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Arq. bras. med. vet. zootec. (Online) ; 73(6): 1381-1390, Nov.-Dec. 2021. tab
Article in English | LILACS, VETINDEX | ID: biblio-1355675


The utilization of antimicrobials in animal production, causes selection of resistant bacteria. The objective of this study was to compare the utilization of alternatives in association with preventive antibiotic therapy in swine feed during the growing and finishing phases. 1,045 animals were used from 60 to 190 days of age and were subjected to six treatments with 16 repetitions as follows: 1) antibiotic free; 2) antibiotics; 3) prebiotic; 4) probiotic; 5) essential oils; and 6) organic acid. Animals were weighted, and clinical history was recorded including mortality and diarrhea. At the abattoir, pneumonia index and gastric ulcers were investigated. The cost for each treatment was discussed. No difference between treatments were observed (P>0.05) regarding feed conversion rate (2.64±0.03), overall average weight gain (107.06±0.9kg), average daily weight gain (856.49±7.7g) and carcass weight (92.4±0.7kg). The application injectable drugs in animals presenting clinical symptoms, represented US$ 0.56/intervention, without difference between the treatments (P>0.05). Furthermore, independently of the treatment, high frequency of pneumonia was observed (>0.90). No difference for the degree of gastric ulcer nor feces consistency were observed (P>0.05). The utilization of antibiotic therapy and alternatives to antibiotics in feed did not produce benefits to the production indices and sanitary performances of the animals.(AU)

A utilização de antimicrobianos na produção animal provoca seleção de bactérias resistentes. O objetivo do estudo foi comparar a utilização de alternativas associadas à antibioticoterapia preventiva na alimentação de suínos nas fases de recria e de terminação. Foram utilizados 1.045 animais de 60 a 190 dias de idade, submetidos a seis tratamentos com 16 repetições, como segue: 1) sem antibióticos; 2) com antibióticos; 3) prebióticos; 4) probióticos; 5) óleos essenciais; e 6) ácidos orgânicos. Os animais foram pesados, e a história clínica foi registrada, incluindo mortalidade e diarreia. No abatedouro, foram investigados índices de pneumonia e úlceras gástricas. O custo de cada tratamento foi discutido. Não houve diferença entre os tratamentos (P>0,05) em relação à taxa de conversão alimentar (2,64 ± 0,03), ao ganho de peso médio geral (107,06 ± 0,9kg), ao ganho de peso médio diário (856,49 ± 7,7g) e ao peso de carcaça (92,4 ± 0,7kg). A aplicação de medicamentos injetáveis em animais com quadro clínico representou US$ 0,56/intervenção, sem diferença entre os tratamentos (P>0,05). Além disso, independentemente do tratamento, foi observada alta frequência de pneumonia (>0,90). Não foi observada diferença para o grau de úlcera gástrica nem na consistência das fezes (P>0,05). A utilização de antibioticoterapia e de alternativas aos antibióticos na ração não trouxe benefícios aos desempenhos zootécnico e sanitário dos animais.(AU)

Animals , Swine/growth & development , Probiotics/administration & dosage , Prebiotics/administration & dosage , Antimicrobial Stewardship/methods , Animal Feed/analysis , Anti-Bacterial Agents/administration & dosage , Oils, Volatile/therapeutic use
Electron. j. biotechnol ; 51: 67-78, May. 2021. graf, tab
Article in English | LILACS | ID: biblio-1343435


BACKGROUND: Endometritis is the most common disease of dairy cows and traditionally treated with antibiotics. Lactic acid bacteria can inhibit the growth of pathogens and also have potential for treatment of endometritis. Using PacBio single-molecule real-time sequencing technology, we sequenced the fulllength l6S rRNA of the microbiota in uterine mucus samples from 31 cows with endometritis, treated with lactic acid bacteria (experimental [E] group) and antibiotics (control [C] group) separately. Microbiota profiles taken before and after treatment were compared. RESULTS: After both treatments, bacterial species richness was significantly higher than before, but there was no significant difference in bacterial diversity. Abundance of some bacteria increased after both lactic acid bacteria and antibiotic treatment: Lactobacillus helveticus, Lactococcus lactis, Lactococcus raffinolactis, Pseudomonas alcaligenes and Pseudomonas veronii. The bacterial species that significantly decreased in abundance varied depending on whether the cows had been treated with lactic acid bacteria or antibiotics. Abundance of Staphylococcus equorum and Treponema brennaborense increased after lactic acid bacteria treatment but decreased after antibiotic treatment. According to COG-based functional metagenomic predictions, 384 functional proteins were significantly differently expressed after treatment. E and C group protein expression pathways were significantly higher than before treatment (p < 0.05). CONCLUSIONS: In this study, we found that lactic acid bacteria could cure endometritis and restore a normal physiological state, while avoiding the disadvantages of antibiotic treatment, such as the reductions in abundance of beneficial microbiota. This suggests that lactic acid bacteria treatment has potential as an alternative to antibiotics in the treatment of endometritis in cattle.

