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1.
Prensa méd. argent ; 106(4): 264-272, 20200000. tab, graf
Article in English | LILACS, BINACIS | ID: biblio-1368133

ABSTRACT

Introduction: Urinary tract infections (UTIs) are widespread clinical disorder among early neonates. Neonates with UTIs were susceptible to higher rates of morbidity and mortality, particularly when presented with hyperbilirubinemia. Early diagnosis may help in complete recoveryrather than being threatened in terms of complications. The study aimed at determining the prevalence and predictive risk factors of UTIs in neonates with an unexplained hyperbilirubinemia. Method: A cross-sectional study was carried out in the NICU of Aswan University Hospital, Egypt from August 2018 to February 2019. The study was conducted on 140 newborns who were diagnosed with indirect hyperbilirubinemia in the first 4 weeks of life after exclusion of unrelated criteria. Demographic and clinical data were collected by an interview questionnaire. Biochemical markers including bilirubin level, CBC, urine analysis and urine cultures and sensitivity were determined. Results: The prevalence rate of UTIs in the studied newborns was 25%. Escherichia -coli was the dominant organism isolated. Amikacin was the most common antibiotic sensitive to the isolates. There was a significant difference between the UTI positive and negative neonates in the univariate analysis regarding some studied variables. While, an increase in the number of WBCs in the blood (OR = 6.90, P = 0.001), small for gestational age (OR = 4.07, P = 0.021), prolonged phototherapy (OR = 3.50, P = 0.034), and presence of maternal complications (OR = 2.92, P = 0.001) were statistically associated with a positive urine culture in multivariate analysis. Conclusions and recommendations: The prevalence rate of UTIs was 25%. The study indicated the importance of routine screening of UTI (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia in neonates with an increase in the number of WBCs in their blood, small for gestational age, prolonged duration of phototherapy, and neonates born from mothers who had a history of obstetric complications


Subject(s)
Humans , Infant, Newborn , Urinary Tract Infections/therapy , Amikacin/therapeutic use , Predictive Value of Tests , Morbidity , Mortality , Clinical Laboratory Techniques , Early Diagnosis , Hyperbilirubinemia, Neonatal/complications
2.
Cienc. tecnol. salud ; 7(2): 196-204, 2020. il 27 c
Article in Spanish | LILACS, LIGCSA, DIGIUSAC | ID: biblio-1348153

ABSTRACT

Salmonellosis is a relevant public health threat worldwide. Reptiles are commonly involved in human cases. A microbiological survey was conducted from August to October 2018 to isolate Salmonella bacteria and de-termine if they were resistant to regularly used antibiotics in eight species of pet turtles (Kinosternon acutum sp., K. leucostomum, K. scorpioides, Rhinoclemmys areolata sp., R. pulcherrima, Staurotypus salvinii sp., Trachemys scripta and T. venusta) in Guatemala city, San Lucas Sacatepéquez and Antigua Guatemala. Cloacal swabs were taken from 63 turtles and cultivated in the Microbiology Laboratory at the Veterinary Medicine and Animal Hus-bandry Faculty, University of San Carlos of Guatemala, in Guatemala City. Three samples were positive to the presence of Salmonella sp. One of these isolates (from Trachemys scripta) was resistant to gentamicin, penicillin and amikacin, other isolate (from T. scripta) was partially resistant to amoxicilin + clavulanic acid and penicillin, and other (from T. venusta) to penicillin. These findings highlight the need for better biosecurity practices and show the capacity of bacteria to develop survival strategies that involve resistance to harmful substances like antibiotics.


La salmonelosis es una importante enfermedad zoonótica considerada una amenaza a la salud pública a nivel mundial. Los reptiles están comúnmente involucrados en la transmisión animal-humano. Con el objetivo de determinar la presencia de Salmonella y determinar su resistencia a antibióticos de uso común, se realizó un estudio exploratorio en ocho especies de tortugas (Kinosternon acutum sp., K. leucostomum, K. scorpioides, Rhinoclem-mys areolata sp., R. pulcherrima, Staurotypus salvinii sp., Trachemys scripta y T. venusta) en Guatemala y en San Lucas Sacatepéquez. Se tomaron hisopados cloacales de 63 especímenes y se cultivaron en el Laboratorio de Microbiología de la Facultad de Medicina Veterinaria y Zootecnia de la Universidad de San Carlos de Guatemala. Tres muestras fueron positivas a la presencia de Salmonella sp. Uno de los aislados (de Trachemys scripta) fue resistente a gentamicina, penicilina y amikacina, otro aislado (de T. scripta) fue parcialmente resistente a amoxicilina + ácido clavulánico y a penicilina y un tercer aislado (de T. venusta) a penicilina. Estos hallazgos resaltan la necesidad de mejores prácticas de bioseguridad y muestran la capacidad de las bacterias para desarrollar estrategias de sobrevivencia que involucran la resistencia a sustancias que les son nocivas, como los antibióticos.


