ABSTRACT
Objective : In the few cases of childhood dirrhea that require the antimicrobial therapy, the correct choice of the drug depends on detailed previous knowledge of local strains and pattern of antimicrobial resistance. Shigellosis is one of the most improtant examples of this group of intestinal infections. In order to establish such parameters in Nagpur city, this study was carried out to determine the antimcrobial resistance profile of Shigella flexneri isolated from patients suffering from diahhrea admitted to Various hoapitals in Nagpur district, India. Materials and Methods: The study included 110 stool samples collected from patients during the 3 year period. All the isolates were characterized and confirmed by VITEK® 2 GN ID cards and antimicrobial susceptibility was tested by VITEK® 2 AST test cards. Results: We received 73 positive cultures of S. flexneri out of 110 stool samples during three year periods of January 2009 to January 2012. S. flexneri strains presented a high resistance rate to Ampicillin (100%), Chloramphenicol (76.71%), Trimethoprime-sulfamethaxazole (TMP-SMZ) (68.49%) and low resistance to third- and fourth-generation Cephalosporin. None of the isolates was found to be resistant to Ciprofloxacin (MIC ≥ 4), Norfloxacin (MIC ≥12), and Nalidixic acid (MIC ≥30). Conclusion: Our results provide data on antimicrobial resistance to choose a proper antibiotic for the treatment of Shigellosis in our country. According to current findings, Quinolones and Cephalosporins are the drug of choice for the diarrheic patients. In conclusion, systematic monitoring is needed to identify changes in the antimicrobial resistance.
Subject(s)
Adult , Anti-Bacterial Agents/therapeutic use , Cephalosporins/therapeutic use , Child, Preschool , Drug Resistance, Bacterial/drug effects , Dysentery/drug therapy , Dysentery/epidemiology , Dysentery/microbiology , Dysentery, Bacillary/drug therapy , Dysentery, Bacillary/epidemiology , Dysentery, Bacillary/microbiology , Feces/microbiology , Female , Humans , India/epidemiology , Infant , Infant, Newborn , Male , Medication Therapy Management/statistics & numerical data , Microbial Sensitivity Tests/methods , Microbial Sensitivity Tests/statistics & numerical data , Microbiological Techniques/instrumentation , Microbiological Techniques/methods , Quinolones/therapeutic use , Shigella flexneri/drug effects , Shigella flexneri/isolation & purificationABSTRACT
O estudo caracterizou o perfil biodemográfico e clínico dos pacientes internados na clínica médica do Hospital Universitário da USP e os fármacos prescritos, avaliou as prescrições médicas em relação à ocorrência ou não de interações medicamentosas potenciais (IMP) e os fatores relacionados a elas para elaboração de instrumento educativo para auxiliar a atuação da equipe multidisciplinar na detecção de eventos adversos evitáveis potenciais de relevância clínica. Foram extraídos dos prontuários médicos os dados referentes à internação, identificação e estado clínico dos pacientes internados na clínica médica, entre março e agosto de 2006. Coletou-se ainda o diagnóstico principal no resumo de alta e o tempo de internação. Os fármacos prescritos foram coletados das prescrições médicas para análise da ocorrência de interações medicamentosas potenciais e classificação, empregando-se o banco de monografias Micromedex® DrugReax®. Empregou-se estatística descritiva e regressão logística multivariada na análise dos dados. Analisaram-se 5.666 prescrições médicas, a média de idade foi de 56,7±19,8 anos e o tempo médio de internação 10,7±9,4 dias. Os diagnósticos mais freqüentes foram broncopneumonia (138; 21,3%) e infarto agudo do miocárdio (57; 8,8%). Os grupos anatômicos mais freqüentemente prescritos, segundo o Anatomical Therapeutical Chemical, foram C (21,2%), A (17,5%), N (15,6%), B (15,0%) e J (13,6%). O número médio de fármacos por prescrição foi 5,7±2,9. Para a análise de IMP foram consideradas somente as prescrições com dois ou mais fármacos prescritos (5.336), das quais 3.097 (58,0%) apresentavam IMP. O número médio de fármacos entre essas prescrições foi 6,2±2,3. Observou-se associação significativa com as IMP identificadas no estudo: idade (p<0,001), tempo de internação (p<0,001), doenças cardiovasculares (p=0,0059) e número de fármacos (p<0,001). Tanto hipertensão arterial sistêmica quanto diabetes mellitus foram fatores de risco para ocorrência de IMP...
