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1.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 757-762, jan.-dez. 2021. graf, tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1222817

ABSTRACT

Objective:To identify the prevalence of klebsiella pneumoniae and to analyze the factors related to the infection by this bacterium in a private hospital in northeastern Brazil. Method: descriptive retrospective documentary study, carried out with patients who developed infection in the year 2017 (n: 64). Sociodemographic and infection information was collected. The data was processed in SPSS 20.0. The project was approved by the ethics committee. Results: the most prevalent topographic site was the urinary tract (34; 56.7%). the main risk factor for triggering klebsiella pneumoniae infection was the use of mechanical ventilation, presenting a risk of 43.8% for the appearance of infections by this microorganism. Higher resistance was found for the piperacillin / tazobactam 52 antimicrobial (82.5%). Conclusion: because of the high resistance to antibiotics and the great potential of klebsiella contamination, measures should be taken to minimize the high level of contamination and, especially, the negative prognosis for the patient


Objetivo: Identificar a prevalência de Klebsiella pneumoniae e analisar os fatores relacionados à infecção por essa bactéria em hospital privado do nordeste brasileiro. Método: estudo descritivo retrospectivo documental, realizado com pacientes que desenvolveram infecção no ano de 2017 (n:64). Coletou-se informações sociodemográficas e referentes a infecção. Os dados foram processados no SPSS 20.0. O projeto foi aprovado pelo comitê de ética. Resultados: o sítio topográfico mais prevalente foi o trato urinário (34;56,7%). o principal fator de risco para desencadear infecção por Kebsiella pneumoniae foi a utilização de ventilação mecânica, apresentando risco de 43,8% para o aparecimento de infecções por esse microrganismo. Maior resistência foi encontrada para o antimicrobiano piperacilina/tazobactam 52 (82,5%). Conclusão: pela alta resistência aos antibióticos e o grande potencial de contaminação da klebsiella, medidas devem ser adotadas para minimizar o alto nível de contaminação e, principalmente do prognóstico negativo para paciente


Objetivo: Identificar la prevalencia de klebsiella pneumoniae y analizar los factores relacionados con la infección por esta bacteria en un hospital privado en el noreste de Brasil. Método: estudio descriptivo retrospectivo, realizado con pacientes que desarrollaron infección en el año 2017 (n: 64). Se recogió información sociodemográfica y de infección. Los datos fueron procesados en SPSS 20.0. El proyecto fue aprobado por el comité de ética. Resultados: el sitio topográfico más prevalente fue el tracto urinario (34; 56,7%). El principal factor de riesgo para desencadenar la infección por Klebsiella pneumoniae fue el uso de ventilación mecánica, que presenta un riesgo del 43.8% por la aparición de infecciones por este microorganismo. Se encontró una mayor resistencia para el antimicrobiano piperacilina / tazobactam 52 (82.5%). Conclusión: debido a la alta resistencia a los antibióticos y al gran potencial de contaminación por klebsiella, se deben tomar medidas para minimizar el alto nivel de contaminación y, especialmente, el pronóstico negativo para el paciente


Subject(s)
Humans , Male , Female , Infection Control/statistics & numerical data , Klebsiella pneumoniae/drug effects , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Piperacillin/therapeutic use , Urinary Tract/microbiology , Prevalence , Risk Factors , Hospitals, Private , Tazobactam/therapeutic use
2.
Rev. chil. infectol ; 37(3): 216-218, jun. 2020. tab
Article in Spanish | LILACS | ID: biblio-1126112

ABSTRACT

Resumen Introducción: Se desconocen las alteraciones farmacocinéticas de piperacilina/tazobactam (PT) en pacientes pediátricos que requieren de membrana de oxigenación extracorpórea (ECMO) y cómo dosificar adecuadamente dicho antimicrobiano. Objetivo: Describir las concentraciones plasmáticas (CP)y evaluar el cumplimiento del objetivo farmacocinético/famacodinámico de piperacilina en pacientes pediátricos en soporte con ECMO. Métodos: Presentamos tres pacientes pediátricos en tratamiento con PT que requirieran de ECMO en los que se midieron CP de piperacilina en la mitad del intervalo de dosificación mediante cromatografía liquida de alta resolución. Resultados: Las CP fueron 51,7-14,1 y 6,5 μg/mL para los pacientes A, B y C, respectivamente. Sólo se alcanzaron CP adecuadas en un paciente. Conclusión: Estos resultados preliminares sugieren que la disponibilidad de CP de piperacilina podría optimizar el cumplimiento de los objetivos farmacocinéticos/farmacodinámicos en pacientes pediátricos en soporte con ECMO.


Abstract Background: Pharmacokinetics and optimal dosing of piperacillin tazobactam (PT) have not been well studied in pediatric patients undergoing extracorporeal oxygenation membrane (ECMO). Aim: To describe piperacillin plasmatic concentration and evaluate achievement of pharmaccokinetic/pharmacodinamic objective in patients on ECMO support. Method: We report three pediatric patients admitted to the Pediatric Intensive Care Unit, treated with PT undergoing ECMO. Plasmatic concentrations of piperacillin were obtained in the middle of the dosing interval using high performance liquid chromatography. Results: Plasmatic concentrations were 51,7-14,1 and 6,5 μg/mL for patient A, B and C respectively. Only one patient reached adequate concentrations. Conclusion: These preliminary results suggest that availability of plasmatic concentrations of piperacillin could optimize the achievement of pharmacokinetic/pharmacodynamic objectives in pediatric patients on ECMO support.


Subject(s)
Humans , Child , Extracorporeal Membrane Oxygenation , Piperacillin , Penicillanic Acid , Piperacillin, Tazobactam Drug Combination , Anti-Bacterial Agents
3.
Brasília; s.n; 22 maio 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1097386

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 21 artigos e 13 protocolos.