Animals , Female , Cattle , Cattle Diseases/drug therapy , Endometritis/drug therapy , Lactobacillales/metabolism , High-Throughput Nucleotide Sequencing/methods , Anti-Bacterial Agents/administration & dosage , Bacteria/isolation & purification , Bacteria/growth & development , Bacteria/drug effects , Uterus/microbiology , RNA, Ribosomal, 16S/genetics , Lactic Acid , Lactobacillales/genetics , Microbiota
Rev. cuba. estomatol ; 58(1): e2919, ene.-mar. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156427


Introducción: La osteomielitis mandibular crónica es considerada como una infección odontogénica que cursa con tumefacción de la cara, limitación de la abertura bucal y dolor. Pocas veces es tratada a través de gammagrafías con fijación a ciprofloxacino con la consiguiente obtención de resultados efectivos. Objetivo: Describir un caso clínico de osteomielitis mandibular crónica tratada con terapia antibiótica y quirúrgica. Presentación de caso: Paciente femenina de 63 años de edad que acudió al servicio de estomatología del Hospital María Auxiliadora, Lima, Perú; con un historial de tres meses de hinchazón creciente a nivel del borde inferior izquierdo de la mandíbula desde que le realizaron una extracción dentaria. Los exámenes tomográficos, gammagrafía, biopsia y antibiograma confirmaron la osteomielitis y la susceptibilidad bacteriana. La decorticación, debridamiento, exodoncia y la administración de metronidazol más vancomicina por dos meses permitió la remisión del cuadro. Conclusiones: El seguimiento clínico de dos años y las gammagrafías de evaluación permitieron verificar la presencia de regeneración ósea y ausencia de focos de reactivación. La osteomielitis crónica puede ser provocada por restos de exodoncias dentarias. Su diagnóstico y seguimiento clínico requiere de múltiples exámenes y controles a largo plazo(AU)

Introduction: Chronic mandibular osteomyelitis is considered to be an odontogenic infection manifesting as facial tumefaction, limited mouth opening and pain. It is not often enough treated with ciprofloxacin fixation gammagraphies with the consequent achievement of effective results. Objective: Describe a clinical case of chronic mandibular osteomyelitis treated with antibiotic and surgical therapy. Case presentation: A female 63-year-old patient attends the dental service at María Auxiliadora Hospital in Lima, Peru, with a history of three-months' swelling of the lower left edge of her mandible upon performance of a dental extraction. Tomographic examination, gammagraphy, biopsy and antibiograms confirmed the presence of osteomyelitis and bacterial susceptibility. Decortication, debridement, exodontia and administration of metronidazole plus vancomycin for two months led to remission of the patient's status. Conclusions: Two-year clinical follow-up and evaluation gammagraphies made it possible to verify the presence of bone regeneration and the absence of reactivation foci. Chronic osteomyelitis may be caused by remains of dental exodontias. Its diagnosis and clinical follow-up require a large number of long-term tests and controls(AU)

Humans , Female , Middle Aged , Osteomyelitis/diagnostic imaging , Surgery, Oral/methods , Vancomycin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Metronidazole/therapeutic use
Rev. panam. salud pública ; 45: e76, 2021. tab, graf
Article in English | LILACS | ID: biblio-1289870


ABSTRACT Objective. To describe bacterial resistance and antimicrobial consumption ratio at the subnational level in Argentina during 2018, considering beta-lactams group as a case-study. Methods. Antimicrobial consumption was expressed as defined daily doses (DDD)/1000 inhabitants. Resistance of Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae and Staphylococcus aureus to beta-lactams was recorded. Resistance/consumption ratio was estimated calculating "R" for each region of Argentina, and this data was compared with other countries. Results. The most widely consumed beta-lactams in Argentina were amoxicillin (3.64) for the penicillin sub-group, cephalexin (0.786) for first generation cephalosporins, cefuroxime (0.022) for second generation; cefixime (0.043) for third generation and cefepime (0.0001) for the fourth generation group. Comparison between beta-lactams consumption and bacterial resistance demonstrated great disparities between the six regions of the country. Conclusions. The case-study of Argentina shows that antimicrobial consumption and resistance of the most common pathogens differed among regions, reflecting different realities within the same country. Because this situation might also be occurring in other countries, this data should be taken into account to target local efforts towards better antimicrobial use, to improve antimicrobial stewardship programs and to propose more suitable sales strategies in order to prevent and control antimicrobial resistance.

RESUMEN Objetivo. Determinar la razón entre la resistencia bacteriana y el consumo de antimicrobianos a nivel subnacional en Argentina en el 2018, considerando el grupo de los betalactámicos como estudio de caso. Métodos. El consumo de antimicrobianos se expresó como una dosis diaria determinada (DDD) por 1000 habitantes. Se registró la resistencia de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae y Staphylococcus aureus a los betalactámicos. Se determinó la razón entre la resistencia y el consumo calculando "R" para cada región de Argentina, y estos datos se compararon con los de otros países. Resultados. Los betalactámicos más consumidos en Argentina fueron la amoxicilina (3,64) para el subgrupo de la penicilina; la cefalexina (0,786) para las cefalosporinas de primera generación; la cefuroxima (0.022) para las de segunda generación; la cefixima (0.043) para las de tercera generación, y la cefepima (0.0001) para el grupo de la cuarta generación. La comparación entre el consumo de betalactámicos y la resistencia bacteriana demostró que había grandes disparidades entre las seis regiones del país. Conclusiones. El estudio de caso en Argentina indica que el consumo de antimicrobianos y la resistencia a los patógenos más comunes difería entre las regiones; esto demuestra que hay distintas realidades dentro del mismo país. Como esta situación también se puede dar en otros países, estos datos se deben tener en cuenta para definir las actividades locales destinadas a fomentar un mejor uso de los antimicrobianos, para mejorar los programas de manejo de los antimicrobianos y para proponer estrategias de venta más adecuadas con el fin de prevenir y controlar la resistencia a los antimicrobianos.

