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1.
Rev. ADM ; 79(6): 318-324, nov.-dic. 2022.
Article in Spanish | LILACS | ID: biblio-1434701

ABSTRACT

Los antiinflamatorios no esteroideos (AINE) son un grupo de fármacos que han sido comúnmente prescritos por sus propiedades antiinflamato- rias, antipiréticas y analgésicas, mismas que se deben a la inhibición de la formación de prostaglandinas. Este mecanismo ha sido ampliamente respaldado en la literatura; sin embargo, en la actualidad poco se co- noce sobre las propiedades adicionales de estos medicamentos como el efecto antirresortivo y antimicrobiano. La función antirresortiva se debe principalmente al bloqueo de la producción de prostaglandinas en específico la PGE2, que posee gran potencial osteoclastogénico, esencial para la aparición de lesiones periapicales; asimismo, la acción antimicrobiana de los AINE está relacionada con la afectación directa de la perpetuación de biopelícula, potencian la acción de los antibióticos, entre otros. Dichos efectos combinados podrían contribuir en la cura- ción de lesiones periapicales. El objetivo de este estudio es recopilar información actualizada sobre estas funciones agregadas de los AINE, con el fin de dar a conocer a los profesionales estos beneficios en la terapéutica de las lesiones periapicales (AU)


Non-steroidal anti-inflammatory (NSAIDs) are a group of drugs that have been commonly prescribed for their anti-inflammatory, antipyretic and analgesic properties, which are due to the inhibition of prostaglandin formation. This mechanism has been widely supported in the literature; however, currently little is known about the additional properties of these drugs such as the antiresorptive and antimicrobial effect. The antiresorptive function is mainly due to the blockage of prostaglandin production, specifically PGE2, which has great osteoclastogenic potential, and is essential for the appearance of periapical lesions; likewise, the antimicrobial action of NSAIDs is related to the fact that they directly affect the perpetuation of biofilms, enhance the action of antibiotics, among others. These combined effects could contribute to the healing of periapical lesions. The aim of this study is to gather updated information on these added functions of NSAIDs, in order to inform professionals about these benefits in the therapy of periapical lesion (AU)


Subject(s)
Periapical Diseases/drug therapy , Anti-Inflammatory Agents, Non-Steroidal , Bacterial Infections/drug therapy , Tooth Resorption/drug therapy
2.
Rev. chil. infectol ; 39(2): 174-183, abr. 2022. tab
Article in Spanish | LILACS | ID: biblio-1388355

ABSTRACT

Resumen La infección del tracto urinario (ITU) es una de las infecciones bacterianas más frecuentes en la infancia. Un adecuado diagnóstico es esencial para poder realizar un tratamiento racional, eficiente y eficaz; sin embargo, existe gran heterogeneidad en los métodos diagnósticos, específicamente en el estudio de la susceptibilidad antimicrobiana. El objetivo de estas recomendaciones es entregar herramientas para uniformar los criterios diagnósticos, el estudio de susceptibilidad bacteriana in vitro y el tratamiento antimicrobiano de la ITU en la población pediátrica, con un enfoque de uso racional de los antimicrobianos. En esta primera parte, se presentan las recomendaciones en cuanto a cómo obtener una adecuada muestra de orina, el diagnóstico de laboratorio incluyendo puntos de corte -unidades formadoras de colonias/mL de orina-, además de consideraciones microbiológicas para el estudio de susceptibilidad y finalmente, el manejo de la ITU en pediatría. En la segunda parte se detalla el tratamiento antimicrobiano de sus complicaciones, el manejo de ITU en situaciones especiales y consideraciones farmacocinéticas y farmacodinámicas de los antimicrobianos a indicar en ITU.


Abstract The urinary tract infection (UTI) is one of the most common bacterial infections in childhood. An adequate diagnosis is essential to be able to carry out a rational, efficient and effective treatment, however, there great heterogeneity in diagnostic methods, specifically in the study of antimicrobial susceptibility. The aim of these recommendations is to provide tools to homogenize the diagnosis criteria, susceptibility study and antimicrobial treatment of urinary tract infection in the pediatric population, with a rational use of antibiotics approach. In the first part, the recommendations regarding diagnosis are presented, such as sampling and cut-off points, as well as microbiological considerations for susceptibility study and management of UTI in pediatrics. The second part details the management of complications, UTI in special situations, and pharmacokinetic and pharmacodynamic considerations of antimicrobials to be prescribed in UTI.


Subject(s)
Humans , Child , Pediatrics , Bacterial Infections/drug therapy , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology , Chile , Anti-Bacterial Agents/therapeutic use
3.
Rev. Assoc. Med. Bras. (1992) ; 68(2): 142-146, Feb. 2022. tab
Article in English | LILACS | ID: biblio-1365338

ABSTRACT

SUMMARY OBJECTIVE: The vast majority of patients who hospitalized with coronavirus disease 2019 are given empirical antibiotic therapy. However, information on the frequency, microorganism species, and resistance rates of secondary bacterial infections in coronavirus disease 2019 patients are insufficient. We aimed to show the frequency of secondary infections and resistance conditions in patients with coronavirus disease 2019 hospitalized in the intensive care unit. METHODS: The results of tracheal aspirate culture, blood culture, and urine culture obtained from coronavirus disease 2019 patients - at least 2 days after their admission to the intensive care unit - were examined microbiologically. RESULTS: A total of 514 patients hospitalized in intensive care unit were included in our study. Tracheal aspirate, blood, or urine cultures were collected from 369 patients (71.8%). Bacterial reproduction was detected in at least one sample in 171 (33.3%) of all patients. The rate of respiratory tract infection and/or bloodstream infection was found to be 21%. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa in tracheal aspirate culture; Coagulase-negative staphylococci, K. pneumoniae, and A. baumannii in blood culture; and Escherichia coli, K. pneumoniae, and Enterococcus faecalis in urine culture were the most common microorganisms. A. baumannii was resistant to most antibiotics except colistin and P. aeruginosa strains were resistant to most antibiotics except amikacin, colistin, cefepime, and imipenem. In K. pneumoniae, the highest meropenem sensitivity (73%) was observed; there was a strong resistance to most of the remaining antibiotics. CONCLUSIONS: We think that our study can be useful in choosing empirical antibiotic therapy in the coronavirus disease 2019 pandemic and reducing the mortality that may occur with secondary infection.


