Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 510
Filter
1.
ABCS health sci ; 47: e022202, 06 abr. 2022. tab
Article in English | LILACS | ID: biblio-1363542

ABSTRACT

INTRODUCTION: Tigecycline is an antimicrobial agent, approved for the treatment of complicated skin and soft tissue infections, hospital-acquired and community-acquired pneumonia, intra-abdominal infections and anaerobic or atypical infections. OBJECTIVE: To describe the use of tigecycline in a teaching hospital and to compare data from patients who had their prescriptions audited by the hospital infection committee with those who did not have audited prescriptions. METHODS: Retrospective observational cohort study conducted at a teaching hospital from April 2012 to March 2014 including patients who received tigecycline. Demographic variables, comorbidities, microbiological findings, prescribed antibiotics and technical opinions issued by the Hospital Infection Control Service were collected. RESULTS: 71 patients were included, aged between 13 and 92 years, 63.4% were male and 56.3% were non-white. Tigecycline was the first antimicrobial choice in 19.7% (14/71) of the cases, while the use associated with other antibiotics was observed in 66.2% (45/71) of the prescriptions. mainly with meropenem (28.9%). Empirical use was performed in 69.0% of cases, after culture and the antibiogram in 31.0% and off label use in 81.7%. The microorganisms frequently identified by the culture tests were Enterococcus faecalis (17.6%), Pseudomonas aeruginosa (14.7%) and Klebsiella penumoniae (11.8%). CONCLUSION: The study demonstrated that empirical and off label use is common in clinical practice and few prescriptions were guided by the results of the culture and the antibiogram, demonstrating the need for prescribers to evaluate the benefits/ risks of using this antibiotic, risk of resistance, adverse effects and drug interactions, in addition to cost.


INTRODUÇÃO: A tigeciclina é agente antimicrobiano, aprovada para o tratamento de infecções complicadas na pele e tecidos moles, pneumonia hospitalar e adquirida na comunidade, infecções intra-abdominal e infecções anaeróbias ou atípicas. OBJETIVO: Descrever o uso da tigeciclina em hospital de ensino e comparar dados de pacientes que tiveram suas prescrições auditadas pela comissão de infecção hospitalar com os que não tiveram prescrições auditadas. MÉTODOS: Estudo de coorte retrospectivo observacional realizado em hospital de ensino de abril de 2012 a março de 2014 incluindo pacientes que receberam tigeciclina. Foram coletadas variáveis ​​demográficas, comorbidades, achados microbiológicos, antibióticos prescritos e pareceres técnicos emitidos pelo Serviço de Controle de Infecção Hospitalar. RESULTADOS: Foram incluídos 71 pacientes, com idade entre 13 e 92 anos, 63,4% eram do sexo masculino e 56,3% eram não brancos. A tigeciclina foi primeira escolha antimicrobiana em 19,7% (14/71) dos casos, enquanto o uso associado a outros antibióticos foi observado em 66,2% (45/71) das prescrições. principalmente com meropenem (28,9%). O uso empírico foi realizado em 69,0% dos casos, após cultura e o antibiograma em 31,0% e o uso off label em 81,7%. Os microrganismos frequentemente identificados pelos testes de cultura foram Enterococcus faecalis (17,6%), Pseudomonas aeruginosa (14,7%) e Klebsiella penumoniae (11,8%). CONCLUSÃO: O estudo demonstrou que o uso empírico e off label é comum na prática clínica e poucas prescrições foram orientadas pelos resultados da cultura e do antibiograma, demonstrando necessidade de prescritores avaliarem os benefícios/riscos do uso desse antibiótico, risco de resistência, efeitos adversos e interações medicamentosas, além do custo.


Subject(s)
Humans , Male , Female , Tigecycline , Hospitals, University , Cross Infection , Off-Label Use , Anti-Infective Agents
2.
Univ. salud ; 24(1): 85-94, ene.-abr. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS, COLNAL | ID: biblio-1361189

ABSTRACT

Introducción: La resistencia a los antimicrobianos (RAM) es un problema de salud pública que manifiesta la disminuida eficacia de estos agentes en la prevención y tratamiento de una proporción cada vez más amplia de patologías. Los actinomicetos son un grupo bacteriano importante de productores de metabolitos activos contra patógenos. Objetivo: Aislar actinomicetos del bosque tropical de Nariño, con potencial producción de metabolitos inhibitorios contra bacterias multidrogo-resistentes. Materiales y métodos: Se tomaron muestras de suelo de Bosque Tropical Húmedo de la Reserva Natural del Río Ñambí, se analizaron microbiológica y molecularmente. Se estimuló la producción in vitro de metabolitos secundarios y evaluó el efecto inhibitorio de estos extractos contra las bacterias multidrogo-resistentes Escherichia coli y Staphylococcus aureus. Resultados: Se obtuvieron 11 aislados presuntivos, se confirmó que cuatro de ellos correspondieron al género Streptomyces sp. Las pruebas de inhibición contra bacterias multidrogo-resistentes E. coli y S. aureus, permitieron verificar que el aislado P3772 fue el más eficiente en la inhibición de los patógenos. Conclusiones: Todos los actinomicetos evaluados presentan actividad antibacteriana contra al menos una de las bacterias patógenas estudiadas; destacando el aislado P3772, que inhibe a E. coli y S. aureus. Se espera caracterizar los compuestos vinculados a la actividad antibacteriana.