Subject(s)
Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Disease Progression , Betacoronavirus/drug effects , Piperacillin/therapeutic use , Technology Assessment, Biomedical , Vaccines/supply & distribution , Chloroquine/therapeutic use , Tissue Plasminogen Activator/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Ritonavir/therapeutic use , Drug Combinations , Lopinavir/therapeutic use , Fingolimod Hydrochloride/therapeutic use , Tazobactam/therapeutic use , Hydroxychloroquine/therapeutic use , Insulin/therapeutic use , Anticoagulants/therapeutic use
4.
Article in Korean | WPRIM | ID: wpr-816603

ABSTRACT

BACKGROUND: The emergence of multidrug-resistant Acinetobacter baumannii as a nosocomial pathogen is one of the major public health problems. The aim of this study was to evaluate the role of an efflux pump gene adeJ for the multidrug resistance of A. baumannii clinical isolates.METHODS: Two groups (MDRAB and SAB) of A. baumannii clinical isolates were studied. The SAB group consisted of strains that did not meet the criteria of MDRAB and were susceptible to more categories of antibiotics than MDRAB. Antimicrobial susceptibility results obtained by VITEKII system were used in data analysis and bacterial group allocation. We performed real-time reverse transcription PCR to determine relative expression of adeJ. We compared relative expression of adeJ in comparison groups by considering two viewpoints: i) MDRAB and SAB groups and ii) susceptible and non-susceptible groups for each antibiotic used in this study.RESULTS: The mean value of relative expression of adeJ of MDRAB and SAB groups was 1.4 and 0.92, respectively, and showed significant difference (P=0.002). The mean values of relative expression of adeJ of susceptible and non-susceptible groups to the antibiotics cefepime, ceftazidime, ciprofloxacin, imipenem, meropenem, tigecycline, piperacillin/tazobactam, ticarcillin/clavulanic acid, trimethoprim/sulfamethoxazole, piperacillin, and gentamicin showed statistically significant differences.CONCLUSION: The overexpression of adeIJK might contribute to the multi-drug resistance in A. baumannii clinical isolates. Further, the overexpression of adeIJK might be one of the factors contributing to the resistance to numerous antibiotics.


Subject(s)
Acinetobacter baumannii , Acinetobacter , Anti-Bacterial Agents , Ceftazidime , Ciprofloxacin , Drug Resistance, Multiple , Gentamicins , Imipenem , Piperacillin , Polymerase Chain Reaction , Public Health , Reverse Transcription , Statistics as Topic
5.
Einstein (Säo Paulo) ; 18: eAO5023, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056064

ABSTRACT

ABSTRACT Objective To adapt an antibiotic dose adjustment software initially developed in English, to Portuguese and to the Brazilian context. Methods This was an observational, descriptive study in which the Delphi method was used to establish consensus among specialists from different health areas, with questions addressing the visual and operational aspects of the software. In a second stage, a pilot experimental study was performed with the random comparison of patients for evaluation and adaptation of the software in the real environment of an intensive care unit, where it was compared between patients who used the standardized dose of piperacillin/tazobactam, and those who used an individualized dose adjusted through the software Individually Designed and Optimized Dosing Strategies. Results Twelve professionals participated in the first round, whose suggestions were forwarded to the software developer for adjustments, and subsequently submitted to the second round. Eight specialists participated in the second round. Indexes of 80% and 90% of concordance were obtained between the judges, characterizing uniformity in the suggestions. Thus, there was modification in the layout of the software for linguistic and cultural adequacy, minimizing errors of understanding and contradictions. In the second stage, 21 patients were included, and there were no differences between doses of piperacillin in the standard dose and adjusted dose Groups. Conclusion The adapted version of the software is safe and reliable for its use in Brazil.


RESUMO Objetivo Adaptar um software de ajuste de dose de antibióticos inicialmente elaborado em língua inglesa para o português e a conjuntura brasileira. Métodos Trata-se de estudo observacional, descritivo, em que foi utilizado o método Delphi para estabelecer consenso entre especialistas de diferentes áreas da saúde, com perguntas que abordaram os aspectos visuais e operacionais do software. Em uma segunda etapa, foi realizado um estudo piloto, experimental, com alocação aleatória dos pacientes, para avaliação e adaptação do software em ambiente real de uma unidade de tratamento intensivo, onde foram comparadas diferenças entre pacientes que utilizaram dose padronizada usual de piperacilina/tazobactam, e os que utilizaram a dose individualizada ajustada por meio do software Individually Designed Optimum Dosing Strategies. Resultados Participaram da primeira rodada 12 profissionais cujas sugestões foram encaminhadas ao desenvolvedor do software para adequação e ajustes, e posteriormente submetidas à segunda rodada. Oito especialistas participaram da segunda rodada. Foram obtidos índices de 80% e 90% de concordância entre os juízes, caracterizando uniformidade nas sugestões. Dessa forma, houve modificação no layout do software para adequação linguística e cultural, minimizando erros de entendimento e contradições. Na segunda etapa, foram incluídos 21 pacientes, e não houve diferenças entre doses de piperacilina nos grupos dose padronizada e dose ajustada. Conclusão A versão adaptada do software é segura e confiável para seu uso no Brasil.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Piperacillin/administration & dosage , Software Design , Tazobactam/administration & dosage , Linguistics/standards , Anti-Infective Agents/administration & dosage , Reference Standards , Brazil , Anthropometry , Cross-Cultural Comparison , Surveys and Questionnaires , Reproducibility of Results , Delphi Technique , Statistics, Nonparametric , Intensive Care Units , Middle Aged
6.
Article in English | WPRIM | ID: wpr-788062

ABSTRACT

PURPOSE: Anastomotic leakage (AL) is a type of intra-abdominal infection (IAI) which requires appropriate antibiotics with proper intervention. This study aimed to improve the appropriateness of antibiotic treatment by assessing the patterns of antibiotic treatment and resistance of pathogen profiles in patients who had AL after colorectal cancer surgery.METHODS: From June 2006 through December 2017, the medical records of the patients who had AL after elective abdominal surgery for colorectal cancer in Kyung Hee University Hospital at Gangdong, Seoul, Korea were reviewed retrospectively. Baseline characteristics and consistence of antibiotics with culture study results were analyzed to evaluate the appropriateness of treatment.RESULTS: Among 982 patients who underwent primary surgery for colorectal cancer, 41 (4.2%) had AL. Mean time of diagnosis of AL from surgery was 6.3 days. The most commonly used prophylactic antibiotics for the primary surgery was 2nd generation cephalosporin (66.6%). Mean duration of prophylactic antibiotics usage was 2.8 days. The most commonly used empirical antibiotics after AL occurred was piperacillin and tazobactam (32.6%). Mean duration of empirical antibiotics usage was 8.2 days. The most commonly identified pathogens were Escherichia coli and Enterococci spp. (26.8% each), and 12.2% of the “ESKAPE” pathogens were identified. Resistance to empirical antibiotics was 45.5% (10/22).CONCLUSION: Penetration of culture study for AL after colorectal cancer surgery appeared relatively low, although the profile of pathogens isolated from the AL patients can give important clues and evidence for appropriate antibiotics use. Surgeons should pay attention in performing culture studies for IAI including AL for proper patient treatment.


