvious extracellular matrix formation, and staining for collagen type H antibody was weakly positive. After a 4-week culture, toluidine blue staining was obvious in the periphery of the cell microspheres in both groups, but the staining was unapparent in the center; extracellular matrix around the cell clusters had less blue colored substance, and the central cell clusters had more mauve substance; collagen type E staining was strongly positive in both groups. Conclusion Local sustained-release of appropriate amount of gentamicin has no noticeable effect on the growth and transformation of BMSCs while reaching the minimum inhibitory concentration. The influence of Gentamicin on ultrastructure of BMSCs and chondrocytes remains to be further investigated.

Analysis of multiple drug resistance of 2311 strains of Helicobacter pylori isolated from patients of different ages / 中华消化杂志

Objective To investigate condition of single drug or multiple drug resistance and sensitivities of different combinations of antibiotics in Helicobacter pylori (H.pylori) infected patients of different ages in Jiaxing City,Zhejiang Province.Methods From January 2007 to December 2011,a total of 6280 patients underwent gastroendoscopy examination were enrolled,the average age of them was 50.8 years old.Among them,129 cases were less than 20 years old,1802 cases were between 20 and 40,3016 cases were between 40 and 60,and 1333 cases were over 60.The mucosa of gastric antrum was collected for H.pylori culture.Drug sensitivity of isolated H.pylori strains was tested with metronidazole,amoxicillin and gentamycin,furazolidone,clarithromycin and levofloxacin.x2 test was performed for the comparison of drug resistance among different age groups.Results Among 6280 specimens,H.pylori culture of 2311 cases was positive (positive rate 36.80％).The positive rate of patients aged between 40 and 60 was the highest (38.43％,1159/3016),and that of patients over 60 was the lowest (33.76％,450/1333).The drug resistance rate of metronidazole in patients between 20 and 40 years reached 98.02％ (644/657) and was the highest.The drug resistance rate of clarithromycin in patents over 60 years old was the highest,which was 22.67％(102/450).The drug resistance rates of the levofloxacin,furazolidone,amoxicillin and gentamicin were low of all ages.Mixed resistance of two antibiotic appeared in 586 strains,mixed resistance rate of metronidazole and clarithromycin was the highest (259 strains,15.23 ％).Mixed resistance of three drugs appeared in 49 strains,mixed resistance rate of metronidazole,clarithromycin and levofloxacin was the highest (32 strains,12.88％).A total of 1691 strains were sensitive to the combination of amoxicillin and gentamycin,the sensitive was rate 99.41％.The sensitive rate of the combination of amoxicillin and furazolidone,gentamycin and furazolidone was both 94.24％.Conclusions Metronidazole presented high drug resistance of all ages,and should not be chosen.The combination use of amoxicillin and gentamicin is the ideal antibiotic combination for different ages.The combination of gentamycin and furazolidone is recommended for patients who are allergic to penicillin.

The in vitro study of gentamicin combined with trisodium citrate for locking solution in preventing catheter-related bloodstream infection / 中华检验医学杂志

Objective To predict the effectiveness of gentamicin combined with trisodium citrate for locking solution in preventing catheter-related bloodstream infection.Methods This is a retrospective study,ten kinds of common pathogens in catheter-related bloodstream infections were selected from medical intensive care unit (n =9) and cardiac care unit (n =1) between July 2011 and July 2012,and the diffusion method was used to analyze the inhibitory effect of gentamicin combined with trisodium citrate against tested pathogens.Results When trisodium citrate was tested alone,a certain antimicrobial activity could be detected from 10％ trisodium citrate,only Staphylococcus aureus and Staphylococci haemolyticus were inhibited,and then Enterococcus faecium was inhibited by 30％ trisodium citrate.Compared with trisodium citrate,gentamicin showed stronger antimicrobial activity.Staphylococcus aureus,Staphylococci haemolyticus,Enterococcus faecium and Escherichia coli could be inhibited by 0.32 g/L gentamicin and the antimicrobial activity was enhanced by increasing concentrations.The maximum activity was in 5 g/L gentamicin with 7-17 mm diameters.However,the antimicrobial activity of gentamicin didn't increase when combined with trisodium citrate,especially in 4％ trisodium citrate,the Staphylococci haemolyticus was not inhibited by all of the combinations with any concentration of gentamicin.In 0.32 g/L gentamicin,only the combination with 50％ trisodium citrate could inhibit the four kinds of pathogens (Staphylococcus aureus,Staphylococci haemolyticus,Enterococcusfaecium and Escherichia coli) with 8-21 mm diameters,while in 1 g/L,2 g/L,and 5 g/L gentamicin,these pathogens could be inhibited by the combination with only 10％ trisodium citrate,and the diameters were 5-24 mm,12-27 mm,and 17-28 mm,respectively.Conclusion Based on the data,gentamicin combined with trisodium citrate lock solution may play an important role in preventing catheter-related bloodstream infections caused by Gram-positive bacteria and Escherichia coli.