Introduction: Antimicrobial resistance (AR) is a public health problem that reveals the diminished efficacy of these agents in the prevention and treatment of an increasingly larger number of pathologies. Actinomycetes are an important bacterial producer group of metabolites that are active against pathogens. Objective: To isolate actinomycetes from the tropical forest of Nariño (Colombia), which have the potential to produce inhibitory metabolites against multi-drug resistant bacteria. Materials and methods: Soil samples were taken from the Humid Tropical Forest of the Río Ńambí Natural Reserve and analyzed through microbiological and molecular assays. In vitro production of secondary metabolites was first stimulated, followed by the assessment of the inhibitory effect of these extracts against multi-drug resistant Escherichia coli and Staphylococcus aureus. Results: 11 presumptive isolates were obtained, confirming that four of them corresponded to the Streptomyces sp. genus. The bacterial isolate P3772 was identified as the one with the highest inhibitory effect against multi-drug resistant E. coli and S. aureus. Conclusions: All the actinomycetes evaluated presented antibacterial activity. The isolate P3772 stands out, which inhibited both E. coli and S. aureus. The compounds associated with this antibacterial activity will be characterized in future studies.


Subject(s)
Humans , Male , Female , Bacteria , Anti-Infective Agents , Staphylococcus aureus , Actinobacteria , Drug Resistance, Bacterial , Escherichia coli , Anti-Bacterial Agents
3.
Biomédica (Bogotá) ; 42(1): 54-66, ene.-mar. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1374507

ABSTRACT

Resumen Introducción. La creciente resistencia bacteriana a los antibióticos representa una amenaza mundial de salud pública. Las excreciones y secreciones larvarias derivadas de moscas necrófagas de la familia Calliphoridae podrían configurar una fuente promisoria para contrarrestar sus efectos. Objetivo. Comparar la actividad antimicrobiana de las excreciones y secreciones larvarias nativas, y de las mayores y menores de 10 kDa de Calliphora vicina y Sarconesiopsis magellanica (Diptera: Calliphoridae). Materiales y métodos. El bioensayo se hizo a partir de la técnica de turbidimetría y en el caso de las excreciones y secreciones menores de 10 kDa se determinó la concentración inhibitoria mínima (CIM). Resultados. Las excreciones y secreciones nativas y las menores de 10 kDa de C. vicina y S. magellanica, evidenciaron una potente actividad antibacteriana contra tres cepas de Staphylococcus aureus y cuatro bacterias Gram negativas, siendo las menores de 10 kDa más efectivas que las nativas en las dos especies de moscas evaluadas. Además, las menores de 10 kDa presentaron la misma efectividad, aunque en las pruebas de CIM se observó que las de S. magellanica fueron más potentes en todas las bacterias evaluadas, excepto contra la cepa de S. aureus ATCC 25923. Las mayores de 10 kDa no inhibieron el crecimiento bacteriano. Conclusión. Los resultados validaron, en general, que estas sustancias son fuente importante para el aislamiento y la caracterización de agentes antimicrobianos.


Abstract Introduction: The growing resistance to antibiotics worldwide represents a global threat to public health. The larval excretions and secretions derived from necrophagous flies from the Calliphoridae family could represent a promising source for counteracting their effects. Objective: To compare the antimicrobial activity of Calliphora vicina and Sarconesiopsis magellanica (Diptera: Calliphoridae) native excretions and secretions and those weighing more than 10 kDa and less. Materials and methods: We used the turbidimetry technique for the bioassay; we determined the minimum inhibitory concentration (MIC) for excretions and secretions weighing less than 10 kDa. Results: Calliphora vicina and S. magellanica native excretions and secretions and those weighing less than 10 kDa exhibited potent antibacterial activity against three Staphylococcus aureus strains and four Gram-negative bacteria; those weighing less than 10 kDa were more effective than the native ones in the two species of flies evaluated here. Furthermore, excretions and secretions weighing less than 10 kDa had the same effectiveness, except in the MIC trials where S. magellanica excretions and secretions weighing less than 10 kDa were more potent against all the bacteria evaluated, except for S. aureus ATCC 25923. Excretions and secretions weighing more than 10 kDa did not inhibit bacterial growth. Conclusions: These results potentially validate these substances as an important source for isolating and characterizing antimicrobial agents.

4.
Horiz. meÌüd. (Impresa) ; 22(1): e1693, ene.-mar. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1375613

ABSTRACT

RESUMEN Objetivo: Determinar el comportamiento clínico epidemiológico de apoyo al diagnóstico terapéutico y susceptibilidad antimicrobiana de infección del tracto urinario (ITU) en hospitalización del servicio de Pediatría del Hospital Regional de Moquegua durante los años 2014-2020. Materiales y métodos: Estudio observacional, descriptivo y retrospectivo. Para el propósito del estudio se tomó en cuenta una población de 248 pacientes, de 1 mes de edad a 14 años con 11 meses y 30 días, con diagnóstico de ITU, a quienes se les realizó un urocultivo. Se utilizó una ficha de recolección de datos y se procesaron los resultados en el programa SPSS versión 23. Resultados: La infección se presentó con más frecuencia en pacientes de sexo femenino (82,26 %) y la fiebre (83,87 %) fue la manifestación clínica predominante. El tratamiento médico que más se utilizó fue la amikacina (49,19 %). El germen que se aisló con mayor frecuencia fue E. coli (70,57 %). Los gérmenes aislados mostraron mayor frecuencia de sensibilidad frente a los antibióticos nitrofurantoina (70,16 %), ceftazidima (51,20 %), gentamicina (43,14 %) y amikacina (28,62 %). Por otro lado, presentaron resistencia frente al sulfametoxazol-trimetropim (74,59 %). Dentro de los hallazgos más comunes sobre estudios de imágenes se encontró la pielectasia unilateral (43,14 %). Conclusiones: La ITU se presenta con mayor frecuencia en mujeres. Es fundamental realizar la anamnesis y el examen clínico y, además, contar con el examen completo de orina y de imágenes. El diagnóstico definitivo se obtendrá vía urocultivo; iniciar el tratamiento de manera empírica dependerá del historial de sensibilidad y resistencia en base a los urocultivos realizados.


