Predictors of mortality in multidrug-resistant tuberculosis patients from Brazilian reference centers, 2005 to 2012

ABSTRACT Objectives To determine the main predictors of death in multidrug-resistant (MDRTB) patients from Brazil. Design Retrospective cohort study, a survival analysis of patients treated between 2005 and 2012. Results Of 3802 individuals included in study, 64.7% were men, mean age was 39 (1-93) years, and 70.3% had bilateral pulmonary disease. Prevalence of human immunodeficiency virus (HIV) was 8.3%. There were 479 (12.6%) deaths. Median survival time was 1452 days (4 years). Factors associated with increased risk of death were age greater than or equal to 60 years (hazard rate [HR] = 1.6, confidence interval [CI] = 1.15-2.2), HIV co-infection (HR = 1.46; CI = 1.05-1.96), XDR resistance pattern (HR = 1.74, CI = 1.05-2.9), beginning of treatment after failure (HR = 1.72, CI = 1.27-2.32), drug abuse (HR = 1.64, CI = 1.22-2.2), resistance to ethambutol (HR = 1.30, CI = 1.06-1.6) or streptomycin (HR = 1.24, CI = 1.01-1.51). Mainly protective factors were presence of only pulmonary disease (HR = 0.57, CI = 0.35-0.92), moxifloxacin use (HR = 0.44, CI = 0.25-0.80), and levofloxacin use (HR = 0.75; CI = 0.60-0.94). Conclusion A more comprehensive approach is needed to manage MDRTB, addressing early diagnostic, improving adhesion, and comorbidities, mainly HIV infection and drug abuse. The latest generation quinolones have an important effect in improving survival in MDRTB.

Management of community acquired pneumonia by Family Physicians

Background and Objective: Community Acquired Pneumonia [CAP] is a major burden on health system with significant mortality and morbidity. Family Physicians [FPs] can play important role. To determine management strategies and prescription of FPs regarding CAP

Methods: A multicenter cross sectional survey was done in 10 cities of Pakistan from November 2014 to January 2015. Self-administered questionnaire was filled by 110 Family Physicians

Results: Of total 71% of FPs reported to work in high prevalence areas for respiratory ailments. Only 32% of FPs used PSI and 34% CURB 65 for assessment of severity. It was alarming to note that only 58% of FPs treats severe pneumonia with Intravenous antibiotics while rests were comfortable with oral route

The overall use of quinolones to treat CAP, irrespective of severity, in combination or as single agent was > 60%

Duration of antibiotics for severe pneumonia was sub optimal [<10 days]. Only 52.8% patients came back for follow-up so true outcome cannot be anticipated

Conclusion: Major deficiencies were treatment of severe pneumonia in community, inappropriate use of quinolones and poor knowledge of recent guidelines. This can lead to emergence of resistant bacteria and high mortality and morbidity

Moduladores mejoran la función pulmonar en la mutación más frecuente de la fibrosis quística / Proteine modulators improve pulmonary function in the most common cystic fibrosis mutation

Un tópico de análisis crítico es un resumen estandarizado que se organiza en torno a una pregunta clínica estructurada, realiza una revisión crítica y resalta la relevancia de sus resultados aplicados a nuestra realidad. El estudio analizado evalúa en 1100 pacientes de 12 años o más portadores de fibrosis quística (FQ) homocigotos para la mutación más frecuente phe508del CFTR, la terapia combinada de dos moduladores de la proteína CFTR, comparado con placebo, la que mostró mejoría significativa de la función pulmonar (VEF1) de 2.6 a 4 puntos porcentuales 1. Estos resultados proponen un tratamiento curativo al 50 por ciento de los pacientes en USA y al 15 por ciento en nuestro país, una vez superado los costos.

A CAT is a standardized summary of research evidence organized around a clinical question, aimed to provide a critique of the research and a statement of the clinical relevance of results. In the analyzed paper, the authors evaluated 1100 patients with cystic fibrosis (CF) 12 years and older with two copies of phe508del CFTR genetic mutation, the combination therapy of two CFTR modulators led to mean absolute improvements in lung function (VEF1) between 2.6 and 4 percentage points, which was statistically significant. These results are promising for the 50 percent of the USA CF population and 15 percent of the CF Chilean population.

