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1.
Acta otorrinolaringol. cir. cabeza cuello ; 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
2.
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
3.
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
5.
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
6.
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
7.
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
8.
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
9.
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
11.
Braz. j. microbiol ; 49(supl.1): 205-212, 2018. tab, graf
Article in English | LILACS | ID: biblio-974346

ABSTRACT

Abstract This study compares patients with and without non-viral microbial keratitis in relation to sociodemographic variables, clinical aspects, and involved causative agent. Clinical aspects, etiology and therapeutic procedures were assessed in patients with and without keratitis that were diagnosed in an Eye Care Center in Campo Grande, MS, Brazil. Patients were divided into two groups: (a) cases: 64 patients with non-viral microbial keratitis diagnosed at biomicroscopy; and (b) controls: 47 patients with other eye disorders that were not keratitis. Labor activity related to agriculture, cattle raising, and contact lens use were all linked to keratitis occurrence (p < 0.005). In patients with keratitis, the most common symptoms were pain and photophobia, and the most frequently used medicines were fourth-generation fluoroquinolones (34.4%), amphotericin B (31.3%), and natamycin (28.1%). Microbial keratitis evolved to corneal perforation in 15.6% of cases; transplant was indicated in 10.9% of cases. Regarding the etiology of this condition, 23 (42.2%) keratitis cases were caused by bacteria (Pseudomonas aeruginosa, 12.5%), 17 (39.1%) by fungi (Fusarium spp., 14.1% and Aspergillus spp., 4.7%), and 4 (6.3%) by Acanthamoeba. Patients with keratitis present with a poorer prognosis. Rapid identification of the etiologic agent is indispensable and depends on appropriate ophthalmological collection and microbiological techniques.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Bacteria/isolation & purification , Bacterial Infections/microbiology , Fungi/isolation & purification , Keratitis/microbiology , Mycoses/microbiology , Bacteria/classification , Bacteria/drug effects , Bacteria/genetics , Bacterial Infections/drug therapy , Brazil , Fungi/classification , Fungi/drug effects , Fungi/genetics , Keratitis/drug therapy , Middle Aged , Anti-Bacterial Agents/pharmacology , Mycoses/drug therapy , Antifungal Agents/pharmacology
12.
Asunción; Universidad Politécnica y Artística del Paraguay;Universidad Autónoma de Chile; 2018. 53 p. ilus.
Monography in Spanish | LILACS, BDNPAR | ID: biblio-915988

ABSTRACT

Bacterias, ¿Por qué me enferman? Es un libro que pretende acercarnos al diminuto e invisible mundo de los microorganismos con los que convivimos día a día y con quienes interactuamos constantemente, muchas veces sin darnos cuenta. Este texto entrega material exploratorio y de divulgación científica para lectores curiosos de todas las edades, con énfasis en estudiantes y profesores, que pueden encontrar en Bacterias. ¿Por qué me enferman? una herramienta educativa útil, didáctica y visualmente atractiva


Subject(s)
Humans , Male , Female , Bacteria/pathogenicity , Bacterial Infections/prevention & control , Bacterial Infections/drug therapy , Bacteria/classification , Drug Resistance, Microbial , Vaccines/therapeutic use , Adaptive Immunity , Microbiota , Immunity, Innate
13.
Acta méd. (Porto Alegre) ; 39(1): 307-313, 2018.
Article in Portuguese | LILACS | ID: biblio-911014