Subject(s)
Anastomotic Leak , Anti-Bacterial Agents , Colonic Neoplasms , Colorectal Neoplasms , Diagnosis , Escherichia coli , Humans , Intraabdominal Infections , Korea , Medical Records , Piperacillin , Retrospective Studies , Seoul , Surgeons
7.
Article in Korean | WPRIM | ID: wpr-717151

ABSTRACT

BACKGROUND: In July 2016, the Infectious diseases society of america and the american thoracic society (IDSA & ATS) published a guideline recommending piperacillin/tazobactam (Pip/Tazo) 18 g/day as the anti-pseudomonal dose for the treatment of pathogenic pneumonia. After the guideline was published, the Pip/Tazo dose used for the treatment of pathogenic pneumonia was changed from 13.5 g/day to 18 g/day in a superior general hospital intensive care unit (ICU). In this study, we analyzed the effectiveness and safety of the new dose. METHODS: Adult patients aged ≥19 years who were diagnosed with pneumonia in ICU and who received Pip/Tazo for 7 days or more from September 1, 2015 to May 31, 2017 were included in the study. The electronic medical record (EMR) was retrospectively analyzed. RESULTS: At baseline, there was a significant difference between 44 patients treated with 13.5 g/day and 31 patients treated with 18 g/day of Pip/Tazo. The 18 g/day-treatment group comprised more elderly patients than the 13.5 g/day-treatment group (p=0.028). The results of the treatment-effects analysis showed no significant difference between the two groups. In case of safety data, there were significant differences in two parameters related to blood count, namely hemoglobin (p=0.016) and platelet count (p=0.011). CONCLUSION: Based on the significant difference in baseline age, there is a possibility that high-dose Pip/Tazo showed improved therapeutic effect. However, when high-dose Pip/Tazo was used, the blood cell count was found to drop from the reference value more frequently. Therefore, blood cell count should be monitored carefully when high-dose Pip/Tazo is administered.


Subject(s)
Adult , Aged , Americas , Blood Cell Count , Communicable Diseases , Critical Care , Electronic Health Records , Hospitals, General , Humans , Intensive Care Units , Piperacillin , Platelet Count , Pneumonia , Pneumonia, Ventilator-Associated , Reference Values , Retrospective Studies
8.
Rev. chil. infectol ; 34(6): 563-569, dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899760

ABSTRACT

Resumen Introducción: Las enterobacterias son bacilos gram-negativos responsables de infecciones graves en el ser humano. Se reporta una susceptibilidad en Klebsiella pneumoniae de 79,4% a piperacilina/tazobactam (PIP/TAZO) en hospitales pediátricos de Chile, pero según nuestro conocimiento, no existen datos publicados a la fecha respecto a la susceptibilidad de otras enterobacterias a PIP/TAZO en la población pediátrica chilena. Objetivo: Determinar la susceptibilidad in vitro a PIP/TAZO en cepas obtenidas de infecciones por Enterobacteriaceae en un hospital pediátrico de Chile. Material y Método: Estudio descriptivo y prospectivo de cepas de Enterobacteriaceae en Hospital de Niños Roberto del Río (HRRIO) entre 1 de enero de 2013 y el 27 de agosto de 2014. Se definió la susceptibilidad a PIP/TAZO por método de gradiente (E-test®) según puntos de corte CLSI 2014. Resultados: Se incluyeron 163 casos. El promedio de edad fue de 4 años 15 días. 70,6% de sexo femenino. El 79,7% de las cepas fueron aisladas en urocultivos. La susceptibilidad de Enterobacteriaceae a PIP/TAZO fue 95,1% (n = 155). La susceptibilidad intermedia fue 1,8% (n = 3). Discusión: Los aislados estudiados presentan alta susceptibilidad a PIP/TAZO. Este hallazgo puede explicarse por la baja circulación de microrganismos productores de BLEE y el limitado uso de PIP/TAZO en esta población pediátrica.


Introduction: Enterobacteriaceae are a group of gram-negative rods that can cause serious infections in humans. A susceptibility in Klebsiella pneumoniae of 79.4% to piperacillin/tazobactam (PIP/TAZO) is reported in pediatric hospitals in Chile. There is no published data published to date regarding PIP/TAZO susceptibility to other Enterobacteriaceae species in this population. Aim: To measure the in vitro PIP/TAZO susceptibility in Enterobacteriaceae isolates from patients in a pediatric hospital in Chile. Methods: Descriptive and prospective study of Enterobacteriaceae positive cultures from patients assisting to the "Hospital de niños Roberto del Río" (HRRIO) between January 2013 and August 2014. PIP/TAZO susceptibility was established by gradient diffusion method (E-test®) according to the 2014 CLSI standards. Results: 163 cases were included. The average age was 4 years and 15 days. 70.6% were female. 79.7% of samples were urine cultures. PIP/TAZO susceptibility in Enterobacteriaceae was 95.1% (n = 155). The intermediate susceptibility was 1.8% (n = 3). Discussion: The isolates studied present high susceptibility to PIP/TAZO. This finding could be explained by the fact that this population has not been exposed to this antimicrobial therapy and also the low rates for ESBL in pediatric infections.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Penicillanic Acid/analogs & derivatives , Enterobacteriaceae/isolation & purification , Enterobacteriaceae/drug effects , Hospitals, Pediatric , Anti-Bacterial Agents/pharmacology , Piperacillin/pharmacology , Reference Values , Microbial Sensitivity Tests , Chile , Prospective Studies , Penicillanic Acid/pharmacology , Drug Resistance, Bacterial , Piperacillin, Tazobactam Drug Combination
9.
Rev. med. Risaralda ; 23(2): 38-42, jul.-dic. 2017. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-902079

ABSTRACT

La amplia distribución de los bacilos gram negativos no fermentadores en medios ambientales como el agua y especies vegetales cobra importancia al ser reconocidos como agentes causales de enfermedades en pacientes inmunocomprometidos, de allí la relevancia del porque debemos conocer la prevalencia y perfil de susceptibilidad de estos microorganismos en ambientes no hospitalarios. Materiales y Métodos: Estudio transversal, realizado en muestras hídricas de fuentes naturales y artificiales de almacenamiento para el consumo humano en la ciudad de Bogotá y municipios aledaños. La identificación se realizó a través de pruebas IMVIC y el perfil de resistencia a través del método de kirby bauer o E-TEST®. Resultados: Se obtuvieron 42 muestras, 7 (16,6%) con aislamientos de interés: 3 (60%) Pseudomonas spp, 2 (20%) Acinetobacter spp, 1 (10%) Sphingomonas paucimobilis y 1 (10%) Pantoea spp. El 70% presento resistencia a la ceftriaxona, el 30% a cefoxitina, 20% a gentamicina, 10% a ciprofloxacina y 10% a piperacilina-tazobactam. No se presentó resistencia a imipenem. Conclusión: 5 de 7 aislamientos revelaron un BGNNF de importancia en infección en humanos, siendo importante la resistencia encontrada a la ceftriaxona.