Subject(s)
Salmonella/drug effects , Turtles/parasitology , Anti-Bacterial Agents/analysis , Penicillins/adverse effects , Amikacin/adverse effects , Gentamicins/adverse effects , Pets/microbiology
4.
Infectio ; 23(4): 313-317, Dec. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1019862

ABSTRACT

Resumen Introducción: los programas de optimización del uso de antimicrobianos son fundamentales para mejorar los resultados clínicos de los pacientes. Objetivos: determinar el impacto en el consumo de amikacina y ceftriaxona, además de cambios de sensibilidad de las principales bacterias en la unidad de emergencias del hospital Carlos van Buren de Valparaíso, Chile, luego de la implementación de una guía para el tratamiento de la ITU alta. Materiales y método: estudio cuasi-experimental antes/después. Se implementó una guía de tratamiento para la ITU alta, la cual fue enviada vía WhatsApp a los médicos de la unidad. Luego se midieron las dosis diarias definidas (DDD) de amikacina y ceftriaxona y se compararon con las DDD de los mismos meses del año anterior. Además se extrajo la sensibilidad de E.coli, K. pneumonia y P.mirabilis aisladas de urocultivos. Resultados: posterior a la intervención hubo un aumento de las DDD de amikacina y una disminución de las de ceftriaxona. K.pneumoniae mantuvo su sensibilidad a amikacina y la aumentó para cefotaxima, ertapenem y meropenem. Conclusiones: la implementación de una guía de tratamiento de la ITU alta aumentó el consumo de amikacina y disminuyó el de ceftriaxona. K.pneumoniae aumentó su sensibilidad a cefotaxima, ertapenem y meropenem.


Abstract Introduction: different antimicrobial stewardship programs are fundamental to improve clinical results in patients. Objectives: to determine the impact on amikacin and ceftriaxone consumption, in addition to knowing changes in sensitivity of the main agents in the emergency unit of the Carlos van Buren Hospital in Valparaíso, Chile, after the implementation of a treatment guide for pyelonephritis. Materials and methods: quasi-experimental before/after study. A treatment guide was implemented for pyelonephritis. The guide was sent by WhatsApp to all clinicians in the emergency unit. Following the intervention, amikacin and ceftriaxone defined daily dose (DDD) were measured and compared with the DDD for the same months of the previous year. In addition, the sensitivity of E.coli, K. pneumonia and P.mirabilis isolated from urine cultures was extracted. Results: after the intervention there was a sustained increase of the DDD of amikacin and a decrease in the DDD of ceftriaxone in the months studied period. K. pneumoniae maintained its sensitivity to amikacin and increased it to cefotaxime, ertapenem, and meropenem. Conclusions: The guide's implementation for treatment of high UTI in the emergency unit of the Carlos van Buren hospital increased the consumption of amikacin and decreased that of ceftriaxone. K. pneumoniae increased its sensitivity to cefotaxime, ertapenem and meropenem.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Urinary Tract Infections , Amikacin , Emergency Medical Services , Ceftriaxone , Chile , Clinical Laboratory Techniques , Data Visualization , Anti-Infective Agents
5.
Rev. cuba. med. gen. integr ; 35(1): e814, ene.-mar. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093480

ABSTRACT

Introducción: El incremento de la multirresistencia bacteriana constituye un problema de salud pública a nivel internacional. Objetivos: Determinar la susceptibilidad antimicrobiana y los patrones de multirresistencia en cepas de Escherichia coli y Klebsiella pneumoniae aisladas de urocultivos. Métodos: Se realizó un estudio descriptivo retrospectivo en el Centro Municipal de Higiene, Epidemiología y Microbiología, municipio Güines, provincia Mayabeque, Cuba, en el periodo comprendido de enero a diciembre de 2017. El estudio incluyó 250 cepas de Escherichia coli y 62 de Klebsiella pneumoniae aisladas e identificadas de muestras de orina de pacientes con infección del tracto urinario adquirida en la comunidad. La susceptibilidad antimicrobiana fue evaluada con el método de difusión en agar empleado la técnica de Kirby Bauer. Resultados: En Escherichia coli se observó niveles de resistencia superiores al 60 por ciento a los antimicrobianos ácido nalidíxico, cefotaxima, trimetoprim - sulfametoxazol y ceftazidima. La nitrofurantoína y la amikacina presentaron 88,8 por ciento y 83,8 por ciento de efectividad, respectivamente. Se apreció en Klebsiella pneumoniae altos valores de resistencia a ceftazidima, trimetoprim - sulfametoxazol y ácido nalidíxico. Amikacina, presentó niveles de sensibilidad de un 71 por ciento. La resistencia a las cefalosporinas de tercera generación se detectó en 78 (31,2 por ciento) de Escherichia coli y 26 (41,9 por ciento) de Klebsiella pneumoniae. De los aislados de Escherichia coli 143 (57,2 por ciento) y Klebsiella pneumoniae 35 (56,4 por ciento) presentaron multidrogoresistencia. Conclusiones: Existe la circulación de cepas resistentes a cefalosporinas de tercera generación y multidrogorresistentes causantes de infecciones de las vías urinarias adquiridas en la comunidad y se informa sobre los antibióticos (nitrofurantoína y amikacina) que podrían ser utilizados para combatirlas de forma empírica en esta área geográfica(AU)


