Resistência antimicrobiana na infecção urinária em unidade de terapia intensiva / Antimicrobial resistance in urinary tract infection in the intensive care unit / Resistencia a los antimicrobianos en la infección del tracto urinario en la unidad de cuidados intensivos

A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.

Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.

La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.

Endometrite crônica e infertilidade / Chronic endometritis and infertility

A endometrite crônica (EC) é uma doença que, apesar de ainda pouco investigada, tem sido associada a resultados reprodutivos desfavoráveis. Estudos têm mostrado que a EC pode prejudicar a receptividade endometrial, levando a falhas de implantação e perdas gestacionais recorrentes. Os métodos padronizados para diagnóstico incluem histeroscopia, histologia para pesquisa de plasmócitos e cultura endometrial para identificação de agentes bacterianos. O tratamento com antibióticos para EC parece melhorar as taxas de gestação e nascidos vivos em pacientes com falhas de implantação e perdas gestacionais recorrentes sem causa conhecida. Esta publicação tem por objetivo fazer uma revisão da etiologia, fisiopatologia, diagnóstico e tratamento da EC, seu impacto no microambiente endometrial e sua associação com infertilidade. Esta revisão narrativa da literatura atualizada sintetiza os achados encontrados em bases de dados computadorizadas.(AU)

Chronic endometritis (CE) is a poorly investigated disease, which has been related to adverse reproductive outcomes. Published studies have shown that CE can impair endometrial receptivity, which is associated with implantation failure and recurrent pregnancy loss. The standard tools for diagnosis include hysteroscopy, histology to identification of plasma cells and endometrial culture for identification of bacterial pathogens. Effective antibiotic treatment for CE seems to improve the pregnancy and live birth rates in patients with implantation failure and unexplained recurrent pregnancy loss. This paper intends to provide an overview of etiology, pathophysiology, diagnosis and treatment of CE, its impact on endometrial microenvironment and its association with infertility. This narrative review of the current literature synthesizes the findings retrieved from searches in computerized databases.(AU)

Hallazgos microbiológicos y susceptibilidad antimicrobiana en cirugía abdominal de urgencia / Microbiological findings and antimicrobial susceptibility in emergency abdominal surgery

Resumen Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial. Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la susceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan líquido libre intraperitoneal entre noviembre de 2017 y abril de 2018. Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica. Resultados: De 63 pacientes 55% fueron hombres, edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococcus faecium y Streptococcus anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii. Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

Introduction: It is important to maintain bacterial surveillance programs to decrease resistance and define adequate pharmacological schemes. Patients with abdomen represent a special microbiological group. Objetives: Make a review of pathogens in adult patients operated in our Emergency Service for abdominal pathology with free fluid and analyze the results obtained from cultures with respect to the strains and susceptibility to antibiotics. Materials and Method: Prospective cohort study with descriptive statistics. We include consecutive patients, older than 18 years old, operated on by abdomen who present free intraperitoneal fluid between November 2017 and April 2018. Cases with antimicrobial therapy, hospitalization and/or surgery 3 months prior are excluded. Positive cultures, isolated strains, antimicrobial susceptibility, demographic data and clinical evolution are recorded. Results: Of 63 patients, 55% were men and the average age was 52.2 years. The most frequent pathologies were of appendicular origin (62%) and of enteric origin (30%). In 44% the crop was positive and in 36% with more than one germ. Escherichia coli was the most frequent pathogen (64.2%) followed by Enterococcus faecium and Streptococcus anginosus (7.1%). Of the others, cultivated pathogens have only observed multiple resistance in an isolated case of Morganella Morganii. Conclusions: These data include the local microbiological reality in acute abdomen. Escherichia coli is still the most frequent germ that must be faced with the profile and the appropriate treatment. It is necessary to maintain local microbiology surveillance for a proper management.