ABSTRACT

Objetivos: revisar a prevalência, a etiologia, o diagnóstico e o tratamento da rinossinusite aguda. A rinossinusite aguda é uma doença comum de prevalência mundial, caracterizada por uma inflamação da cavidade nasal e dos seios paranasais, podendo ter origem fúngica, viral ou bacteriana. Os sintomas são principalmente obstrução e secreção nasal, porém a sintomatologia pode ser ampla. Consequentemente, a correta identificação e manejo torna essa patologia um desafio na prática clínica. Metodologia: Foi realizado uma busca nas bases de dados Medline/ Pubmed e LILACS no mês de maio de 2018, incluindo artigos publicados em inglês ou português nos últimos 5 anos. Foram utilizados os seguintes descritores: "acute rhinosinusitis", "rhinitis" e "sinusitis". Os artigos foram selecionados com busca direta, considerando relevância do tema à proposta e fator de impacto. Resultados: De 228 publicações, 10 foram selecionadas, demonstrando que a rinossinusite aguda é uma doença cuja incidência ainda não está bem definida, mas é maior em indivíduos com idade entre 12 e 17 anos em relação à população geral, com prevalência de etiologia viral. Conclusão: A rinossinusite aguda é uma doença com alta incidência. O diagnóstico é predominantemente clínico, mas em casos restritos há exames de imagem, sendo o tratamento sempre sintomático.


Objectives: To review the prevalence, etiology, diagnosis and treatment of acute rhinosinusitis. Acute rhinosinusitis is a common global disease characterized by inflammation of the nasal cavity and paranasal sinuses, which may be of fungal, viral or bacterial origin. The symptoms are mainly obstruction and nasal secretion, but the symptomatology can be ample. Methodology: The search was performed in the Medline / Pubmed and LILACS databases in May 2018, including articles published in English or Portuguese in the last 5 years. The following descriptors were used: "acute rhinosinusitis", "rhinitis" and "sinusitis". The articles were selected with direct search, considering relevance of the theme to the proposal and impact factor. Results: Of 228 publications, 10 were selected, demonstrating that acute rhinosinusitis is a disease whose incidence is still not well defined, but is higher in individuals aged 12 to 17 years in relation to the general population, with a prevalence of viral etiology. Conclusion: Acute rhinosinusitis is a disease with a high incidence. The diagnosis is predominantly clinical, but in restricted cases there are imaging tests, and the treatment is always symptomatic.


Subject(s)
Acute Disease , Rhinitis , Sinusitis , Bacterial Infections/drug therapy , Virus Diseases/drug therapy
14.
Braz. j. infect. dis ; 21(6): 648-655, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-888915

ABSTRACT

ABSTRACT A panel of national experts was convened by the Brazilian Infectious Diseases Society in order to determine the recommendations for outpatient parenteral antimicrobial therapy (OPAT) in Brazil. The following aspects are covered in the document: organization of OPAT programs; patient evaluation and eligibility criteria, including clinical and sociocultural factors; diagnosis of eligibility; venous access and antimicrobial infusion devices; protocols for antimicrobial use and monitoring and cost-effectiveness.


Subject(s)
Humans , Outpatients , Bacterial Infections/drug therapy , Anti-Bacterial Agents/administration & dosage , Societies, Medical , Brazil , Clinical Protocols , Cost-Benefit Analysis , Infusions, Parenteral
15.
Rev. Soc. Bras. Clín. Méd ; 15(3): 201-205, 20170000. ilus
Article in Portuguese | LILACS | ID: biblio-875537

ABSTRACT

Foram revisados os parâmetros ou índices farmacocinéticos e farmacodinâmicos, com o objetivo de enfatizar sua importância como ferramenta de otimização da terapia antimicrobiana na prática médica. Destacam-se a ligação proteica, o clearance e o volume de distribuição da droga como parâmetros farmacocinéticos fundamentais, que podem ser alterados pelas características dos pacientes e da infecção. Foram apresentados ainda os parâmetros farmacodinâmicos (concentração máxima/concentração inibitória mínima, tempo > concentração inibitória mínima e área sob a curva/concentração inibitória mínima), que representam a relação dose-resposta e são determinantes para a eficácia terapêutica das drogas anti-infecciosas, considerando a dinâmica bactericida/bacteriostática dos diferentes grupos farmacológicos. Discutiu-se ainda o modelo matemático preditor de resultados prováveis para desfechos de tratamentos, como o método de Monte Carlo. Para finalizar, os índices farmacocinéticos e farmacodinâmicos foram apontados como estratégia de racionalização de antimicrobianos e redução da resistência bacteriana.(AU)