Introduction: The increase of bacterial multiresistance constitutes a public health problem at the international level. Objectives: To determine antimicrobial sensitivity and multiresistance patterns in strains of Escherichia coli and Klebsiellapneumoniae isolated from urine cultures. Methods: A retrospective, descriptive study was conducted at the Municipal Center for Hygiene, Epidemiology and Microbiology, Güines municipality, Mayabeque Province, Cuba, in the period from January to December, 2017. The study included 250 Escherichia coli and 62 Klebsiellapneumoniae strains isolated and identified from urine samples from patients with urinary tract infection acquired in the community. Antimicrobial sensitivity was evaluated with the method of diffusion in agar using Kirby Bauer´s technique. Results: In Escherichia coli, resistance levels higher than the 60% were observed in antimicrobial nalidixic acid, cefotaxime, trimethoprim-sulfamethoxazole and ceftazidime. Nitrofurantoin and amikacin presented 88.8 percent and 83.8 percent of effectiveness, respectively. High values of resistance to ceftazidime, trimethoprim-sulfamethoxazole and nalidixic acid were present in Klebsiellapneumoniae. Amikacin presented sensitivity levels of 71 percent. Resistance to third-generation cephalosporins was detected in 78 (31.2 percent) of Escherichia coli and 26 (41.9 percent) Klebsiellapneumoniae. From the Escherichia coli and Klebsiellapneumoniae isolates, 143 (57.2 percent) and 35 (56.4 percent),respectively, presented multidrug resistance. Conclusions: There is circulation of strains which are resistant to third generation cephalosporins and multidrug resistants that cause urinary tract infections acquired in the community and there are reports on antibiotics (nitrofurantoin and amikacin) that might be used to combat them empirically in this geographical area(AU)


Subject(s)
Humans , Male , Female , Klebsiella Infections/epidemiology , Drug Resistance, Microbial , Amikacin/therapeutic use , Cephalosporin Resistance , Escherichia coli Infections/epidemiology , Nitrofurantoin/therapeutic use , Epidemiology, Descriptive , Retrospective Studies
7.
Article in English | WPRIM | ID: wpr-760359

ABSTRACT

The production of rmtB-encoded 16S rRNA methylases has emerged as a novel mechanism promoting high-level resistance toward aminoglycosides in Gram-negative bacteria. Between 2015 and 2017, 636 distinct commensal Escherichia (E.) coli isolates were collected from different farms in South Korea to determine the prevalence and molecular characteristics of rmtB. The positive rates of rmtB between all the isolates and amikacin-resistant isolates were 1.1 and 100%, respectively. High-level aminoglycoside resistance could be transferred by conjugation from rmtB-positive donors to higher amikacin-resistance efficacies. This is the first report of 16S rRNA methylase-encoding genes in E. coli isolated from food-producing animals in Korea.


Subject(s)
Agriculture , Amikacin , Aminoglycosides , Animals , Escherichia coli , Escherichia , Gram-Negative Bacteria , Humans , Korea , Prevalence , Tissue Donors
8.
Korean Journal of Medicine ; : 343-352, 2019.
Article in Korean | WPRIM | ID: wpr-759949

ABSTRACT

Mycobacterium abscessus is the second most important pathogen in pulmonary disease caused by nontuberculous mycobacteria (NTM), following Mycobacterium avium. Mycobacterium abscessus is classified into three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Mycobacterium abscessus is the most difficult to treat NTM due to its resistance to many antibiotics. Treatment should include an initial regimen of 2–3 injectable and oral antibiotics for several weeks or months, followed by inhaled amikacin and 1–3 oral antibiotics, depending on the subspecies and drug susceptibility patterns, including macrolide susceptibility. The continuation phase should be continued for a minimum of 12 months after culture conversion. Suitable injectable antibiotics include amikacin, imipenem, cefoxitin, and tigecycline, while oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and moxifloxacin. Surgery can be a useful adjunctive therapy for some patients with refractory disease. However, the overall treatment prognosis is still unsatisfactory. Therefore, novel and more effective interventions are required for the treatment of M. abscessus pulmonary disease.