Infecciones en pie diabético: Elección del tratamiento antibiótico empírico / Infections in diabetic foot. Choice of empirical antibiotic regimen

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Tuberculosis intestinal de difícil decisión diagnóstica y terapéutica / Intestinal tuberculosis of difficult diagnostic decision and therapeutic

En este reporte se describe un caso de tuberculosis intestinal (TBCI) de difícil decisión diagnóstica y terapéutica, en el cual se indicó un protocolo de tratamiento anti TBC durante 6 meses con resolución clínica, paraclínica y endoscópica(AU)

In this report we describe a case of intestinal Tuberculosis of difficult diagnostic and therapeutic decision which received anti-TBC treatment for 6 months with clinical, paraclinical and endoscopic resolution(AU)

Resistência de Neisseria gonorrhoeae a antimicrobianos na prática clínica: como está o Brasil? / Antimicrobials resistance of Neisseria gonorrhoeae in clinical practice: where Brazil stands?

Estima-se que um milhão de infecções sexualmente transmissíveis (IST) sejam adquiridas por dia no mundo, segundo a Organização Mundial da Saúde. Elas podem ser causadas por diversos micro-organismos pelo contato sexual. Embora tratáveis, as infecções, como a clamidiana, sífilis, tricomoníase e gonorreia, são responsáveis por 350 milhões de novos casos de IST anualmente no mundo. A gonorreia é a segunda IST bacteriana mais prevalente no planeta e tem chamado atenção nos últimos anos em decorrência da baixa eficácia em seu tratamento. O agente etiológico é a Neisseria gonorrhoeae. Na maioria das mulheres, a infecção por esse micro-organismo é assintomática, dificultando ainda mais seu diagnóstico e tratamento e, portanto, aumentando o risco de desenvolvimento de suas complicações associadas. Mesmo quando diagnosticada, essa infecção está sujeita a um alto índice de insucesso terapêutico que se deve, principalmente, à grande plasticidade genética da N. gonorrhoeae para aquisição de genes cromossômicos ou plasmidiais de resistência. O aumento da resistência desse micro-organismo a antimicrobianos comumente utilizados no tratamento, como penicilina, tetraciclina e ciprofloxacina, tem sido relatado em diversos países. No Brasil, poucos estudos estão disponíveis, mas em alguns estados já foram relatadas linhagens resistentes à ciprofloxacina. Dessa forma, deve-se ressaltar a importância de novos estudos que visem descrever o perfil da resistência da N. gonorrhoeae a antimicrobianos. Tais achados certamente nortearão a implementação de sistemas de vigilância epidemiológica no país visto que, até o momento, as infecções por N. gonorrhoeae sequer estão incluídas na lista nacional de doenças e agravos de notificação compulsória.(AU)

According to the World Health Organization, approximately one million sexually transmitted infections (STI) are acquired daily in the world. These infections can be caused by several microorganisms via contact. The treatable STI, such as chlamydia, syphilis, trichomoniasis and gonorrhea, account for 350 million new cases of STI each year worldwide. Gonorrhoea is caused by Neisseria gonorrhoeae and is the second most common bacterial STI in the world. It has drawn more attention in the last years due to the low efficacy in its treatment. Most women with this infection are asymptomatic, which makes its diagnosis and treatment troublesome increasing the risk for its associated complications. Even when diagnosed, this infection is subject to a high rate of therapeutic failure mainly due to the great genetic plasticity of N. gonorrhoeae for the acquisition of chromosomal or resistance plasmid enes. Increased resistance of this microorganism to antimicrobials commonly used in treatment such as penicillin, tetracycline and ciprofloxacin has been reported in several countries. In Brazil, few studies are available, but in some states strains resistant to ciprofloxacin were alreadyreported. The refore, it is important to highlight the importance of new studies aimed at describing the resistance profile of N. gonorrhoeae to antimicrobials in Brazil context. These findings will certainly guide the implementation of epidemiological surveillance systems in the country, since until now N. gonorrhoeae infections do not figure into the national list of compulsorily notifiable diseases.(AU)

Reservoritis/pouchitis: fisiopatología y manejo basado en la evidencia / Reservoirs/pouchitis: physiopathology and evidence-based management

Pouchitis is a frequent complication following proctocolectomy with ileal pouch-anal anastomosis, mainly in patients with ulcerative colitis. Though etiology is still unknown, evidence shows that there is a relation with host microbiota. Management of chronic refractory pouchitis is challenging, and current evidence showns that the use of biologic agents may have a favourable response.