Tuberculoma cerebral en paciente joven inmunocompetente / Cerebral tuberculoma in young immunocompetent patient

RESUMEN La tuberculosis con afección del sistema nervioso central es una afectación infrecuente pero muy grave de esta enfermedad, representa el 1% de todos los casos de tuberculosis. Reportamos el caso de una joven HIV negativa, con daño del sistema nervioso central de tipo miliar a nivel cerebral y sin enfermedad pulmonar. La tuberculosis puede afectar extensamente a sujetos inmunocompetentes y este fenómeno ha sido descripto en muchas series a los largo del tiempo. Ante la sospecha clínica, el seguimiento de un protocolo específico para confirmar el diagnóstico es de vital importancia para el temprano diagnóstico y correcto manejo de una situación que puede comprometer la vida y generar a largo plazo secuelas graves. Se presenta el caso por el reto diagnóstico que ha supuesto y rara presentación en paciente inmunocompetente.

ABSTRACT Tuberculosis with central nervous system involvement is an uncommon but very serious disease, with a frecuence of 1% of all cases of tuberculosis. We report the case of a young HIV negative woman, with central nervous system damage of the miliary type in the brain without lung disease. Tuberculosis can extensively affect immunecompetent subjects and this phenomenon has been described in many series over the time. In the presence of clinical suspicion, the follow-up of a specific protocol to confirm the diagnosis is of vital importance for the early diagnosis and correct management of a situation that can compromise life and generate long-term serious sequelae. The case is presented because of diagnostic challenge and a rare presentation in an immunocompetent patient.

Molecular characterization of multidrug-resistant Klebsiella pneumoniae isolates

Klebsiella pneumoniae is an important cause of healthcare-associated infections worldwide. Selective pressure, the extensive use of antibiotics, and the conjugational transmission of antibiotic resistance genes across bacterial species and genera facilitate the emergence of multidrug-resistant (MDR) K. pneumoniae. Here, we examined the occurrence, phenotypes and genetic features of MDR K. pneumoniae isolated from patients in intensive care units (ICUs) at the First Affiliated Hospital of Xiamen University in Xiamen, China, from January to December 2011. Thirty-eight MDR K. pneumoniae strains were collected. These MDR K. pneumoniae isolates possessed at least seven antibiotic resistance determinants, which contribute to the high-level resistance of these bacteria to aminoglycosides, macrolides, quinolones and β-lactams. Among these isolates, 24 strains were extended-spectrum β-lactamase (ESBL) producers, 2 strains were AmpC producers, and 12 strains were both ESBL and AmpC producers. The 38 MDR isolates also contained class I (28/38) and class II integrons (10/38). All 28 class I-positive isolates contained aacC1, aacC4, orfX, orfX’ and aadA1 genes. β-lactam resistance was conferred through bla_SHV (22/38), bla_TEM (10/38), and bla_CTX-M (7/38). The highly conserved bla_KPC-2 (37/38) and bla_OXA-23(1/38) alleles were responsible for carbapenem resistance, and a gyrAsite mutation (27/38) and the plasmid-mediated qnrB gene (13/38) were responsible for quinolone resistance. Repetitive-sequence-based PCR (REP-PCR) fingerprinting of these MDR strains revealed the presence of five groups and sixteen patterns. ...

Molecular characterization of multidrug-resistant Klebsiella pneumoniae isolates

Klebsiella pneumoniae is an important cause of healthcare-associated infections worldwide. Selective pressure, the extensive use of antibiotics, and the conjugational transmission of antibiotic resistance genes across bacterial species and genera facilitate the emergence of multidrug-resistant (MDR) K. pneumoniae. Here, we examined the occurrence, phenotypes and genetic features of MDR K. pneumoniae isolated from patients in intensive care units (ICUs) at the First Affiliated Hospital of Xiamen University in Xiamen, China, from January to December 2011. Thirty-eight MDR K. pneumoniae strains were collected. These MDR K. pneumoniae isolates possessed at least seven antibiotic resistance determinants, which contribute to the high-level resistance of these bacteria to aminoglycosides, macrolides, quinolones and β-lactams. Among these isolates, 24 strains were extended-spectrum β-lactamase (ESBL) producers, 2 strains were AmpC producers, and 12 strains were both ESBL and AmpC producers. The 38 MDR isolates also contained class I (28/38) and class II integrons (10/38). All 28 class I-positive isolates contained aacC1, aacC4, orfX, orfX’ and aadA1 genes. β-lactam resistance was conferred through blaSHV (22/38), blaTEM (10/38), and blaCTX-M (7/38). The highly conserved blaKPC-2 (37/38) and blaOXA-23(1/38) alleles were responsible for carbapenem resistance, and a gyrAsite mutation (27/38) and the plasmid-mediated qnrB gene (13/38) were responsible for quinolone resistance. Repetitive-sequence-based PCR (REP-PCR) fingerprinting of these MDR strains revealed the presence of five groups and sixteen patterns. ...