The wide distribution of non-fermenting gram negative bacilli in environmental media such as water and plants becomes important as they are recognized a cause of diseases in immunocompromised patients, that’s the reason why we should to know the prevalence and the susceptibility profile of these microorganisms in non-hospital environments. Materials and Methods: Cross-sectional study done with samples of natural and artificial water storage for human consumption in the city of Bogotá and surrounding municipalities. The identification was made through IMVIC tests and the resistance profile through the kirby bauer or E-TEST® method. Results: 42 samples were obtained, 7 (16.6%) with isolates of interest: 3 (60%) Pseudomonas spp, 2 (20%) Acinetobacter spp, 1 (10%) Sphingomonas paucimobilis and 1 (10%) Pantoea spp. The 70% had resistance to ceftriaxone, 30% to cefoxitin, 20% to gentamicin, 10% to ciprofloxacin and 10% to piperacillin-tazobactam. No resistance to imipenem was shown. Conclusion: 5 of 7 isolates revealed a BGNNF of importance in infection in humans, with an important resistance to ceftriaxone.


Subject(s)
Humans , Pseudomonas , Acinetobacter , Drug Resistance, Microbial , Water Storage , Environment , Gram-Negative Bacteria , Piperacillin , Ceftriaxone , Gentamicins , Ciprofloxacin , Cefoxitin , Imipenem , Cross-Sectional Studies , Immunocompromised Host , Elapidae , Sphingomonas , Pantoea , Orlistat , Piperacillin, Tazobactam Drug Combination , Tazobactam , Hospitals
10.
Chinese Medical Journal ; (24): 659-664, 2017.
Article in English | WPRIM | ID: wpr-266930

ABSTRACT

<p><b>BACKGROUND</b>Acinetobacter baumannii has emerged as an important pathogen causing a variety of infections. Using data from the China Surveillance of Antimicrobial Resistance Program conducted biennially, we investigated the secular changes in the resistance of 2917 isolates of A. baumannii from 2004 to 2014 to differ antimicrobial agents.</p><p><b>METHODS</b>Pathogen samples were collected from 17 to 20 hospitals located in the eastern, central, and western regions of China. Minimum inhibitory concentrations (MICs) were determined by a 2-fold agar dilution method, and antimicrobial susceptibility was established using the 2014 Clinical Laboratory Standards Institute-approved breakpoints. Isolates not susceptible to all the tested aminoglycosides, fluoroquinolones, β-lactams, β-lactam/β-lactam inhibitors and carbapenems were defined as extensively drug resistant.</p><p><b>RESULTS</b>The rates of nonsusceptibility to common antimicrobial agents remained high (>65%) over the years with some fluctuations to certain agents. The prevalence of imipenem-resistant A. baumannii (IRAB) increased from 13.3% in 2004 to 70.5% in 2014 and that of extensively drug-resistant A. baumannii (XDRAB) increased from 11.1% in 2004 to 60.4% in 2014. The activity of tigecycline was stable with MIC90 ≤4 mg/L against A. baumannii from 2009 to 2014. Susceptibility to colistin remained high (97.0%) from 2009 to 2014. The prevalence of XDRAB increased in all the three surveillance regions over the years and was significantly higher in Intensive Care Unit (ICU) wards than non-ICU wards.</p><p><b>CONCLUSIONS</b>This longitudinal multicenter surveillance program revealed the nationwide emergence of A. baumannii in China and showed a significant increase in prevalence from 2004 to 2014. High levels of bacterial resistance were detected among samples collected from clinical settings in China, with IRAB and XDRAB being especially prevalent. This study will help to guide empirical therapy and identify at-risk groups requiring more intense interventional infection control measures, while also helping to focus surveillance efforts.</p>


Subject(s)
Acinetobacter baumannii , Amikacin , Pharmacology , Anti-Infective Agents , Pharmacology , Cefoperazone , Pharmacology , Ceftazidime , Pharmacology , Cephalosporins , Pharmacology , China , Colistin , Pharmacology , Drug Resistance, Multiple, Bacterial , Humans , Imipenem , Pharmacology , Levofloxacin , Pharmacology , Microbial Sensitivity Tests , Minocycline , Pharmacology , Penicillanic Acid , Pharmacology , Piperacillin , Pharmacology , Sulbactam , Pharmacology
11.
Biosci. j. (Online) ; 32(6): 1669-1678, nov./dec. 2016. ilus, graf
Article in English | LILACS | ID: biblio-965829

ABSTRACT

Febrile neutropenia (FN) causes a major threat to cancer patients after chemotherapy. Broadspectrum antibiotic treatment is a well-established practice for febrile neutropenia. Piperacillin/Tazobactam (P/T) is the frequently used antibiotic in most of FN cases, whereas the use of cefepime remains unclear regarding its potential risk. However, little systematic analysis has been conducted about comparison between these two drugs. Thus, we undertook this meta-analysis to compare these two monotherapies for febrile neutropenia. Through searching Pubmed, Google scholar, Medline databases, EMBASE, OvidSP, ScienceDirect, Web of science, and China Journal Net (CJN) databases, we used the keywords "(Piperacillin/Tazobactam AND cefepime) AND (febrile neutropenia) AND (cancer or tumor)". Only studies with randomized controlled trials were included in the meta-analysis. We screened out a total number of seven clinical trials. This meta-analysis supported that P/T treatment was superior to cefepime treatment based on the average OR comparison, without statistical significance (OR = 1.27, 95% confidence interval = 0.98 to 1.64, p = 0.07). We further divided the seven studies into two subgroups based on age and treatment time. The young group (age <= 19) showed no significant difference (OR = 1.10, p = 0.65). While the old group (age > 19) showed that P/T treatment was better than cefepime with statistical difference (OR = 1.44, p = 0.05). The short-term group (time <= 3 ds) showed P/T treatment was better than cefepime with statistical difference (OR = 1.40, p = 0.05). While in the long-term group (time > 5 ds), there was no significant difference between P/T and cefepime therapy (OR = 1.06, p = 0.79) Asymmetry in Funnel plots indicated no publication bias (CHI2 = 1.47, I2=0%, and p-value = 0.96) in this meta-analysis. It would be a good clinical trial to use P/T treatment to cure FN in cancer patients compared with cefepime treatment, especially in adult patients or patients with a short-term treatment period. This meta-analysis is practically important during antibiotic treatment in FN management.