La reservoritis es una complicación frecuente en pacientes en quienes se ha practicado una proctocolectomía con reservorio ileal, principalmente en pacientes con colitis ulcerosa. La etiología si bien es desconocida, la evidencia actual apunta a que exista una relación con la microbiota del huésped. La reservoritis refractaria crónica es un desafio en el manejo y actualmente ha surgido evidencia que apunta que el uso de biológicos puede tener una respuesta favorable.

Comparación entre ciprofloxacina y antibióticos de otros grupos farmacológicos para el tratamiento de infecciones del tracto urinario / Comparison between ciprofloxacine and antibiotics of other pharmacological groups for urinary tract infection treatment / Comparação entre a ciprofloxacina e outros antibióticos grupos farmacológicos para o tratamento de infecções do tracto urinário

ResumenIntroducción. Las infecciones de tracto urinario son un tema común en los servicios de consulta externa y emergencias de los centros de salud. El uso inadecuado e irracional de antibióticos puede favorecer la aparición de cepas resistentes y limitar la capacidad de respuesta de estos fármacos. Este artículo busca revisar el uso de quinolonas (específicamente ciprofloxacina) con antibióticos de otros grupos farmacológicos y comparar efectividad y resistencia bacteriana.Método. A partir de la metodología que señala la práctica clínica basada en la evidencia para las revisiones rápidas, se estableció una pregunta clínica a la que se le procuró responder mediante la búsqueda de investigaciones primarias en bases de datos electrónicas como MEDLINE, PubMed, Cochrane Library Plus y el Journal of Infection.Resultado. Según el tipo de bacteria y cepa analizada, hay presencia de resistencia a diversos antibióticos. Las infecciones de origen comunitario han sido tratadas con betalactámicos, nitrofurantoína, trimetoprimsulfametoxasol y fluoroquinolonas (especialmente ciprofloxacina).Conclusión. No se determinó si las quinolonas son más efectivas que los antibióticos que pertenecen a otros grupos farmacológicos

AbstractIntroduction. Urinary tract infections are a common reason of consultation in medical practical in ambulatory and emergency rooms in centers of health. The inadequate and irrational use of antibiotics can favor the appearance of resistant bacterial strain and limit the capacity of response of these medicines. This article seeks to review the use of quinolones (specifically ciprofloxacine) with antibiotics of other pharmacological groups and to compare efficiency and bacterial resistance.Method.From the methodology that indicates the clinical practice based on the evidence for the rapid reviews, there was established a clinical question to which response was tried to give by means of the search of primary investigations in electronic databases like MEDLINE, PubMed, Cochrane Library Plus and the Journal of Infection.Result. According to the type of bacterium and analyzed bacterial strain there is presence of resistance to diverse antibiotics. The infections of community origin have been treated by beta-lactamics, nitrofurantoine, trimetoprimsulfametoxasol and fluoroquinolones (specially ciprofloxacine).Conclusion. It was not possible to determine if the quinolonas are more effective than the antibiotics that belong to other pharmacological groups.

ResumoIntrodução. As infecções do trato urinário são um tema comum nos serviços de consulta externa e emergências dos centros de saúde. O uso inadequado e irracional de antibióticos pode favorecer o aparecimento de cepas resistentes e limitar a capacidade de resposta destes medicamentos. Este artigo busca revisar o uso de quinolonas (especificamente ciprofloxacina) com antibióticos de outros grupos farmacológicos e comparar efetividade e resistência bacteriana.Método. A partir da metodologia que aponta a prática clínica baseada na evidência para as revisões rápidas, se estabeleceu uma pergunta clínica que se procurou responder mediante pesquisas primárias em bases de dados eletrônicas como MEDLINE, PubMed, Cochrane Library Plus e o Journal of Infection.Resultado. Segundo o tipo de bactéria e cepa analisada, há presença de resistência a diversos antibióticos. As infecções de origem comunitária tem sido tratadas com betalactâmicos, nitrofurantoína, trimetoprimsulfametoxasol e fluoroquinolonas (especialmente ciprofloxacina).Conclusão. Não se determinou se as quinolonas são mais eficazes que os antibióticos que pertencem a outros grupos farmacológicos

Caracterización clínica, epidemiológica y terapéutica de los pacientes con otitis externa maligna / Clinical, epidemiological and therapeutical characterization of patients with malignant external