Uso terapéutico de los antibióticos en el tratamiento periodontal: revisión de la literatura / Therapeutic use of antibiotics in periodontal treatment: a review of the literature

Las enfermedades periodontales son consecuencia de la acumulación de la placa dental. Las bacterias presentes en ella inician un proceso inflamatorio en los tejidos periodontales por medio de la liberación de toxinas bacterianas. El tratamiento indicado implica terapias mecánicas no quirúrgicas y quirúrgicas y, en algunos casos, terapia farmacológica. En pacientes que no responden a la terapia mecánica, los estudios sugieren el uso de terapias complementarias con antibióticos locales o sistémicos. En esos casos, es necesario el desarreglo previo de la placa dental adherida a la superficie radicular. Los antibióticos, junto con el raspado y alisado radicular (RAR) y el colgajo periodontal, son una alternativa de agentes terapéuticos, pues garantizan resultados satisfactorios en el tratamiento periodontal. El objetivo de esta revisión es analizar las propiedades de los antibióticos como agentes coadyuvantes de la terapia periodontal...

Effect of Indacaterol on Cough and Phlegm in Chronic Obstructive Pulmonary Disease Patients: A Meta-Analysis of Five Randomized Controlled Trials

We investigated the effects of indacaterol on cough and phlegm in patients with stable chronic obstructive pulmonary disease (COPD). We performed a meta-analysis with five randomized controlled trials (RCTs) of indacaterol in stable COPD patients. The symptom severity was defined using the St. George's Respiratory Questionnaire (SGRQ). We analyzed patients treated with 150 microg (n = 945) and 300 microg (n = 832) out of 3,325 patients who completed the SGRQ from five RCTs. After a 12-week treatment of 150 microg indacaterol, cough improvement was reported in 36.5% (316/866) of patients treated with indacaterol vs. 32.2% (259/804) patients treated with placebo (Relative Ratio [RR], 1.13; 95% confidence interval [CI], 0.99-1.29). Phlegm improvement was reported in 31.0% (247/798) of patients treated with indacaterol vs. 30.6% (225/736) of patients treated with placebo (RR, 1.01; 95% CI, 0.87-1.18). Dyspnea improvement was reported in 39.5% (324/820) of patients treated with indacaterol vs. 31.5% (237/753) patients treated with placebo (RR, 1.33; 95% CI, 1.03-1.71; P = 0.001, I2 = 55.1%). Only dyspnea improvement was significant compared to placebo even at the 300 microg indacaterol dose. Compared to placebo, a 12-week treatment of the long-acting beta-agonist, indacaterol might not have a significant effect on cough or phlegm in stable COPD.

Pesquisa de genes de resistência a quinolonas em bacilos Gram negativos de origem clínica e ambiental / Research for genes of quinolone resistance in Gram negative bacilli from clinical and environmental origin

