Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 90
Filter
1.
Medicina (B.Aires) ; 80(2): 185-188, abr. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1125064

ABSTRACT

Miasis es la infestación de humanos y animales por larvas de dípteros ciclorrafos con invasión y destrucción tisular. Cochliomyia hominivorax es responsable del 80% de las miasis en la Argentina. Es importante realizar el diagnóstico etiológico específico debido a la agresividad de las larvas de esta especie, las que pueden provocar cuadros clínicos graves. Presentamos cuatro casos de miasis por C. hominivorax. Dos de los pacientes residían en la ciudad de Buenos Aires y trabajan en zona rural, y los otros dos residían en el Gran Buenos Aires.


Miasis is the infestation of man and animals by larvae of flies belonging to the order Diptera, suborder Cyclorrapha. Eighty percent of miasis in Argentina is caused by Cochliomyia hominivorax, a species that induces pronounced tissue invasion and destruction, and results in severe clinical forms. Because of the aggressiveness of its larvae, it is important to reach a specific etiological diagnosis. We present four cases of miasis by C. hominivorax in two patients living in the city of Buenos Aires but working in a rural area and two patients living in the Greater Buenos Aires.


Subject(s)
Humans , Animals , Male , Female , Middle Aged , Aged , Myiasis/parasitology , Argentina , Ivermectin/therapeutic use , Tetanus Toxoid/therapeutic use , Diptera , Larva , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use , Myiasis/etiology , Myiasis/drug therapy , Antiparasitic Agents/therapeutic use
2.
Rev. Assoc. Med. Bras. (1992) ; 66(supl.1): s37-s44, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057099

ABSTRACT

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).


Subject(s)
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
3.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 126-129, Jan.-Mar. 2019. graf
Article in Portuguese | LILACS | ID: biblio-985129

ABSTRACT

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.


ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.


Subject(s)
Humans , Male , Female , Streptococcus pneumoniae/isolation & purification , Pericardial Effusion/diagnostic imaging , Pericarditis/diagnosis , Pericarditis/physiopathology , Pericarditis/microbiology , Pericarditis/therapy , Pneumococcal Infections/diagnosis , Pneumococcal Infections/physiopathology , Pneumococcal Infections/therapy , Echocardiography/methods , Radiography, Thoracic/methods , Cerebrospinal Fluid/microbiology , Fatal Outcome , Blood Culture/methods , Meningitis/diagnosis , Meningitis/physiopathology , Meningitis/microbiology , Meningitis/therapy , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification , Neurologic Examination/methods
4.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 27-33, Jan.-Mar. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-985138

ABSTRACT

RESUMO Objetivo: Verificar o perfil e a adequabilidade do uso de antibacterianos em crianças hospitalizadas. Métodos: Estudo transversal. Foi feita a análise de todas as crianças que utilizaram antibacterianos durante a internação de janeiro a dezembro de 2015, em um hospital filantrópico de direito privado de grande porte no sul do Brasil. As informações foram obtidas por revisão dos prontuários e incluíram dados demográficos (idade, sexo, raça e peso corporal) e clínicos (motivo da internação, uso deantibacterianos e desfecho clínico). Utilizou-se estatística descritiva. Resultados: Dos 318 pacientes incluídos, 61,3% eram do sexo masculino. A faixa etária variou de 2 a 11 anos (média: 5,8±2,9 anos de idade). A prevalência do uso de antibacterianos foi de 24,4% considerando o total de 1.346 crianças que foram hospitalizadas. O tempo de internação apresentou mediana de quatro dias. O principal motivo de internação foi clínico e o antibacteriano mais prescrito foi a cefazolina, sendo a via intravenosa predominante. Em relação ao uso de antibacterianos, 62,2% apresentaram prescrições de antibacterianos consideradas adequadas. A subdosagem e a superdosagem tiveram, respectivamente, os valores de 11,7 e 14,6% dos pacientes incluídos. Quanto aos intervalos de administração, 8% foram caracterizados com intervalos longos e 3,5%, curtos. Conclusões: Apesar de a prevalência encontrada do uso de antibacterianos nas crianças hospitalizadas não ser tão elevada, parte considerável da amostra apresentou inadequabilidade quanto ao uso desse tipo de medicamento, se considerados a dose e o intervalo de utilização. Esses dados são motivo de preocupação para o desenvolvimento de resistência bacteriana e ocorrência de reações adversas.


ABSTRACT Objective: To examine the profile and appropriate use of antibiotics among hospitalized children. Methods: A cross-sectional study was conducted with children who had taken antibiotics during hospitalization in a private philanthropic hospital in Southern Brazil, from January to December 2015. The data were obtained by reviewing medical records, encompassing demographic data (age, gender, ethnicity, and body weight) and clinical data (causes of hospitalization, use of antibiotics, and clinical outcome). Descriptive statistics was used to present the data. Results: Of the 318 participants included in the study, 61.3% were male patients. The age range varied between 2 and 11 years, with mean age of 5.8±2.9 years. The prevalence of antibiotics was 24.4% out of the 1,346 hospitalized children. Median hospital stay was four days. The main cause of hospitalization was clinical instability, and the most commonly prescribed antibiotics was Cefazolin, mostly administered intravenously. Regarding the administration of antibiotics, 62.2% were adequately prescribed, even though underdose was 11.7%, and overdose was 14.6% in the studied patients. Antibiotic administration intervals were characterized as long in 8% of cases, and short in 3.5% of cases. Conclusions: Although the prevalence of antibiotics among hospitalized children was not that high, a considerable part of the sample presented inadequacy regarding the dosage and range of use. These data raise concerns about bacterial resistance and adverse reactions.