The pharmacokinetic and pharmacodynamic parameters were reviewed with the objective to emphasise their importance as tools for optimizing antimicrobial therapies in medical practice. The protein binding, clearance and drug distribution volume are highlighted as fundamental pharmacokinetic parameters that can be altered according to the characteristics of the patient or infection. We present the pharmacodynamic parameters (maximum concentration/minimal inhibitory concentration, time > minimal inhibitory concentration, and area under the curve/minimal inhibitory concentration) that represent the dose-response ratio and are determinants for the therapeutic efficacy of the antimicrobial drugs, considering the bactericidal/ bacteriostatic dynamics of the different pharmacological groups. We also commented on the predictive mathematical model for probable results for treatment outcomes, such as Monte Carlo method. Finally, the pharmacokinetic and pharmacodynamics indexes were shown as a strategy for antimicrobial rationalization and reduction of bacterial resistance.(AU)


Subject(s)
Humans , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/pharmacology , Bacterial Infections/drug therapy , Prescriptions
16.
Rev. chil. infectol ; 34(4): 307-313, ago. 2017. graf
Article in Spanish | LILACS | ID: biblio-899716

ABSTRACT

Resumen En el siglo XXI, la humanidad se encuentra frente a una era post-antibiótica, en la cual es común la aparición de infecciones con una menor o nula alternativa terapéutica. En este contexto, se hace indispensable implementar medidas que optimicen el arsenal terapéutico disponible, generando nuevas estrategias para contrarrestar la creciente resistencia bacteriana y la era post-antibiótica. Las interacciones evolutivas plantean que el desarrollo de susceptibilidad o resistencia de un microorganismo a un antimicrobiano tendrá un efecto inverso (susceptibilidad colateral) o similar (resistencia cruzada) en un segundo antimicrobiano incorporado en este sistema. Las interacciones evolutivas se plantean como un nuevo mecanismo de interacción medicamentosa, al tiempo que se identifica a la susceptibilidad colateral como una estrategia terapéutica para combatir la resistencia bacteriana, que se podría integrar y evaluar en un futuro como una nueva estrategia en los programas de gerenciamiento de antimicrobianos.


In the 21st century, the world is facing a post-antibiotic era, in which the appearance of infections with a minor or no therapeutic alternative is common. In this context, it is essential to implement measures that optimize the available therapeutic tool, thus generating new strategies that strengthen the fight against growing bacterial resistance. The evolutionary interactions suggest that the development of sensitivity or resistance of a microorganism to an antimicrobial will have an inverse effect (collateral sensitivity) or similar (cross resistance) in a second antimicrobial that is involved in this system. The evolutionary interactions are considered as a new mechanism of drug interaction, and additional, it establishes the collateral sensitivity as a therapeutic strategy to combat bacterial resistance, which could be integrated and evaluated in the future as a new strategy in the antimicrobial stewardship programs.


Subject(s)
Humans , Bacterial Infections/drug therapy , Drug Resistance, Bacterial/drug effects , Anti-Bacterial Agents/pharmacology , Drug Monitoring , Drug Interactions , Biological Evolution , Anti-Bacterial Agents/therapeutic use
17.
Rev. bras. anal. clin ; 49(1): 18-21, jun.16, 2017. ilus
Article in Portuguese | LILACS | ID: biblio-1151732