Introdução. Quinolonas são antimicrobianos sintéticos que inibem as enzimas DNA-girase e topoisomerase IV resultando na morte bacteriana. São altamente eficazes no tratamento de infecções bacterianas, especialmente causadas por bactérias Gram negativas, e portanto amplamente utilizados na medicina humana e veterinária, na qual também são empregados como profiláticos. Porém, o uso indiscriminado e inadequado levou ao aumento de bactérias resistentes a estes compostos. Esta resistência pode ocorrer devido a mutações nas enzimas DNA-girase e topoisomerase IV, e também por genes contidos em plasmídeos. Estes últimos são os principais responsáveis pela disseminação e circulação da resistência entre o meio ambiente e o ambiente hospitalar. Objetivos. Pesquisar genes de resistência a antimicrobianos do grupo das quinolonas em bactérias Gram negativas de origem clínica e ambiental que apresentam resistência fenotípica a este grupo. Material e Métodos. 73 cepas de Enterobacteriaceae e Aeromonas sp. de origem clínica e ambiental foram selecionadas para o estudo, e avaliadas quanto à sensibilidade aos antimicrobianos do grupo das quinolonas e à pesquisa de genes de resistência a este mesmo grupo e mutações no gene que codifica a enzima DNA-girase por meio de PCR e sequenciamento. Resultados. Das 73 cepas previamente selecionadas para compor o estudo, 65 foram utilizadas, devido à exclusão de perfis clonais similares. Nestas, foram observados os genes, qnrS1 (1,5 por cento ), qnrS2 (26,2 por cento ), qnrB1 (3,1 por cento ), qnrB19 (12,3 por cento ), qnrD1 (1,5 por cento ), aac(6)-Ib-cr (10,8 por cento ), oqxA (43,1 por cento ) e oqxB (41,5 por cento ), e duas variantes determinadas qnrB-like (3,1 por cento ) e qnrB69-like (1,5 por cento ). Os genes qnrA, qnrC e qepA não foram identificados. Mutações na enzima DNA-girase foram observadas em 97,9 por cento das cepas positivas para algum dos genes pesquisados...

Introduction. Quinolones are synthetic antimicrobial agents that inhibit DNA gyrase and topoisomerase IV enzymes resulting in bacterial death. They are highly effective in the treatment of bacterial infections, especially the ones caused by Gram negative bacteria, as well as for prophylaxy. Therefore they are widely used in human and veterinary medicine. However, indiscriminate and improper use led to an increase of bacteria resistance to these compounds. This resistance can be due to mutations in DNA gyrase and topoisomerase IV enzymes and also by genes contained in plasmids, which are mainly responsible for the spread and transmission of resistance between the environment and the hospital set. Objectives. To search for genes of resistance to quinolone antimicrobial agents in Gram-negative bacteria from clinical and environmental strains that present phenotypic resistance to this group. Material and Methods. 73 strains of Enterobacteriaceae and Aeromonas spp., from clinical and environmental origin, were selected for this study, and evaluated for antimicrobial susceptibility of quinolone and search of resistance genes in this same group and also for mutations in the gene encoding the enzyme DNA gyrase by PCR and sequencing. Results. Of the 73 strains previously selected to compose this study, 65 were used, due to the exclusion of similar clonal profiles. In these, genes qnrS1 (1.5 per cent ), qnrS2 (26.2 per cent ) qnrB1 (3.1 per cent ), qnrB19 (12.3 per cent ) qnrD1 (1.5 per cent ) aac(6')-Ib-cr (10.8 per cent ) oqxA (43.1 per cent ) and oqxB (41.5 per cent ) were observed, and two variants were named as qnrB-like (3.1 per cent ) and qnrB69-like (1.5 per cent ). The qnrA, qnrC and qepA genes were not identified. Mutations in DNA gyrase enzyme were observed in 97.9 per cent of the positive strains for at least one of the genes studied. It was possible to establish the association of aac(6')-Ib-cr with class 1 integron gene in four strains...

Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia / Fatores de risco para multirresistência bacteriana em pneumonias adquiridas no hospital não associadas à ventilação mecânica

OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP. .

OBJETIVO: Identificar fatores de risco para o desenvolvimento de pneumonia adquirida no hospital (PAH), não associada à ventilação mecânica e causada por bactérias multirresistentes (MR). MÉTODOS: Estudo de coorte observacional retrospectivo, conduzido ao longo de três anos em um hospital universitário terciário. Incluímos apenas pacientes sem ventilação mecânica, com diagnóstico de PAH e com cultura bacteriana positiva. Variáveis categóricas foram comparadas por meio do teste do qui-quadrado. A análise de regressão logística foi usada para determinar os fatores de risco para PAH causada por bactérias MR. RESULTADOS: Dos 140 pacientes diagnosticados com PAH, 59 (42,1%) apresentavam infecção por cepas MR. As taxas de mortalidade nos pacientes com cepas de Staphylococcus aureus resistentes e sensíveis à meticilina, respectivamente, foram de 45,9% e 50,0% (p = 0,763). As taxas de mortalidade nos pacientes com PAH causada por bacilos gram-negativos MR e não MR, respectivamente, foram de 45,8% e 38,3% (p = 0,527). Na análise univariada, os fatores associados com cepas MR foram DPOC, insuficiência cardíaca crônica, insuficiência renal crônica, diálise, cateterismo urinário, infecções extrapulmonares e uso de antimicrobianos nos 10 dias anteriores ao diagnóstico de PAH. Na análise multivariada, o uso de antimicrobianos nos 10 dias anteriores ao diagnóstico foi o único fator preditor independente de cepas MR (OR = 3,45; IC95%: 1,56-7,61; p = 0,002). CONCLUSÕES: Neste estudo unicêntrico, o uso de antimicrobianos de largo espectro 10 dias antes do diagnóstico de PAH foi o único preditor independente da presença de bactérias MR em pacientes ...