ABSTRACT Objective: To determine the clinical and epidemiological characteristics of urinary tract infections (UTIs) supported by the diagnosis, therapy and antimicrobial susceptibility of inpatients of the Pediatric Unit of the Hospital Regional de Moquegua from 2014 to 2020. Materials and methods: An observational, descriptive and retrospective study. The research included a population of 248 patients aged between 1 month and 14 years 11 months 30 days with a diagnosis of UTI who underwent a urine culture. A data collection sheet was used and the results were processed using the IBM SPSS Statistics statistical software 23.0. Results: The infection occurred more often in female patients (82.26 %), with fever being the most prevalent clinical manifestation (83.87 %). The most widely used medical treatment was amikacin (49.19 %). E. coli was the most frequently isolated germ (70.57 %). The isolated germs showed sensitivity to antibiotics such as nitrofurantoin (70.16 %), ceftazidime (51.20 %), gentamicin (43.14 %) and amikacin (28.62 %). In contrast, they were resistant to sulfamethoxazole-trimethoprim (74.59 %). One of the most common findings in the imaging tests was unilateral pyelectasis (43.14 %). Conclusions: UTIs occur more frequently in women. The anamnesis and clinical examination, together with a complete urinalysis and imaging tests, are essential for the diagnosis and treatment of these patients. The definitive diagnosis must be established by a urine culture. The choice of an empirical therapy will depend on the patient's history of sensitivity and resistance to antibiotics based on the urine cultures performed.

5.
Braz. oral res. (Online) ; 36: e002, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BBO | ID: biblio-1355930

ABSTRACT

Abstract The objective of this study was to analyze possible associations between antibiotic dental prescriptions in the public health service, health service characteristics, and social characteristics of the municipalities. Using the register of dispensing in the public health service of a state in the Southeast region of Brazil, in 2017 we analyzed patterns of antibiotic prescriptions by dentists. Data were obtained from the Integrated Pharmaceutical Services Management System (SIGAF, in Portuguese). The outcome variable was the number of Daily Defined Doses (DDD) per 1,000 residents/year in each municipality. CART (Classification and Regression Tree) technique was used to determine the influence of the following variables: populational social characteristics (Human Development Index, Gini Index, the proportion of rural population and proportion of families benefiting from the Bolsa Família Program) and oral health services characteristics (access to individual dental care, number of dentists and oral health teams per 1,000 residents, and percentage of preventive and restorative individual dental procedures. Data analysis was performed using IBM SPSS Statistics 21.0. Antibiotics were the medications most prescribed by dentists in the public health service, with penicillin being the most frequently prescribed class. The average DDD/1,000 residents/year for the 421 municipalities surveyed was 96.54 (range 0.008 and 619.660). Select factors were associated with antibiotic prescriptions including access to individual dental care (Adjusted p-value ≤0.001), a number of oral health teams/1,000 inhabitants (Adjusted p-value=0.001), and Gini Index (Adjusted p-value = 0.046). Access to oral health services and inequality were associated with the use of antibiotics.

6.
J. appl. oral sci ; 30: e20210483, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1365009

ABSTRACT

Abstract Objectives: To evaluate the mechanical, physicochemical, and antimicrobial properties of four different formulations containing micro- or nanoparticles of sodium trimetaphosphate (mTMP and nTMP, respectively). Methodology: Four experimental groups were used in this investigation: two mTMP groups and two nTMP groups, each containing zirconium oxide (ZrO2), and solution containing either chitosan or titanium oxide (TiO2) nanoparticles (NPs). Setting time, compression resistance, and radiopacity were estimated. The agar diffusion test was used to assess the antimicrobial activity of the formulations against five different microbial strains: Streptococcus mutans, Lactobacillus casei, Actinomyces israelii, Candida albicans, and Enterococcus faecalis. Parametric and nonparametric tests were performed after evaluating homoscedasticity data (p<0.05). Results: From the properties evaluated, nTMP cements required less setting time and showed greater resistance to compression. Cements containing TiO2 showed greater radiopacity for both nTMP and mTMP. All four cement formulations showed antimicrobial activity against S. mutans and L. casei Conclusion: Formulations containing nTMP have shorter setting times and higher compressive strength, and those with TiO2 nanoparticles showed antimicrobial activities. Clinical relevance: The cement containing nTMP, ZrO2, and TiO2 could be an alternative material for protecting the pulp complex.