RESUMO Objetivo. Descrever a relação entre o consumo de antimicrobianos e a resistência bacteriana no nível subnacional na Argentina em 2018, considerando o grupo dos betalactâmicos no estudo de caso. Métodos. O consumo de antimicrobianos foi representado por doses diárias definidas (DDD) por 1.000 habitantes. Foi registrada a resistência de Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella pneumoniae e Staphylococcus aureus aos betalactâmicos. A relação entre consumo e resistência foi calculada com base no "R" para cada região do país e os dados da Argentina foram comparados aos de outros países. Resultados. Os betalactâmicos de maior consumo na Argentina foram amoxicilina (3,64) no grupo das penicilinas, cefalexina (0,786) no grupo das cefalosporinas de primeira geração, cefuroxima (0.022) no grupo das cefalosporinas de segunda geração, cefixima (0.043) no grupo das cefalosporinas de terceira geração e cefepima (0.0001) no grupo das cefalosporinas de quarta geração. Ao se comparar o consumo de betalactâmicos e a resistência bacteriana, observou-se grande disparidade entre as seis regiões do país. Conclusões. O estudo de caso revela diferenças no consumo de antimicrobianos e na resistência dos patógenos mais comuns entre as regiões da Argentina, refletindo realidades distintas dentro do mesmo país. Como esta mesma situação pode estar ocorrendo em outros países, estes achados devem servir para direcionar os esforços locais a uma melhor utilização dos antimicrobianos, aperfeiçoar os programas de gestão do uso destes medicamentos e propor estratégias de venda mais apropriadas, visando a prevenir e controlar a resistência aos antimicrobianos.

Humans , Drug Prescriptions/statistics & numerical data , beta-Lactam Resistance , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Anti-Bacterial Agents/administration & dosage , Argentina , Retrospective Studies
Medwave ; 20(11): e8072, dic. 2020.
Article in Spanish | LILACS | ID: biblio-1146067


INTRODUCCIÓN La cirugía ortognática, al ser un procedimiento quirúrgico invasivo, puede presentar importantes morbilidades postoperatorias para el paciente. Dentro de las complicaciones descritas con mayor frecuencia, está la infección del sitio quirúrgico. En vista de esto, la administración de antibióticos profilácticos previo a este tipo de procedimientos se presenta como una práctica frecuente. Sin embargo, el costo-beneficio del uso de antibióticos, el tipo de antibiótico, la vía de administración, la posología, y el esquema a utilizar no han sido claramente definidos y se presentan como una temática controversial. En este resumen de evidencia, se comparará la utilidad del esquema profiláctico de largo plazo contra el de corto plazo. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos cinco revisiones sistemáticas que en conjunto incluyeron nueve estudios primarios, de los cuales, todos corresponden a ensayos aleatorizados. Concluimos que dar un esquema profiláctico antibiótico de largo plazo probablemente disminuye el riesgo de infección del sitio quirúrgico y podría aumentar el riesgo de estadía hospitalaria mayor a dos días, pero en este último punto, la certeza de la evidencia es baja.

INTRODUCTION Orthognathic surgery, being an invasive surgical procedure, may present significant postoperative morbidities for the patient. Among the most frequently described complications is surgical site infection. The administration of prophylactic antibiotics prior to this type of procedure is a common practice, however, the cost-benefit of the use of antibiotics, the type of antibiotics, the route of administration, the dosage, and the regimen to be used have not been clearly defined and are still considered a controversial issue. In this summary of evidence, we will compare long-term antibiotic prophylaxis with short-term prophylaxis. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified five systematic reviews including nine studies overall, of which all nine were randomized trials. We conclude that administering a long-term prophylactic antibiotic regimen probably decreases the risk of surgical site infection and that it may increase the risk of hospital stay longer than two days, nevertheless, regarding this last point, the certainty of the evidence is low.

Humans , Surgical Wound Infection/prevention & control , Antibiotic Prophylaxis/methods , Orthognathic Surgical Procedures/methods , Anti-Bacterial Agents/therapeutic use , Treatment Outcome , Systematic Reviews as Topic , Anti-Bacterial Agents/administration & dosage
Rev. bras. ter. intensiva ; 32(3): 391-397, jul.-set. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138519


RESUMO Objetivo: Investigar a efetividade da vancomicina contra Gram-positivos com concentração inibitória mínima de 1mg/L em pacientes pediátricos com base na razão entre área sob a curva e concentração inibitória mínima > 400. Métodos: População de 22 pacientes pediátricos (13 meninos) internados no centro de terapia intensiva pediátrica, com função renal preservada, que foram distribuídos em dois grupos (G1 < 7 anos e G2 ≥ 7 anos). Após a quarta dose de vancomicina (10 - 15mg/kg a cada 6 horas), duas amostras de sangue foram colhidas (terceira e quinta horas), seguidas da dosagem sérica por imunoensaios para investigação da farmacocinética e da cobertura do antimicrobiano. Resultados: Não se registrou diferença entre os grupos com relação à dose, ao nível de vale ou ainda na área sob a curva. A cobertura contra Gram-positivos com concentração inibitória mínima de 1mg/L ocorreu em apenas 46% dos pacientes em ambos os grupos. A farmacocinética se mostrou alterada nos dois grupos diante dos valores de referência, mas a diferença entre grupos foi registrada pelo aumento da depuração total corporal e pelo encurtamento da meia-vida biológica, mais pronunciados nos pacientes mais novos. Conclusão: A dose empírica mínima de 60mg/kg ao dia deve ser prescrita ao paciente pediátrico de unidade de terapia intensiva com função renal preservada. A utilização da razão entre área sob a curva e concentração inibitória mínima na avaliação da cobertura da vancomicina é recomendada para se atingir o desfecho desejado, uma vez que a farmacocinética está alterada nesses pacientes, podendo impactar na efetividade do antimicrobiano.