Subject(s)
Humans , Pneumonia , Bacterial Infections/complications , Bacterial Infections/drug therapy , Acinetobacter baumannii , Coinfection , Pseudomonas aeruginosa , Microbial Sensitivity Tests , SARS-CoV-2 , COVID-19/complications , Anti-Bacterial Agents/therapeutic use
4.
Chinese Journal of Burns ; (6): 697-700, 2022.
Article in Chinese | WPRIM | ID: wpr-940977

ABSTRACT

Chronic and infectious wound healing has always been an issue of concern in clinical and scientific research, in which bacterial infection and oxidative damage are the key factors hindering wound healing. Carbon dots, as a new material, has attracted much attention because of its unique physical and chemical properties and good biological safety. In recent years, the researches on the antibacterial property, antioxidant, and photoluminescence properties of carbon dots are more and more extensive and carbon dots have great potential in the treatment of chronic and infectious wounds. This paper reviews the research progress of carbon dots in three aspects: antibacterial, anti-oxidation and monitoring of wound infection are reviewed, and further discusses its specific mechanism, potential research direction, and application prospect.


Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Carbon/therapeutic use , Wound Healing , Wound Infection/drug therapy
5.
J. pediatr. (Rio J.) ; 97(3): 329-334, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1279316

ABSTRACT

Abstract Objective The use of broad-spectrum antimicrobials, such as third and fourth-generation, are responsible for emergence of multidrug-resistant microorganisms in neonatal units. Furthermore, antimicrobial daily doses are not standardized in neonatology. This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care. Methods This is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016. The data of all hospitalized neonates was collected daily. The infection criteria used were the standardized national criteria, based on definitions of Center for Diseases Control and Prevention. In this study, the use of antimicrobials was evaluated as antimicrobial-day (ATM-day) and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated. The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais (ETIC 312/08 e CAAE 58973616.2.0000.5149). Results From 2008 to 2016, 2751 neonates were hospitalized, corresponding to 60,656 patient-days. The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1,3 in the first period and 4,3 in the second period (p = 0,005). Conclusion It was observed that use of broad-spectrum antimicrobials, especially those with coverage for Gram-negative bacteria, was associated with an increase of multidrug-resistant bacteria.


Subject(s)
Humans , Infant, Newborn , Bacterial Infections/drug therapy , Cross Infection/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Anti-Infective Agents , Microbial Sensitivity Tests , Cohort Studies , Delivery of Health Care , Gram-Negative Bacteria , Anti-Bacterial Agents/therapeutic use
6.
Acta otorrinolaringol. cir. cuello (En línea) ; 49(2): 112-120, 2021. TAB, ILUS, GRAF
Article in Spanish | LILACS | ID: biblio-1253865

ABSTRACT

Resumen Introducción: actualmente los profesionales de la salud se enfrentan al manejo de las vías aéreas artificiales en grupos pediátricos, esto requiere de cuidados delicados y mucha atención para detectar, establecer y manejar situaciones apremiantes; por esta razón, existe un mayor riesgo de aparición de infecciones bacterianas traqueopulmonares. El objetivo del estudio fue analizar la caracterización de las infecciones en pacientes pediátricos portadores de cánula de traqueotomía en las diferentes publicaciones científicas. Materiales y métodos: se realizó una revisión sistemática mediante la búsqueda de la literatura existente entre los años 2015-2020 en las bases de datos Elsevier, PubMed, Google Académico y SciELO, teniendo en cuenta los criterios de inclusión artículos en idioma inglés, español y población de edad entre los 0-15 años con infección de cánula de traqueotomía en los años 2015-2020. Resultados: de 258 artículos distribuidos en las bases de datos, se seleccionaron 21 artículos que cumplían con los criterios de inclusión. Conclusiones: a pesar de que en la actualidad existan criterios clínicos, factores de riesgo y pruebas de laboratorio asociados a infecciones de la cánula postraqueotomía en pacientes pediátricos, se requiere mayor investigación para definir las guías clínicas de manejo en la toma de decisiones médicas. Asimismo, se consideró como limitación importante la cantidad de literatura existente con respecto al tema.


Abstract Introduction: Currently, health professionals face the management of artificial airways in pediatric groups, this requires delicate care and a lot of attention to detect, establish and manage pressing situations, which is why there is a greater risk of tracheo-pulmonary bacterial infections. The objective was to analyze the characterization of infections in pediatric patients with tracheostomy tubes in the different scientific publications. Method: A systematic review of the literature was carried out between the years 2015-2020 in Elsevier, PubMed, Google Academic and SciELO databases, taking into account the inclusion criteria of the population aged 0-15 years in the years 2015-2020. The amount of existing literature on the subject was considered an important limitation. Results: From 258 articles distributed in the databases, 21 articles were selected that met the inclusion criteria. Conclusions: Although there are currently clinical criteria, risk factors and laboratory tests associated with infections of the post-tracheotomy tube in pediatric patients, further research is required to define clinical guidelines for management in medical decision-making.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Bacterial Infections/etiology , Tracheitis/microbiology , Tracheotomy/adverse effects , Bronchitis/microbiology , Cannula/adverse effects , Respiration, Artificial/adverse effects , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Tracheitis/diagnosis , Tracheitis/drug therapy , Bronchitis/diagnosis , Bronchitis/drug therapy
7.
Medicina (B.Aires) ; 80(6): 599-605, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1250281