7.
NOVA publ. cient ; 19(37): 57-69, jul.-dic. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1365191

ABSTRACT

Resumen Objetivo. Describir la frecuencia de los microorganismos y la resistencia antibiótica de bacterias aisladas en hemocultivos de pacientes con Bacteremia, en un hospital universitario de Colombia. Métodos. Se desarrolló un estudio observacional, descriptivo y de corte transversal, en individuos mayores de 18 años, en donde se describió los hemocultivos positivos, aislados en todos los servicios del Hospital Universitario del Caribe. Resultados. De los 211 hemocultivos analizados, el 53,1% fueron hombres. Los microorganismos Gram positivos corresponden a 49,8%, con una alta frecuencia de S. aureus en un 16,1%. De los microorganismos Gram negativos fue aislado E.coli en un 18%. La resistencia a vancomicina se estableció en 4,4%. La K. pneumoniae presentó una resistencia a meropenem en un 15,3% de los casos. E.coli, P. aeruginosa y E.cloacae son sensibles a carbapénicos. Así en nuestro estudio las bacterias más frecuentemente aisladas en los hemocultivos fueron predominantemente Gram negativos, con resistencia a carbapénicos para algunas cepas de K. Pneumoniae.


Abstract Objective. To describe the frequency of microorganisms and the antibiotic resistance of isolated bacteria in blood cultures of patients with bacteremia, in a university hospital in Colombia. Methods. An observational, descriptive, and cross-sectional study was developed in individuals older than 18 years, where the positive blood cultures were described, isolated in all the services of the University Hospital of the Caribbean. Results. Of the 211 blood cultures analyzed, 53.1% were men. The Gram-positive microorganisms correspond to 49.8%, with a high frequency of S. aureus in 16.1%. Of the Gram negative microorganisms, E.coli was isolated by 18%. Vancomycin resistance was established at 4.4%. K. pneumoniae showed resistance to meropenem in 15.3% of cases. E.coli, P. aeruginosa and E. cloacae are sensitive to carbapenes. Thus, in our study, the bacteria most frequently isolated in the blood cultures were predominantly Gram negative, with resistance to carbapenes for some strains of K. pneumoniae.

8.
Rev. peru. med. exp. salud publica ; 38(4): 608-614, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1365941

ABSTRACT

Resumen Con el objetivo de evaluar las tendencias en el uso de fármacos en pacientes con la COVID-19 de un hospital del Perú durante la primera ola de la pandemia se realizó un estudio retrospectivo entre abril y septiembre del 2020. Se revisaron las historias clínicas de pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional Dos de Mayo (Lima, Perú). De un total de 3103 pacientes, se incluyeron 381 historias clínica (77,4% varones y mediana de edad de 44 años). Se observó un incremento del uso de cuatro fármacos prehospitalarios (azitromicina, ivermectina, corticoides y ceftriaxona), y una disminución del uso de seis fármacos intrahospitalarios (ceftriaxona, azitromicina, hidroxicloroquina, ivermectina, pulso de corticoides y anticoagulación profiláctica); además, el uso de anticoagulación intrahospitalaria aumentó. Estos hallazgos sugieren que el manejo de la COVID-19 varió durante la primera ola de la pandemia, aumentando el uso de fármacos prehospitalarios y disminuyendo el uso de fármacos intrahospitalarios.


Abstract This study aimed to evaluate the pharmacological trends in patients with COVID-19 from a hospital in Peru during the first wave of the pandemic. Retrospective study conducted between April and September 2020. The medical records of patients hospitalized for COVID-19 pneumonia at the Dos de Mayo National Hospital (Lima, Peru) were reviewed. Of a total of 3103 patients, 381 medical records were included (77.4% male, median age: 44 years). The use of four prehospital drugs increased (azithromycin, ivermectin, corticosteroids, and ceftriaxone), while the in-hospital use of six drugs (ceftriaxone, azithromycin, hydroxychloroquine, ivermectin, corticosteroid pulse, and prophylactic anticoagulation) decreased and in-hospital anticoagulation use decreased. These findings suggest that the management of COVID-19 has varied during the first wave of the pandemic, typically increasing prehospital drug use and decreasing inpatient use.

9.
Arch. pediatr. Urug ; 92(2): e306, dic. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278306

ABSTRACT

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.


Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.


Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.


Subject(s)
Humans , Female , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Vancomycin/therapeutic use , Endocarditis/diagnosis , Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/complications , Coagulase , Infant, Very Low Birth Weight , Endocarditis/etiology , Infant, Extremely Premature
10.
Braz. j. oral sci ; 20: e213690, jan.-dez. 2021. ilus
Article in English | LILACS, BBO | ID: biblio-1281104

ABSTRACT

Aim: to develop a model for regenerative endodontics using newly-weaned Wistar rats immature molars with pulp necrosis to histologically describe the evolution of apical tissues following treatment with a bi-antibiotic paste, induced bloodclot formation and MTA. Methods: Ten 25-day-old female Wistar rats were divided into an initial control group (Ci) and two experimental groups in which pulp necrosis was experimentally induced on the left mandibular first molar by exposing the pulp chamber and leaving it open to the oral environment. One of the experimental groups was left untreated (E1) while the other was submitted to a protocol of regenerative endodontics 10 days thereafter (E2). Fifteen days after placement of a bi-antibiotic paste, bleeding was induced into the root canal space and MTA was placed upon. Animals were euthanized 30 days later. Right mandibular first molars served as an 80-day-old final control group (Cf). Each hemimandible was histologically processed to analyse parameters associated with root development. Statistical analysis was carried by means of ANOVA; p values below 0.05 were considered statistically significant. Results: baseline (i.e. 25-days old) mean root length and apical diameter of the distal root canal were 1.84±0.25 and 0.38±0.02mm respectively. Following the regenerative endodontic protocol, cells lining the walls of the root canal and significant increase to both length (2.37±0.22mm) and diameter (0.32±0.03 mm) were observed. Conclusions: newly-weaned Wistar rats serve as a suitable model to evaluate regenerative endodontic protocols. However, further research is needed in order to disclose the nature of the cells and/or cell mediators involved