Abstract Objective: To investigate the vancomycin effectiveness against gram-positive pathogens with the minimum inhibitory concentration of 1mg/L in pediatric patients based on the area under the curve and the minimum inhibitory concentration ratio > 400. Methods: A population of 22 pediatric patients (13 boys) admitted to the pediatric intensive care unit with preserved renal function was stratified in two groups (G1 < 7 years and G2 ≥ 7 years). After the fourth dose administered of vancomycin (10 - 15mg/kg every 6 hours) was administered, two blood samples were collected (third and fifth hours), followed by serum measurement by immunoassays to investigate the pharmacokinetics and antimicrobial coverage. Results: There was no difference between the groups regarding dose, trough level or area under the curve. Coverage against gram-positive pathogens with a minimum inhibitory concentration of 1mg/L occurred in only 46% of patients in both groups. The pharmacokinetics in both groups were altered relative to the reference values, and the groups differed in regard to increased total body clearance and shortening of the biological half-life, which were more pronounced in younger patients. Conclusion: A minimum empirical dose of 60mg/kg per day should be prescribed for pediatric patients in intensive care units with preserved renal function. The use of the ratio between the area under the curve and minimum inhibitory concentration in the evaluation of vancomycin coverage is recommended to achieve the desired outcome, since the pharmacokinetics are altered in these patients, which may impact the effectiveness of the antimicrobial.

Humans , Male , Infant , Child, Preschool , Child , Adolescent , Vancomycin/administration & dosage , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacteria/drug effects , Anti-Bacterial Agents/administration & dosage , Vancomycin/pharmacology , Vancomycin/pharmacokinetics , Intensive Care Units, Pediatric , Microbial Sensitivity Tests , Pilot Projects , Age Factors , Area Under Curve , Dose-Response Relationship, Drug , Half-Life
Rev. chil. pediatr ; 91(4): 553-560, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138670


INTRODUCCIÓN: Las infecciones graves son la principal causa de ingreso a cuidados intensivos pediátricos. El panel FilmArray BCID permite identificar rápidamente a microorganismos causantes de bacteriemias. OBJETIVO: evaluar la eficacia de la identificación rápida de microorganismos asociado a un Programa de Uso Racional de Antibióticos (URA) en reducir los tiempos de terapias antibióticas, en un hospital pediátrico. PACIENTES Y MÉTODO: Estudio retrospectivo, que incluyó 100 pacientes, en su primer episo dio de bacteriemia, divididos en 2 grupos de 50 cada uno: Intervención (FilmArray BCID y programa URA) y Controles históricos pareados para la misma especie del microrganismo identificado (microbiología convencional). Las variables evaluadas fueron los tiempos de identificación microbiana, latencia de la terapia dirigida y de desescalar antibióticos. RESULTADOS: Los grupos fueron comparables en características demográficas, foco de infección y etiología de bacteriemia. El tiempo promedio de identificación de microorganismos fue de 23 h (IC 95% 12,4-26,7) en el grupo intervención, y 70,5 h (IC 95% 65,2-78,6) en el control (p < 0,05), mientras que la latencia de inicio de terapia dirigida fue de 27,9 h (IC 95% 22,3-32,8) y 71,9 h (IC 95% 63,2-77,8) respectivamente (p < 0,05). El tiempo de desescalar o suspender antibióticos fue de 6,4 h (IC 95% 2,76-9,49) y 22 h (IC 95% 6,74-35,6) en los grupos mencionados (p > 0,05). CONCLUSIÓN: El panel FilmArray BCID articulado a un programa URA, contribuye a la identificación de los microorganismos causantes de bacteriemias en menor tiempo que los métodos convencionales, siendo una herramienta que optimiza las terapias antibióti cas en niños críticamente enfermos.

INTRODUCTION: Severe infections are the leading cause of admission to pediatric intensive care. The FilmArray BCID panel quickly identifies microorganisms that cause bacteremia. OBJECTIVE: To evaluate if the rapid identification of the microorganisms that cause bacteremia, along with a Rational Use of Antibio tics (RUA) Program, allows optimizing the time of antibiotic therapy in a pediatric hospital. PATIENTS AND METHOD: Retrospective study which included 100 patients presenting their first episode of bacteremia, divided into 2 groups of 50 each. The first one was Intervention (FilmArray BCID and RUA program) and the second one was Historical Controls (conventional automated ID/AST). The variables evaluated were the time required for microbial identification, duration of appropriate therapy, and antibiotic de-escalation. RESULTS: The groups were comparable in terms of demographic characteristics, focus of infection, and etiology of bacteremia. The average time of microorganisms' identification of the control group was 70.5 hours (IC 95% 65.2-78.6) and 23.0 hours (IC 95% 12.4 -26.7) in the intervention one (p < 0.05). The average time of targeted therapy onset was shorter in the intervention group (27.9 h [IC 95% 22.3-32.8]) than that of the control one (71.9 h [IC 95% 63.2-77.8]) (p < 0.05). Finally, the time to de-escalate or discontinue antibiotics in the intervention group and the control one was 6.4 hours (IC 95% 2.76-9.49) hours and 22.0 hours (IC 95% 6.74-35.6 h) respectively (p > 0.05). CONCLUSION: The FilmArray panel along with the RUA Program allows the identification of the microorganisms causing bacteremia faster than conventional methods, which positions it as a tool that optimizes antibiotic therapy of critical patients.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Bacteremia/diagnosis , Bacteremia/drug therapy , Molecular Typing/methods , Blood Culture/methods , Antimicrobial Stewardship/methods , Anti-Bacterial Agents/administration & dosage , Time Factors , Drug Administration Schedule , Retrospective Studies , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/drug therapy , Bacteremia/microbiology , Hospitals, Pediatric , Anti-Bacterial Agents/therapeutic use
Arq. bras. oftalmol ; 83(2): 109-112, Mar.-Apr. 2020. tab
Article in English | LILACS | ID: biblio-1088962


ABSTRACT Purpose: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. Methods: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. Results: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. Conclusion: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.