Subject(s)
Amikacin , Anti-Bacterial Agents , Cefoxitin , Clofazimine , Humans , Imipenem , Linezolid , Lung Diseases , Macrolides , Mycobacterium avium , Mycobacterium , Nontuberculous Mycobacteria , Prognosis
9.
Article in English | WPRIM | ID: wpr-719621

ABSTRACT

The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.


Subject(s)
Amikacin , Body Mass Index , Clofazimine , Consensus , Disease Progression , Ethambutol , Humans , Lung , Lung Diseases , Macrolides , Mycobacterium avium Complex , Mycobacterium avium , Mycobacterium , Nontuberculous Mycobacteria , Nutritional Status , Recurrence , Rifampin , Sputum , Treatment Failure , Treatment Outcome
10.
Article in English | WPRIM | ID: wpr-719585

ABSTRACT

We implemented a carbapenem-saving strategy in hemato-oncology patients from 2013, using an empirical combination of piperacillin-tazobactam and amikacin for high-risk hemato-oncology patients with febrile neutropenia, who remain hemodynamically unstable > 72 hours despite initial cefepime treatment. All-cause mortality was not different between the two periods (6.54 and 6.57 deaths per 1,000 person-day, P = 0.926). Group 2 carbapenem use significantly decreased after strategy implementation (78.43 vs. 67.43 monthly days of therapy, P = 0.018), while carbapenem-resistant gram-negative bacilli did not show meaningful changes during the study period. Our carbapenem-saving strategy could effectively suppress carbapenem use without an increase of overall mortality.


Subject(s)
Amikacin , Febrile Neutropenia , Humans , Mortality
11.
Article in English | WPRIM | ID: wpr-765057

ABSTRACT

The susceptibility of Escherichia coli from community onset urinary tract infection (UTI) was evaluated by dividing community onset UTI into the simple community acquired-UTI (CA-UTI) and healthcare associated UTI (HCA-UTI) groups for a period of 10 years. The susceptibility of E. coli to most antibiotics, except amikacin and imipenem, continued to decrease. In the CA-UTI group, the susceptibility to cefotaxime was 88% in 2015, but rapidly decreased to 79.3% in 2017. The susceptibility to cefepime and piperacillin-tazobactam were 88.8% and 90.5% in 2017, respectively. In the HCA-UTI group, the susceptibility to most antibiotics markedly decreased to less than 60% by 2017. The incidence of ESBL-producing E. coli increased to 23.3% in the CA-UTI group in 2017.


Subject(s)
Amikacin , Anti-Bacterial Agents , Cefotaxime , Delivery of Health Care , Escherichia coli , Escherichia , Imipenem , Incidence , Korea , Tertiary Healthcare , Urinary Tract Infections , Urinary Tract
12.
Article in English | WPRIM | ID: wpr-763267

ABSTRACT

PURPOSE: We studied the pathogens and trends in antibiotic sensitivity pattern in children with urinary tract infection (UTI) over 8 years in order to evaluate adequate treatment. METHODS: We performed a retrospective review of medical records of children with UTI from January 2009 to December 2016 in Daegu Fatima Hospital. Uropathogens and antibiotic sensitivity patterns were selected. Only 1 bacterial species with a colony count of ≥105 CFU/mL was considered a positive result. We compared 2 periods group (A: 2009~2012, B: 2013~2016) to investigate trends of antibiotic sensitivity pattern. RESULTS: During the 8 year period, 589 cases are identified (E. coli was cultured in 509 cases, 86.4%). Among all patients, this study investigated the antibiotic sensitivity of E. coli . Antimicrobial susceptibility to ampicillin was steadily low for both periods (A: 32.6%, B: 40.1%, P=0.125), and to amikacin was consistently high for both periods (A: 99.4%, B: 99.3%, P=1.000). Antibiotic sensitivity to third-generation cephalosporin decreased from period A to B (A: 91.7%, B: 75.5%, P=0.000). Antibiotic sensitivity to quinolone significantly decreased from A to B (A: 88.4%, B: 78.2%, P=0.003). The prevalence of extended-spectrum β-lactamase-producing E. coli increased from period A to B (A: 6.1%, B: 17.1%, P=0.000). CONCLUSION: This study showed that conventional antibiotic therapy for the treatment of pediatric UTI needs to be reevaluated. A careful choice of antibiotic is required due to the change in antibiotic sensitivity and the emergence of antibiotic-resistant bacteria.


