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1.
In. Giachetto Larraz, Gustavo A; Pardo Casaretto, Lorena Victoria; Speranza Mourine, María Noelia. Prescripción de antimicrobianos para infecciones frecuentes en pediatría. Montevideo, Bibliomédica, 2020. p.91-118, tab.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1373295
3.
Rev. medica electron ; 41(2): 435-444, mar.-abr. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1004279

ABSTRACT

RESUMEN Rhodococcus equi es un microorganismo emergente asociado a infecciones oportunistas en individuos inmunocomprometidos, especialmente en pacientes con infección por virus de inmunodeficiencia humana. Se desarrolló una búsqueda en la Biblioteca Virtual de Infomed, fueron revisados 215 trabajos científicos sin limitación de año y país, seleccionándose 55. El rhodococcus es un patógeno intracelular capaz de crecer y persistir dentro de los macrófagos que expresan en su superficie el receptor Mac-1 (CD11b/CC18), y posteriormente destruirlos. La manifestación clínica más frecuente es la neumonía de comienzo insidioso y en su evolución natural tiende a la cavitación. El diagnóstico se realiza mediante su identificación en cultivo de muestras de tejido afectado. Los hemocultivos son positivos en el 50% de los inmunodeprimidos En el diagnóstico radiográfico, los hallazgos más comunes referidos en la literatura científica son el compromiso lobar y la cavitación. La particular evolución que experimentan los pacientes con síndrome de inmunodeficiencia adquirida y neumonía por R. equi, obliga a implementar esquemas terapéuticos basados en antimicrobianos con actividad bactericida intracelular, administrados inicialmente por vía intravenosa y durante un tiempo prolongado e incluso la cirugía. La infección por R. equi es una complicación infrecuente en pacientes con síndrome de inmunodeficiencia adquirida, pero con una elevada tasa de letalidad, por lo que debe ser sospechado en pacientes que presenten una infección respiratoria de curso inhabitual. El diagnóstico precoz, el tratamiento antimicrobiano combinado y prolongado y el inicio de la Terapia Antiretroviral de Gran Actividad en forma temprana pueden mejorar la evolución y el pronóstico de estos pacientes.


ABSTRACT Rhodococcus equi is an emergent microorganism associated to opportunistic infections in immune-compromised individuals, especially in patients infected with the human immunodeficiency virus. A search was carried out in the Virtual Library of Infomed; 215 scientific works were reviewed without limits of publication years and countries. From them, 55 were chosen. Rhodococcus equi is an intracellular pathogen that is able to grow and live inside the macrophages expressing the Mac-1 (CD11b/CC18) receptor in the surface and destroying them later. The most common clinical manifestation is insidious beginning pneumonia, tending to cavitation in its natural evolution. The diagnosis is made through identification in culture of affected tissues samples. Blood cultures are positive in 50 % of the immune-depressed people. At the radiographic diagnosis, the most common findings referred to in the scientific literature are lobar compromise and cavitation. The particular evolution of the patients with acquired immune-deficiency syndrome and pneumonia due to Rhodococcus equi forces the implementation of therapeutic schemes based on antimicrobials with intracellular bactericide activity, administered firstly intravenously and during a long time, and even to perform the surgery. Rhodococcus equi infection is an infrequent complication in patients with acquired immunodeficiency syndrome, but having a high lethality rate, therefore it should be suspected in patients presenting a respiratory infection of unusual curse. The precocious diagnosis, combined and prolonged antimicrobial treatment and early beginning of the highly active antiretroviral therapy could improve the evolution and prognosis of these patients.


Subject(s)
Humans , HIV Infections/complications , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/drug therapy , Anti-Retroviral Agents/therapeutic use , Actinomycetales Infections/diagnosis , Rhodococcus equi/pathogenicity , Pneumonia, Bacterial/etiology
4.
J. bras. pneumol ; 44(5): 405-423, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-975948

ABSTRACT

ABSTRACT Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.