Subject(s)
Humans , Male , Female , Child , Hospitalization/statistics & numerical data , Medical Records, Problem-Oriented/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Brazil/epidemiology , Child, Hospitalized/statistics & numerical data , Cross-Sectional Studies , Length of Stay/statistics & numerical data , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/adverse effects
5.
Rev. Soc. Bras. Med. Trop ; 52: e20180502, 2019. tab, graf
Article in English | LILACS | ID: biblio-1041563

ABSTRACT

Abstract INTRODUCTION: Plant products are sources for drug development against multidrug resistant bacteria. METHODS The antimicrobial activity of Origanum vulgare L. essential oil (OVeo) against carbapenem-resistant strains was assessed by disk-diffusion, microdilution (REMA-Resazurin Microtiter Assay), and time kill assays. RESULTS Carbapenemase production was confirmed for all strains. OVeo exhibited a minimum inhibitory concentration of 0.059% v/v for Klebsiella pneumoniae and Serratia marcescens, and of 0.015 % v/v for Acinetobacter baumannii. A decrease in cell count was observed after a 4 h treatment. CONCLUSIONS OVeo antimicrobial effect was rapid and consistent, making it a candidate for developing alternative therapeutic options against carbapenem-resistant strains.


Subject(s)
Humans , Serratia marcescens/drug effects , Oils, Volatile/pharmacology , Acinetobacter baumannii/drug effects , Origanum/chemistry , Gram-Negative Bacteria/drug effects , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Serratia marcescens/growth & development , Bacterial Proteins , beta-Lactamases , Microbial Sensitivity Tests , Carbapenems/pharmacology , Drug Resistance, Multiple, Bacterial , Acinetobacter baumannii/growth & development , Gram-Negative Bacteria/growth & development , Klebsiella pneumoniae/growth & development , Anti-Bacterial Agents/classification
6.
Rev. méd. Chile ; 146(9): 968-977, set. 2018. tab, graf
Article in English | LILACS | ID: biblio-978786

ABSTRACT

ABSTRACT Background: The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported. Aim: To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings. Material and Methods: A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed. Results: Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%. Median antimicrobial expenditure per bed (initially US$ 13) declined to US$ 10 at the first year (-28%) and to US$ 6 the last year (-57%). As the reduction in consumption was lower than the reduction in expenditure during the last year, we assumed that only 48.4% of savings were attributable to the ASP. According to antimicrobial charges per bed from prior and after ASP implementation, we estimated global savings of US$ 393072 and US$ 190000 directly attributable to the ASP, difference explained by parallel competitive biddings. Drug resistance among nosocomial bacterial isolates did not show significant changes. Global and infectious disease-associated mortality per 1000 discharges significantly decreased during the study period (p < 0.05). Conclusions: The ASP had a favorable impact on antimicrobial consumption, savings and mortality rates but did not have effect on antimicrobial resistance in selected bacterial strains.


Antecedentes: Existe poca información sobre el impacto a largo plazo de un programa de control de antimicrobianos (PCA) y su efecto combinado con licitaciones públicas de fármacos. Objetivo: Evaluar el impacto de un PCA sobre el consumo, gasto, mortalidad y estimar la contribución de las licitaciones. Material y Métodos: Comparación antes (2005-2008) - después (2009-2015) del PCA y estimación porcentual del ahorro atribuible al PCA y licitaciones. Resultados: El consumo bajó de 221,3 a 170 dosis diarias definidas por 100 días camas (medianas) al primer año. En el último año el consumo declinó un 27,6%. La mediana del gasto por cama ocupada se redujo de 13 a 10 US$ el primer año y a 6 US$ el último año (-57%). Debido a que el gasto bajó más que el consumo, estimamos que solo el 48,4% del ahorro fue debido al PCA (cuociente de ambas reducciones: −27,6%/-57%). De acuerdo con el gasto en antimicrobianos por cama entre ambos períodos, se calculó un ahorro global de 393.000 US$ y de 190.000 US$ directamente atribuible al PCA, siendo la diferencia explicada por licitaciones. Los porcentajes de resistencia en cepas de infecciones nosocomiales no mostraron incrementos o reducciones significativas en el tiempo y la mortalidad por egresos asociada a enfermedades infecciosas (Códigos CIE 10) se redujo significativamente (p < 0,05). Conclusiones: El PCA se asoció a largo plazo a un impacto favorable sobre el consumo de antimicrobianos, gasto por antimicrobianos y egresos por enfermedades infecciosas sin un impacto en la resistencia antimicrobiana. Las licitaciones tuvieron un efecto aditivo en el ahorro.


Subject(s)
Humans , Competitive Bidding/economics , Communicable Diseases/economics , Antimicrobial Stewardship/economics , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/economics , Chile/epidemiology , Communicable Diseases/mortality , Communicable Diseases/drug therapy , Hospital Mortality , Drug Resistance, Bacterial , Antimicrobial Stewardship/statistics & numerical data , Hospitals, General , Anti-Bacterial Agents/classification
7.
Rev. méd. Chile ; 146(9): 1070-1073, set. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978799

ABSTRACT

Vasculitic midline destructive lesions can be a complication of cocaine use. We report a 44-year-old man who presented with a two months history of left facial pain associated with ipsilateral facial paralysis and a cheek phlegmon. Magnetic resonance imaging showed broad soft tissue destruction linked to important cranial nerve involvement. Antibiotic and antifungal therapy was started and multiple surgical debridement procedures were performed, with no clinical improvement. Microbiological analysis was negative. Finally, thanks to the histologic findings corresponding to vasculitis and granuloma formation and the history of cocaine abuse, a cocaine induced midline destructive lesion was diagnosed.