Se realizó un estudio descriptivo de serie de casos, de 42 pacientes con otitis externa maligna, atendidos en el Servicio de Otorrinolaringología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora de la provincia de Santiago de Cuba desde enero de 2002 hasta diciembre de 2014 y tratados básicamente con ciprofloxacina, a fin de caracterizarles clínica, epidemiológica y terapéuticamente, así como determinar su evolución clínica con el tratamiento indicado. También se incluyó un segundo grupo de 29 integrantes con la misma afección, quienes durante esos 12 años recibieron otros antibióticos y no la citada quinolona, tratados igualmente en dicho Servicio durante el período señalado. Entre los principales resultados sobresalió el predominio del grupo etario de 55-64 años (30,6 por ciento) en los que se utilizó ciprofloxacino y de 75 y más (74,8 por ciento) en los que se indicaron otros antimicrobianos; del tiempo de evolución de la diabetes mellitus de 0-10 años en 24 (57,1 por ciento) de quienes recibieron ciprofloxacino y en 14 (48,2 por ciento) de aquellos que no la consumieron y de la Pseudomonas aeruginosa como el germen más frecuentemente aislado. La evolución de los pacientes fue favorable, independientemente del tratamiento antimicrobiano prescrito, pero todos los tratados con ciprofloxacina egresaron en menos de 30 días mejorados o curados. Se concluyó que la edad avanzada favorece la aparición de la otitis externa maligna, sin importar el tiempo de evolución de la diabetes mellitus

A descriptive, serial cases study, of 42 patients with malignant external otitis was carried out. They were assisted in the Otolaryngology Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba from January, 2002 to December, 2014 and treated basically with ciprofloxacin, in order to characterize them clinical, epidemiological and therapeutically, as well as to determine their clinical course with the suitable treatment. A second group of 29 members with the same disorder was also included who received other antibiotics during those 12 years, treated in this Service during that period. Among the main results there was a prevalence of the 55-64 years age group (30.6 percent) in which ciprofloxacin was used and over 75 years (74.8 percent) in which other antimicrobians were indicated; of the time in the diabetes mellitus course 0-10 years in 24 (57.1 percent) of those who received ciprofloxacin and in 14 (48.2 percent) of those that didn't consume it and of the Pseudomonas aeruginosa as the most frequently isolated germ. The patients had a favorable clinical course, no matter the antimicrobian prescribed treatment, but all the patients treated with ciprofloxacin got better or were cured and were discharged in less than 30 days. It was concluded that the advanced age favors the emergence of the malignant external otitis, no matter the time of the diabetes mellitus course

Severe sepsis from a Ciprofloxacin resistant salmonellosis in a kidney transplant recipient / Sepse grave por salmonelose Ciprofloxacino-resistente em paciente transplantado renal

Abstract Introduction: Salmonellosis is a relatively rare complication in kidney transplant recipients that cannot be clinically distinguished from other forms of enteritis. Among kidney transplant patients, it varies broadly in intensity, and is highly associated with extra-intestinal disease, bacteremia, and, in this case, a high mortality rate. Case Report: Here we describe a clinical case of ciprofloxacin resistant salmonellosis in a kidney transplant patient. Conclusion: This case illustrates how immunosuppressed patients can be exposed to rare forms of infection, often clinically difficult to identify, and possibly with severe clinical courses and poor outcomes despite evidence-based empiric antibiotic therapy.

Resumo Introdução: A salmonelose é uma complicação relativamente rara em transplantados renais, e não pode ser diferenciada de outras formas de enterite pela apresentação clínica. Em pacientes transplantados renais, a salmonelose varia em gravidade, e é frequentemente associada com formas extra intestinais, bacteremia, e, neste caso, com elevada mortalidade. Relato de Caso: Descrevemos o caso clínico de um paciente transplantado renal com salmonelose Ciprofloxacino-resistente. Conclusão: Este caso ilustra o risco, relacionado à imunossupressão, da ocorrência de formas raras de infecção, por vezes de difícil diagnóstico, e com cursos clínicos potencialmente graves e prognóstico ruim, apesar do emprego de antibioticoterapia empírica adequada e de acordo com as evidências disponíveis.