RESUMO A pneumonia adquirida na comunidade (PAC) constitui a principal causa de morte no mundo. Apesar da vasta microbiota respiratória, o Streptococcus pneumoniae permanece como a bactéria de maior prevalência dentre os agentes etiológicos. Apesar da redução significativa das taxas de mortalidade por infecções do trato respiratório inferior nas últimas décadas, a PAC ocupa o terceiro lugar como causa de mortalidade em nosso meio. Desde a última publicação das Diretrizes Brasileiras sobre PAC da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT; 2009), houve importantes avanços na aplicação dos exames de imagem, na investigação etiológica, na estratificação de risco à admissão e de escores prognósticos evolutivos, no uso de biomarcadores e nas recomendações de antibioticoterapia (e sua duração) e da prevenção por vacinas. Para revisar esses tópicos, a Comissão de Infecções Respiratórias da SBPT reuniu 13 membros com reconhecida experiência em PAC no Brasil que identificaram aspectos relevantes à prática clínica que demandam atualizações frente às novas evidências epidemiológicas e científicas publicadas. Foram determinados doze tópicos envolvendo aspectos diagnósticos, prognósticos, terapêuticos e preventivos. Os tópicos foram divididos entre os autores, que realizaram uma revisão de forma não sistemática da literatura, porém priorizando as principais publicações nas áreas específicas, incluindo artigos originais, artigos de revisão e revisões sistemáticas. Todos os autores tiveram a oportunidade de revisar e opinar sobre todas as questões, criando um documento único final que foi aprovado por consenso.


Subject(s)
Humans , Pneumonia, Viral/diagnostic imaging , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Viral/drug therapy , Societies, Medical , Brazil , Consensus Development Conferences as Topic , Community-Acquired Infections/drug therapy , Community-Acquired Infections/diagnostic imaging , Pneumonia, Bacterial/drug therapy , Evidence-Based Medicine , Anti-Bacterial Agents/therapeutic use
5.
Rev. méd. Chile ; 146(2): 249-253, feb. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961384

ABSTRACT

Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress. He was managed with vasoactive drugs and prone positioning ventilation for 48 hours. Chest radiography showed a right superior lobe condensation. The electrocardiogram and echocardiogram suggested septic myocarditis. Blood cultures demonstrated the presence of serogroup W135-NM. A lumbar puncture ruled out meningitis, and a 10-day ceftriaxone therapy was completed favorably.


Subject(s)
Humans , Male , Adolescent , Pneumonia, Bacterial/microbiology , Neisseria meningitidis/isolation & purification , Ceftriaxone/therapeutic use , Chile , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/drug therapy , Anti-Bacterial Agents/therapeutic use
6.
Yonsei Medical Journal ; : 180-186, 2017.
Article in English | WPRIM | ID: wpr-126258

ABSTRACT

PURPOSE: Patients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) according to guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrug resistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality between NHAP and community-acquired pneumonia (CAP) patients. MATERIALS AND METHODS: We retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded. RESULTS: Among 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequently used a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional status were higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens (p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was no association between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray [odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to 55.632) were significantly associated with in-hospital mortality. CONCLUSION: Patients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAP and CAP was related to disease severity but not to the presence of multidrug resistant pathogens.


Subject(s)
Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/drug therapy , Cross Infection/drug therapy , Drug Resistance, Multiple, Bacterial , Female , Hospital Mortality , Humans , Male , Nursing Homes , Odds Ratio , Pneumonia, Bacterial/drug therapy , Retrospective Studies
7.
Rev. chil. infectol ; 33(2): 177-186, abr. 2016. tab
Article in Spanish | LILACS | ID: lil-784868

ABSTRACT

Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. There are recommendations about these topics in national and intemational guidelines, based on clinical trials which do not demónstrate diffe-rences in mortality and complications when there is an early change from intravenous administration to the oral route. There are no statistically significant differences in safety and resolution of the disease when short and long treatment schemes were compared. In this review we present the most important guidelines and clinical studies, taking into account the pharmacological differences between different medications. It is considered that early switch from intravenous to oral administration route and use of short cycles in CAP is safe and brings benefits to patients and institutions.


La neumonía adquirida en la comunidad (NAC) es una causa importante de morbilidad y mortalidad en el mundo, con costos elevados por cuenta de las hospitalizaciones y las complicaciones (infección asociada al cuidado de la salud, efectos adversos de medicamentos, resistencia antimicrobiana, etc.). Ante este panorama se ha propuesto administrar ciclos cortos y el cambio temprano de la vía administración de antimicrobianos de endovenosa a oral. Existen recomendaciones acerca de los puntos anteriores en guías locales e internacionales, así como ensayos clínicos que no demuestran diferencias en cuanto a mortalidad y complicaciones cuando se realiza un cambio temprano de vía de administración de endovenosa a oral en NAC. Tampoco hay diferencias estadísticamente significativas en seguridad y resolución de enfermedad cuando se compararon esquemas cortos y prolongados. En esta revisión se presentan las guías y estudios más importantes, considerando las diferencias farmacológicas de los diferentes medicamentos. Se considera que el cambio temprano de vía de administración y el uso de ciclos cortos en NAC es seguro y presenta beneficios para pacientes e instituciones.