A Neutropenia Febril (NF) apresenta-se como uma grande ameaça aos pacientes oncológicos após a quimioterapia. O tratamento antibiótico de amplo espectro é uma prática bem estabelecida para a neutropenia febril. Piperacilina/tazobactam (P/T) é o antibiótico frequentemente na maioria dos casos de NF, enquanto que o uso de cefepima permanece pouco claro em relação ao seu potencial risco. No entanto, pouca análise sistemática foi feita sobre a comparação entre esses dois fármacos. Assim, nós realizamos esta meta-análise para comparar estas duas monoterapias para a neutropenia febril. Através da pesquisa na Pubmed, Google Scholar, nas bases de dados da Medline, EMBASE, OvidSP, ScienceDirect, Web of science e nas bases de dados do China Journal Net (CJN), nós usamos as palavras-chave "(Piperacillin/Tazobactam AND cefepime) AND (febrile neutropenia) AND (cancer or tumor)". Apenas estudos com ensaios clínicos randomizados foram incluídos na meta-análise. Nós selecionamos um número total de sete ensaios clínicos. Esta meta-análise suportou que o tratamento com P/T foi superior ao tratamento com cefepima baseado na média da comparação OU (average OR comparision, em inglês), sem significância estatística (OR = 1.27, 95% confidence interval = 0.98 to 1.64, p = 0.07). Posteriormente, nós dividimos os sete estudos em dois subgrupos baseados na idade e no tempo de tratamento. O grupo jovem (idade <= 19) não mostrou uma diferença significativa (OR = 1.10, p = 0.65). Enquanto que o grupo mais velho (idade > 19) mostrou que o tratamento com P/T foi melhor do que o com cefepima com diferença estatística (OR = 1.44, p = 0.05). O grupo de curto prazo (tempo <= 3 ds*) mostrou que o tratamento com P/T foi melhor do que o com cefepima com diferença estatística (OR = 1.40, p = 0.05). Enquanto isso, no grupo de longo termo (tempo > 5 ds) não houve diferença significativa entre as terapias com P/T e Cefepima (OR = 1.06, p = 0.79). A assimetria nos gráficos de funil (funnel plots, em inglês) não indicaram viés de publicação (CHI2 = 1.47, I2=0%, and pvalue = 0.96) nesta meta-análise. Seria um bom ensaio clínico utilizar o tratamento P/T para curar NF em pacientes oncológicos comparados com o tratamento com cefepima, especialmente em pacientes adultos ou pacientes submetidos a um tratamento de curto prazo. Esta meta-análise é importante na prática durante o tratamento com antibióticos na administração de NF.


Subject(s)
Piperacillin , Febrile Neutropenia , Neoplasms
12.
Article in Chinese | WPRIM | ID: wpr-815089

ABSTRACT

To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.


Subject(s)
Abdominal Pain , Epidemiology , Anti-Bacterial Agents , Bacteria , Bacterial Infections , Epidemiology , Microbiology , Candidiasis , Epidemiology , Catheters , Microbiology , Diarrhea , Epidemiology , Drug Resistance, Bacterial , Enterococcus faecalis , Escherichia coli , Fever , Epidemiology , Gram-Negative Bacteria , Gram-Positive Bacteria , Humans , Imipenem , Klebsiella pneumoniae , Microbial Sensitivity Tests , Mycoses , Epidemiology , Penicillanic Acid , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Epidemiology , Microbiology , Piperacillin , Piperacillin, Tazobactam Drug Combination , Recurrence , Retrospective Studies , Staphylococcus epidermidis , Staphylococcus haemolyticus , Vomiting , Epidemiology
13.
Article in Chinese | WPRIM | ID: wpr-814951

ABSTRACT

OBJECTIVE@#To determine the drug resistance of Comamonas testosteroni (C. testosteroni) by the Kirby-Bauer (K-B) method without Clinical and Laboratory Standards Institute (CLSI) explanation or the minimum inhibitory concentration (MIC) method with the standard CLSI explanation to evaluate the sensitivity of K-B method in detection of C. testosteroni.
@*METHODS@#K-B method and MIC method was used to determine the sensitivity of C. testosteroni to Piperacillin, Cefepime, Piperacillin/tazobactam, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, Ceftazidime and Ciprofloxacin. The interpretation standard for Pseudomonas aeruginosa was temporary used for the K-B method. The coincident rate was compared between the two methods.
@*RESULTS@#The complete or partial coincident rate for K-B method and MIC method to detect Piperacillin and Cefepime was 97.4% or 2.6%; the complete coincidence rate to detect Piperacillin/tazobactam, Imipenem and Meropenem was 100%; the complete or partial coincident rate to detect Amikacin, Gentamicin and Tobramycin 94.7% or 5.3%; the complete or partial coincident rate to detect Ceftazidime was 97.4% or 2.6%; the complete or partial coincident rate to detect Ciprofloxacin 86.8% or 10.6%, and the full non-coincidence rate was 2.6%.
@*CONCLUSION@#The results of drug sensitive test from the two methods are highly consistent. We suggest that the microbiology labs do not report the interpretive results for C. testosteroni with K-B method but report the test results.


Subject(s)
Anti-Bacterial Agents , Cefepime , Cephalosporins , Comamonas testosteroni , Imipenem , Meropenem , Microbial Sensitivity Tests , Penicillanic Acid , Piperacillin , Piperacillin, Tazobactam Drug Combination , Pseudomonas aeruginosa , Thienamycins
14.
Annals of Dermatology ; : 98-101, 2016.
Article in English | WPRIM | ID: wpr-223544

ABSTRACT

Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.