RESUMO Objetivos: Comparar o impacto das alterações oculares entre o tratamento sistêmico de doxiciclina e isotretinoína em baixa dosagem em pacientes com rosácea papulopustulosa moderada a grave. Métodos: Os pacientes form randomizados para receber isotretinoína 0,3 a 0,4 mg/kg (grupo A) ou doxiciclina 100mg/dia (grupo B) por 16 semanas. Os sintomas oculares foram pesquisados e avaliados, incluindo melhor acuidade visual corrigida, teste de Schirmer, tempo de ruptura do filme lacrimal, coloração de rosa bengala e graduação da disfunção de glândula de Meibomius. Os pacientes foram novamente testados no final do tratamento. Resultados: O presente estudo incluiu 39 pacientes (30 mulheres e 9 homens). A melhor acuidade visual corrigida foi >20/30 em >90% dos pacientes em ambos os grupos e não se alterou após o tratamento. A melhora dos sintomas oculares e da disfunção de glândula de Meibomius foi mais pronunciada no grupo B (p<0,05) após o tratamento; as demais variáveis não atingiram significância estatística. Conclusão: A doxiciclina melhorou a disfunção de glândula de Meibomius, os sintomas oculares e a superfície ocular de pa cientes com rosácea. Mesmo que alguns pacientes tenham piorado a disfunção e os sintomas da glândula de Meibomius, nenhum indivíduo apresentou complicações graves após a admi nistração de baixas doses de isotretinoína.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Isotretinoin/administration & dosage , Doxycycline/administration & dosage , Rosacea/drug therapy , Dermatologic Agents/administration & dosage , Meibomian Gland Dysfunction/drug therapy , Anti-Bacterial Agents/administration & dosage , Severity of Illness Index , Visual Acuity , Administration, Oral , Treatment Outcome , Rosacea/physiopathology , Eye/drug effects , Meibomian Gland Dysfunction/physiopathology , Meibomian Glands/drug effects
Int. braz. j. urol ; 46(1): 60-66, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1056357


ABSTRACT Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.

Humans , Male , Aged , Ornidazole/administration & dosage , Prostatitis/etiology , Biopsy, Needle/adverse effects , Ciprofloxacin/administration & dosage , Antibiotic Prophylaxis/methods , Enema/methods , Anti-Bacterial Agents/administration & dosage , Prostate/pathology , Prostatitis/prevention & control , Time Factors , Biopsy, Needle/methods , Reproducibility of Results , Retrospective Studies , Risk Factors , Treatment Outcome , Ultrasonography, Interventional , Drug Combinations , Middle Aged
Rev. Assoc. Med. Bras. (1992) ; 66(2): 187-193, Feb. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136182


SUMMARY OBJECTIVE To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis. METHODS A cross-sectional study included hospitalized infants with bronchiolitis caused by the respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records. RESULTS Among 120 cases, 90% used inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time, and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization, and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time. CONCLUSIONS Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of the inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.

RESUMO OBJETIVOS Analisar variáveis clínicas e demográficas possivelmente associadas às prescrições de terapêuticas não recomendadas, porém rotineiramente utilizadas, para lactentes com bronquiolite viral aguda. MÉTODOS Estudo transversal incluiu lactentes hospitalizados com bronquiolite por vírus sincicial respiratório. Excluídos aqueles com outras infecções e/ou morbidades. Dados coletados de prontuários. RESULTADOS Analisados 120 casos, para os quais foram prescritos: beta-agonistas inalatórios a 90%; corticosteroides a 72,5%, antibióticos a 40% e solução salina hipertônica inalatória a 66,7%. O uso de broncodilatadores não apresentou associação independente com outra variável. Maior uso de corticosteroide associou-se à baixa oximetria, maior tempo de internação e idade >3 meses. Antibioticoterapia associou-se à presença de febre, maior tempo de internação e idade >3 meses. Solução salina hipertônica inalatória associou-se a maior tempo de internação. CONCLUSÕES A frequência das prescrições não recomendadas foi elevada. Corticosteroide e antibioticoterapia foram associados a sinais de gravidade, como esperado, porém, interessantemente, foram mais utilizados nos lactentes com idade acima de 3 meses, o que sugeriu menor segurança no diagnóstico de bronquiolite viral nesses pacientes. O uso de broncodilatadores foi ainda mais preocupante, uma vez que foram indiscriminadamente utilizados, sem associação com outra variável, seja relacionada à gravidade, seja a características do hospedeiro. O uso de solução hipertônica inalatória, apesar de não associado à gravidade, parece ter implicado maior tempo de internação. A identificação dessas condições de maior vulnerabilidade à prescrição de terapêuticas inadequadas contribui para a implantação de protocolos para o tratamento da BVA, para educação continuada e para posteriores comparações e análises de eficácia das estratégias empregadas.