Subject(s)
Humans , Adult , Pneumonia, Bacterial/drug therapy , Anti-Bacterial Agents/administration & dosage , Time Factors , Drug Administration Schedule , Administration, Oral , Treatment Outcome , Practice Guidelines as Topic , Community-Acquired Infections/drug therapy , Dose-Response Relationship, Drug , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/adverse effects
8.
Arch. argent. pediatr ; 113(5): 397-403, oct. 2015. graf, tab
Article in English, Spanish | LILACS, BINACIS | ID: lil-757060

ABSTRACT

Introducción. A pesar de que la mayoría de las neumonías en menores de 5 años son virales, en la práctica diaria, frecuentemente, son tratadas con antibióticos. Una regla clínica de decisión (BPS: Bacterial Pneumonia Score) demostró ser eficaz para identificar qué niños con neumonía requerían antibióticos, pero su desempeño no ha sido evaluado en la población vacunada contra neumococo. El objetivo fue evaluar si el empleo del BPS permitía un menor uso de antibióticos comparado con el manejo habitual en niños con neumonía adquirida en la comunidad, que recibieron vacunación antineumocóccica. Material y método. Ensayo clínico controlado, aleatorizado, de grupos paralelos, con enmascaramiento parcial, que compara dos métodos de manejo de niños de 3-60 meses de edad asistidos ambulatoriamente por neumonía, que hubieran recibido vacuna antineumocóccica conjugada. El Grupo BPS recibió antibióticos con BPS > 4 puntos; el grupo control recibió antibióticos según criterio del médico tratante. El tamaño muestral calculado contempló, al menos, 30 pacientes por grupo. Se comparó la proporción de uso de antibióticos y la evolución clínica en ambos grupos. Resultados. Se incluyeron 65 pacientes (33 en el grupo BPS y 32 en el grupo control), con edad promedio de 17,5 meses. El empleo de antibióticos fue significativamente mayor en el grupo control que en el grupo BPS (21/32 vs. 9/33; OR 5,09; IC 95%: 1,57-16,85; p = 0,001). Se observó una mala evolución en 7 pacientes (3 del grupo BPS y 4 del grupo control). Conclusión. El empleo de BPS permitió un menor uso de antibióticos para el manejo inicial de pacientes con neumonía vacunados contra neumococo, sin aumentar el riesgo de mala evolución.


Introduction. Although most cases of pneumonia in children younger than 5 years old have a viral nature, in everyday practice, they are frequently treated with antibiotics. A clinical decision rule (BPS:Bacterial Pneumonia Score) proved to be effective for identifying which children with pneumonia required antibiotics, but its performance has not been assessed in the population vaccinated against pneumococcal disease. Our objective was to assess whether using the BPS would allow to reduce antibiotic use compared to routine management of children with community acquired pneumonia vaccinated against pneumococcal disease. Material and Methods. Randomized, controlled, partially-blinded clinical trial with parallel groups comparing two approaches in the management of children aged 3-60 months old in an outpatient setting because of pneumonia, who had been vaccinated with the pneumococcal conjugate vaccine.The BPS group received antibiotics with a BPS >4 points; while the control group was administered antibiotics at the discretion of the treating physician. The estimated sample size was calculated as, at least, 30 patients per group. The rate of antibiotic use and the clinical course were compared in both groups. Results. Sixty-five patients (33 in the BPS group and 32 in the control group) were included; their average age was 17.5 months old. Antibiotic use was significantly higher in the control group than in the BPS group (21/32 versus 9/33; OR: 5.09; 95% CI: 1.57-16.85; p= 0.001). Seven patients had an unfavorable course (three in the BPS group, and four in the control group). Conclusion. The use of the BPS allowed to reduce antibiotic use in the initial management of patients with pneumonia vaccinated against pneumococcal disease, without increasing the probability of an unfavorable course of the disease.