ABSTRACT

Resumen La cinética de la procalcitonina es útil para reducir la duración de la antibioticoterapia en pacientes críticos, pero no se analizó su rol en infecciones por gérmenes multirresistentes. Se realizó un estudio observacional retrospectivo, analizando las curvas de procalcitonina de pacientes con neumonías asociadas a ventilación mecánica (NAVM) y bacteriemias asociadas a catéter (BAC) con rescate bacteriano durante el período 1/11/16 a 1/7/19. Se estudiaron 16 pacientes con infección por gérmenes sensibles (10 BAC y 6 NAVM) y 10 por gérmenes multirresistentes (10 BAC y 10 NAVM). Los pacientes con BAC generadas por gérmenes multirresistentes presentaron valores de procalcitonina mayores que los pacientes con BAC por gérmenes sensibles: (39 ± 30 μg/l vs. 10.7 ± 11 μg/l, p = 0.02). Los pacientes con NAVM generada por gérmenes sensibles y multirresistentes presentaron valores de procalcitonina similares. El descenso de procalcitonina a niveles 80% menores al valor máximo o menores a 0.5 μg/l (con tratamiento antibiótico efectivo) fue más veloz en pacientes con infección por gérmenes sensibles (5 ± 1.8 días vs. 7.2 ± 2.9 días, p = 0.03). En las infecciones por gérmenes multirresistentes, la respuesta inflamatoria medida por procalcitonina fue más intensa y prolongada, aun con un tratamiento antibiótico efectivo. Sin embargo, el descenso se produjo antes de que finalizaran los esquemas antibióticos convencionales. Por este motivo, se considera necesario estudiar la potencial utilidad de protocolos antibióticos guiados por procalcitonina en pacientes con infecciones por gérmenes multirresistentes para reducir la exposición a antibióticos.


Abstract Procalcitonin guidance stimulates a reduction in the duration of antibiotic treatment in critically ill patients with a presumed bacterial infection, but its role in infections caused by multidrug-resistant bacteria has not been sufficiently explored. In this retrospective observational study, we analyzed procalcitonin curves of 32 patients with culture-confirmed ventilation-associated pneumonia (VAP) and catheter-related bloodstream infections (CRBSI) occurred during the period 11/1/2016 to 7/1/2019. Sixteen infections were caused by multidrug-resistant bacteria (10 CRBSI and 6 VAP) and other 16 by sensitive bacteria (10 CRBSI and 6 VAP). CRBSI generated by multidrug-resistant bacteria elicited significantly higher procalcitonin levels than CRBSI infections caused by sensitive bacteria (39 ± 30 μg/l vs. 10.7 ± 11 μg/l, p = 0.02). Patients with VAP caused by sensitive and multidrug-resistant bacteria elicited similar procalcitonin levels. The time to a decrease in procalcitonin level to less than 80% of the peak value or less than 0.5 μg/l upon effective antibiotic treatment was 7.2 ± 2.9 days in multidrug-resistant bacteria vs. 5 ± 1.8 days in sensitive bacteria (p = 0.03). In multidrug-resistant bacteria, the inflammatory response measured by procalcitonin is stronger and longer, even with an effective antibiotic treatment. However, the decline occurs before the conventional antibiotic scheme is completed. The potential application of antibiotic protocols guided by procalcitonin to these groups of patients grants further studies aimed to reduce exposure to antibiotics in critical multidrug-resistant infections.


Subject(s)
Humans , Bacterial Infections/drug therapy , Procalcitonin , Kinetics , Intensive Care Units , Anti-Bacterial Agents/therapeutic use
9.
Rev. cir. (Impr.) ; 72(3): 217-223, jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1115545

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Bacterial Infections/drug therapy , Abdomen, Acute/surgery , Abdomen, Acute/complications , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/etiology , Bacterial Infections/prevention & control , Ascitic Fluid , Ciprofloxacin/therapeutic use , Enterococcus faecium/drug effects , Streptococcus anginosus , Escherichia coli/drug effects , Abdomen, Acute/pathology , Metronidazole
10.
Gac. méd. Méx ; 156(2): 172-180, mar.-abr. 2020.
Article in English, Spanish | LILACS | ID: biblio-1249889

ABSTRACT

Resumen La Organización Mundial de la Salud estima que en 2050 la resistencia bacteriana ocasionará 10 millones de muertes. Como parte del Plan de Acción Mundial sobre la Resistencia a los Antimicrobianos propuso redes de laboratorios especializados, para conservar cepas y optimizar el uso de los antimicrobianos. En un estudio de 2019 se identificó que las principales bacterias del grupo ESKAPE (con alta resistencia a los antibióticos más usados) que causan infecciones en hospitales de México son Klebsiella spp. resistentes a múltiples fármacos (MDR) y productoras de betalactamasa de espectro extendido (BLEE), Enterobacter spp. BLEE, Acinetobacter baumannii, Pseudomonas aeruginosa MDR, Staphylococcus aureus meticilinorresistente y Enterococcus faecium resistente a vancomicina. Con la información de resistencia a los fármacos se recomiendan esquemas para tratar la infección causada por Helicobacter pylori, relacionado con el desarrollo de cáncer y cuya prevalencia en la población adulta de Latinoamérica se estima es de entre 60 y 70 %.


Abstract The World Health Organization estimates that bacterial resistance will cause 10 million deaths by 2050. As part of the Global Action Plan on Antimicrobial Resistance, it proposed networks of specialized laboratories in order to preserve strains and optimize the use of antimicrobials. In a 2019 study, the main bacteria of the ESKAPE group (which are highly-resistant to the most widely used antibiotics) that cause infections in Mexican hospitals were identified to be multidrug-resistant (MDR) and extended spectrum beta-lactamase (ESBL)-producing Klebsiella spp., ESBL-producing Enterobacter spp., Acinetobacter baumannii, MDR Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. With information on drug resistance, regimens are recommended to treat infection caused by Helicobacter pylori, a pathogen related to the development of cancer and whose prevalence in the adult population of Latin America is estimated to range between 60 and 70%.