Subject(s)
Amikacin , Ampicillin , Bacteria , Child , Humans , Medical Records , Prevalence , Retrospective Studies , Urinary Tract Infections , Urinary Tract
13.
Enferm. actual Costa Rica (Online) ; (35): 185-200, Jul.-Dez. 2018. tab, graf
Article in Spanish | LILACS, BDENF | ID: biblio-1039750

ABSTRACT

Resumen 17. El objetivo de este artículo es presentar la mejor evidencia científica disponible sobre el uso de la amikacina como profilaxis en pacientes sometidos a prostatectomía. La indicación de amikacina en cirugías tipo prostatectomías se remite al uso profiláctico, razón por la cual surge la inquietud sobre el beneficio de la administración del medicamento en estos pacientes tomando en cuenta que, entre los efectos adversos, se evidencia nefrotoxicidad y ototoxicidad principalmente en personas adultas mayores o con problemas renales previos. Se utilizó la metodología de práctica clínica basada en la evidencia (PCBE), partiendo de una pregunta clínica para posteriormente hacer las búsquedas electrónicas en bases de datos como: MEDLINE, Google académico y Cochrane Library Plus. Después de establecer los criterios de inclusión y exclusión y análisis crítico, se seleccionó cuatro documentos que se relacionan con la respuesta a la pregunta planteada. Los resultados para el análisis crítico fueron revisados minuciosamente a través de la plataforma informática FCL 2.0 con las plantillas correspondientes. La evidencia señala que ningún estudio respondió directamente a la pregunta clínica planteada, las investigaciones analizadas no demuestran evidencia que confirme que el uso profiláctico de la amikacina sea beneficioso en pacientes intervenidos quirúrgicamente. Se concluye que no se encuentró evidencia significativa que respalde el uso profiláctico de la amikacina para disminuir las infecciones. La profilaxis se enfoca en administrar en pacientes sometidos a procedimientos quirúrgicos urológicos como primera elección un antibiótico de menor espectro, ya que para administrar amikacina hay que cumplir con los lineamientos institucionales establecidos según la condición de cada usuario, tomando en cuenta los resultados de las pruebas de función renal pre y post administración.


Abstract 21. The aim of this article is to present the best available scientific evidence on the use of amikacin as prophylaxis in patients undergoing prostatectomy. The indication of amikacin in prostatectomy-type surgeries refers to prophylactic use, which is why the concern about the benefit of administering the drug in these patients arises, taking into account that, among the adverse effects, nephrotoxicity and ototoxicity are evidenced mainly in people older adults or with previous kidney problems. We used the evidence-based clinical practice methodology (PCBE), based on a clinical question to later perform the electronic searches in databases such as: MEDLINE, Google academic and Cochrane Library Plus. After establishing the inclusion and exclusion criteria and critical analysis, four documents were selected that relate to the answer to the question posed. The results for the critical analysis were thoroughly reviewed through the FCL 2.0 computer platform with the corresponding templates. The evidence indicates that no study directly responded to the clinical question posed, the investigations analyzed do not demonstrate evidence confirming that the prophylactic use of amikacin is beneficial in patients undergoing surgery. It was concluded that no significant evidence was found to support the prophylactic use of amikacin to reduce infections. Prophylaxis focuses on administering patients with urological surgical procedures as first choice a lower spectrum antibiotic, since to administer amikacin it is necessary to comply with established institutional guidelines according to the condition of each user, taking into account the results of the tests of renal function pre and post administration.


Resumo 25. O objetivo deste artigo é apresentar as melhores provas disponíveis sobre o uso da doença como profilaxia em pacientes com uma prostatectomia. A indicação de amicacina em cirugias tipo prostatectomia é remediada com o uso de profiláctico, a razão pela investigação surge sobre o benefício da administração do medicamento em estágios, a tomada de controle, entre os efetivos adversos, a evidência nefrotoxicidad e ototoxicidad principalmente em personas adultas mayores o com problemas renales previos. Use a metodologia de prática clínica baseada na evidência (PCBE), partindo de uma clínica pré-existente para o futuro sobre as bússulas electrónicas em bases de dados como: MEDLINE, Google académico e Biblioteca Cochrane Plus. Depois de estabelecer os critérios de inclusão e exclusão e análise crítica, selecione o documento que se relaciona com a resposta à pregunta plantada. Os resultados para a análise crítica foram revisados ​​minuciosamente através da plataforma informática FCL 2.0 com os plantillas correspondentes. A evidência é que o exame é respondido diretamente à consulta clínica plantada, as investigações não demonstram evidências que confirmam o uso profiláctico da amidação do mar em pacientes intervencionados quirúrgicamente. Se concluye que não há provas de que são importantes o uso do termo profiláctico da amicina para disminuir as infecciones. A profilaxia do enfarte na administração de doentes é um procedimento quirúrgico urológico como a primeira eleição do antibiótico de menor espectro, o que ajuda a administrar o feno que cumplir com os lineamentos institucionais estabelecidos segundo a condição de cada um, tomando os resultados dos exames de función renal pré y pós administración.