A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolones / Um caso atípico de esclero-uveíte por Nocardia Asteroides resistente a fluorquinolona de quarta-geração

ABSTRACT We describe an unusual case of Nocardia spp scleritis in a health girl resistant to topical fourth-generation fluoroquinolones. Clinically, there was only partial response of the scleritis to initial therapy. Treatment was changed to meropenem intravenously and topical amikacin. Following several weeks of antibiotic treatment, the patient's infection resolved but her vision was reduced to no light perception. Nocardia asteroides must be considered as a possible agent in cases of necrotizing scleritis in patients without a clear source. Antibiotic sensitivity testing has a definitive role in view of the resistance to these new medications.

RESUMO Nós descrevemos um raro caso de esclerite por Nocardia spp em uma criança sadia resistente a utilização tópica de fluorquinolona de quarta-geração. Clinicamente, a paciente apresentou apenas uma resposta parcial do quadro de esclerite a terapêutica inicial. O tratamento foi então modificado para meropenem intravenoso e amicacina tópica. Após várias semanas de tratamento com antibiótico, o quadro infeccioso regrediu porém a visao da pacientes evoluiu para perda da percepção luminosa. Em casos de esclerite necrotizante em pacientes sem fatores de risco aparente é necessário considerer a Nocardia Asteroides como possível agente causador. Os testes de sensibilidade medicamentosa apresentam importância significativa em virtude do aparecimento de resistência aos novos medicamentos.

Resistencia antimicrobiana de cepas de Bartonella bacilliformis procedentes de regiones endémicas de la enfermedad de Carrión en el Perú / Antimicrobial resistance of Bartonella bacilliformis strains from regions endemic to bartonellosis in Peru

Evaluar la susceptibilidad antimicrobiana in vitro a cloranfenicol (CHL) y ciprofloxacino (CIP) de cepas de Bartonella bacilliformis procedentes de áreas endémicas de la enfermedad de Carrión (EC) en el Perú, mediante tres métodos de laboratorio. Materiales y métodos. Se evaluó la susceptibilidad antimicrobiana a CHL y CIP de 100 cepas de Bartonella bacilliformis, los aislamientos procedieron de pacientes de los departamentos de Ancash, Cusco, Cajamarca, Lima y La Libertad; las cepas se evaluaron mediante: disco difusión, E-Test y dilución en agar. Resultados. El 26% de las cepas de Bartonella bacilliformis evaluadas, presentaron resistencia a CIP y 1% a CHL. Se obtuvieron patrones similares de sensibilidad/resistencia antimicrobiana en los tres métodos utilizados. Conclusiones. Las cepas de Bartonella bacilliformis circulantes en el Perú, presentan elevados niveles de resistencia in vitro a CIP, por lo que se recomienda ampliar la investigación sobre la utilización del fármaco en los esquemas de tratamiento de la EC. Los métodos de E-test y disco difusión resultaron más convenientes para la evaluación de la susceptibilidad antimicrobiana in vitro del microorganismo...

To evaluate in vitro antimicrobial susceptibility to chloramphenicol (CHL) and ciprofloxacin (CIP) in strains of Bartonella bacilliformis from areas that are endemic to Bartonellosis in Peru, through three laboratory methods. Materials and methods. Antimicrobial susceptibility to CHL and CIP from 100 strains of Bartonella bacilliformis isolated in patients from the regions of Ancash, Cusco, Cajamarca, Lima and La Libertad were evaluated. Strains were evaluated by: disk diffusion, E-test and agar dilution. Results. 26% of the strains of Bartonella bacilliformis evaluated were resistant to CIP and 1% to CHL. Similar patterns of antimicrobial sensitivity / resistance were obtained in all three methods. Conclusions. Bartonella bacilliformis strains circulating in Peru have high levels of in vitro resistance to CIP, so it is advisable to expand research on the use of drug treatment regimens of the Bartonellosis. The methods of E-test and disk diffusion were the most suitable for assessment in vitro of antimicrobial susceptibility of the microorganism...

Pioderma gangrenoso em abdominoplastia: relato de caso / Pyoderma gangrenosum in abdominoplasty: a case report

Pioderma gangrenoso é uma doença caracterizada por úlceras dolorosas, com bordos imprecisos, de diversos tamanhos e profundidade. O diagnóstico é eminentemente clínico, sendo muitas vezes de exclusão. O tratamento não é específico. O desbridamento cirúrgico não é indicado devido a seu potencial de patergia. Neste trabalho, relatamos um caso de pioderma gangrenoso em uma paciente submetida à abdominoplastia.