Subject(s)
Humans , Bacterial Infections/epidemiology , Drug Resistance, Multiple , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/prevention & control , Bacterial Infections/drug therapy , Latin America/epidemiology
12.
Rev. chil. infectol ; 37(1): 9-18, feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1092716

ABSTRACT

Resumen Introducción: Los programas de optimización de uso de antimicrobianos (PROA) se enfocan en el uso apropiado de antimicrobianos para ofrecer mejores resultados clínicos y menores riesgos de eventos adversos. Objetivos: Comparar consumo y costos de antimicrobianos antes y después de instauración de un programa de regulación de antimicrobianos y describir la proporción de resistencia de bacterias prioritarias. Métodos: Estudio cuasi-experimental, retrospectivo y prospectivo, descriptivo y analítico, que comparó el consumo y costo de antimicrobianos en un período pre- intervención (2007-2010) y un período post-intervención (2011-2017). Se realizó análisis descriptivo de resistencias bacterianas prioritarias. Resultados: El consumo de gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem disminuyó significativamente en el período post-intervención comparado con el período pre-intervención (p < 0,05), mientras que el consumo de amikacina, piperacilina/tazobactam, cefepime y levofloxacina en el período post-intervención mostró un aumento significativo. La reducción de costos no fue significativa para gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem. Para amikacina, cefepime, piperacilina/tazobactam y levofloxacina el aumento de costos no fue significativo. Los aislamientos de Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus y Enterococcus faecalis disminuyeron durante el período post-intervención. Conclusión: el PROA demostró disminución en consumo y costos de algunos antimicrobianos.


Abstract Background: Antimicrobial Stewardship Programs (ASP) focus in the appropriate use of antimicrobials to improve clinical results and minimize risk of adverse events. Aims: To compare consumption and costs of antimicrobials before and after the establishment of an antimicrobial stewardship program and to describe the resistance proportion of priority bacteria. Methods: Quasi-experimental, retrospective and prospective, descriptive and analytical study, to compare consumption and costs of antimicrobials in a pre- intervention period (2007-2010) and a post- intervention period (2011-2017). Additionally, a descriptive analysis of bacterial resistance from 2010 was performed. Results: Gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem consumption decreased significantly in the post-intervention period compared to the pre-intervention period (p < 0.05) while consumption of amikacin, piperacillin/tazobactam, cefepime and levofloxacin increased significantly in the post-intervention period. The reduction in costs was not significant for gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem, meanwhile, costs increased for amikacin, piperacillin/tazobactam, cefepime and levofloxacin, but this was not significant. The isolation of Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis decreased during the post-intervention period. Conclusion: The ASP showed a decrease in consumption and costs of some antimicrobials.


Subject(s)
Humans , Child , Preventive Health Services/economics , Preventive Health Services/standards , Preventive Health Services/statistics & numerical data , Bacterial Infections/prevention & control , Bacterial Infections/drug therapy , Antimicrobial Stewardship/economics , Antimicrobial Stewardship/standards , Antimicrobial Stewardship/statistics & numerical data , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/therapeutic use , Panama , Microbial Sensitivity Tests , Prospective Studies , Retrospective Studies , Hospitals, Pediatric/economics , Hospitals, Pediatric/statistics & numerical data
13.
Rev. chil. infectol ; 37(1): 19-22, feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1092717

ABSTRACT

Resumen Introducción: Vancomicina ha sido considerada como el tratamiento de elección en especial para Staphylococcus aureus resistente a meticilina (SARM); pero su escasa penetración tisular, su toxicidad renal y el requerir monitoreo de su dosis, plantean la necesidad de nuevas alternativas de tratamiento, como daptomicina. Objetivos: Analizar la seguridad y efectividad de daptomicina en niños. Pacientes y Métodos: Se incluyeron, retrospectivamente, niños con infecciones microbiológicamente documentadas, tratados con daptomicina. Resultados: Las infecciones más frecuentes fueron endocarditis en 9 (32%), sepsis de la comunidad en 4 (14%), bacteriemia en 7 (asociada a catéter en 3) (25%), osteomielitis en 3 (10%), peritonitis asociada a diálisis en 3 (10%) y tromboflebitis supurativa en 2 pacientes (7%). Staphylococcus aureus resistente a meticilina fue el patógeno más común en 18 pacientes (64%), Daptomicina fue indicada por el fracaso del tratamiento convencional en 17 (61%), y la toxicidad o intolerancia a vancomicina en 11 pacientes (39%). La duración media de tratamiento fue de 19 días (RIC 95% 7-42 días). Cuatro pacientes (14%) completaron tratamiento ambulatorio. Tuvieron respuesta favorable 22 pacientes (79%) Se reportaron eventos adversos en tres pacientes: dos elevaciones de creatina-fosfocinasa) y una erupción cutánea grave. Conclusiones: Daptomicina demostró una eficacia y seguridad favorables en esta población pediátrica.


Abstract Background: Vancomycin has been considered the treatment of choice especially for methicillin-resistant Staphylococcus aureus (MRSA) infections; but its poor tissue penetration, renal toxicity, and requiring of dosages monitoring, raises the need for new treatment alternatives such as daptomycin. Aims: To analyze the safety and effectiveness of daptomycin in children. Methods: Children with microbiologically documented infections treated with daptomycin were retrospectively included. Results: The most frequent infections were endocarditis in 9 (32%), sepsis in 4 (14%), bacteremia in 7 (associated with catheter in 3) (25%), osteomyelitis in 3 (10%), peritonitis associated with dialysis in 3 (10%) and suppurative thrombophlebitis in 2 patients (p) (7%). Methicillin-resistant Staphylococcus aureus was the most common pathogen in 18 patients (64%). The indications for daptomycin were due to the failure of conventional treatment in 17 (61%), and the toxicity or intolerance to vancomycin in 11 patients (39%). The average duration of treatment was 19 days (95% ICR 7-42 days). Four patients (14%) completed outpatient treatment, 22 patients had a favorable response (79%). Adverse events were reported in 3 patients (2 creatinine-phosfo-kinase increase) and in one severe skin rash. Conclusions: Daptomycin demonstrated a favorable efficacy and safety in this pediatric population.