Subject(s)
Humans , Male , Adult , Nose Diseases/diagnosis , Nose Diseases/chemically induced , Cocaine-Related Disorders/complications , Nasal Septum/drug effects , Magnetic Resonance Imaging , Tomography Scanners, X-Ray Computed , Granulomatosis with Polyangiitis/diagnosis , Nose Diseases/therapy , Diagnosis, Differential , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use
8.
Rev. méd. Chile ; 146(8): 823-830, ago. 2018. tab
Article in Spanish | LILACS | ID: biblio-978764

ABSTRACT

Background: Most cases of Clostridium difficile infection (CDI) respond to a standard course of antibiotics, however recurrent CDI is becoming common and alternative therapeutic strategies are needed. In this scenario, fecal microbiota transplantation (FMT) has been suggested. Aim: To describe the efficacy and safety of FMT for the treatment of recurrent CDI. Patients and Methods: Review of medical records of all patients with recurrent CDI treated with FMT between April 2013 and April 2017. Demographic and clinical data were abstracted including details of treatment prior to FMT, rate of FMT treatment success and clinical course during follow-up period. Telephone surveys were conducted to determine patient satisfaction. Results: Eight patients aged 19 to 82 years (six women) underwent FMT. They experienced a median of four previous episodes of CDI (range 3-8). The mean duration of CDI was 18 days (range 3-36) before FMT. All procedures were performed by colonoscopy. Effectiveness with one session of FMT was 100%. During the follow-up period (median 24 months, range 7-55), two patients developed CDI, one of them after using antibiotics. Adverse events were reported in three patients. Two had bloating and one patient with Crohn's disease and a history of bacteremia had an episode of Escherichia coli bacteremia. All patients would use FMT again if necessary. Conclusions: FMT through colonoscopy appears to be a safe, effective and long-lasting therapy in cases of recurrent CDI.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Colonoscopy , Clostridium Infections/therapy , Fecal Microbiota Transplantation/methods , Recurrence , Clostridioides difficile , Treatment Outcome , Feces/microbiology , Fecal Microbiota Transplantation/adverse effects , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use
9.
Rev. chil. infectol ; 35(2): 213-215, abr. 2018. tab
Article in Spanish | LILACS | ID: biblio-1042645

ABSTRACT

Resumen Introducción: Campylobacter es un importante agente de diarrea en el ser humano. En Ecuador, la información sobre Campylobacter es escasa y no existen antecedentes de susceptibilidad antimicrobiana. Objetivo: Describir la prevalencia de Campylobacter en niños con diarrea y su comportamiento in vitro frente a cinco antimicrobianos. Método: Se estudiaron 253 niños entre siete meses y 9 años de edad, que consultaron por diarrea en dos hospitales de la ciudad de Loja. Se realizó cultivo de muestras fecales e identificación por pruebas fenotípicas y por RPC múltiple. La susceptibilidad antimicrobiana fue determinada por el método de difusión en disco. Resultados: Campylobacter fue diagnosticado en 16 (6,3%) de las muestras, aislándose C. jejuni en 13 (5,1%) y C. coli en 3 (1,2%). Todas las cepas fueron susceptibles a gentamicina y ampicilina/ ácido clavulánico, con baja resistencia a ampicilina y eritromicina y alta resistencia a ciprofloxacina.


Introduction: Campylobacter is an important agent of diarrhea in humans. In Ecuador, the information on Campylobacter is scarce and there are not antecedents about antimicrobial susceptibility. Objective: To describe Campylobacter prevalence in children with diarrhea and their behavior against five antimicrobials in vitro. Method: We studied 253 children with diarrhea aging 7 months to 9 years who consulted for diarrhea in two hospitals in the city of Loja. Fecal samples were cultured and identification by tests by phenotypic tests and multiplex PCR. Susceptibility to 5 antibiotics was determined by the disc-diffusion method. Results: Campylobacter was found in 16 (6.3%) children, being C. jejuni the most frequent one (5.1%), followed by C. coli (1.2%). All strains were susceptible to gentamicin and ampicillin/clavulanic acid, being found low resistance to ampicillin and erythromycin and high resistance to ciprofloxacin.


Subject(s)
Humans , Infant , Child, Preschool , Child , Campylobacter Infections/microbiology , Campylobacter Infections/epidemiology , Campylobacter jejuni/isolation & purification , Campylobacter jejuni/drug effects , Campylobacter coli/isolation & purification , Campylobacter coli/drug effects , Drug Resistance, Multiple, Bacterial , Diarrhea/microbiology , Anti-Bacterial Agents/pharmacology , Campylobacter Infections/drug therapy , Prevalence , Ecuador/epidemiology , Feces/microbiology , Anti-Bacterial Agents/classification
10.
Medicina (B.Aires) ; 78(2): 99-106, abr. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-954957

ABSTRACT

Representantes de la Sociedad Argentina de Infectología (SADI) y la Sociedad Argentina de Terapia Intensiva (SATI) se unieron para trabajar en la elaboración de recomendaciones de diagnóstico, tratamiento y prevención de la neumonía asociada a ventilación mecánica (NAVM). La metodología utilizada fue el análisis de la bibliografía publicada en los últimos 15 años, complementada con la opinión de expertos y los datos locales. En este documento se pretende ofrecer herramientas básicas de optimización del diagnóstico en base a criterios clínicos y microbiológicos, orientación en los esquemas antibióticos empíricos y dirigidos, novedades en posología y administración de antibióticos en pacientes críticos y promocionar las medidas efectivas para reducir el riesgo de NAVM. Asimismo, ofrece un algoritmo de diagnóstico y tratamiento y consideraciones sobre antibióticos inhalados. El trabajo conjunto de ambas sociedades, infectólogos y terapistas, pone en evidencia la preocupación por el manejo de la NAVM y la importancia de velar por la mejora en las prácticas cotidianas. A través de esta recomendación se establecen pautas locales para optimizar el diagnóstico, tratamiento y prevención de la NAVM con el objeto de disminuir la morbimortalidad, días de internación, costos y resistencia a antibióticos debida al mal uso de los antimicrobianos.