Subject(s)
Animals , Rats , Root Canal Therapy , Dental Pulp Necrosis , Regenerative Endodontics , Anti-Bacterial Agents
11.
Rev. bras. cir. cardiovasc ; 36(5): 614-622, Sept.-Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351650

ABSTRACT

Abstract Introduction: Destructive aortic root endocarditis is associated with high mortality rates. The objective of this article was to characterize the clinical and microbiological profiles of these patients, especially concerning an already implanted aortic valve prosthesis. We also focused on prognostic factors. Methods: Eighty patients underwent aortic root replacement due to destructive endocarditis from 1999 to 2018 in our institution. We analyzed their pre, intra, and postoperative data, outcomes, and predictors of mortality. Results: Thirty-one patients had native valve endocarditis (NVE), eight patients had early-onset prosthetic valve endocarditis (PVE), and 41 patients had late-onset PVE. Streptococcus was found in 19.4% of NVE cases and no PVE case. Coagulase-negative Staphylococcus was responsible for 62.5% of the cases of early-onset PVE. Thirty-four (42.5%) patients had received inappropriate antibiotics before admission. No microorganism was associated with higher risk of mortality. Aortoventricular dehiscence was identified as an independent risk factor of mortality along with PVE, concomitant bypass surgery, and delayed diagnosis. The incidence of postoperative complications was similar in all three groups. Rates of long-term survival (P=0.044) and freedom from the composite endpoint (P=0.024) defined as death, stroke, aortic valve reinfection, and aortic valve reoperation were the lowest within the NVE group and the highest among the PVE patients. Conclusion: In endocarditis, prolonged diagnostics, inadequate antimicrobial treatment, and late surgery led to destructive local complications and worsened the prognosis. PVE is associated with higher mortality than NVE.


Subject(s)
Humans , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/surgery , Heart Valve Prosthesis Implantation/adverse effects , Endocarditis, Bacterial/surgery , Aortic Valve
12.
Arq. bras. oftalmol ; 84(5): 506-512, Sept.-Oct. 2021. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1339211

ABSTRACT

ABSTRACT The degree to which viral infection and the host's immune reaction to viral particles participate in the inflammatory process across various forms of herpetic keratitis has remained controversial. This fact has created conflicts regarding the classification of and therapeutic planning for such morbidities. This review aims to stimulate reflection on the classifications' adequacy, nomenclatures, and therapeutic approaches related to these entities.


RESUMO O grau de participação da infecção viral e da reação imunológica do hospedeiro às partículas virais no processo infamatório das diferentes formas de ceratites herpéticas ainda é objeto de controvérsia. Esse fato gera conflitos de classificação e planejamento terapêutico relativos a essas morbidades. Esta revisão visa estimular a reflexão sobre a adequabilidade das classificações, nomenclaturas e abordagens terapêuticas dessas entidades.

13.
Arq. bras. cardiol ; 117(1): 89-90, July. 2021.
Article in Portuguese | LILACS | ID: biblio-1285234

ABSTRACT

Resumo A fístula da artéria coronária é uma anormalidade anatômica rara das artérias coronárias que afeta 0,002% da população geral e representa 14% de todas as anomalias das artérias coronárias. A sua relevância clínica concentra-se principalmente no mecanismo do fenômeno do roubo coronário, que causa isquemia funcional do miocárdio, mesmo na ausência de estenose; portanto, angina e dispneia aos esforços são sintomas comuns. A abordagem diagnóstica sugerida é orientada pelos sintomas dos pacientes e consiste em uma série de exames instrumentais, como ECG, teste de esteira, ecocardiografia, tomografia computadorizada, ressonância magnética cardíaca e angiografia coronária. Nos casos onde não é um achado acidental, a angiografia coronária é necessária para o planejamento terapêutico otimizado. As pequenas fístulas geralmente são assintomáticas e o prognóstico é excelente se forem tratadas medicamente com acompanhamento clínico e ecocardiografia no período de 2 a 5 anos. As fístulas grandes/gigantes e sintomáticas, ao contrário, devem ser submetidas a fechamento invasivo, por via transcateter ou ligadura cirúrgica, cujos resultados são equivalentes no acompanhamento de longo prazo. A profilaxia antibiótica para a prevenção da endocardite bacteriana é recomendada para todos os pacientes com fístulas da artéria coronária submetidos a procedimentos dentários, gastrointestinais ou urológicos. O acompanhamento ao longo da vida é sempre essencial para garantir que o paciente não sofra progressão da doença ou outras complicações cardíacas.


Abstract Coronary artery fistula is a rare anatomic abnormality of the coronary arteries that affects 0.002% of the general population and represents 14% of all anomalies of coronary arteries. Its clinical relevance focuses mainly on the mechanism of the coronary steal phenomenon, causing myocardial functional ischemia, even in the absence of stenosis; therefore, angina and effort dyspnea are common symptoms. The suggested diagnostic approach is driven by patients' symptoms, and it consists of a number of instrumental examinations like ECG, treadmill test, echocardiography, computed tomography scan, cardiac magnetic resonance, and coronary angiography. If it is not an incidental finding, coronary angiography is required in view of optimal therapeutic planning. Small fistulae are usually asymptomatic, and prognosis is excellent if they are managed medically with clinical follow-up and echocardiography every 2 to 5 years. Large/giant, symptomatic fistulae, on the contrary, should undergo invasive closure, via either transcatheter approach or surgical ligation, whose results are equivalent at long-term follow-up. Antibiotic prophylaxis for prevention of bacterial endocarditis is recommended in all patients with coronary artery fistulae who undergo dental, gastrointestinal, or urological procedures. Life-long follow-up is always essential to ensure that the patient does not undergo progression of the disease or further cardiac complications.