Humans , Male , Female , Infant, Newborn , Infant , Bronchiolitis, Viral/drug therapy , Respiratory Syncytial Virus Infections/drug therapy , Inappropriate Prescribing/statistics & numerical data , Saline Solution, Hypertonic/administration & dosage , Bronchodilator Agents/administration & dosage , Logistic Models , Acute Disease , Cross-Sectional Studies , Multivariate Analysis , Adrenal Cortex Hormones/administration & dosage , Statistics, Nonparametric , Hospitalization , Anti-Bacterial Agents/administration & dosage
Bol. latinoam. Caribe plantas med. aromát ; 19(1): 65-76, ene. 2020. tab, ilus
Article in English | LILACS | ID: biblio-1102867


Due to the biological activities of Syzygium aromaticum essential oil, its incorporation in methacrylate polymeric (Eudragit E100) nanoparticles (NP), physical characterization, and antimicrobial essays were evaluated. The clove bears great potential for applications in dentistry. The oil was obtained by hydrodistillation and oil loaded NP using the nanoprecipitation method. Particle size and polydispersity index were determined by photon correlation spectroscopy, and physical morphology by electron microscopy. Loading capacity and in vitro eugenol release were evaluated by gas mass chromatography, and the antimicrobial activity of oil loaded-NP was calculated against Streptococcus mutans. Different chemical ingredients were characterized, and eugenol was the principal compound with 51.55%. Polymer content was directly related to NP homogenous size, which was around 150 nm with spherical morphology. A 73.2% loading capacity of eugenol was obtained. Oil loaded NP presented a fickian-type release mechanism of eugenol. Antimicrobial activity to 300 µg/mL was obtained after 24 h.

Debido a las actividades biológicas del aceite esencial de Syzygium aromaticum, se evaluó su incorporación en nanopartículas (NP) de metacrilato polimérico (Eudragit E100), su caracterización y ensayos antimicrobianos. El clavo tiene un gran potencial para aplicaciones en odontología. El aceite se obtuvo por hidrodestilación y las NP cargado de aceite utilizando el método de nanoprecipitación. El tamaño de partícula y el índice de polidispersidad se determinaron mediante espectroscopia de correlación fotónica y su morfología por microscopía electrónica. La capacidad de carga y la liberación de eugenol in vitro se evaluaron mediante cromatografía de gases en masa, y la actividad antimicrobiana se evaluó contra Streptococcus mutans. Se caracterizaron diferentes ingredientes químicos, siendo el eugenol el principal compuesto con 51.55%. El contenido de polímero se relacionó directamente con el tamaño homogéneo de NP, que fue de alrededor de 150 nm con morfología esférica. Se obtuvo un 73,2% de capacidad de carga de eugenol. El aceite cargado en NP presentó un mecanismo de liberación de eugenol de tipo fickiano. La actividad antimicrobiana a 300 µg/mL se obtuvo después de 24 h.

Polymers/chemistry , Oils, Volatile/administration & dosage , Syzygium/chemistry , Nanoparticles/chemistry , Anti-Bacterial Agents/administration & dosage , Streptococcus mutans/drug effects , Eugenol/pharmacology , Oils, Volatile/pharmacology , Administration, Oral , Chromatography, Thin Layer , Drug Delivery Systems , Gas Chromatography-Mass Spectrometry , Anti-Bacterial Agents/pharmacology
ABCD arq. bras. cir. dig ; 33(4): e1558, 2020. tab
Article in English | LILACS | ID: biblio-1152631


ABSTRACT Introduction: Infection of the surgical site is the common complication, with significant rates of morbidity and mortality, representing a considerable economic problem for the health system. Objective: To carry out a narrative review of the literature on surgical site infection and the principles of antibiotic prophylaxis to update the knowledge of its use in surgery. Method: Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane and SciELO were used for the research. The keywords used were "anti-bacterial agents"; "antibioticoprophylaxis" AND "surgical wound infection". The inclusion criteria were articles of recent publication, with full texts available and performed in humans. Result: A total of 29 articles were evaluated and selected according to the eligibility criteria. Conclusion: Infection of the surgical site is the most common postoperative complication. The key point of its prevention is the combination of several interventions that aim to reduce risk factors, such as: compliance with the new guidelines of the Center for Disease Control and Prevention; the principles of the use of prophylactic antibiotics; factors and risk index of the surgical site; administration time; duration and dosage of antibiotics. These data are available in this article.

RESUMO Introdução: A infecção do sítio cirúrgico é a complicação comum, com taxas significativas de morbimortalidade, representando considerável problema econômico para o sistema de saúde. Objetivo: Realizar revisão narrativa da literatura sobre infecção de sítio cirúrgico e os princípios da antibioticoprofilaxia para atualizar o conhecimento de seu uso em cirurgia. Método: Utilizou-se para a pesquisa a base de dados Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane e SciELO. As palavras-chave usadas foram "anti-bacterial agents"; "antibioticoprophylaxis" AND "surgical wound infection". Os critérios de inclusão foram artigos de publicação recente, com textos completos disponíveis e realizados em humanos. Resultado: Um total de 29 artigos foi avaliado e selecionado de acordo com os critérios de elegibilidade. Conclusão: A infecção do sítio cirúrgico é a complicação pós-operatória mais comum. O ponto-chave da sua prevenção consiste na combinação de várias intervenções que visam reduzir os fatores de risco, tais como: a obediência às novas diretrizes do Centro de Controle e Prevenção de Doenças; aos princípios do uso de antibióticos profiláticos; fatores e índice de risco do local cirúrgico; tempo de administração; duração e dosagem dos antibióticos. Esses dados estão disponíveis neste artigo.