Representatives of the Argentine Society of Infectious Diseases (SADI) and the Argentine Society of Intensive Therapy (SATI) worked together on the development of specific recommendations for the diagnosis, treatment and prevention of ventilator-associated pneumonia (VAP). The methodology used was the analysis of the literature published in the last 15 years, complemented with the opinion of experts and local data. This document aims to offer basic tools to optimize diagnosis based on clinical and microbiological criteria, orientation in empirical and targeted antibiotic schemes, news on posology and administration of antibiotics in critical patients and to promote effective measures to reduce the risk of VAP. It also offers a diagnostic and treatment algorithm and considerations on inhaled antibiotics. The joint work of both societies -infectious diseases and intensive care- highlights the concern for the management of VAP and the importance of ensuring improvement in daily practices. This guideline established recommendations to optimize the diagnosis, treatment and prevention of VAP in order to reduce morbidity and mortality, days of hospitalization, costs and resistance to antibiotics due to misuse of antimicrobials.


Subject(s)
Humans , Respiration, Artificial/adverse effects , Pneumonia, Ventilator-Associated/diagnosis , Pneumonia, Ventilator-Associated/drug therapy , Anti-Bacterial Agents/therapeutic use , Risk Factors , Pneumonia, Ventilator-Associated/prevention & control , Intensive Care Units , Anti-Bacterial Agents/classification
11.
Rev. Asoc. Odontol. Argent ; 105(3): 123-132, sept. 2017.
Article in Spanish | LILACS | ID: biblio-973107

ABSTRACT

El tratamiento endodóntico convencional en casos de dientes con desarrollo radicular incompleto y periodontitis apical incluye opciones como la cirugía endodóntica o laapexificación mediante el uso de hidróxido de calcio o del compuesto de minerales trióxido. Sin embargo, numerosos ensayos ex vivo e in vivo en modelos animales, así como estudios clínicos en humanos, han demostrado que, luego de una adecuada desinfección y la formación de un coágulo sanguíneo, la posibilidad de obtener la regeneración de los tejidos infectados dentro del espacio del sistema de conductos radiculares –permitiendo a su vez la continuación del desarrollo de la raíz en DDRI con periodontitis apical– es actualmente una realidad con evidencia científicacomprobada. En ese sentido, la combinación de tres antibióticos talescomo metronidazol, ciprofloxacina y minociclina –conocida como pasta triple antibiótica– ha demostrado ser muy efectiva para obtener el nivel de desinfección necesaria. El propósito del presente estudio fue analizar la bibliografía referida al rol de la pasta triple antibiótica en endodoncia regenerativa para el tratamiento de dientes con desarrollo radicular incompleto con periodontitis apical.


Subject(s)
Adolescent , Child, Preschool , Child , Periapical Periodontitis/drug therapy , Regenerative Medicine/instrumentation , Regenerative Medicine/methods , Root Canal Filling Materials/pharmacology , Root Canal Filling Materials/therapeutic use , Tooth Apex/physiology , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use , Drug Combinations , Tooth, Deciduous , Dentition, Permanent
12.
J. pediatr. (Rio J.) ; 93(3): 260-266, May.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-841345

ABSTRACT

Abstract Objective: Urinary tract infection (UTI) caused by resistant strains of bacteria is increasingly prevalent in children. The aim of this study was to investigate the clinical characteristics and risk factors for UTI caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing bacteria in infants. Methods: This was a retrospective study performed over 5 years in a single Korean center. Hospitalized infants with febrile UTI were enrolled and divided into two groups (CA-ESBL vs. CA non-ESBL UTI). The yearly prevalence was calculated. Baseline characteristics and clinical course such as fever duration, laboratory and radiological findings were compared between the two groups. Risk factors associated with the CA-ESBL UTI were investigated. Results: Among the enrolled infants (n = 185), 31 (17%) had CA-ESBL UTI. The yearly prevalence of ESBL of CA-ESBL UTI increased during the study (0% in 2010, 22.2% in 2015). Infants with CA-ESBL UTI had a longer duration of fever after initiating antibiotics (2.0 ± 1.1 vs. 1.5 ± 0.6 days, p = 0.020). Cortical defects on renal scan and early treatment failure were more frequent in CA-ESBL (64.5 vs. 42.2%, p = 0.023; 22.6 vs. 4.5%, p = 0.001). A logistic regression analysis revealed that urinary tract abnormalities and previous UTI were independent risk factors for CA-EBSL UTI (odds ratio, 2.7; p = 0.025; 10.3; p = 0.022). Conclusion: The incidence of UTI caused by ESBL-producing bacteria has increased in Korean infants. Recognition of the clinical course and risk factors for ESLB-producing UTI may help to determine appropriate guidelines for its management.