Subject(s)
Humans , Coronary Artery Disease/diagnostic imaging , Coronary Vessel Anomalies , Fistula , Coronary Angiography
14.
Arch. pediatr. Urug ; 92(1): e204, jun. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1248843

ABSTRACT

Resumen: Introducción: la prescripción inadecuada de antibióticos (ATB) es un problema de salud pública. Objetivo: describir la frecuencia y los motivos de utilización inadecuada de ATB en niños hospitalizados en salas de cuidados moderados del Hospital Pediátrico, Centro Hospitalario Pereira Rossell, entre 15/6/2019 y 15/7/2019. Material y método: estudio descriptivo, transversal. Se incluyeron los menores de 15 años en tratamiento ATB sistémico independientemente del motivo de prescripción. Variables: edad, comorbilidades, diagnóstico al egreso, ATB (tipo, dosis, vía, intervalo, duración). El uso inadecuado se categorizó en: tipo A (selección de ATB inapropiado) y tipo B (ATB no indicado). Resultados: se incluyeron 100 niños, 53% sexo femenino, mediana edad 2,2 años (rango 0-14). Presentaban comorbilidades 52%. Se detectó prescripción inadecuada en 43%, categoría A 30% y categoría B 13% (p <0,05). La principal causa de prescripción inadecuada fueron las infecciones respiratorias (33%). Se observó predominio de prescripción adecuada en menores de 1 año e inadecuada en mayores de 5 años (p <0,05). En la categoría A (n=30) la causa más frecuente de prescripción inadecuada fue el uso de ATB de mayor espectro al requerido (14/30), seguido de la administración por vía intravenosa (5/30). Los ATB más frecuentemente prescriptos en forma inadecuada fueron ampicilina (17/43) y ceftriaxona (14/43). Conclusiones: la prescripción inadecuada de ATB en este centro es un problema frecuente. La indicación de ATB de mayor espectro al necesario por vía intravenosa en el tratamiento de infecciones respiratorias es el patrón predominante. Es necesario vigilar el cumplimiento de las recomendaciones nacionales.


Summary: Introduction: inappropriate prescription of antibiotics (ATB) is a public health problem. Objective: to describe the frequency and reasons for the inappropriate use of ATB in children hospitalized in the Moderate Care Ward of the Pereira Rossell's Pediatric Hospital Center between 06/15/2019 and 07/15/2019. Materials and Methods: descriptive, cross-sectional study. Children under 15 years of age were included in systemic ATB treatment regardless of the reason for the prescription. Variables: age, comorbidities, diagnosis at discharge, ATB (type, dose, route, interval, duration). Inappropriate use was categorized into: type A (selection of inappropriate ATB) and type B (ATB not indicated). Results: 100 children were included, 53% female, median age 2.2 years (range 0-14), 52% had comorbidities. Inappropriate prescription was detected in 43%, category A 30% and category B 13% (p <0.05). The main cause of inappropriate prescription was respiratory infections (33%). Prevalence of appropriate prescription was observed for the case of children under one year of age and inadequate in those over 5 years of age (p <0.05). In category A (n = 30), the most frequent cause of inadequate prescription was the use of ATB with a greater spectrum than required (14/30) followed by intravenous administration (5/30). The most frequently inappropriately prescribed ATBs were ampicillin (17/43) and ceftriaxone (14/43). Conclusions: the inappropriate prescription of ATB in this center is a frequent problem. The main pattern is the prescription of intravenous ATBs of a broader range than that required for respiratory infections. It is necessary to monitor compliance with national recommendations.


Resumo: Introdução: a prescrição inadequada de antibióticos (ATB) é um problema de saúde pública. Objetivo: descrever a frequência e os motivos do uso inadequado de ATB em crianças internadas em enfermarias de cuidados moderados do Hospital Pediátrico do Centro Hospitalar Pereira Rossell entre 15/06/2019 e 15/07/2019. Materiais e métodos: estudo descritivo, transversal. Incluíram-se menores de 15 anos de idade em tratamento sistêmico com ATB, independentemente do motivo da prescrição. Variáveis: idade, comorbidades, diagnóstico na alta, ATB (tipo, dose, via, intervalo, duração). O uso inadequado foi categorizado em: tipo A (seleção ATB inadequada) e tipo B (ATB não indicado). Resultados: incluíram-se 100 crianças, 53% do sexo feminino, meia-idade 2,2 anos (variação 0-14). 52% tinham comorbidades. Detectou-se prescrição inadequada em 43%, categoria A 30% e categoria B 13% (p <0,05). A principal causa de prescrição inadequada foi para o caso de infecções respiratórias (33%). Observou-se predomínio de prescrição adequada em menores de um ano e inadequada em maiores de 5 anos (p <0,05). Na categoria A (n = 30), a causa mais frequente de prescrição inadequada foi o uso de ATB com espectro superior ao necessário (14/30), seguido de administração intravenosa (5/30). Os ATBs mais frequentemente prescritos de forma inadequada foram ampicilina (17/43) e ceftriaxona (14/43). Conclusões: a prescrição inadequada de ATB neste centro é um problema frequente. A indicação de ATB com espectro maior que o necessário por via intravenosa no tratamento das infecções respiratórias é o padrão predominante. É necessário monitorar o cumprimento das recomendações nacionais.