Subject(s)
Humans , Male , Prostate , Prostatectomy , Amikacin/therapeutic use , Antibiotic Prophylaxis , Costa Rica
14.
J. bras. pneumol ; 44(2): 85-92, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-893914

ABSTRACT

ABSTRACT Objective: To investigate early detection of amikacin-induced ototoxicity in a population treated for multidrug-resistant tuberculosis (MDR-TB), by means of three different tests: pure-tone audiometry (PTA); high-frequency audiometry (HFA); and distortion-product otoacoustic emission (DPOAE) testing. Methods: This was a longitudinal prospective cohort study involving patients aged 18-69 years with a diagnosis of MDR-TB who had to receive amikacin for six months as part of their antituberculosis drug regimen for the first time. Hearing was assessed before treatment initiation and at two and six months after treatment initiation. Sequential statistics were used to analyze the results. Results: We included 61 patients, but the final population consisted of 10 patients (7 men and 3 women) because of sequential analysis. Comparison of the test results obtained at two and six months after treatment initiation with those obtained at baseline revealed that HFA at two months and PTA at six months detected hearing threshold shifts consistent with ototoxicity. However, DPOAE testing did not detect such shifts. Conclusions: The statistical method used in this study makes it possible to conclude that, over the six-month period, amikacin-associated hearing threshold shifts were detected by HFA and PTA, and that DPOAE testing was not efficient in detecting such shifts.


RESUMO Objetivo: Verificar a detecção precoce de ototoxicidade causada pelo uso de amicacina numa população tratada para tuberculose multirresistente (TBMR) por meio da realização de três testes distintos: audiometria tonal liminar (ATL), audiometria de altas frequências (AAF) e pesquisa de emissões otoacústicas por produto de distorção (EOAPD). Métodos: Estudo longitudinal de coorte prospectiva incluindo pacientes de ambos os sexos, com idade entre 18 e 69 anos, com diagnóstico de TBMR pulmonar e que necessitaram utilizar amicacina por seis meses em seu esquema medicamentoso antituberculose pela primeira vez. A avaliação auditiva foi realizada antes do início do tratamento e depois de dois e seis meses do início do tratamento. A análise dos resultados foi realizada por meio de análise estatística sequencial. Resultados: Foram incluídos 61 pacientes, mas a população final foi constituída de 10 pacientes (7 homens e 3 mulheres), em razão da análise sequencial. Ao se comparar os valores das respostas dos testes com aqueles encontrados na avaliação basal, foram verificadas mudanças nos limiares auditivos compatíveis com ototoxicidade após dois meses de tratamento através da AAF e após seis meses de tratamento através da ATL. Entretanto, essas mudanças não foram verificadas através da pesquisa de EOAPD. Conclusões: Ao se considerar o método estatístico utilizado nessa população, é possível concluir que mudanças nos limiares auditivos foram associadas ao uso da amicacina no período de seis meses por meio de AAF e ATL e que a pesquisa de EOAPD não se mostrou eficiente na identificação dessas mudanças.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tuberculosis, Pulmonary/drug therapy , Amikacin/adverse effects , Tuberculosis, Multidrug-Resistant/therapy , Hearing Disorders/diagnosis , Hearing Disorders/chemically induced , Antitubercular Agents/adverse effects , Audiometry, Pure-Tone/methods , Auditory Threshold/drug effects , Time Factors , Tuberculosis, Pulmonary/complications , Prospective Studies , Reproducibility of Results , Statistics as Topic , Longitudinal Studies , Treatment Outcome , Otoacoustic Emissions, Spontaneous/drug effects , Tuberculosis, Multidrug-Resistant/complications , Early Diagnosis , Hearing/drug effects , Hearing Disorders/physiopathology , Hearing Tests/methods
15.
Rev. chil. infectol ; 35(1): 22-28, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-899773

ABSTRACT

Resumen La presente revisión resume la evidencia sobre la monitorización terapéutica de tres antimicrobianos basada en datos regionales: vancomicina, amikacina y voriconazol en la población pediátrica. Estos datos coinciden con la literatura internacional en relación al requerimiento de dosis mayores que 40 mg/kg/día de vancomicina, la posibilidad de usar monodosis diarias de amikacina y el requerimiento de dosis mayores de voriconazol en relación a las iniciales recomendadas de 8 mg/kg/día. Contar con datos locales sobre el comportamiento farmacocinético/farmacodinámico de diversos antimicrobianos en la pediatría es de gran valor para adecuar la dosificación de los mismos en nuestra población. Se deberían incrementar los estudios de monitorización terapéutica en el uso de antimicrobianos en pediatría que permitan generar pautas de tratamiento adecuadas para este grupo etario.