Resumo Objetivo: A infecção do trato urinário (ITU) causada por cepas de bactérias resistentes está cada vez mais prevalente em crianças. O objetivo deste estudo foi investigar as características clínicas e os fatores de risco de ITU causada por bactérias produtoras de β-lactamases de espectro ampliado adquiridas na comunidade (ESBL CA) em neonatos. Métodos: Estudo retrospectivo feito por mais de cinco anos em um único centro sul-coreano. Neonatos internados com ITU febril foram inscritos e divididos em dois grupos (ITU por ESBL CA em comparação com não ESBL CA). A prevalência anual foi calculada. As características básicas e o curso clínico, como duração da febre e achados laboratoriais e radiológicos, foram comparados entre os dois grupos. Os fatores de risco associados à ITU por ESBL CA foram investigados. Resultados: Entre os neonatos inscritos (n = 185), 31 (17%) apresentaram ITU por ESBL CA. A prevalência anual de ESBL em ITU por ESBL CA aumentou durante o estudo (0% em 2010, 22,2% em 2015). Os neonatos com ITU por ESBL CA apresentaram maior duração de febre após o início dos antibióticos (2 ± 1,1 em comparação com 1,5 ± 0,6 dias, p = 0,020). Os defeitos corticais no exame renal e a falha precoce no tratamento foram mais frequentes em ESBL CA (64,5 em comparação com 42,2%, p = 0,023; 22,6 em comparação com 4,5%, p = 0,001). Uma análise de regressão logística revelou que as anomalias do trato urinário e a ITU anterior eram fatores de risco independentes de ITU por ESBL CA (razão de chance: 2,7; p = 0,025; 10,3; p = 0,022). Conclusão: A incidência de ITU causada por bactérias produtoras de ESBL aumentou em neonatos sul-coreanos. O reconhecimento do curso clínico e dos fatores de risco de ITU por ESBL poderá ajudar a determinar as diretrizes adequadas de manejo.


Subject(s)
Humans , Male , Female , Child, Preschool , Urinary Tract Infections/microbiology , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology , beta-Lactamases/biosynthesis , Drug Resistance , Epidemiologic Methods , Community-Acquired Infections/microbiology , Community-Acquired Infections/epidemiology , Escherichia coli , Republic of Korea/epidemiology , Klebsiella , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use
13.
Braz. j. infect. dis ; 20(3): 272-275, May.-June 2016. tab
Article in English | LILACS | ID: lil-789475

ABSTRACT

Abstract Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Osteomyelitis/therapy , beta-Lactams/therapeutic use , Infusions, Parenteral/methods , Minocycline/analogs & derivatives , Anti-Bacterial Agents/administration & dosage , Outpatients , Bone Diseases, Infectious/classification , Bone Diseases, Infectious/drug therapy , Brazil , Ertapenem , Tigecycline , Anti-Infective Agents , Minocycline/therapeutic use , Anti-Bacterial Agents/classification
14.
Braz. j. microbiol ; 46(4): 1111-1118, Oct.-Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-769642

ABSTRACT

Abstract In the present work, twelve bacilli were isolated from four different regions of human skin from Bela population of Nagpur district, India. The isolated bacilli were identified by their morphological, cultural and biochemical characteristics. Seven isolates were Gram negative rods, out of which five were belong to genus Pseudomonas. Three among the five Gram positive isolates were identified as Dermabactor and the remaining two Bacillus. Their antimicrobial susceptibility profile was determined by Kirby-Bauer disc diffusion method. The isolates showed resistance to several currently used broad-spectrum antibiotics. The Dermabactor genus was resistant to vancomycin, although it was earlier reported to be susceptible. Imipenem was found to be the most effective antibiotic for Pseudomonas while nalidixic acid, ampicillin and tetracycline were ineffective. Isolates of Bacillus displayed resistance to the extended spectrum antibiotics cephalosporin and ceftazidime. Imipenem, carbenicillin and ticarcillin were found to be the most effective antibiotics as all the investigated isolates were susceptible to them. Antibiotic resistance may be due to the overuse or misuse of antibiotics during the treatment, or following constant exposure to antibiotic-containing cosmetic formulations.


Subject(s)
Adolescent/classification , Adolescent/drug effects , Adolescent/genetics , Adolescent/isolation & purification , Adolescent/microbiology , Adolescent/pharmacology , Adult/classification , Adult/drug effects , Adult/genetics , Adult/isolation & purification , Adult/microbiology , Adult/pharmacology , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/drug effects , Anti-Bacterial Agents/genetics , Anti-Bacterial Agents/isolation & purification , Anti-Bacterial Agents/microbiology , Anti-Bacterial Agents/pharmacology , Bacillus/classification , Bacillus/drug effects , Bacillus/genetics , Bacillus/isolation & purification , Bacillus/microbiology , Bacillus/pharmacology , Female/classification , Female/drug effects , Female/genetics , Female/isolation & purification , Female/microbiology , Female/pharmacology , Healthy Volunteers/classification , Healthy Volunteers/drug effects , Healthy Volunteers/genetics , Healthy Volunteers/isolation & purification , Healthy Volunteers/microbiology , Healthy Volunteers/pharmacology , Humans/classification , Humans/drug effects , Humans/genetics , Humans/isolation & purification , Humans/microbiology , Humans/pharmacology , Male/classification , Male/drug effects , Male/genetics , Male/isolation & purification , Male/microbiology , Male/pharmacology , Microbial Sensitivity Tests/classification , Microbial Sensitivity Tests/drug effects , Microbial Sensitivity Tests/genetics , Microbial Sensitivity Tests/isolation & purification , Microbial Sensitivity Tests/microbiology , Microbial Sensitivity Tests/pharmacology , Middle Aged/classification , Middle Aged/drug effects , Middle Aged/genetics , Middle Aged/isolation & purification , Middle Aged/microbiology , Middle Aged/pharmacology , Skin/classification , Skin/drug effects , Skin/genetics , Skin/isolation & purification , Skin/microbiology , Skin/pharmacology , Young Adult/classification , Young Adult/drug effects , Young Adult/genetics , Young Adult/isolation & purification , Young Adult/microbiology , Young Adult/pharmacology
15.
Article in English | IMSEAR | ID: sea-163483