Subject(s)
Acute Generalized Exanthematous Pustulosis , Anti-Bacterial Agents , beta-Lactamases , Drug Hypersensitivity Syndrome , Eosinophilia , Exanthema , Fever , Humans , Hypersensitivity , Lymphocytosis , Piperacillin , Prognosis , Sodium
15.
Infection and Chemotherapy ; : 190-198, 2016.
Article in English | WPRIM | ID: wpr-28871

ABSTRACT

BACKGROUND: Acinetobacter baumannii has emerged as a major cause of nosocomial outbreaks. It is particularly associated with nosocomial pneumonia and bloodstream infections in immunocompromised and debilitated patients with serious underlying pathologies. Over the last two decades, a remarkable rise in the rates of multidrug resistance to most antimicrobial agents that are active against A. baumannii has been noted worldwide. We evaluated the rates of antimicrobial resistance and changes in resistance over a 5-year period (2010–2014) in A. baumannii strains isolated from hospitalized patients in a tertiary Greek hospital. MATERIALS AND METHODS: Identification of A. baumannii was performed by standard biochemical methods and the Vitek 2 automated system, which was also used for susceptibility testing against 18 antibiotics: ampicillin/sulbactam, ticarcillin, ticarcillin/clavulanic acid, piperacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, meropenem, gentamicin, amikacin, tobramycin, ciprofloxacin, tetracycline, tigecycline, trimethoprim/sulfamethoxazole, and colistin. Interpretation of susceptibility results was based on the Clinical and Laboratory Standards Institute criteria, except for tigecycline, for which the Food and Drug Administration breakpoints were applied. Multidrug resistance was defined as resistance to ≥3 classes of antimicrobial agents. RESULTS: Overall 914 clinical isolates of A. baumannii were recovered from the intensive care unit (ICU) (n = 493), and medical (n = 252) and surgical (n = 169) wards. Only 4.9% of these isolates were fully susceptible to the antimicrobials tested, while 92.89% of them were multidrug resistant (MDR), i.e., resistant to ≥3 classes of antibiotics. ICU isolates were the most resistant followed by isolates from surgical and medical wards. The most effective antimicrobial agents were, in descending order: colistin, amikacin, trimethoprim/sulfamethoxazole, tigecycline, and tobramycin. Nevertheless, with the exception of colistin, no antibiotic was associated with a susceptibility rate >40% for the entire study period. The most common phenotype showed resistance against ampicillin/sulbactam, cephalosporins, carbapenems, aminoglycosides, ciprofloxacin, and tigecycline. An extremely concerning increase in colistin-resistant isolates (7.9%) was noted in 2014, the most recent study year. CONCLUSION: The vast majority of A. baumannii clinical isolates in our hospital are MDR. The remaining therapeutic options for critically ill patients who suffer from MDR A. baumannii infections are severely limited, with A. baumannii beginning to develop resistance even against colistin. Scrupulous application of infection control practices should be implemented in every hospital unit. Lastly, given the lack of available therapeutic options for MDR A. baumannii infections, well-controlled clinical trials of combinations of existing antibiotics are clearly needed.


Subject(s)
Acinetobacter baumannii , Acinetobacter , Amikacin , Aminoglycosides , Anti-Bacterial Agents , Anti-Infective Agents , Carbapenems , Cefotaxime , Ceftazidime , Cephalosporins , Ciprofloxacin , Colistin , Critical Illness , Disease Outbreaks , Drug Resistance, Multiple , Gentamicins , Hospital Units , Humans , Imipenem , Infection Control , Intensive Care Units , Pathology , Phenotype , Piperacillin , Pneumonia , Tetracycline , Ticarcillin , Tobramycin , United States Food and Drug Administration
16.
Infection and Chemotherapy ; : 209-215, 2016.
Article in English | WPRIM | ID: wpr-28869

ABSTRACT

BACKGROUND: For more effective and safer usage of antibiotics, the dosing strategy should be individualized based on the patients’ characteristics, including race. The aim of this study was to investigate the population pharmacokinetic (PK) profiles of piperacillin and tazobactam in Korean patients with acute infections. MATERIALS AND METHODS: At least four consecutive 2/0.25 g or 4/0.5 g doses of piperacillin/tazobactam (TZP) were intravenously infused over 1 h every 8 h for patients with creatinine clearance (CL(cr)) ≤50 ml/min or CL(cr) >50 mL/min, respectively. Blood samples from 33 patients at a steady-state were taken pre-dose and at 0 min, 30 min, and 4-6 h after the fourth infusion. The population PK analysis was conducted using a non-linear mixed-effects method. A likelihood ratio test was used to select significant covariates, with significance levels of P <0.05 for selection and P <0.01 for elimination. RESULTS: Both piperacillin PK and tazobactam PK were well described by a two-compartment model with first-order elimination. Creatinine clearance and body weight, as covariates on clearance (CL) and volume of central compartment (V1), were selected among the covariates possibly affecting PK parameters of both drugs. CL was defined as CL = 2.9 + 4.03 × CL(cr)/47 for piperacillin and CL = 1.76 + 4.81 × CL(cr)/47 for tazobactam. V1 was defined as V1 = 19.5 × weight/60 for piperacillin and V1 = 22.6 × weight/60 for tazobactam. CONCLUSION: The PK profiles of TZP at a steady-state in Korean patients with acute infections were well described by a two-compartment model with first-order elimination. Both piperacillin and tazobactam clearances were significantly influenced by creatinine clearance.