Meta analysis of the bacteria culture results after conjunctiva sac irrigation by two common disinfectant / 中华检验医学杂志

Objective To provide strong evidence for sterilization standardization by comparing the results of bacteria culture after conjunctiva sac irrigation by gentamicin and povidone-iodine (PVI) and analyzing the sterilization effect of these two common disinfectant.Methods Six randomized control trials comparing the sterilization effect between gentamicin and PVI in conjunctiva sac irrigation were retrieved through the following databases:Pubmed,Embase,Cochrane Library,WANFANG DATA,CNKI and VIP database.Relative Risk (RR) was set as the effect indexes to evaluating the conjunctiva sac bacterial-culture results before and after irritation.The data of these articles were processed with Meta analysis by random model.The side effects of both dilutions were also compared using the descriptive analysis.Results Before irrigation,bacteria in the sac were mostly gram-positive coccus,among which Staphylococcus epidermidis and Staphylococcus aureus were most common.The detection rate of these two bacteria were 30.5％ (226/740) and 2.4％ (18/740),and the constituent ratio were 65.5％ and 5.2％ respectively.After irrigation,the number of the bacteria was decreased dramatically,but could not be totally eliminated.There was no significant difference in sterilization effect between gentamicin and PVI after conjunctiva sac irrigation.The weighted average value of RR was 0.51 with 95％ confidence interval (CI) in (0.25,1.06),P =0.07.Comparing to gentamicin,PVI was less comfortable after conjunctiva sac irrigation,but when the concentration was regulated,it would be acceptable by patients and didn't affect surgeries.Conclusions There was no significant difference in sterilization effect between gentamicin and PVI in conjunctiva sac irrigation.The side effect of PVI was minor in low concentration.PVI is more specific to the bacteria species than gentamicin.Using PVI was recommended in preoperation sterilization.

A influência do laboratório no tratamento da ceratite infecciosa / The influence of the laboratory in the treatment of the infectious keratitis

OBJETIVO: Avaliar a resposta terapêutica das ceratites infecciosas e sua correlação com o resultado laboratorial. MÉTODOS: Foram estudados 62 casos retrospectivamente de ceratite infecciosa de moderada à grave, atendidos no Hospitaldo Servidor Público Estadual de São Paulo no período de janeiro de 2000 a dezembro de 2006. Foi avaliada a resposta ao tratamento tópico com colírios antibióticos (Cefalotina 50mg/ml e Gentamicina 14mg/ml ou Ciprofloxacino 0,3 por cento), verificando-se a necessidade de modificação da terapêutica inicial de acordo com a evolução clínica e correlação com os testes microbiológicos pré-tratamento. RESULTADOS: Observou-se que 21 culturas (33,9 por cento) foram positivas e 41 (66,1 por cento) foram negativas. Houve crescimento de fungo em uma amostra (1,6 por cento). Em apenas dois casos (3,5 por cento) houve correlação do exame bacterioscópico com o da cultura. Em 5 casos (8,1 por cento) houve necessidade de modificação da medicação devido à piora clínica e 91,9 por cento dos pacientes cursaram com cura do processo infeccioso com o tratamento inicial instituído. CONCLUSÃO: O uso tópico de antibióticos fortificados ou quinolonas foi eficaz no tratamento das ceratites de provável etiologia infecciosa com culturas positivas e negativas.

PURPOSE: To evaluate the initial treatment of infectious keratitis, evolution and their correlation with laboratory tests. METHODS: 62 cases of infectious corneal ulcers seen in the Hospital do Servidor Público Estadual - São Paulo underwent Gramstaining and culture for bacterial and fungus. Treatment with fortified Cefalotine (50mg/ml) and Gentamicin (14mg/ml) or fluoroquinolone 0,3 percent was started. RESULTS: 21 cultures (33,9 percent) were positive for bacterial infection and 41 (66,1 percent) showed no growth. Just one case was positive for fungus(1,61 percent). In 2 cases (3,5 percent) the Gram staining showed correlation with the culture. Five cases (8,8 percent) did not respond to the initial treatment and had the medications changed and 91,9 percent responded to the initial clinical treatment. CONCLUSION: Ours results showed that combination of fortified eye drops or quinolones was efficient to treat infectious corneal ulcers with positive or negative cultures.

A Case of Posterior Fossa Meningioma Presenting with Meniere's-Like Symptoms / 대한이비인후과학회지

Posterior fossa meningioma located on the endolymphatic sac may present Meniere's disease-like symptoms possibly due to endolymphatic hydrops by tumor compression. A 70-year-old woman presented with recurrent vertigo and combined hearing loss that had lasted for 6 years. She had been diagnosed as left-sided posterior fossa meningioma with a maximum diameter of 20.3x7.7x12 mm about 10 years ago and had been followed up regularly. Since then she was found with a slightly increased tumor and thus referred to our department for the treatment of intractable recurrent vertigo accompanying Tumarkin attacks with secondary head trauma. Since pharmaceutical treatment was not effective, intratympanic gentamicin was repeatedly injected. After successful ablation of vestibular function, no further recurrence of vertigo or Tumarkin attack was reported. This case illustrates that posterior fossa meningioma can be intimately involved with endolymphatic sac and present symptoms and signs suggestive of endolymphatic hydrops.