This review summarizes recommendations of therapeutic monitoring of three antimicrobials based in regional data: vancomycin, amikacin and voriconazole in pediatric population. Regional evidence agrees with international literature regarding the requirement of higher daily doses than 40 mg/kg/day of vancomycin, as well as with the possibility of use one daily doses of amikacin and to recommend higher doses of voriconazole compared to the initially recommended doses of 8 mg/kg/day. Local data on the pharmacokinetic/pharmacodynamic behavior of various antimicrobials in pediatrics are of great value for dosing adjustment in our pediatric population. More studies in therapeutic monitoring in the use of antimicrobials in pediatrics should be performed in order to allow the generation of adequate treatment guidelines for this age group.


Subject(s)
Humans , Amikacin/administration & dosage , Amikacin/pharmacokinetics , Vancomycin/administration & dosage , Vancomycin/pharmacokinetics , Drug Monitoring/trends , Voriconazole/administration & dosage , Voriconazole/pharmacokinetics , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacokinetics , Antifungal Agents/administration & dosage , Antifungal Agents/pharmacokinetics , Dose-Response Relationship, Drug , Latin America
16.
Braz. J. Pharm. Sci. (Online) ; 54(3): e17258, 2018. tab, graf
Article in English | LILACS | ID: biblio-974394

ABSTRACT

A simple, accurate, isocratic stability indicating RP-HPLC method was developed for the determination of cefepime and amikacin in Pure and its pharmaceutical formulations. The method consists of methanol: acetonitrile:acetate buffer 75:20:05 (v/v) mobile phase at pH 5.1 with C18 column as stationary phase. The flow rate and detection wave length were 1.0 mL/min and 212 nm respectively. The linearity range for the method was found to be 2.5-25 µg/mL for amikacin and 10-100 µg/mL cefepime respectively. The developed method was validated as per ICH guidelines and the results of all the validation parameters were well within their acceptance values. Also the forced degradation studies were conducted with standard drugs. Degradation products formed during the different stress conditions were separated from both drugs. This validated method was applied for the simultaneous estimation of cefepime and amikacin in commercially available formulation sample.


Subject(s)
Amikacin/analysis , Chromatography, High Pressure Liquid/methods , Validation Study , Pharmaceutical Preparations
17.
Article in English | WPRIM | ID: wpr-717604

ABSTRACT

Pathogenic gram-negatives that produce 16S ribosomal RNA methyltransferases (16S RMTases) have already been distributed all over the world. To investigate the predominance of aminoglycoside resistance associated with 16S RMTases in Korea, we collected a total of 222 amikacin resistant Gram-negative clinical isolates from patient specimens between 1999 and 2015 from three hospital banks across Korea. ArmA and rmtB were the predominant 16S RMTase genes responsible for aminoglycoside-resistant isolates circulating in Korean community settings although only one rmtA-producing isolate was detected in 2006.


Subject(s)
Amikacin , Humans , Korea , Methyltransferases , RNA, Ribosomal, 16S
18.
Article in English | WPRIM | ID: wpr-717230

ABSTRACT

We describe a cutaneous abscess caused by Nocardia abscessus in a previously healthy woman. A 74-year-old woman presented with recurrent bullae on her left forearm that developed 1 week prior and was initially suspected to be a cutaneous infection with Mycobacteria or Tinea corporis. Histopathologically, the skin lesion formed an abscess. A smear revealed a few branched Gram-positive filamentous microorganisms that formed a creamy white colony on a blood agar plate after incubation for 3 days. The colony tested negative on acid-fast bacilli (AFB) staining, but was positive on modified AFB staining. The isolate was confirmed to be N. abscessus by 16S rRNA sequencing analysis. The isolate was susceptible to trimethoprim-sulfamethoxazole, amikacin, cefotaxime and erythromycin but resistant to penicillin. The patient was treated with clarithromycin but subsequently lost to follow-up. To the best of our knowledge, this is the first report of a human cutaneous infection with N. abscessus in Korea.