Subject(s)
Anti-Bacterial Agents , Body Weight , Racial Groups , Creatinine , Humans , Methods , Piperacillin
17.
São Paulo; s.n; s.n; 2016. 101 p. tab, graf, ilus.
Thesis in Portuguese | LILACS | ID: biblio-846598

ABSTRACT

Introdução: Reportam-se modificações metabólicas e hemodinâmicas em pacientes críticos em sepse e incluem-se neste grupo, os grandes queimados. Nesses pacientes ocorrem profundas alterações na farmacocinética de agentes antimicrobianos hidrofílicos prescritos no tratamento empírico das infecções bacterianas graves. Então, o alvo terapêutico não é alcançado em decorrência das concentrações plasmáticas desses antimicrobianos serem inferiores às requeridas para o controle das infecções. Na suspeita de sepse, a terapia antimicrobiana de primeira escolha prevê administração sistêmica dos antimicrobianos a vancomicina e a piperacilina, sendo esta última associada à tazobactana, um inibidor da beta-lactamase. Objetivo: Propôs-se nesse projeto a investigação da farmacocinética da vancomicina e da piperacilina através do monitoramento plasmático. Propôs-se ainda a avaliação da efetividade dos dois antimicrobianos na dose empírica recomendada com base na função renal aos pacientes críticos grandes queimados em sepse por patógeno hospitalar. Métodos: Investigaram-se 42 pacientes grandes queimados em terapia intensiva com lesões de 2° grau profundo e de 3° grau com suspeita de sepse por patógeno hospitalar. A prescrição constou de terapia combinada de vancomicina e piperacilina nas doses empíricas recomendadas com base na função renal de cada paciente. Seguem as características dos pacientes investigados: adultos de ambos os sexos (33M/9F), médias/ DP: 40,9±17,5 anos, 70,1±11,5 Kg, 33,6±20,7% de superfície corpórea total queimada (SCTQ), sendo 37/42 pacientes apresentaram função renal normal, e 5/42 pacientes com insuficiência renal, sem necessidade de prescrição de diálise pelo nefrologista. Registrou-se trauma térmico/ elétrico em 39/3; a lesão inalatória ocorreu em 25 pacientes. Efetuou-se coleta seriada de 2-3 amostras sanguíneas (Vacutainer/EDTA sódico); após separação do sangue por centrifugação a 2800g para obtenção do plasma, realizou-se o processamento laboratorial para os dois analitos pelo monitoramento plasmático da vancomicina e da piperacilina através da cromatografia líquida de alta eficiência. Realizou-se o estudo farmacocinético com base no modelo aberto monocompartimental. Através da análise PK/PD foi possível determinar os índices de efetividade para a vancomicina a partir da razão da área sob a curva no intervalo de 24 horas e a concentração inibitória mínima ASCss 0-24/CIM > 400, e para a piperacilina 70%fΔT>CIM; o significado desse último índice determinado para o derivado ß-lactâmico está relacionado a fração do intervalo de dose em que a concentração plasmática livre da piperacilina permanece acima da CIM. Resultados: Registrou-se alteração da farmacocinética da vancomicina e da piperacilina nos pacientes queimados com função renal normal pela comparação entre cada paciente e o valor de referência reportado para voluntários sadios. Nos pacientes com insuficiência renal registrou-se o prolongamento da meia vida biológica pela alteração na depuração e/ou no volume de distribuição. Registrou-se farmacocinética alterada em diferentes proporções tanto nos pacientes queimados com função renal preservada, como naqueles com disfunção renal. Após a análise PK/PD, a dose empírica de vancomicina administrada aos pacientes com função renal normal, registrou-se cobertura em 37/37 pacientes contra patógenos sensíveis (CIM 1mg/L), caindo para 18/37 (49%) pacientes para patógenos, CIM 2 mg/L. Não se registrou cobertura contra patógenos CIM>2 mg/L (CIM 4mg/L) independente da função renal dos pacientes. Após a dose empírica prescrita na função renal preservada, a cobertura da piperacilina ocorreu até CIM 4mg/L, para os patógenos sensíveis, caindo para 34/37 (92%) CIM 8 mg/L. Apenas 22/37 (60%) pacientes se encontraram protegidos contra patógenos sensíveis mais agressivos CIM 16 mg/L Pseudomonas aeruginosa e Enterococcus spp. Conclusão: O monitoramento plasmático da vancomicina e da piperacilina indica que a dose empírica recomendada para os dois agentes não alcança efetividade no controle das infecções causadas por patógenos hospitalares sensíveis à vancomicina (CIM>1mg/L) e à piperacilina (CIM >4 mg/L) em consequência de níveis plasmáticos inferiores aos requeridos no controle das infecções, devido a profundas alterações na farmacocinética desses antimicrobianos


Introduction: Metabolic and hemodynamic changes were reported in critically ill patients including burn patients in sepsis. Then, pharmacokinetics is altered in those patients mainly for hydrophilic antimicrobial agents prescribed for the control of severe bacterial infections; consequently, the therapeutic target wasn't reached based on drug plasma concentrations lower than expected. Antimicrobial therapy recommended in sepsis suspicious is based in a combination of two antimicrobials; vancomycin, a glycopeptides derivative and a beta-lactam agent piperacillin-tazobactam, a beta-lactamase inhibitor. Objective: It was proposed a pharmacokinetic investigation for vancomycin and piperacillin based on drug plasma monitoring followed by drug effectiveness measurements by PK/PD analysis after the empiric dose regimen recommended to normal renal function or renal failure burn patients in sepsis. Methods: 42 adult burn patients of both gender (33M/9F) with deep 2nd and 3rd injuries in septic shock by nosocomial pathogens under intensive care were investigated. A combined antimicrobial therapy at the recommended empirical dose regimen vancomycin-piperacillin was prescribed on the basis of renal function. Characteristics of population of patients investigated, means/SD were: 40.9±17.5 yrs, 70.1±11.5 kg, 33.6±20.7% total burn surface area (TBSA). Normal renal function was registered in 37/42 patients against 5/42 of them with renal failure. Thermal/electrical injuries occur in 39/3, and inhalation injury were in 25 of them. A serial of 2-3 blood samples were obtained from venous catheter into vacuum tubes (sodium EDTA); after centrifugation (2800g) plasma samples were obtained for drug plasma monitoring; both analytes, vancomycin and piperacillin were quantified by high performance liquid chromatography. Pharmacokinetics investigation based on one compartment open model was performed. PK/PD analysis was done to determine antimicrobial effectiveness against nosocomial pathogens isolated. Recommended drug effectiveness index was AUCss 0-24/MIC > 400 for vancomycin and 70%fΔT>MIC for piperacillin. Results: Pharmacokinetics for both antimicrobials investigated showed to be altered in a different extension for vancomycin and piperacillin in burn patients with normal renal function by comparison with reference data reported in healthy adult volunteers. PK/PD analysis indicated that after the initial dose regimen 2g daily for patients with normal renal function, the vancomycin effectiveness occurs only for susceptible pathogens MIC 1mg/L, once drug effectiveness falls to 49% (18/37) against pathogens (MIC 2mg/L). Similarly, piperacillin effectiveness occurs just for susceptible pathogens MIC ≤ 4 mg/L in patients with normal renal function, once only 22/37 (60%) of patients reached the target MIC 16mg/L for Pseudomonas aeruginosa and Enterococcus spp. Conclusion: Vancomycin and piperacillin plasma monitoring indicated that the therapeutic target wasn´t reached with the empiric dose regimen recommended against nosocomial pathogens vancomycin susceptible (MIC>1mg/L) and piperacillin susceptible (MIC >4 mg/L) due to plasma levels lower than expected as a consequence of kinetic disposition altered for both antimicrobials