Controversias sobre el uso de fluoroquinolonas en los niños / Debate over the use of fluoroquinolones in children

En ciertas especies de animales inmaduros se ha documentado que las quinolonas generan el desarrollo de una artropatía secundaria a alteración del cartílago de crecimiento

Previous use of quinolones: a surrogate marker for first line anti-tuberculosis drugs resistance in HIV-infected patients?

OBJECTIVES: Drug resistant Mycobacterium tuberculosis causes much higher rates of treatment toxicity, failure or relapse, and mortality. We determined the drug resistant profile of Mycobacterium tuberculosis strains isolated from a population of HIV-infected patients in southern Brazil and studied the potential factors associated with resistance. METHODS: We conducted a retrospective cohort study to determine the resistance profile of Mycobacterium tuberculosis isolated from HIV-infected patients and factors that could be associated with resistance from 2000 to 2005. RESULTS: 236 patients were included in the study. Resistance to at least one drug was observed in 32 (14.6%) isolates, and multi-drug resistance was observed in 4 (1.82%) isolates. On multivariate analysis, previous use of tuberculostatics and quinolones were related to any first-line drug resistance. CONCLUSIONS: In our study, previous quinolone use was significantly associated to first-line anti-TB drugs resistance. Multi-drug-resistant tuberculosis (MDR-TB) is a major problem worldwide, and we believe quinolones should be used with caution in settings where TB is endemic.

An insight into the drug resistance profile & mechanism of drug resistance in Neisseria gonorrhoeae.

Among the aetiological agents of treatable sexually transmitted diseases (STDs), Neissseria gonorrhoeae is considered to be most important because of emerging antibiotic resistant strains that compromise the effectiveness of treatment of the disease - gonorrhoea. In most of the developing countries, treatment of gonorrhoea relies mainly on syndromic management rather than the aetiological based therapy. Gonococcal infections are usually treated with single-dose therapy with an agent found to cure > 95 per cent of cases. Unfortunately during the last few decades, N. gonorrhoeae has developed resistance not only to less expensive antimicrobials such as sulphonamides, penicillin and tetracyclines but also to fluoroquinolones. The resistance trend of N. gonorrhoeae towards these antimicrobials can be categorised into pre-quinolone, quinolone and post-quinolone era. Among the antimicrobials available so far, only the third-generation cephalosporins could be safely recommended as first-line therapy for gonorrhoea globally. However, resistance to oral third-generation cephalosporins has also started emerging in some countries. Therefore, it has become imperative to initiate sustained national and international efforts to reduce infection and misuse of antibiotics so as to prevent further emergence and spread of antimicrobial resistance. It is necessary not only to monitor drug resistance and optimise treatment regimens, but also to gain insight into how gonococcus develops drug resistance. Knowledge of mechanism of resistance would help us to devise methods to prevent the occurrence of drug resistance against existing and new drugs. Such studies could also help in finding out new drug targets in N. gonorrhoeae and also a possibility of identification of new drugs for treating gonorrhoea.

Resistencia antimicrobiana en bacterias aisladas, en el Instituto Hondureño de Seguridad Social / Antimicrobial resistance in isolated bacteria in the Instituto Hondureño de Seguridad Social