ABSTRACT

O século XXI revela um novo cenário no cuidado à saúde como consequência do avanço científico e tecnológico. Novos microrganismos têm sido documentados e as infecções têm ressurgido com nova força. Diante desta situação, a infecção tem sido apontada como um dos mais importantes riscos aos pacientes hospitalizados, e a situação fica ainda mais complicada quando as bactérias causadoras tornam-se multirresistentes aos antibióticos disponíveis. Este estudo teve como objetivo, por meio de revisão literária, associar a infecção relacionada à assistência à saúde causada por Acinetobacter baumannii nos principais sítios em pacientes comprometidos. Dentre os microrganismos envolvidos nessas infecções relacionadas à assistência à saúde, encontra-se o gênero Acinetobacter, compreendendo 31 espécies diferentes. A. baumannii é responsável por diferentes tipos de infecções, como pneumonias, septicemias, infecções urinárias e meningites, especialmente em pacientes imunocomprometidos, sendo considerado um patógeno oportunista de grande importância nas infecções nosocomiais e capaz de adquirir resistência a antimicrobianos com facilidade. Sugere-se que este gênero de bactérias tem grande importância clínica devido à sua grande incidência nas infecções relacionadas à assistência à saúde, como também à sua resistência aos antimicrobianos.


Subject(s)
Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Cross Infection , Acinetobacter baumannii
19.
Braz. j. infect. dis ; 20(3): 255-261, May.-June 2016. tab, graf
Article in English | LILACS | ID: lil-789477

ABSTRACT

Abstract There is a lack of formal economic analysis to assess the efficiency of antimicrobial stewardship programs. Herein, we conducted a cost-effectiveness study to assess two different strategies of Antimicrobial Stewardship Programs. A 30-day Markov model was developed to analyze how cost-effective was a Bundled Antimicrobial Stewardship implemented in a university hospital in Brazil. Clinical data derived from a historical cohort that compared two different strategies of antimicrobial stewardship programs and had 30-day mortality as main outcome. Selected costs included: workload, cost of defined daily doses, length of stay, laboratory and imaging resources used to diagnose infections. Data were analyzed by deterministic and probabilistic sensitivity analysis to assess model's robustness, tornado diagram and Cost-Effectiveness Acceptability Curve. Bundled Strategy was more expensive (Cost difference US$ 2119.70), however, it was more efficient (US$ 27,549.15 vs 29,011.46). Deterministic and probabilistic sensitivity analysis suggested that critical variables did not alter final Incremental Cost-Effectiveness Ratio. Bundled Strategy had higher probabilities of being cost-effective, which was endorsed by cost-effectiveness acceptability curve. As health systems claim for efficient technologies, this study conclude that Bundled Antimicrobial Stewardship Program was more cost-effective, which means that stewardship strategies with such characteristics would be of special interest in a societal and clinical perspective.


Subject(s)
Humans , Bacterial Infections/economics , Bacterial Infections/drug therapy , Cost-Benefit Analysis , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/economics , Pharmacy Service, Hospital , Bacterial Infections/mortality , Brazil , Markov Chains , Outcome Assessment, Health Care , Kaplan-Meier Estimate , Length of Stay
20.
Rev. Asoc. Odontol. Argent ; 104(1): 1-3, mar. 2016.
Article in Spanish | LILACS | ID: lil-789827

ABSTRACT

Desde 1928, los antibióticos eran las primeras armas contra los microoganismos. En 1998 apareció una bacteria resistente que permitió el incremento de las enfermedades infecciosas. Cuanto más expuesta esté una población bacteriana a un antibiótico, las bacterias que sobrevivan se harán más resistentes, aún para defenderse de futuros antibióticos. Pero su empleo está justificado como método de profilaxis en pacientes médicamente comprometidos. En principio, debe indicarse medicación local para reducir la carga microbiana. El proifesional debe saber cuándo recetar un antibiótico y no olvidar que éste es un coadyuvante del tratamiento, ya que es el propio sistema inmune del paciente el que realiza la curación.


Subject(s)
Humans , Drug Resistance, Microbial/physiology , Focal Infection, Dental/drug therapy , Bacterial Infections/drug therapy , Antibiotic Prophylaxis , Dental Pulp Diseases/microbiology , Periodontal Diseases/microbiology , Staphylococcus aureus
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