Subject(s)
Abscess , Agar , Aged , Amikacin , Cefotaxime , Clarithromycin , Erythromycin , Female , Forearm , Humans , Korea , Lost to Follow-Up , Nocardia , Penicillins , Skin , Tinea , Trimethoprim, Sulfamethoxazole Drug Combination
19.
Article in English | WPRIM | ID: wpr-715663

ABSTRACT

BACKGROUND: We examined the feasibility of a full-length gene analysis for the drug resistance-related genes inhA, katG, rpoB, pncA, rpsL, embB, eis, and gyrA using ion semiconductor next-generation sequencing (NGS) and compared the results with those obtained from conventional phenotypic drug susceptibility testing (DST) in multidrug-resistant Mycobacterium tuberculosis (MDR-TB) isolates. METHODS: We extracted genomic DNA from 30 pure MDR-TB isolates with antibiotic susceptibility profiles confirmed by phenotypic DST for isoniazid (INH), rifampin (RIF), ethambutol (EMB), pyrazinamide (PZA), amikacin (AMK), kanamycin (KM), streptomycin (SM), and fluoroquinolones (FQs) including ofloxacin, moxifloxacin, and levofloxacin. Enriched ion spheres were loaded onto Ion PI Chip v3, with 30 samples on a chip per sequencing run, and Ion Torrent sequencing was conducted using the Ion AmpliSeq TB panel (Life Technologies, USA). RESULTS: The genotypic DST results revealed good agreement with the phenotypic DST results for EMB (Kappa 0.8), PZA (0.734), SM (0.769), and FQ (0.783). Agreements for INH, RIF, and AMK+KM were not estimated because all isolates were phenotypically resistant to INH and RIF, and all isolates were phenotypically and genotypically susceptible to AMK+KM. Moreover, 17 novel variants were identified: six (p.Gly169Ser, p.Ala256Thr, p.Ser383Pro, p.Gln439Arg, p.Tyr597Cys, p.Thr625Ala) in katG, one (p.Tyr113Phe) in inhA, five (p.Val170Phe, p.Thr400Ala, p.Met434Val, p.Glu812Gly, p.Phe971Leu) in rpoB, two (p.Tyr319Asp and p.His1002Arg) in embB, and three (p.Cys14Gly, p.Asp63Ala, p.Gly162Ser) in pncA. CONCLUSIONS: Ion semiconductor NGS could detect reported and novel amino acid changes in full coding regions of eight drug resistance-related genes. However, genotypic DST should be complemented and validated by phenotypic DSTs.


Subject(s)
Amikacin , Clinical Coding , Complement System Proteins , DNA , Drug Resistance , Ethambutol , Fluoroquinolones , Isoniazid , Kanamycin , Levofloxacin , Mycobacterium tuberculosis , Mycobacterium , Ofloxacin , Pyrazinamide , Rifampin , Semiconductors , Streptomycin
20.
Rev. Soc. Bras. Med. Trop ; 50(5): 646-651, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-897011

ABSTRACT

Abstract INTRODUCTION: A total of 771 cases of multidrug-resistant tuberculosis (MDR-TB) were reported in Brazil in 2014. Treatment of MDR-TB with aminoglycosides can produce serious side effects such as permanent and irreversible hearing loss, which occurs in 5-64% of cases, and severely compromise patient quality of life. The goal of this research was to evaluate auditory and vestibular side effects in patients treated for MDR-TB and to identify associations between these complaints and the type of aminoglycoside used. METHODS: We performed a retrospective review of 599 medical records from patients with MDR-TB who were treated at the Hélio Fraga/Fiocruz Reference Center between 2006 and 2010. Cases without auditory or vestibular complaints and patients who were not treated with aminoglycoside drugs were excluded from the study. RESULTS: Of 164 eligible cases, 55 (33.5%) reported an auditory or vestibular complaint and medication was subsequently suspended, although hearing damage was not confirmed in all cases. Audiometric testing confirmed hearing loss in 11 (21.7%) of 12 cases submitted for evaluation. Hearing loss related to ototoxicity was confirmed in 15 (62.5%) cases. Tinnitus was significantly associated with the use of amikacin and streptomycin. CONCLUSIONS: Evaluations of ototoxicity symptoms were not usually reported in the routine care of patients with MDR-TB. Complaints of tinnitus were associated with amikacin and streptomycin use. These results require confirmation in future studies.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Audiometry/methods , Tuberculosis, Multidrug-Resistant/drug therapy , Aminoglycosides/adverse effects , Hearing Loss/diagnosis , Hearing Loss/chemically induced , Anti-Bacterial Agents/adverse effects , Time Factors , Tinnitus/diagnosis , Tinnitus/chemically induced , Amikacin/adverse effects , Streptomycin/adverse effects , Vestibular Diseases/diagnosis , Vestibular Diseases/chemically induced , Sex Factors , Retrospective Studies , Age Factors , Tuberculosis, Multidrug-Resistant/complications , Dizziness/diagnosis , Dizziness/chemically induced , Middle Aged
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