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Anti-Infective Agents , Infections , Piperacillin/analysis , Vancomycin/analysis , Pharmacokinetics , Sepsis/complications
18.
Rev. Soc. Bras. Clín. Méd ; 13(2)jun. 2015. tab
Article in Portuguese | LILACS | ID: lil-749187

ABSTRACT

Pneumatosis intestinalis (PI) is a rare condition, especially when associated with volvulus; it is often misdiagnosed and inappropriately treated. We present the case of a 27 year-old woman suffering from an acute abdomen. An abdominal tomography was performed revealing Pneumatosis intestinalis. Once in the operating theatre sigmoid volvulus was diagnosed and Hartmann surgery performed. Histology showed intestinal ischemia. During the hospital stay, evolution was favourable. The authors present this case and a brief theoretical review, due to its rarity and clinical interest.


A pneumatose intestinal (PI) é uma condição pouco frequente, sendo ainda mais rara em associação com volvo; sendo muitas vezes mal diagnosticada e tratada inapropriadamente. Apresentamos o caso de uma mulher de 27 anos com um quadro de abdómen agudo. Realizou TAC abdominal que demonstrou pneumatose intestinal. Intra-operatoriamente foi diagnosticado volvo da sigmoideia e optado por cirurgia de Hartmann. O resultado anatomo-patológico da peça foi compatível com isquémia intestinal. Durante o internamento hospital, a doente evoluiu favoravelmente. Os autores apresentam este caso e uma breve revisão teórica, pela sua raridade e interesse clínico.


Subject(s)
Humans , Female , Adult , Abdomen, Acute/complications , Pneumatosis Cystoides Intestinalis/diagnosis , Pneumatosis Cystoides Intestinalis/etiology , Intestinal Volvulus/surgery , Intestinal Volvulus/diagnosis , Piperacillin/therapeutic use
19.
Article in English | WPRIM | ID: wpr-110969

ABSTRACT

BACKGROUND: Periodic monitoring of regional or institutional resistance trends of clinically important anaerobic bacteria is recommended, because the resistance of anaerobic pathogens to antimicrobial drugs and inappropriate therapy are associated with poor clinical outcomes. There has been no multicenter study of clinical anaerobic isolates in Korea. We aimed to determine the antimicrobial resistance patterns of clinically important anaerobes at multiple centers in Korea. METHODS: A total of 268 non-duplicated clinical isolates of anaerobic bacteria were collected from four large medical centers in Korea in 2012. Antimicrobial susceptibility was tested by the agar dilution method according to the CLSI guidelines. The following antimicrobials were tested: piperacillin, piperacillin-tazobactam, cefoxitin, cefotetan, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, metronidazole, and tigecycline. RESULTS: Organisms of the Bacteroides fragilis group were highly susceptible to piperacillin-tazobactam, imipenem, and meropenem, as their resistance rates to these three antimicrobials were lower than 6%. For B. fragilis group isolates and anaerobic gram-positive cocci, the resistance rates to moxifloxacin were 12-25% and 11-13%, respectively. Among B. fragilis group organisms, the resistance rates to tigecycline were 16-17%. Two isolates of Finegoldia magna were non-susceptible to chloramphenicol (minimum inhibitory concentrations of 16-32 mg/L). Resistance patterns were different among the different hospitals. CONCLUSIONS: Piperacillin-tazobactam, cefoxitin, and carbapemems are highly active beta-lactam agents against most of the anaerobes. The resistance rates to moxifloxacin and tigecycline are slightly higher than those in the previous study.


Subject(s)
Agar , Bacteria, Anaerobic , Bacteroides fragilis , Cefotetan , Cefoxitin , Chloramphenicol , Clindamycin , Gram-Positive Cocci , Imipenem , Korea , Metronidazole , Piperacillin
20.
Article in English | WPRIM | ID: wpr-34569

ABSTRACT

BACKGROUND: Periodic monitoring of antimicrobial resistance trends of clinically important anaerobic bacteria such as Bacteroides fragilis group organisms is required. We determined the antimicrobial susceptibilities of clinical isolates of B. fragilis group organisms recovered from 2009 to 2012 in a tertiary-care hospital in Korea. METHODS: A total of 180 nonduplicate clinical isolates of B. fragilis group organisms were collected in a tertiary care hospital. The species were identified by conventional methods: the ATB 32A rapid identification system (bioMerieux, France) and the Vitek MS matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (bioMerieux). Antimicrobial susceptibility was determined by the CLSI agar dilution method. RESULTS: Imipenem and meropenem resistance rates were 0-6% for B. fragilis group isolates. The rate of resistance to piperacillin-tazobactam was 2% for B. fragilis and 0% for other Bacteroides species, but 17% for B. thetaiotaomicron isolates. High resistance rates to piperacillin (72% and 69%), cefotetan (89% and 58%), and clindamycin (83% and 69%) were observed for B. thetaiotaomicron and other Bacteroides spp. The moxifloxacin resistance rate was 27% for other Bacteroides spp. The MIC50 and MIC90 of tigecycline were 2-4 microg/mL and 8-16 microg/mL, respectively. No isolates were resistant to chloramphenicol or metronidazole. CONCLUSIONS: Imipenem, meropenem, chloramphenicol, and metronidazole remain active against B. fragilis group isolates. Moxifloxacin and tigecycline resistance rates are 2-27% and 8-15% for B. fragilis group isolates, respectively.


Subject(s)
Anti-Infective Agents/pharmacology , Bacteroides Infections/microbiology , Bacteroides fragilis/drug effects , Drug Resistance, Multiple, Bacterial , Humans , Imipenem/pharmacology , Inhibitory Concentration 50 , Microbial Sensitivity Tests , Penicillanic Acid/analogs & derivatives , Piperacillin/pharmacology , Republic of Korea , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Tertiary Care Centers , Thienamycins/pharmacology
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