Subject(s)
Humans , Child , Daptomycin/therapeutic use , Hospitals, Pediatric/statistics & numerical data , Bacterial Infections/drug therapy , Retrospective Studies , Treatment Outcome , Anti-Bacterial Agents/therapeutic use
14.
Revista Digital de Postgrado ; 9(1): e192, 2020. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1053027

ABSTRACT

Objetivo: Evaluar la epidemiología de la sepsis neonatal en los recién nacidos atendidos en emergencia pediátrica del HUC del 1 de enero 2017 al 31 de diciembre del 2017. Métodos: estudio descriptivo, prospectivo, que incluyó a los recién nacidos con diagnóstico de sepsis neonatal. Se recolectaron datos como edad, sexo, lugar de nacimiento, lugar de procedencia, factores de riesgos, manifestaciones clínicas. Resultados: se incluyeron 14 pacientes con diagnóstico de sepsis neonatal. Grupo de edad más afectado: 15-21 días 50% (n=7), género más afectado: masculino 71,42% (n=10), lugar de nacimientos más frecuente Distrito Capital 57,15% (n=8), lugar de procedencia más frecuente estado Miranda 71,43% (n=10), Según tiempo de evolución, la más frecuente fue sepsis neonatal tardía 92,86% (n=13), los principales factores de riesgos identificados fueron: infección materna en el 3er trimestre 36,35% (n=8), prematuridad 29,42% (n=5), bajo peso al nacer 23,54% (n=4), procedimientos invasivos 37,50% (n=3), las manifestaciones clínicas más frecuentes fueron: fiebre, ictericia, palidez o aspecto séptico 7,89% (n=6), la incidencia de sepsis neonatal en el estudio fue 3.92 por 1000 nacidos vivos y 2,6% de casos atendidos con sepsis neonatal. Conclusión: epidemiológicamente la sepsis neonatal, es más frecuente en el grupo de edad de 15-21 días, sexo masculino, lugar de nacimiento Distrito Capital, procedencia estado Miranda, factores de riesgo más frecuentes infección materna en el 3er trimestre, prematuridad, bajo peso al nacer, procedimientos invasivos. Manifestaciones clínicas más frecuente fiebre, ictericia, palidez o aspecto séptico, incidencia de 3.92 por 1000 nacidos vivos y 2,6% de casos atendidos con sepsis neonatal(AU)


Objective: To evaluate the epidemiology of neonatal sepsis in newborns attended in pediatric emergency of the HUC from January 1, 2017 to December 31, 2017. Methods: a prospective, descriptive study that included newborns with a diagnosis of neonatal sepsis. Data were collected as age, sex, place of birth, place of origin, risk factors, clinical manifestations. Results: 14 patients with diagnosis of neonatal sepsis were included. Most affected age group: 15-21 days 50% (n = 7), most affected gender: male 71.42% (n = 10), most frequent place of births Capital District 57.15% (n = 8), Most frequent place of origin Miranda state 71.43% (n = 10), According to time of evolution, the most frequent was late neonatal sepsis 92.86% (n = 13), the main risk factors identified were: maternal infection in 3rd trimester 36.35% (n = 8), prematurity 29.42% (n = 5), low birth weight 23.54% (n = 4), invasive procedures 37.50% (n = 3), the most frequent clinical manifestations were: fever, jaundice, pallor or septic appearance 7.89% (n = 6), the incidence of neonatal sepsis in the study was 3.92 per 1000 live births and 2.6% of cases attended with neonatal sepsis. Conclusion: neonatal sepsis is epidemiologically more frequent in the age group of 15-21 days, male sex, place of birth, Capital District, Miranda state origin, most frequent risk factors maternal infection in the 3rd trimester, prematurity, low weight at birth, invasive procedures. Clinical manifestations more frequent fever, jaundice, pallor or septic appearance, incidence of 3.92 per 1000 live births and 2.6% of cases treated with neonatal sepsis(AU)


Subject(s)
Humans , Infant, Newborn , Bacterial Infections/drug therapy , Breast Feeding , Neonatal Sepsis/diagnosis , Neonatal Sepsis/epidemiology , Infant, Newborn , Infant, Premature/growth & development , Prospective Studies , Heart Defects, Congenital , Metabolic Diseases/drug therapy
15.
Einstein (Säo Paulo) ; 18: eAO5427, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133722

ABSTRACT

ABSTRACT Objective: To assess the surgical antibiotic prophylaxis. Methods: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis. Results: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes. Conclusion: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.


RESUMO Objetivo: Avaliar a utilização de antibioticoprofilaxia cirúrgica. Métodos: Foi realizado um estudo descritivo em um hospital universitário de cuidado terciário por meio de coleta de dados de prescrição, sociodemográficos e de hospitalização sobre todos os pacientes internados em 2014 que utilizaram pelo menos um medicamento antimicrobiano. Esses dados foram coletados da base de dados eletrônica do hospital. O consumo de antimicrobianos foi analisado de acordo com a classificação anatômica terapêutica e química/dose diária definida por mil pacientes-dia. Realizou-se uma análise exploratória por meio da análise de componentes principais. Resultados: Um total de 5.182 pacientes internados receberam prescrição de antibioticoprofilaxia cirúrgica, que corresponde a 11,7% do total de antibióticos utilizados no hospital. As unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular e terapia intensiva pós-operatória foram responsáveis pela utilização de mais da metade (56,3%) da antibioticoprofilaxia cirúrgica. A duração de uso desses antimicrobianos nessas unidades foi 2,2, 2,0 e 2,4 dias, respectivamente. Cefalosporinas de terceira geração e fluoroquinolonas foram as classes de antimicrobianos com tempo de utilização mais longo. Conclusão: A utilização de antibioticoprofilaxia cirúrgica foi inadequada nas unidades de ortopedia, pós-operatória de cirurgia torácica e cardiovascular, terapia intensiva pós-operatória, ginecologia e obstetrícia e otorrinolarigonlogia. Portanto, são importantes o desenvolvimento e a implantação de estratégias que promovam o uso racional de antibioticoprofilaxia cirúrgica nos hospitais.