Humans , Surgical Wound Infection/prevention & control , Bacterial Infections/prevention & control , Antibiotic Prophylaxis/methods , Anti-Bacterial Agents/administration & dosage , Postoperative Complications , Surgical Wound Infection/microbiology , Infection Control , Anti-Bacterial Agents/therapeutic use
Medwave ; 20(7): e8006, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122649


Una de las principales causas de neumonía en niños entre 5 y 15 años es el Mycoplasma pneumoniae, una bacteria que causa manifestaciones clínicas atípicas como la miositis y encefalitis. Reportamos un caso de una niña de cinco años que presentó limitación funcional en extremidades inferiores precedida por una infección respiratoria superior. Posteriormente, se complicó con neumonía y encefalitis. Se administraron antibióticos y antivirales debido al deterioro clínico del paciente. La serología de inmunoglobulinas para Mycoplasma pneumoniae fue positiva; mientras que los demás estudios virales fueron negativos. El curso clínico fue favorable con disminución progresiva de la dificultad respiratoria, trastorno del sensorio y mejoría en la limitación funcional en las extremidades inferiores a los 15 días de tratamiento.

One of the leading causes of pneumonia in children between 5 to 15 years is Mycoplasma pneumoniae, a bacterium that causes atypical clinical manifestations such as myositis and encephalitis. We report a 5-year-old girl who presented functional limitations of the lower extremities preceded by an upper respiratory infection. Later on, she developed pneumonia and encephalitis. Antibiotics and antivirals were administered due to the clinical deterioration of the patient. IgM serology for Mycoplasma pneumoniae was positive, while the other viral studies were negative. The clinical course was favorable with a progressive decrease in respiratory distress, sensorial disorder, and improvement in the functional limitations of the lower limbs after 15 days of treatment.

Humans , Female , Child, Preschool , Pneumonia, Mycoplasma/diagnosis , Encephalitis/diagnosis , Mycoplasma pneumoniae/isolation & purification , Myositis/diagnosis , Pneumonia, Mycoplasma/microbiology , Pneumonia, Mycoplasma/drug therapy , Acute Disease , Encephalitis/microbiology , Encephalitis/drug therapy , Anti-Bacterial Agents/administration & dosage , Myositis/microbiology , Myositis/drug therapy
Medwave ; 20(7): e7986, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122534


INTRODUCCIÓN: La actinomicosis es una enfermedad infecciosa poco frecuente, ocasionada por una bacteria Gram positiva. La especie más común es Actinomyces israelii. Dentro de sus formas de presentación, la torácica es la menos frecuente. PRESENTACIÓN DE CASOS: Reportamos dos pacientes con actinomicosis torácica de 8 y 13 años de diferentes zonas geográficas de Perú. El primer caso tuvo empiema necessitatis y el segundo, consolidación pulmonar y hemoptisis recurrente. Ambos tuvieron cierto grado de dificultad en su diagnóstico, pero con una buena respuesta al tratamiento antibiótico y quirúrgico. El diagnóstico fue mediante estudio histopatológico. Sin embargo, no se pudo identificar la especie de Actinomyces. CONCLUSIÓN: La actinomicosis torácica es poco frecuente en niños y se presenta como una lesión parenquimal con posible fistulización a la pared torácica. Este es uno de los pocos casos reportados en la literatura peruana, constituyendo una contribución al conocimiento de esta enfermedad y su manejo en pediatría.

INTRODUCTION: Actinomycosis is a rare infectious disease caused by Gram-positive bacteria. The most common species is Actinomyces israelii. Among its forms of presentation, the thoracic is the least frequent. CASE PRESENTATION: We report two patients with thoracic actinomycosis, 8 and 13 years old, from different geographical areas of Peru. The first case had empyema necessitans and the second, lung consolidation and recurrent hemoptysis. Both had a certain degree of difficulty in their diagnosis but responded favorably to antibiotics and surgical treatment. The diagnosis was based on the histopathological study. However, we were not able to ascertain the species of actinomyces. CONCLUSION: Thoracic actinomycosis is rare in children and presents as a parenchymal lesion with possible fistulization to the chest wall. This article is one of the few in the Peruvian literature, constituting a contribution to the knowledge of the disease and its management in pediatrics.

Humans , Male , Female , Child , Adolescent , Actinomyces/isolation & purification , Actinomycosis/diagnosis , Lung Diseases/diagnosis , Peru , Actinomycosis/microbiology , Actinomycosis/therapy , Lung Diseases/microbiology , Lung Diseases/therapy , Anti-Bacterial Agents/administration & dosage
Rev. Assoc. Med. Bras. (1992) ; 66(supl.1): s37-s44, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057099


SUMMARY Peritoneal dialysis (PD) is a renal replacement therapy based on infusing a sterile solution into the peritoneal cavity through a catheter and provides for the removal of solutes and water using the peritoneal membrane as the exchange surface. This solution, which is in close contact with the capillaries in the peritoneum, allows diffusion solute transport and osmotic ultrafiltration water loss since it is hyperosmolar to plasma due to the addition of osmotic agents (most commonly glucose). Infusion and drainage of the solution into the peritoneal cavity can be performed in two ways: manually (continuous ambulatory PD), in which the patient usually goes through four solution changes throughout the day, or machine-assisted PD (automated PD), in which dialysis is performed with the aid of a cycling machine that allows changes to be made overnight while the patient is sleeping. Prescription and follow-up of PD involve characterizing the type of peritoneal transport and assessing the offered dialysis dose (solute clearance) as well as diagnosing and treating possible method-related complications (infectious and non-infectious).