ABSTRACT

Antimicrobial drugs are magic bullets which are used in humans, animals and plants to treat and prevent bacterial infections. The inevitable side effects of the use of antibiotics are the emergence and dissemination of resistant bacteria. Their level of resistance is considered to be a good indicator for selection pressure by antibiotic use and for resistance problems to be expected in pathogens. At least twelve classes of antimicrobials namely arsenicals, polypeptides, glycolipids, tetracyclines, elfamycins, macrolides, lincosamides, polyethers, beta-lactams, quinoxalines, streptogramins, and sulfonamides have been used in veterinary practice. The effect of this selection pressure has been the appearance of numerous resistant strains of Escherichia coli , Salmonella species , Staphylococcus aureus , Pasteurella hemolytica, Pseudomonas aeruginosa, Klebsiella pneumoniae, Clostridium perfringens and many other bacterial species. Bacteria also acquire genes conferring resistance by a variety of mechanisms including acquisition of extrachromosomal plasmids that replicate apart from the chromosomal DNA. Damage caused by antibiotic resistant bacteria is a kind of pollution. The precise effect of agricultural antibiotic use on resistance levels in the general population is not known, but the evidence points to a link. Considerable attention has been focussed on a very small minority of bacteria that cause disease but a vast sea of commensal and environmental bacteria continuously and promiscuously exchange genes totally unnoticed. Immediate action has to be taken to prevent the antibiotic resistance in bacteria by judicious and rational use of antibiotics, effective hospital infection control programs and research for the development of new antibiotics or by combination therapy.


Subject(s)
Animals , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Humans , Plants
16.
Biomédica (Bogotá) ; 34(supl.1): 23-33, abr. 2014. tab
Article in Spanish | LILACS | ID: lil-712418

ABSTRACT

Introducción. La resistencia bacteriana es crítica para la selección de los antibióticos en el tratamiento de las infecciones, por ello es vital conocer su estado actual en nuestro medio. Objetivo. Determinar la sensibilidad antibiótica bacteriana in vitro obtenida de los cultivos de queratitis e infecciones intraoculares. Materiales y métodos. Se llevó a cabo un estudio retrospectivo en la Fundación Oftalmológica de Santander (FOSCAL), entre junio de 2011 y enero de 2012. Resultados. Se examinaron 92 muestras. Se identificaron 110 bacterias, 27 hongos y 12 amebas de vida libre. Del total de bacterias Gram positivas, 1,1 %, 0 %, 1,1 %, 16,9 %, 29,3 % y 85 % fue resistente a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina, respectivamente, mientras que la resistencia a estos mismos fármacos se presentó, respectivamente, en 0 %, 8,3 %, 0 %, 0 %, 18,2 % y 27,3 % de las bacterias Gram negativas. Los porcentajes de resistencia de los estafilococos positivos para coagulasa resistentes a la meticilina fueron 0 %, 0 %, 0 %, 7 %, 17 % y 100 %, respectivamente, y los porcentajes de los estafilococos negativos para coagulasa resistentes a la meticilina fueron 3 %, 0 %, 0 %, 24 %, 44 % y 100 %, respectivamente. Los porcentajes de resistencia bacteriana globales (tanto para bacterias Gram positivas como para Gram negativas) a imipenem, moxifloxacina, gatifloxacina, levofloxacina, ciprofloxacina y tobramicina fueron 1 %, 1 %, 1 %, 15,1 %, 28 % y 64,5 %, respectivamente. Conclusiones. Los niveles de resistencia bacteriana para imipenem, moxifloxacina y gatifloxacina fueron menores que para levofloxacina, ciprofloxacina y tobramicina. Los niveles de resistencia para la tobramicina fueron muy altos, lo que pone en duda su utilidad clínica en las infecciones oculares en nuestro medio.


Introduction: Bacterial resistance is critical for the selection of antibiotics in the treatment of infections, so it is vital to know its current status in our geographical area. Objective: To determine in vitro antibiotic susceptibility of bacterial isolates obtained from keratitis and intraocular infections. Materials and methods: A retrospective study of microbiological tests in Fundación Oftalmológica de Santander (FOSCAL) was carried out between June, 2011, and January, 2012. Results: A total of 92 samples were examined and 110 bacteria, 27 fungi and 12 free-living amoebae were identified. Polymicrobial infections constituted 50% of the total; 1.1%, 0%, 1.1%, 16.9%, 29.3% and 85% of Gram-positive bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively, while 0%, 8.3%, 0%, 0%, 18.2% and 27.3% of Gram-negative bacteria were resistant to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, respectively. For methicillin-resistant coagulase-positive staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 0%, 0%, 0%, 7%, 17% and 100%, respectively. For methicillin-resistant coagulase-negative staphylococci, resistance percentages to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin were 3%, 0%, 0%, 24%, 44% and 100%, respectively. Overall bacterial resistance to imipenem, moxifloxacin, gatifloxacin, levofloxacin, ciprofloxacin and tobramycin, for both Gram-positive and Gram-negative, was 1%, 1%, 1%, 15.1%, 28% and 64.5%, respectively. Conclusions: The levels of bacterial resistance to imipenem, moxifloxacin and gatifloxacin were lower than for levofloxacin, ciprofloxacin and tobramycin. The levels of resistance to tobramycin were very high, which calls into question its usefulness in this region of our country.