Subject(s)
Humans , Drug Prescriptions/statistics & numerical data , Surgical Procedures, Operative/adverse effects , Bacterial Infections/prevention & control , Bacterial Infections/drug therapy , Antibiotic Prophylaxis/methods , Inpatients/statistics & numerical data , Surgical Procedures, Operative/methods , Surgical Wound Infection/prevention & control , Drug Utilization Review , Antibiotic Prophylaxis/adverse effects , Hospitalization , Anti-Bacterial Agents/therapeutic use
16.
Rev. epidemiol. controle infecç ; 9(4): 292-298, out.-dez. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1152255

ABSTRACT

Justificativa e Objetivos: Muitos avanços ocorreram em prevenção, diagnóstico e tratamento das doenças infecciosas, porém elas ainda são as principais causas de hospitalização e morte em idosos. O objetivo deste trabalho foi verificar o benefício do uso de antimicrobianos e sua associação com a implementação de outras medidas terapêuticas e com a indicação de cuidados paliativos nas duas últimas semanas de vida de idosos em internação hospitalar, a fim de subsidiar o desenvolvimento de modelos racionais de prescrição para este grupo. Métodos: Foi desenvolvido um estudo retrospectivo realizado pela análise de prontuários dos idosos participantes do estudo epidemiológico do tipo coorte "Desenvolvimento de uma linha de cuidados para o idoso no Hospital Universitário de Santa Maria" que apresentaram óbito como desfecho. Resultados: Dos 97 indivíduos avaliados, 89,7% (n = 87) fizeram uso de antibiótico nas duas últimas semanas de vida. Entre aqueles que utilizaram antibacteriano, 38,9% apresentaram sinais clínicos de melhora após o início do tratamento (n = 28). Assim, foi possível afirmar que não houve associação entre o alívio dos sintomas e o uso de antibacteriano (p = 0,377). Entre aqueles que se beneficiaram da antibioticoterapia, 46,4% foram indicados para infecção respiratória e 14,3% para infecção do trato urinário. Não foi encontrada dependência entre o uso de antibacteriano e as outras medidas terapêuticas adotadas (p = 0,057), nem com a indicação de cuidado paliativo (p = 0,065). Conclusão: Observou-se pouca evidência de benefício no uso de antibacteriano no grupo estudado, o que sinaliza a necessidade de uma adequação de plano de cuidado diferenciada para esse perfil de pacientes.(AU)


Background and objectives: Many advances have occurred in the prevention, diagnosis and treatment of infectious diseases, but they are still the main causes of hospitalization and death in older adults. The objective of this study was to verify the benefit of antimicrobial use and its association with the implementation of other therapeutic measures and with the indication of palliative care in the last two weeks of life of hospitalized older adults, in order to subsidize the development of rational models for this group. Methods: A retrospective study was carried out by analyzing the medical records of the older adult participants of the cohort epidemiological study "Development of a Care Line for Older Adults at the University Hospital of Santa Maria", which presented death as an outcome. Results: Of the 97 individuals evaluated, 89.7% (n = 87) used antibiotics in the last two weeks of life. Among those who used antibacterial agents, 38.9% presented clinical signs of improvement after treatment initiation (n=28). Thus, it was possible to affirm that there was no association between symptom relief and antibacterial use (p = 0.377). Among those who benefited from antibiotic therapy, 46.4% were indicated for respiratory infection and 14.3% for urinary tract infection. We found no dependence between the use of antibacterial drugs and the other therapeutic measures adopted (p = 0.057), nor with the indication of palliative care (p = 0.065). Conclusion: There was little evidence of benefit in the use of antibiotics in the studied group, which indicates the need for a different care plan adequacy for this patient profile.(AU)


Justificación y Objetivos: Ocurrieron muchos avances en la prevención, diagnóstico y tratamiento de las enfermedades infecciosas, pero todavía son las principales causas de hospitalización y muerte en ancianos. El presente trabajo tuvo como objetivo verificar el beneficio del uso de antimicrobianos y su asociación con la implementación de otras medidas terapéuticas y con la indicación de cuidados paliativos en las dos últimas semanas de vida de ancianos en internación hospitalaria con el fin de fomentar el desarrollo de modelos racionales de prescripción para este grupo. Métodos: Se desarrolló un estudio retrospectivo realizado por el análisis de historiales de los ancianos participantes del estudio epidemiológico del tipo cohorte "Desarrollo de una línea de cuidados para el anciano en el Hospital Universitario de Santa María", que presentaron muerte como desenlace. Resultados: De los 97 individuos evaluados, el 89,7% (n = 87) hicieron uso de antibiótico en las dos últimas semanas de vida. Entre los que utilizaron el antibacteriano, el 38,9% presentó signos clínicos de mejora después del inicio del tratamiento (n = 28). Así fue posible afirmar que no hubo asociación entre el alivio de los síntomas y el uso de antibacteriano (p = 0,377). Entre los que se beneficiaron de la antibioticoterapia, el 46,4% fue indicado para infección respiratoria y el 14,3% para infección del tracto urinario. No se encontró dependencia entre el uso de antibacteriano y las otras medidas terapéuticas adoptadas (p = 0,057), ni con la indicación de cuidado paliativo (p = 0,065). Conclusión: Se observó poca evidencia de beneficio en el uso de antibacteriano en el grupo estudiado, lo que señala la necesidad de una adecuación del plan de cuidado diferenciada para ese perfil de pacientes.(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Palliative Care , Drug Prescriptions , Terminal Care , Hospitalization , Anti-Bacterial Agents/therapeutic use , Respiratory Tract Infections/drug therapy , Bacterial Infections/microbiology , Bacterial Infections/drug therapy , Urinary Tract Infections/drug therapy , Retrospective Studies , Therapeutic Index
18.
Rev. gastroenterol. Perú ; 39(2): 111-115, abr.-jun. 2019. ilus, tab
Article in English | LILACS | ID: biblio-1058500