Pyoderma gangrenosum is a disease characterized by painful ulcers, with imprecise borders of various sizes and depth. The diagnosis is essentially clinical and often exclusionary. The treatment is not specific. Surgical debridement is not indicated because of its potential pathergy. We report a case of pyoderma gangrenosum in a patient who underwent abdominoplasty.

Avaliações comparativas da associação entre antibióticos frente à Pseudomonas aeruginosa / Evaluación comparativa del uso asociado de antibióticos frente a Pseudomonas aeruginosa / Evaluation of the association antibiotics against Pseudomonas aeruginosa

Introdução: Pseudomonas aeruginosa caracteriza-se como bastonete gram-negativo reto ou ligeiramente curvo, aeróbio estrito, podendo ser encontrado na água, solo, vegetais, esgoto e animais. É um patógeno nosocomial com envolvimento em infecções hospitalares provocando infecções oportunistas em pacientes, principalmente naqueles imunocomprometidos. Uma das características de P. aeruginosa é seu alto nível de resistência intrínseca a agentes antimicrobianos estruturalmente diferentes. Objetivo: avaliar as atividades microbiológicas e comparar as atividades decorrentes da associação entre antibióticos que atuam no mesmo alvo e também em alvos diferentes frente às cepas bacterianas de Pseudomonas aeruginosa. Métodos: a Concentração Inibitória Mínima (CIM) foi realizada pelo método de microdiluição em caldo. Foi realizada modulação com bactérias associando os antibióticos. Resultados: as associações claritromicina‒imipenem e claritromicina ‒ciprofloxacina apresentaram sinergismo frente à P. aeruginosa, porém a associação claritromicina‒gentamicina demonstrou indiferença. Por outro lado as associações imipenem‒claritromicina, ciprofloxacino‒claritromicina e gentamicina ‒claritromicina apresentaram antagonismo. Conclusão: o resultado deste ensaio sugere que a associação de dois antibióticos testados aumenta o seu potencial antimicrobiano, podendo ser usado em combinação mediante investigações posteriores que comprovem a segurança de tal uso(AU)

Introduction: Pseudomonas aeruginosa is an anaerobic and gramnegative rod, they can be isolated from water, soil, vegetables, waste and animals. This microorganism is a nosocomial opportunistic infectious agent, mainly for immunocompromised patients. One of the main traits of P. aeruginosa is its intrinsic drug resistance to structurally different antibiotics. Objective: to evaluate the microbiological effect and to compare the activities derived from the antibiotic association s acting on the same target and on different targets against P. aeruginosa strains. Methods: the Minimun Inhibitory Concentration (MIC) was determined by broth microdilution method. The modulation of the activity on the bacteria was based on the antibiotic association. Results: the association of clarithromycin-imipenem and of clarothromycin-ciprofloxacin demonstrate synergism against P. aeruginosa. However, the association of clarithromycin?gentamycin did not show differences. On the other hand, the association of imipenem-clarihtromycin, of ciprofloxacine-clarithromycin and of gentamycin-clarithromycin showed antagonistic effect. Conclusions: the results of this study indicated that the association of two antibiotics enhances the antimicrobial potential of these drugs, and that they can be used in combination whenever other research studies confirm the safety of such use(AU)