Subject(s)
Humans , Corneal Ulcer/microbiology , Drug Resistance, Multiple, Bacterial , Endophthalmitis/microbiology , Eye Infections, Bacterial/microbiology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Acanthamoeba Keratitis/epidemiology , Acanthamoeba Keratitis/microbiology , Acanthamoeba/isolation & purification , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/pharmacology , Aqueous Humor/microbiology , Colombia/epidemiology , Cornea/microbiology , Corneal Ulcer/drug therapy , Corneal Ulcer/epidemiology , Disk Diffusion Antimicrobial Tests , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/epidemiology , Eye Infections, Fungal/epidemiology , Eye Infections, Fungal/microbiology , Eye Infections, Parasitic/epidemiology , Eye Infections, Parasitic/parasitology , Foundations , Fluoroquinolones/pharmacology , Fungi/isolation & purification , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Retrospective Studies , Vitreous Body/microbiology
17.
Biomédica (Bogotá) ; 34(supl.1): 191-208, abr. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-712436

ABSTRACT

En los últimos años se han desarrollado nuevas alternativas para el tratamiento de infecciones por patógenos Gram positivos multirresistentes, entre los cuales Staphylococcus aureus resistente a la meticilina (SARM) y los enterococos resistentes a la vancomicina (ERV) se consideran un verdadero reto terapéutico, y aunque el uso de la vancomicina en infecciones graves causadas por SARM ha generado serias dudas en los últimos años, continúa siendo escasa la información clínica de respaldo al uso de agentes terapéuticos que la superen en eficacia. El linezolid, la daptomicina y la tigeciclina son agentes que tienen actividad contra los cocos Gram positivos y que fueron aprobados e introducidos en la terapia clínica en la década pasada. Además, se han probado o están en las fases finales de desarrollo otros agentes como las cefalosporinas de última generación (ceftarolina y ceftobiprol). El propósito de esta revisión fue describir las nuevas alternativas terapéuticas, particularmente en la era posterior a la vancomicina, y repasar las características químicas más relevantes de los compuestos y su espectro de actividad, haciendo énfasis en sus mecanismos de acción y resistencia.


New therapeutic alternatives have been developed in the last years for the treatment of multidrug-resistant Gram-positive infections. Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are considered a therapeutic challenge due to failures and lack of reliable antimicrobial options. Despite concerns related to the use of vancomycin in the treatment of severe MRSA infections in specific clinical scenarios, there is a paucity of solid clinical evidence that support the use of alternative agents (when compared to vancomycin). Linezolid, daptomycin and tigecycline are antibiotics approved in the last decade and newer cephalosporins (such as ceftaroline and ceftobiprole) and novel glycopeptides (dalvavancin, telavancin and oritavancin) have reached clinical approval or are in the late stages of clinical development. This review focuses on discussing these newer antibiotics used in the "post-vancomycin" era with emphasis on relevant chemical characteristics, spectrum of antimicrobial activity, mechanisms of action and resistance, as well as their clinical utility.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Drug Resistance, Multiple, Bacterial , Gram-Positive Cocci/drug effects , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , Cephalosporins/classification , Cephalosporins/pharmacology , Daptomycin/pharmacology , Drug Resistance, Multiple, Bacterial/genetics , Drug Resistance, Multiple, Bacterial/physiology , Drugs, Investigational/pharmacology , Genes, Bacterial , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Cocci/genetics , Methicillin-Resistant Staphylococcus aureus/drug effects , Minocycline/analogs & derivatives , Minocycline/pharmacology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Vancomycin/pharmacology
18.
Braz. j. pharm. sci ; 49(4): 775-782, Oct.-Dec. 2013. ilus, tab
Article in English | LILACS | ID: lil-704109

ABSTRACT

Serjania erecta Radlk.(Sapindaceae) is a medicinal plant traditionally used in Brazil. We assayed the ethanolic extract of leaves and roots against seven microorganisms. The REMA (Resazurin Microtiter Assay) assay was used to measure the biological activity in vitro against Mycobacterium tuberculosis and our results showed moderate activity of the ethanolic extract. On the other hand S. aureus, P. aeruginosa, S. setubal, C. albicans, S. cerevisiae and E. coli revealed that the leaves and roots of S. erecta inhibited the growth of all microorganisms. The ethanolic extracts of leaves and roots showed low values of antioxidant activities. The ethanolic extracts of leaves and roots were analyzed by chromatographic and spectrometric methods. (-)-Epicatechin, kaempferol aglycone and five glycoside derivates were isolated: kaempferol-3-O-α-L-rhamnopyranoside, kaempferol-3-O-α-L-rhamnopyranosyl-(1→6)-β-D-glucopyranoside from the roots and kaempferol, kaempferol 3,7-di-O-α-L-rhamnopyranoside, vitexin, isovitexin and (-)-epicatechin in the leaves. This is the first chemical study reported in the literature about this specie.