ABSTRACT

Objectives: Small intestinal bacterial overgrowth (SIBO) is challenging to treat and diagnose and is associated with diagnosis of irritable bowel syndrome (IBS). Although no FDA-approved medications exist for treatment of SIBO, rifaximin has recently received approval to treat diarrhea-predominant IBS and patients with methane-positive SIBO breath tests. The aim of this study is to evaluate patient response to rifaximin for SIBO based on breath test results. Materials and methods: All patients underwent breath testing to evaluate for SIBO during a 42-month period. Patients were defined as having a positive glucose breath test for SIBO based on an increase of ≥ 20 ppm of hydrogen and/or ≥ 10 ppm of methane 90 minutes after ingesting glucose. Patient demographic and symptom data, antibiotic treatment regimens, symptomatic response to therapy, and repeat treatments were recorded. Institutional review board approval was obtained. Results: A total of 53 of 443 patients had positive breath testing for SIBO. Response rates to rifaximin (550 mg three times daily for 14 days) were 47.4% for hydrogen positivity alone and 80% for both hydrogen and methane positivity. Conclusions: Rifaximin was the most commonly prescribed antibiotic regimen for SIBO therapy. Patients with hydrogen or hydrogen and methane positive breath tests responded well to rifaximin therapy. For patients with hydrogen-positive SIBO, rifaximin may prove a highly effective therapy in providing symptom relief from the effects of SIBO.


Objetivos: El sobrecrecimiento bacteriano de intestino delgado es una entidad difícil de diagnosticar y tratar, frecuentemente asociada con el síndrome de intestino irritable. A pesar que la FDA no ha aprobado medicamentos para tratar el sobrecrecimiento bacteriano, la rifaximina ha sido recientemente aprobada para tratar el intestino irritable tipo diarrea y en pacientes con test de aliento metano positivo en sobrecrecimiento bacteriano. El objetivo del estudio fue evaluar la respuesta a rifaximina de los pacientes con sobrecremiento bacteriano con prueba de aliento positiva. Material y métodos: Todos los pacientes que se realizaron prueba de aliento por sobrecrecimiento bacteriano durante un periodo de 42 meses. Se definió un paciente con sobrecrecimiento bacteriano positivo si tenía un incremento mayor a 20 ppm de hidrógeno y/o 10 ppm de metano luego de 90 minutos de la ingesta de glucosa. Se registraron los datos demográficos, síntomas, tratamiento antibióticos recibidos, respuesta a la terapia, y repetición de tratamientos. Resultados: Un total de 53 de 443 pacientes tuvieron prueba de aliento positiva para sobrecrecimiento bacteriano. La tasa de respuesta a rifaximina (550 mg tres veces x día x 14 días) fue 47.4% para pacientes con sólo test de hidrógeno positivo, y 80% para pacientes con tanto test de hidrógeno como metano positivos. Conclusiones: La rifaximina es el régimen antibiótico más frecuentemente utilizado en sobrecrecimiento bacteriano. Los pacientes con prueba de aliento de hidrógeno o hidrógeno y metano positivos respondieron bien a la rifaximina. Para pacientes con sobrecrecimiento bacteriano prueba de hidrógeno positiva, la rifaximina puede ser una terapia efectiva en mejorar síntomas.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Bacterial Infections/drug therapy , Rifaximin/therapeutic use , Intestine, Small/microbiology , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/diagnosis , Bacterial Infections/metabolism , Breath Tests , Retrospective Studies , Treatment Outcome , Hydrogen/analysis , Hydrogen/metabolism , Methane/analysis , Methane/metabolism
19.
Bol. méd. Hosp. Infant. Méx ; 75(6): 352-357, nov.-dic. 2018. tab
Article in English | LILACS | ID: biblio-1011482

ABSTRACT

Abstract: Background: Ambulatory therapy in low-risk patients with cancer, fever, and neutropenia seems to be a secure and effective alternative. This study aimed to compare the effectiveness and safety of the antimicrobial treatment in early discharge vs. in-hospital treatment in children with cancer and febrile neutropenia (FN) with low risk of invasive bacterial infection (IBI). Methods: Quasi-experimental design with a historical cohort control group. Children with cancer during an episode of FN and low risk of IBI were included. The control group were inpatient children that received intravenous piperacillin/tazobactam. The experimental group was early discharge patients, who received 48 h of IV treatment and were switched to oral treatment. Outcomes: fever resolution, readmissions, and mortality. Results: Eighty low-risk FN episodes were included; the median age was 6 years old (2.6-11 years), and 43 (54%) were female. Main diagnoses were solid tumors (52 patients) and leukemia or lymphoma (28 patients). Forty-three patients received in-hospital treatment, and 37 were selected for early discharge (31 patients received ciprofloxacin and six received amoxicillin/clavulanate). Two patients were readmitted, one due to a relapse of fever with tumor progression and the other due to epistaxis. Adverse effects occurred in 21.6% of the early discharge group and 12% of the inpatient treatment group (p = 0.04). Conclusions: Early discharge in pediatric patients with cancer, fever, and neutropenia is an acceptable and safe alternative for low-risk patients.