Introducción: la Pseudomonas aeruginosa se caracteriza por ser gramnegativos con imagen de bastones rectos o ligeramente curvos, aeróbios, se pueden encuentrar en el agua, el suelo, en plantas, animales y aguas residuales. Es un patógeno nosocomial implicado en infecciones hospitalarias, causando infecciones oportunistas en pacientes, especialmente en aquellos inmunocomprometidos. Una de las características de la P. aeruginosa es su alto nivel de resistencia intrínseca a agentes antimicrobianos estructuralmente diferentes. Objetivo: evaluar las actividades microbiológicas y comparar las actividades derivadas de la asociación de antibióticos que actúan sobre la misma diana y también sobre diferentes dianas frente a cepas bacterianas de Pseudomonas aeruginosa. Métodos: el cálculo de la Concentración Mínima Inhibitoria (CMI) se realizó por el método de microdilución en caldo. La modulación de la actividad sobre bacterias se realizó por asociación de antibióticos. Resultados: las asociaciones claritromicina‒imipenem y claritromicina ‒ciprofloxacina mostraron sinergismo frente a P. aeruginosa; sin embargo la asociación claritromicina‒gentamicina no mostro diferencias. Por otro lado las asociaciones imipenem‒claritromicina, ciprofloxacino‒claritromicina y gentamicina ‒claritromicina demostraron antagonismo. Conclusión: los resultados de este estudio indican que la combinación de dos antibióticos aumenta su potencial antimicrobiano, y que pueden ser utilizadas en combinación, una vez que otras investigaciones confirmen la seguridad de dicho uso(AU)

Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt

Vancomycin resistant Enterococcus faecium (VREF) ia an emerging and challenging nosocomial pathogen. This study aimed to determine the prevalence, risk factors and clonal relationships between different VREF isolates in the intensive care units (ICUs) of the university hospitals in our geographic location. This prospective study was conducted from July, 2012 until September, 2013 on 781 patients who were admitted to the ICUs of the Mansoura University Hospitals (MUHs), and fulfilled the healthcare-associated infection (HAI) criteria. Susceptibility testing was determined using the disk diffusion method. The clonal relationships were evaluated with pulsed field gel electrophoresis (PFGE). Out of 52 E. faecium isolates, 12 (23.1%) were vancomycin resistant. The significant risk factors for the VREF infections were: transfer to the ICU from a ward, renal failure, an extended ICU stay and use of third-generation cephalosporins, gentamicin, or ciprofloxacin. PFGE with the 12 isolates showed 9 different patterns; 3 belonged to the same pulsotype and another 2 carried a second pulsotypes. The similar pulsotypes isolates were isolated from ICUs of one hospital (EICUs); however, all of the isolates from the other ICUs had different patterns. Infection control policy, in conjunction with antibiotic stewardship, is important to combat VREF transmission in these high-risk patients.

¿Está indicada la profilaxis antibiótica con ciprofloxacino en la realización de cistoscopia flexible? / Usefulness of antimicrobial prophylaxis with ciprofloxacin prior to flexible cystoscopy

Background: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. Aim: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. Material and Methods: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. Results: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. Conclusions: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit.

Pentacyclic triterpenes combined with ciprofloxacin help to eradicate the biofilm formed in vitro by Escherichia coli.

Background & objectives: Ciprofloxacin is commonly used in clinical practice for the treatment of recurrent urinary tract infections caused by Escherichia coli. However, very often these recurrent infections are due to a failure in a complete eradication of the microorganisms colonizing the urinary tract, especially in catheterized patients. To enhance the bactericidal activity of ciprofloxacin against biofilm-forming uropathogenic E. coli (UPECs), we examined its effect in combination with two pentacyclic triterpenes – asiatic and ursolic acids. Methods: The anti-biofilm activity of ciprofloxacin and pentacyclic triterpenes - asiatic acid (AA) and ursolic acid (UA), as well as their synergistic effect were tested on two types of surfaces - polystyrene microtiter plates and silicone catheters. It was investigated using the time-killing and biofilm assays. Results: anti-biofilm activity of ciprofloxacin was not observed on microtiter plates or on the catheters. Ciprofloxacin combined with ursolic acid inhibited the biofilm formation on microtitre plates. This mixture, however, did not express such a strong activity against the synthesis of biofilm on the surface of catheters. Ciprofloxacin combined with asiatic acid had very weak inhibiting effect on the synthesis of biofilm mass on microtitre plates as well as on the catheters. Despite this, both mixtures – ciprofloxacin and asiatic acid, as well as ciprofloxacin and ursolic acid, exhibited strong and significant impact on the eradication of mature biofilm (P < 0.05). Interpretation & conclusions: Although ciprofloxacin is recommended in the treatment of urinary tract infections caused by UPECs, but its efficacy is arguable. Subinhibitory concentrations of ciprofloxacin did not inhibit the formation of biofilm. Pentacyclic triterpenes used in combination with ciprofloxacin enhanced its anti-biofilm effectiveness. However, this anti-biofilm activity was found to depend on the type of surface on which biofilm was formed.