Serjania erecta Radlk. (Sapindaceae) é uma planta medicinal utilizada no Brasil. Analisamos o extrato etanólico de folhas e raízes para sete microorganismos. O REMA (Ensaio de Microtitulação Resazurina) foi utilizado para medir a atividade biológica in vitro contra o Mycobacterium tuberculosis e nossos resultados mostraram atividade moderada do extrato etanólico. Por outro lado, ensaios com S. aureus, P. aeruginosa, S. setubal, C. albicans, S. cerevisiae e E. coli revelaram que as folhas e raízes de S. erecta inibiram crescimento em todos os microorganismos. Os extratos etanólicos de folhas e raízes apresentaram valores baixos de atividade antioxidante. Os extratos etanólicos de folhas e raízes foram analisados por métodos cromatográficos e espectroscópicos. (-)-Epicatequina, canferol aglicona e cinco derivados glicosídicos foram isolados: canferol -3-O-α-L-ramnopiranosídeo, canferol-3-O-α-L-ramnopiranosil-(1→6)-β-D-glucopiranosídeo a partir das raízes e canferol, canferol 3,7-di-O-α-L-ramnopiranosídeo, vitexina, isovitexina e (-) epicatequina nas folhas. Este é o primeiro estudo químico na literatura sobre esta espécie.


Subject(s)
Anti-Bacterial Agents/classification , Anti-Infective Agents/classification , Antioxidants/classification , Phenolic Compounds/analysis , Flavonoids , Plants, Medicinal/classification , Sapindaceae
20.
Article in Spanish | LILACS | ID: lil-612943

ABSTRACT

Antibacterial drug resistance is a particularly significant issue in Latin America. This article explores antimicrobial resistance in three classes of clinically important bacteria: gram-positive bacteria, enterobacteria, and nonfermenting gram-negativebacilli. The gram-positive bacteria frequently responsible for infections in humans are for the most part cocci: staphylococci, streptococci (including pneumococci), and enterococci,in both community and hospital settings. This situation is no different in theRegion of the Americas. Among the gram-positive bacteria, the causative agents of bacteremia are most commonly strains of coagulase-negative Staphylococcus, followed by enterococci. This report explores the resistance of these species to different antimicrobial drugs, resistance mechanisms in community and hospital strains, and new drugs for treating infections caused by these bacteria. In Latin America, antimicrobialresistance in Enterococcus strains is still a minor problem compared to the situation in the United States. The strains of the genus Streptococcus isolated from respiratory infections are still sensitive to penicillin. Furthermore, the resistance of enterobacteriais extremely important in the Region, particularly because of the broad dissemination of CTX-M extended-spectrum beta-lactamases (ESBL), some of which originated in Latin America. This article analyzes the resistance of Streptococcus pneumoniae, betahemolytic streptococci, and viridans group streptococci. Among the nonfermentinggram-negative bacilli, while Pseudomonas aeruginosa strains remain the leading cause of bacteremia, infections caused by strains of Acinetobacter spp. have proliferatedextensively in some areas. With regard to antibiotics, several options are available for treating gram-positive bacterial infections...


La resistencia a los fármacos antibacterianos tiene particular importancia en América Latina. En este artículo se analiza la resistencia a los antimicrobianos de tres clases de bacterias de importancia clínica: bacterias grampositivas, enterobacterias y bacilos gramnegativos no fermentadores.Las bacterias grampositivas que producen infecciones humanas frecuentes son, en su mayoría, cocos: estafilococos, estreptococos (incluidos neumococos) y enterococos, tanto en elmedio comunitario como en el nosocomial. Esta situación no es diferente en la Región de las Américas. Entre las bacterias grampositivas, las que causan bacteriemia con mayor frecuencia corresponden a cepas de estafilococos coagulasa negativos, seguidas de las de enterococos. Eneste informe se analiza la resistencia de estas especies a distintos antimicrobianos, los mecanismosde resistencia para las cepas de origen hospitalario y comunitario y los nuevos medicamentos para tratar las infecciones por estas bacterias. La resistencia a los antimicrobianos delas cepas de Enterococcus en América Latina todavía es un problema menor en relación con la situación en los Estados Unidos de América. Las cepas del género Streptococcus aisladasde infecciones respiratorias aún son sensibles a penicilina. Por otra parte, la resistencia de las enterobacterias es de gran importancia en la Región, particularmente por la gran difusión debetalactamasas de espectro extendido (BLEE) de tipo CTX-M, algunas de las cuales se originaron en América Latina. En el presente artículo se analizan la situación de la resistencia de las cepas de Streptococcus pneumoniae, y de los estreptococos betahemolítico y del grupo viridans. Entre los bacilos gramnegativos no fermentadores, si bien las cepas de Pseudomonasaeruginosa siguen siendo la causa principal de bacteriemias, la proliferación de infecciones por cepas de Acinetobacter spp. tiene en algunas partes gran magnitud...


Subject(s)
Humans , Drug Resistance, Microbial , Drug Resistance, Multiple, Bacterial , Infection Control , Acinetobacter Infections/drug therapy , Acinetobacter Infections/epidemiology , Acinetobacter/drug effects , Acinetobacter/enzymology , Acinetobacter/genetics , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Biofilms , Bacterial Proteins/genetics , Bacterial Proteins/physiology , Developing Countries , Drug Resistance, Microbial/genetics , Drug Resistance, Multiple, Bacterial/genetics , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae/drug effects , Enterobacteriaceae/genetics , Enterococcus/drug effects , Enterococcus/genetics , Global Health , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacteria/drug effects , Gram-Positive Bacteria/genetics , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Latin America , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/genetics , Pseudomonas Infections/drug therapy , Streptococcus/drug effects , Streptococcus/genetics , beta-Lactamases/genetics , beta-Lactamases/physiology
SELECTION OF CITATIONS
SEARCH DETAIL