15.
Cambios rev. méd ; 20(1): 21-25, 30 junio 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1292703

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Appendicitis/complications , Gentamicins , Cephalexin , Ampicillin , Metronidazole , Anti-Bacterial Agents/therapeutic use , Pediatrics , Postoperative Complications , General Surgery , Cost-Benefit Analysis
16.
Cambios rev. méd ; 20(1): 10-14, 30 junio 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1292684

ABSTRACT

INTRODUCCIÓN. Las infecciones del tracto urinario son causa de mayor morbilidad en la población adulta y afectan con frecuencia a la mujer. Al ser un problema prevalente, fue fundamental realizar estudios sobre perfiles de susceptibilidad locales para establecer medidas de vigilancia y control de uso de antibióticos. OBJETIVO. Determinar el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal. La población fue de 437 urocultivos y una muestra de 176 positivos con su antibiograma, realizados en el laboratorio del Hospital Básico de Sangolquí entre enero de 2017 hasta abril de 2018. Los criterios de inclusión fueron: pacientes mayores de 15 años de edad de ambos sexos, ambulatorios y hospitalizados, que presentaron urocultivos positivos definidos por una cuenta mayor a 100 000 Unidades Formadoras de Colonia. RESULTADOS. Del 40,27% (176; 437) de urocultivos positivos, la bacteria aislada con frecuencia fue Escherichia coli. 69,31% (122; 176), con resistencia a ampicilina 77,97% (92; 118), trimetropim-sulfametoxazole 62,26% (66; 106), norfloxacino 37,50% (42; 112), ciprofloxacino 35,65 % (41; 115), ampicilina/sulbactam 32,20% (38; 118) y con susceptibilidad a: fosfomicina, ceftriaxona, amikacina y nitrofurantoina. CONCLUSIÓN. Se determinó el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario; donde Escherichia coli. fue aislada con frecuencia, con susceptibilidad favorable para nitrofurantoína y fosfomicina.


INTRODUCTION. Urinary tract infections are the cause of greater morbidity in the adult population and it often affects women. As it is a prevalent problem, it was essential to carry out studies on local susceptibility profiles to establish surveillance measures and control of antibiotic use. OBJECTIVE. To determine the microbial drug resistance profile in adults with urinary tract infection. MATERIALS AND METHODS. Descriptive, cross-sectional study. The population was 437 urine cultures and a sample of 176 positive with their antibiogram, carried out in the laboratory of the Hospital Básico de Sangolquí between january 2017 and april 2018. Inclusion criteria were: patients older than 15 years of age of both sexes, ambulatory and hospitalized, who presented positive urine cultures defined by a count greater than 100 000 Colony Forming Units. RESULTS. Of the 40,27% (176; 437) of positive urine cultures, the bacterium frequently isolated was Escherichia coli. 69,31% (122; 176), with resistance to ampicillin 77,97% (92; 118), trimethoprim-sulfamethoxazole 62,26% (66; 106), norfloxacin 37,50% (42; 112), ciprofloxacin 35,65% (41; 115), ampicillin / sulbactam 32,20% (38; 118) and with susceptibility to: fosfomycin, ceftriaxone, amikacin and nitrofurantoin. CONCLUSION. The microbial drug resistance profile was determined in adults with urinary tract infection; where Escherichia coli. was frequently isolated, with favorable susceptibility to nitrofurantoin and fosfomycin.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Urinary Tract , Urinary Tract Infections , Drug Resistance, Microbial , Anti-Bacterial Agents , Staphylococcus , Bacteriuria , Ampicillin Resistance , Microbial Sensitivity Tests , Drug Resistance, Bacterial , Escherichia coli
17.
Infectio ; 25(2): 84-88, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1250072

ABSTRACT

Resumen Introducción: Klebsiella pneumoniae produce enzimas como Betalactamasas de Espectro Extendido (BLEE) y Carbapenemasas. Estas enzimas tienen implicancia en las Unidades de Cuidados Intensivos (UCI), porque posibilitan la supervivencia de especies bacterianas a condiciones desfavorables y por ende, facilitan su permanencia en ambiente intrahospitalario. Existe evidencia de presencia de Klebsiella pneumoniae en UCI, en muestras procedentes de: pacientes, personal de salud, habitación, lavamanos y fórmulas nutricionales. Objetivo: Evaluar el perfil de resistencia de los aislamientos de Klebsiella pneumoniae en una UCI de Paraguay. Material y métodos: Estudio descriptivo observacional, transversal. Se recolectaron 200 muestras (124 fórmulas enterales, 40 ambiente y 36 pacientes). Variables analizadas: origen de muestra, presencia del germen, producción de enzimas y perfil de resistencia. Resultados: Se aisló Klebsiella pneumoniae en 14% de las muestras. Se identificó al germen en: 25% pacientes, 12,9% fórmulas enterales y 7,5% ambiente. Se observó producción de BLEE en 85,7% de las cepas, con perfiles de resistencia idénticos, y producción de carbapenemasas en 14,3% de las cepas, con perfiles de resistencia diferentes. Conclusión: la presencia y los perfiles de resistencia de Klebsiella pneumoniae en las tres clases de muestras estudiadas, sugieren transferencia de genes de resistencia y diseminación del germen en UCI.