Short-term prophylaxis with ciprofloxacin in extended 16-core prostate biopsy

Objective To evaluate the safety, efficacy and possible complications of 16-core transrectal prostate biopsies using two doses of ciprofloxacin for prophylaxis of infectious complications. Materials and Methods Sixteen-core prostate biopsies were performed on a number of patients with different signs of potential prostate cancer. Complications were assessed both during the procedure and one week later. After the procedure, urine samples were collected for culture. The rate of post-biopsy complications, hospital visits and hospitalizations were also analyzed. Ciprofloxacin (500 mg) was administered two hours before, and eight hours after the procedure. Results The overall rate of post-biopsy complications was 87.32%, being 5.4% of those considered major complications due to hemorrhage, or to urinary retention. Eight patients required hospital treatment post-biopsy. Fever occurred in just one patient (0.29%). There was no incidence of orchitis, epididymitis, prostatitis, septicemia, hospitalization, or death. The urine culture showed positive results in five patients (2.15%). Conclusion One-day prophylaxis with ciprofloxacin proved to be safe and effective in the prevention of infectious complications following 16-core prostate biopsies. .

Validación del método por espectrofotometría ultravioleta para control de calidad de clorhidrato de ciprofloxacina en tabletas Ciprecu / Validation of the ultraviolet spectrophotometry method for the quality control of ciprofloxacin chlorhydrate in Ciprecu tablets

INTRODUCCCIÓN: las quinolonas son un grupo de agentes antimicrobianos de gran importancia en la clínica. El clorhidrato de ciprofloxacina monohidrato es una fluoroquinolona antibacterial de segunda generación que se indica en el tratamiento de diversas infecciones y se comercializa en forma de colirio, inyectable, cápsulas y tabletas. OBJETIVO: desarrollar y validar un método analítico por espectrofotometría ultravioleta, con vistas a su aplicación al control de calidad del clorhidrato de ciprofloxacina en tabletas Ciprecu recién elaboradas. MÉTODOS: se desarrolló el método en el laboratorio y se realizó una validación exhaustiva atendiendo a los parámetros de la categoría I. El método se seleccionó teniendo en cuenta la presencia de grupos cromóforos en la estructura del compuesto analizado. Se determinó la longitud de onda de máxima absorción a 273 nm de 5 µg/mL en ácido clorhídrico 0,1 mol/L. RESULTADOS: a partir del proceso de validación realizado, se demostró la adecuada especificidad frente a los componentes de la matriz en estudio, así como su linealidad, exactitud y precisión en el rango de 2,5 a 7,5 µg/mL. Los resultados de la aplicación de este método fueron similares a los obtenidos por el método oficial propuesto con iguales propósitos en USP 33, 2010. CONCLUSIONES: el método fue válido con el objetivo propuesto, lo cual constituye una nueva alternativa simple, rápida y económica para el control de calidad de clorhidrato de ciprofloxacina en tabletas Ciprecu(AU)

INTRODUCTION: quinolones are a group of antimicrobials of high clinical significance. Ciprofloxacin hydrochloride monohydrate is a second-generation antibacterial fluoroquinolone for treatment of several infections and is marketed as eye drops, injections, capsule and tablets. OBJECTIVE: to develop and to validate an ultraviolet spectrophotometric analytical method to be used in the quality control of ciprofloxacin hydrochloride monohydrate in newly manufactured Ciprecu tablets. METHODS: this method was devised at the laboratory and thoroughly validated pursuant to the category I parameters. The method was selected on account of the existence of chromophore groups in the structure of the analyzed compound. The maximum absorption wavelength was set at 273 nm of 5 µg/mL in 0.1 mol/L hydrochloric acid. RESULTS: based on the validation process, it was demonstrated that this method has adequate specificity against the study matrix components, as well as its linearity, accuracy and precision in the range of 2.5 to 7.5 µg/mL. The results of the application of this method were similar to those of the official procedure suggested for the same purposes in USP 33, 2010. CONCLUSIONS: The analytical method was valid for the suggested purposes, so it is a new simple, rapid and economic alternative for the quality control of Ciprofloxacin hydrochloride in Ciprecu tablets(AU)