Resumen: Introducción: El tratamiento ambulatorio en pacientes con cáncer, fiebre y neutropenia de bajo riesgo parece ser una alternativa segura y efectiva. El objetivo de este trabajo fue comparar la efectividad y la seguridad del tratamiento antimicrobiano en la modalidad de egreso temprano vs. el tratamiento intrahospitalario en niños con cáncer y neutropenia febril (NF), con bajo riesgo de infección bacteriana invasiva (IBI). Métodos: Diseño cuasi-experimental con un grupo control histórico. Se incluyeron niños con cáncer durante un episodio de NF con bajo riesgo de IBI. El grupo control fue constituido por pacientes que recibieron tratamiento hospitalario con piperacilina-tazobactam intravenosa. Los pacientes en el grupo de egreso temprano recibieron 48 horas de tratamiento intravenoso y egresaron con antimicrobianos por vía oral. Desenlaces: resolución de la fiebre, reingreso al hospital y muerte. Resultados: Se incluyeron 80 pacientes con NF de bajo riesgo; la mediana de edad fue de 6 años; 43 pacientes (54%) eran de sexo femenino. Los diagnósticos principales fueron tumores sólidos (52) y leucemia o linfoma (28). Cuarenta y tres pacientes recibieron tratamiento hospitalario y 37 fueron seleccionados para egreso temprano. En el grupo de egreso temprano, 31 pacientes recibieron ciprofloxacino y 6 recibieron amoxicilina-clavulanato. Dos pacientes reingresaron, uno por fiebre secundaria a progresión tumoral y otro por epistaxis. Los efectos adversos se presentaron en el 21.6% de los pacientes en el grupo de egreso temprano y en el 12% del grupo de tratamiento hospitalario (p = 0.04). Conclusiones: El egreso temprano para niños con cáncer y NF de bajo riesgo es una alternativa aceptable y segura.


Subject(s)
Child , Child, Preschool , Female , Humans , Male , Patient Discharge , Bacterial Infections/drug therapy , Chemotherapy-Induced Febrile Neutropenia/drug therapy , Anti-Bacterial Agents/administration & dosage , Neoplasms/drug therapy , Case-Control Studies , Risk , Tertiary Care Centers , Ambulatory Care , Piperacillin, Tazobactam Drug Combination/administration & dosage , Hospitalization , Hospitals, Pediatric , Mexico
20.
Biomédica (Bogotá) ; 38(3): 398-406, jul.-set. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1019512

ABSTRACT

Resumen Introducción. La política farmacéutica de Colombia establece la necesidad de intensificar la investigación en farmacoepidemiología a nivel nacional, especialmente en el caso de los antibióticos. Objetivo. Aportar información farmacoepidemiológica en cuanto a la efectividad, las condiciones de uso y la seguridad de la cefepima y el meropenem genéricos en un hospital de alta complejidad en Bogotá. Materiales y métodos. Se hizo un estudio descriptivo, longitudinal y retrospectivo sobre la utilización de estos medicamentos. Los datos se recolectaron de todas las historias clínicas en las cuales se registraba el uso de cefepima y meropenem. Resultados. Se incluyeron 82 pacientes tratados con cefepima y 91 con meropenem. La mayoría de ellos había estado internada en servicios diferentes a la unidad de cuidados intensivos (59,8 % con cefepima y 52,7 % con meropenem). El 21,9 % de los tratados con cefepima y el 49 % de los tratados con meropenem, tuvieron consulta con un infectólogo, en tanto que en 47 % de los primeros y en 78 % de los segundos, se hizo cultivo o antibiograma. Las condiciones más frecuentemente tratadas con cefepima fueron las infecciones de vías respiratorias (32,5 %) y, con meropenem, las infecciones genitourinarias (34,8 %). Las tasas de éxito terapéutico fueron de 61,7 % para la cefepima y de 63,0 % para el meropenem. Conclusiones. Este estudio aporta información sobre el desempeño terapéutico de dos antibióticos genéricos de uso hospitalario. No hubo reportes de falla terapéutica durante el periodo de estudio. En los casos en que no hubo respuesta al tratamiento, las causas frecuentes fueron las alteraciones farmacocinéticas, las condiciones clínicas desfavorables y la elección inadecuada del tratamiento antimicrobiano.


Abstract Introduction: The Colombian national pharmaceutical policy establishes as a strategy the generation of greater pharmaco-epidemiological research at the national level, especially in the case of antibiotic drugs. Objective: To provide local pharmaco-epidemiological evidence regarding the effectiveness, conditions of use and safety of generic meropenem and cefepime in a tertiary hospital in Bogotá. Materials and methods: We conducted a descriptive, longitudinal and retrospective drug utilization study. The data were collected from the medical histories of all the patients who had cefepime or meropenem prescribed. Results: We included 82 patients treated with cefepime and 91 treated with meropenem in the study. Most of the patients were in services different from the intensive care unit (taking cefepime: 59.8%, and meropenem: 52.7%). Only 21.9% of the patients treated with cefepime and 49% of those treated with meropenem were seen by an infectious disease specialist. The antibiogram was performed for 47% and 60% of the patients treated with cefepime and meropenem, respectively. The most frequent indication for cefepime were respiratory infections and for meropenem, genitourinary ones. Therapeutic success rates were 61.7% for cefepime and 63.0% for meropenem. Conclusions: This study contributes evidence regarding the therapeutic performance of two generic antibiotics used in tertiary hospitals. There were no reports of therapeutic failure during the study period. In the cases of non-response, pharmacokinetic alterations, unfavorable clinical conditions, and inappropriate choice of antimicrobial treatment were identified as frequent factors.


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Drugs, Generic/therapeutic use , Tertiary Care Centers/statistics & numerical data , Cefepime/therapeutic use , Meropenem/therapeutic use , Anti-Bacterial Agents/therapeutic use , Drug Prescriptions/statistics & numerical data , Bacterial Infections/drug therapy , Retrospective Studies , Treatment Outcome , Drugs, Generic/adverse effects , Diagnosis-Related Groups , Colombia , Drug Utilization , Cefepime/adverse effects , Meropenem/adverse effects , Anti-Bacterial Agents/adverse effects
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