Introducción. La resistencia de las bacterias a los antimicrobianos es un problema creciente a nivel mundial, produciendo un incremento en los costos hospitalarios y en la morbimortalidad. El objetivo de este trabajo es presentar la sensibilidad a los antibióticos de las bacterias aisladas en el Hospital de Especialidades del Instituto Hondureño de Seguridad Social. Materiales y Métodos. Se realizó un estudio descriptivo de la sensibilidad de las bacterias aisladas en pacientes hospitalizados en el Hospital de Especialidades del Instituto Hondureño de Seguridad Social de Tegucigalpa, Honduras del 2006 al 2009. Resultados. Se registraron 4,812 aislamientos procedentes de diversas muestras: 986(20.4%) urocultivos,824(17%) hemocultivos , 627(13%) de secreciones varias y de diversas fuentes. Las bacterias Gram negativas fueron las aisladas con mayor frecuencia, siendo las mas comunes Klebsiella pneumoniae, Echerichia coli y Burkholderia cepacia. La Echerichia coli presentó alta resistencia a quinolonas, de 37% a 42%; Pseudomona aeruginosa presentó alta resistencia a cefalosporina de tercera generación y quinolonas, aumentando de 30% en el 2006 a más del 40% en el 2009. Acinetobacter baumanii tiene una alta resistencia a todos los antibióticos incluso a los carbapenémicos. Stafilococcus aureus resistente a meticilina incrementó de 20% en 2007 hasta 36% en el 2009. El primer caso de neumococo resistente a penicilina se documento en el 2009. Discusió. Los resultados demuestran la necesidad de crear políticas a nivel institucional para contener y controlar el aumento de la resistencia antimicrobiana...

Efectos adversos musculoesqueléticos por el uso de fluoroquinolonas en niños: un metaanálisis / Assessing fluorquinolones as risk factor for musculoskeletal disorders in children: a systematic review and meta-analysis

Introducción. Las quinolonas constituyen un grupo de antibióticos bactericidas derivados del ácido nalidíxico. En pediatría, la más usada esla ciprofloxacina. Al momento, son la única opción por vía oral para tratar las infecciones por Pseudomonas aeruginosa. Está documentado que,en individuos inmaduros de ciertas especies de animales, la exposición a estos compuestos genera el desarrollo de una artropatía secundaria aalteración del cartílago de crecimiento. Esa toxicidad en animales inmaduros fue extrapolada al ser humano, por lo que no se recomienda su usoen menores de 18 años. Dada la controversia relacionada se realizó esta revisión sistemática de las evidencias como medio de evaluación de estosfármacos para su uso en la edad pediátrica.Métodos. La búsqueda se realizó en la base Medline, en la Cochrane Library y por búsqueda en texto libre mediante los motores Google y Yahoo.Se incluyeron trabajos aleatorizados, cohortes y caso-control cuya variable principal fuera la presencia de artropatía-tendinopatía. Los trabajosse clasificaron según niveles de evidencia.Los datos fueron volcados de acuerdo a un protocolo prediseñado.Resultados. La búsqueda incluyó 277 artículos, de los cuales sólo 8 pudieron ser incluidos, que correspondían a 23 166 pacientes. Sólo 1 trabajodemostró asociación entre alteración musculoesquelética y fluoroquinolonas. El cociente de probabilidades(odds ratio) total fue 1,02 (IC 0,76-1,38).Conclusión. Este metaanálisis no pudo probar la relación entre el uso de fluoroquinolonas y alteraciones musculoesqueléticas en pediatría.

Background. Joint cartilage toxicity secondary to fluoroquinolone use has been observed in young animals. These early observations led to the contraindication of fluoroquinolones in children under 18 years. Nevertheless, quinolones may be the only option for oral treatment of infections caused by Pseudomonas aeruginosa. Objective. To evaluate by systematic review andmeta-analysis the relation between fluoroquinolonas and musculoskeletal disorders in children. Methods. Data sources were Medline, Cochrane data base, and free-text search through Google and Yahoo. MESH terms were: quinolones and arthropathy tendinopathy and children. Randomizedclinical trials, cohorts and case-control studies with a primary outcome of arthropaty and/or tendinopathy were included. Each study was scored and classified for methodological key issues according to level of evidence. Datawere extracted using a predetermined protocol. Results. The search identified 277 studies of whom 8 were eligible for inclusion that included 23 166 patients. All except one failed to find a significant link between fluoroquinolones useand musculoskeletal disorders. The pooled odds ratio was 1.02 (CI 0.76-1.38). Conclusion. Our meta-analysis does not supportmusculoskeletal disorders as a result of fluoroquinolones use in children under 18 years. Thus, in selected, appropriate, and mandatory cases fluoroquinolones should not be contraindicated in children.

Surveillance of antibiotic susceptibility pattern among shigella flexneri strain isolated in Nagpur district during three years period, January 2009-January 2012.

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.