Abstract Introduction: Klebsiella pneumoniae produces enzymes such as Extended Spectrum Betalactamases (ESBL) and Carbapenemases. These enzymes have implica tions in Intensive Care Units (ICU), because they enable the survival of bacterial species under unfavorable conditions and, therefore, facilitate their permanence in the hospital environment. There is evidence of the presence of Klebsiella pneumoniae in the ICU, in samples from: patients, health staff, room, sink, and nutri tional formulas. Objective: To evaluate the resistance profile of Klebsiella pneumoniae isolates in an ICU in Paraguay. Material and methods: descriptive, observational, cross-sectional study. 200 samples were collected (124 enteral formulas, 40 ambient and 36 patients). Variables analyzed: sample origin, presence of the germ, enzyme production and resistance profile. Results: Klebsiella pneumoniae was isolated in 14% of the samples. The germ was identified in: 25% patients, 12.9% enteral formulas and 7.5% environment. Pro duction of ESBL was observed in 85.7% of the strains, with identical resistance profiles, and production of carbapenemases in 14.3% of the strains, with different resistance profiles. Conclusion: the presence and resistance profiles of Klebsiella pneumoniae in the three classes of samples studied, suggest transfer of resistance genes and disse mination of the germ in ICU.


Subject(s)
Humans , Male , Female , beta-Lactamases , Intensive Care Units , Klebsiella pneumoniae , Paraguay , Drug Resistance, Microbial , Bacteremia
18.
Colomb. med ; 52(2): e4124776, Apr.-June 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1278946

ABSTRACT

Abstract Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.


Resumen El trauma de recto es poco frecuente, pero generalmente se asocia a lesiones de órganos adyacentes en la región pélvica y abdominal. Estudios recientes han cambiado los paradigmas del manejo tradicional derivados del trauma militar, mostrando mejores resultados en la morbilidad y mortalidad. Sin embargo, las técnicas de control de daños en el trauma rectal aún son controvertidas. El objetivo de este articulo es proponer el algoritmo de manejo del paciente con trauma rectal e inestabilidad hemodinámica, según los principios de la cirugía de control de daños. Se propone que las lesiones del recto en su porción intraperitoneal sean manejadas de la misma manera que las lesiones del colon. Mientras que el manejo de las lesiones extraperitoneales del recto dependerá del compromiso de la circunferencia rectal. Si es mayor del 25% se recomienda realizar una colostomía. Si es menor, se propone optar por el manejo conservador o el reparo primario. Saber que hacer o que no hacer en el trauma de recto marca la diferencia.

19.
Rev. bras. cir. cardiovasc ; 36(2): 172-182, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1251103

ABSTRACT

Abstract Introduction: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results: The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.


Subject(s)
Humans , Infant , Staphylococcal Infections , Endocarditis/diagnosis , Endocarditis, Bacterial , Staphylococcus aureus , Retrospective Studies
20.
Iatreia ; 34(1): 15-24, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1154354

ABSTRACT

RESUMEN Objetivos: medir el impacto en la calidad de la prescripción antibiótica empírica en los médicos generales luego de la implementación de un sistema de evaluación y retroalimentación. Métodos: estudio cuasiexperimental con pre y postintervención en una clínica de tercer nivel en Medellín. Se revisó las prescripciones de un grupo de antibióticos por un médico internista, un epidemiólogo y un infectólogo. Se midió el consumo de antibióticos, las retroalimentaciones realizadas, el diagnóstico de la sepsis, tiempo de inicio de los antibióticos en el servicio de urgencias y la prevalencia de Escherichia coli productora de betalactamasa de espectro extendido. Resultados: el número de retroalimentaciones descendió de 10,9 a 2 %. Se redujo el consumo de ceftriaxona (p = 0,04), piperacilina tazobactam (p = 0,01), cefepime (p = 0,04) y ciprofloxacina (p = 0,01). Se evidenció una tendencia a la reducción en la prevalencia de E. coli BLEE (p = 0,3). La intervención no produjo un retraso en el inicio de antibióticos en el servicio de urgencias. Conclusión: una estrategia de auditoría y retroalimentación a los médicos generales, referente a la calidad de la prescripción antibiótica, reduce el consumo de antibióticos sin afectar la oportunidad del diagnóstico de sepsis o el inicio de su tratamiento y puede impactar favorablemente en el perfil de resistencia de la flora microbiana institucional.


SUMMARY Objectives: To measure the impact on the quality of the empirical antibiotic prescription in general practitioners, after the implementation of an evaluation and feedback system. Methods: Quasi-experimental study with pre- and post-intervention in a tertiary care center in Medellín. The prescriptions of a group of antibiotics were reviewed by an internist, an epidemiologist and an infectologist. When failures were found, prescribing doctors were informed. Subsequently, antibiotic consumption, feedbacks, sepsis diagnosis, start time of antibiotics in the emergency department and monthly incidence of Escherichia coli producing extended spectrum betalactamase were measured. Results: The numbers of feedbacks decreased from 10.9% to 2%. Consumption of ceftriaxone (p = 0.04), piperacillin tazobactam (p = 0.01), cefepime (p = 0.04) and ciprofloxacin (p = 0.01) was reduced. There was a tendency to reduce the prevalence of E. coli ESBL. The intervention did not cause a delay in the start of antibiotics in the emergency department. Conclusions: A strategy of continuous feedback to general practitioners regarding the quality of antibiotic prescription reduces consumption of antibiotics without causing changes in diagnosis opportunity or the beginning of antibiotics in sepsis and can impact favorably the resistance profile of the institutional microbial flora.


Subject(s)
Humans , Prescriptions , Anti-Bacterial Agents , Feedback , General Practitioners
SELECTION OF CITATIONS
SEARCH DETAIL