The study characterized the demographic and clinical profile of patients admitted to the internal medicine unit of the USP University Hospital and the drugs prescribed, the prescriptions evaluated in relation to the occurrence of potential drug interactions (PDI) and factors related to them for developing educational tool to assist the performance of the multidisciplinary team in the detection of preventable adverse drug events of clinical relevance. Data were extracted from medical records regarding the identification and clinical status of patients from March to August 2006. It was still collected the main diagnosis in the discharge summary and the time of admission. The drugs prescribed were obtained from medical prescriptions for analysis of the occurrence of potential drug interactions and classification, using the database monographs Micromedex® DrugReax®. Descriptive statistics and logistic regression were used in data analysis. From 5.666 prescriptions evaluated, the average age was 56.7 ± 19.8 years and mean length of stay was 10.7 ± 9.4 days. The most common diagnoses were pneumonia (138, 21.3%) and heart infarct (57, 8.8%). The anatomical groups most frequently prescribed were C (21.2%), A (17.5%), N (15.6%), B (15.0%) and J (13.6%) according Anatomical Therapeutical Chemical. The average number of drugs per prescription was 5.7 ± 2.9. For the analysis of PDI were considered only the prescriptions with two or more drugs (5.336), and 3.097 (58.0%) presented PDI. The average number of drugs per prescription was 6.2 ± 2.3. There was a significant association the PDI identified in the study with: age (p <0.001), length of stay (p <0.001), cardiovascular diseases (p = 0.0059) and number of drugs prescribed (p <0.001). Both hypertension and diabetes mellitus were risk factors for the occurrence of PDI, with odds ratios 4.93 and 2.79, respectively. The frequency of major and well-documented drug interactions was 26.5%. From 9.951 PDI observed in 2.637.
Subject(s)
Humans , Male , Female , Adult , Aged , Medication Therapy Management/statistics & numerical data , Medication Therapy Management/organization & administration , Drug Interactions , Hospitals, University/statistics & numerical data , Inpatients/statistics & numerical data , Drug Prescriptions/statistics & numerical data , Drug Evaluation/statistics & numerical data , Brazil , Data Interpretation, Statistical , Evaluation of the Efficacy-Effectiveness of InterventionsABSTRACT
This study analyzed questions presented by nursing technicians and auxiliaries during medication preparation and administration. Data were collected through a form in which nurses who worked in the hospitalization unit of a general hospital in São Paulo, Brazil, were asked to take notes of any questions asked to them. Most of the 255 questions were related to medication dilution (103). Regarding the answers source, only 7.5 percent of answers were obtained from pharmaceutical professionals, 35.5 percent of the answers given by nurses was incorrect or partially correct, which can constitute a factor for medication administration errors. In addition, there are no pharmacists present in hospitalization units of Brazilian hospitals. These professionals could, jointly with nurses, facilitate medication orientation to nursing professionals during preparation and administration, as well as to patients themselves.
Este estudio analizó las preguntas presentadas por técnicos y auxiliares de enfermería a los enfermeros durante la preparación y administración de medicamentos. Para recopilar los datos, se utilizó un formulario entregue a los enfermeros de unidades de internación de un hospital general del interior del Estado de São Paulo, Brasil, solicitando que anotaran las dudas que recibieran. La mayoría de las 255 preguntas estaba relacionada a la disolución del medicamento (103). Respecto a las respuestas, solamente el 7,5 por ciento de estas fue obtenido a través de los profesionales de la farmacia. Se destaca que el 35,5 por ciento de las respuestas emitidas por los enfermeros estaban incorrectas o parcialmente correctas, lo que puede constituir un factor para errores en la administración de medicamentos. Además, no existen farmacéuticos en las unidades de internación en los hospitales brasileños. Estos podrían, en conjunto con los enfermeros, facilitar la orientación de los profesionales de enfermería en cuanto a los medicamentos, en el momento de su preparación y administración, y también de los propios pacientes.
Este estudo analisou os questionamentos apresentados por técnicos e auxiliares de enfermagem aos enfermeiros durante o preparo e administração de medicamentos. Para coleta dos dados utilizou-se um formulário entregue aos enfermeiros de unidades de internação de um hospital geral do interior paulista, solicitando que anotassem as dúvidas dos profissionais da equipe que lhe fossem endereçadas. Foram registrados pelos enfermeiros 255 questionamentos sendo que a maioria destes estava relacionada à diluição do medicamento (103). Com relação às respostas dos enfermeiros às dúvidas, somente 7,5 por cento destas foram obtidas através dos profissionais da farmácia. Ressalta-se que 35,5 por cento das respostas emitidas pelos enfermeiros estavam incorretas ou parcialmente corretas podendo constituir fator para erros na administração de medicamentos. Somado a isto, inexistem farmacêuticos nas unidades de internação nos hospitais brasileiros, os quais poderiam, juntamente com o enfermeiro, facilitar a orientação dos profissionais de enfermagem quanto aos medicamentos, no momento do preparo e administração dos mesmos, bem como ao próprio paciente.