RESUMO A diálise peritoneal (DP) é uma terapia renal substitutiva baseada na infusão de uma solução estéril na cavidade peritoneal através de um cateter, proporcionando a remoção de solutos e água usando a membrana peritoneal como superfície de troca. Essa solução, em contato com os capilares do peritônio, permite o transporte difuso de solutos e a perda de água por ultrafiltração osmótica, uma vez que é hiperosmolar ao plasma devido à adição de agentes osmóticos (normalmente, a glicose). A infusão e drenagem da solução dentro da cavidade peritoneal pode ser realizada de duas maneiras: manualmente (DP ambulatorial contínua), em que o paciente, geralmente, passa por quatro trocas de solução durante o dia, ou por DP mecânica (automatizada), em que a diálise é realizada com o auxílio de uma máquina de diálise que permite que as trocas sejam feitas durante a noite, enquanto o paciente está dormindo. A prescrição e o acompanhamento da DP envolvem a caracterização do tipo de transporte peritoneal e a avaliação da dose de diálise oferecida (depuração do soluto), bem como o diagnóstico e tratamento de possíveis complicações relacionadas ao método (infecciosas e não infecciosas).

Humans , Peritoneal Dialysis/methods , Kidney Failure, Chronic/therapy , Dialysis Solutions/therapeutic use , Peritoneal Dialysis, Continuous Ambulatory , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification
Chinese Journal of Traumatology ; (6): 311-313, 2020.
Article in English | WPRIM | ID: wpr-879645


Intra-abdominal infection (IAI) is a deadly condition in which the outcome is associated with urgent diagnosis, assessment and management, including fluid resuscitation, antibiotic administration while obtaining further laboratory results, attaining precise measurements of hemodynamic status, and pursuing source control. This last item makes abdominal sepsis a unique treatment challenge. Delayed or inadequate source control is an independent predictor of poor outcomes and recognizing source control failure is often difficult or impossible. Further complicating issue in the debate is surrounding the timing, adequacy, and procedures of source control. This review evaluated and summarized the current approach and challenges in IAI management, which are the future research directions.

Anti-Bacterial Agents/administration & dosage , Drainage , Fluid Therapy , Hemodynamics , Humans , Intraabdominal Infections/therapy , Laparoscopy , Laparotomy , Prognosis , Sepsis
Chinese Journal of Traumatology ; (6): 314-318, 2020.
Article in English | WPRIM | ID: wpr-879643


In this paper, we review the results of previous studies and summarize the effects of various factors on the regulation of bone metabolism in traumatic bone infections. Infection-related bone destruction incorporates pathogens and iatrogenic factors in the process of bone resorption dominated by the skeletal and immune systems. The development of bone immunology has established a bridge of communication between the skeletal system and the immune system. Exploring the effects of pathogens, skeletal systems, immune systems, and antibacterials on bone repair in infectious conditions can help improve the treatment of these diseases.

Anti-Bacterial Agents/administration & dosage , Bone and Bones/metabolism , Cellular Microenvironment , Humans , Immune System/immunology , Lymphocyte Subsets/immunology , Osteitis/microbiology , Osteoblasts/physiology , Osteoclasts/physiology , Staphylococcal Infections
Rev. bras. ter. intensiva ; 31(4): 541-547, out.-dez. 2019. tab
Article in Portuguese | LILACS | ID: biblio-1058050


RESUMO As infecções do trato respiratório inferior associadas à ventilação mecânica são uma das complicações mais frequentes em pacientes em ventilação mecânica. Há muitos anos, a traqueobronquite associada à ventilação mecânica tem sido considerada uma doença que não demanda antibioticoterapia. Na última década, diversos estudos demonstraram que a traqueobronquite associada à ventilação mecânica deve ser considerada um processo intermediário que leva à pneumonia associada à ventilação mecânica, uma vez que apesar de ter impacto limitado sobre a mortalidade dos pacientes gravemente enfermos internados nas unidades de terapia intensiva, em contrapartida, demonstra associação significativa com o aumento dos custos hospitalares desses pacientes, assim como do tempo de internação na unidade de terapia intensiva e hospitalar, do uso de antibióticos, e da duração da ventilação mecânica. Embora ainda necessitemos de evidências científicas mais robustas, especialmente no que tange às modalidades terapêuticas, os dados atuais a respeito da traqueobronquite associada à ventilação mecânica salientam que há desfechos suficientemente importantes que exigem vigilância epidemiológica e controle clínico adequados.

ABSTRACT Ventilator-associated lower respiratory tract infection is one of the most frequent complications in mechanically ventilated patients. Ventilator-associated tracheobronchitis has been considered a disease that does not warrant antibiotic treatment by the medical community for many years. In the last decade, several studies have shown that tracheobronchitis could be considered an intermediate process that leads to ventilator-associated pneumonia. Furthermore, ventilator-associated tracheobronchitis has a limited impact on overall mortality but shows a significant association with increased patient costs, length of stay, antibiotic use, and duration of mechanical ventilation. Although we still need clear evidence, especially concerning treatment modalities, the present study on ventilator-associated tracheobronchitis highlights that there are important impacts of including this condition in clinical management and epidemiological and infection surveillance.

Humans , Respiration, Artificial/adverse effects , Tracheitis/etiology , Bronchitis/etiology , Respiration, Artificial/methods , Respiratory Tract Infections/etiology , Respiratory Tract Infections/epidemiology , Tracheitis/epidemiology , Bronchitis/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Anti-Bacterial Agents/administration & dosage