Subject(s)
Humans , Infant , Child, Preschool , Pneumococcal Infections/prevention & control , Treatment Outcome , Pneumonia, Bacterial/drug therapy , Pneumococcal Vaccines , Clinical Decision-Making , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use
9.
Rev. méd. Chile ; 143(5): 553-561, tab
Article in Spanish | LILACS | ID: lil-751699

ABSTRACT

Background: The clinical usefulness of blood cultures in the management of patients hospitalized with community-acquired pneumonia (CAP) is controversial. Aim: To determine clinical predictors of bacteremia in a cohort of adult patients hospitalized for community-acquired pneumonia. Material and Methods: A prospective cohort of 605 immunocompetent adult patients aged 16 to 101 years (54% male) hospitalized for CAP was studied. The clinical and laboratory variables measured at admission were associated with the risk of bacteremia by univariate and multivariate analysis using logistic regression models. Results: Seventy seven percent of patients had comorbidities, median hospital stay was 9 days, 7.6% died in hospital and 10.7% at 30 days. The yield of the blood cultures was 12.6% (S. pneumoniae in 69 patients, H. influenzae in 3, Gram negative bacteria in three and S. aureus in one). These results modified the initial antimicrobial treatment in one case (0.2%). In a multivariate analysis, clinical and laboratory variables associated with increased risk of bacteremia were low diastolic blood pressure (Odds ratio (OR): 1.85, 95% confidence intervals (CI) 1.02 to 3.36, p < 0.05), leukocytosis e" 15,000/mm³ (OR: 2.18, 95% CI 1.22 to 3.88, p < 0.009), serum urea nitrogen e" 30 mg/dL (OR: 2.23, 95% CI 1.22 to 4.05, p < 0.009) and serum C-reactive protein e" 30 mg/dL (OR: 2.20, 95% CI 1.22 to 3.97, p < 0.01). Antimicrobial use before hospital admission significantly decreased the blood culture yield (OR: 0.14, 95% CI 0.04 to 0.46, p < 0.002). Conclusions: Blood cultures do not contribute significantly to the initial management of patients hospitalized for community-acquired pneumonia. The main clinical predictors of bacteremia were antibiotic use, hypotension, renal dysfunction and systemic inflammation.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Bacteremia/diagnosis , Pneumonia, Bacterial/diagnosis , Analysis of Variance , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , Cardiovascular Diseases/complications , Community-Acquired Infections/complications , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Hospitalization/statistics & numerical data , Hypotension/complications , Length of Stay/statistics & numerical data , Microbial Sensitivity Tests , Prognosis , Prospective Studies , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/drug therapy , Pneumonia, Pneumococcal/complications , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/microbiology , Renal Insufficiency/complications , Streptococcus pneumoniae/isolation & purification
10.
Braz. j. infect. dis ; 19(2): 156-162, Mar-Apr/2015. tab, graf
Article in English | LILACS | ID: lil-746510

ABSTRACT

Objective: The aim of this article is to compare the efficacy and safety of doripenem for bacterial infections. Methods: We included six randomized clinical trials identified from PubMed and Embase up to July 31, 2014. The included trials compared efficacy and safety of doripenem for complicated intra-abdominal infections, complicated urinary tract infection, nosocomial pneumonia, and acute biliary tract infection. The meta-analysis was carried on by the statistical software of Review Manager, version 5.2. Results: Compared with empirical antimicrobial agents on overall treatment efficacy, doripenem was associated with similar clinical and microbiological treatment success rates (for the clinical evaluable population, odds ratio [OR] = 1.26, 95% confidence interval [CI] 0.93-1.69, p = 0.13; for clinical modified intent-to-treatment population, OR = 0.88, 95% CI 0.55-1.41, p = 0.60; for microbiology evaluable population, OR = 1.16, 95% CI 0.90-1.50, p = 0.26; for microbiological modified intent-to-treatment (m-mITT), OR = 0.98, 95% CI 0.81-1.20, p = 0.87). We compared incidence of adverse events and all-cause mortality to analyze treatment safety. The outcomes suggested that doripenem was similar to comparators in terms of incidence of adverse events and all-cause mortality on modified intent-to-treatment population (for incidence of AEs, OR = 1.10, 95% CI 0.90-1.35, p = 0.33; for all-cause mortality, OR = 1.08, 95% CI 0.77-1.51, p = 0.67). In nosocomial pneumonia and ventilator-associated pneumonia treatment, doripenem was not inferior to other antibacterial agents in terms of efficacy and safety. Conclusion: From this meta-analysis, we can conclude that doripenem is as valuable and well-tolerated than empirical antimicrobial agents for complicated intra-abdominal infections, complicated urinary tract infection, acute biliary tract infection and nosocomial pneumonia treatment. .


Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Carbapenems/therapeutic use , Cross Infection/drug therapy , Acute Disease , Anti-Bacterial Agents/adverse effects , Carbapenems/adverse effects , Cholangitis/drug therapy , Pneumonia, Bacterial/drug therapy , Pneumonia, Ventilator-Associated/drug therapy , Randomized Controlled Trials as Topic , Urinary Tract Infections/drug therapy
12.
Braz. j. infect. dis ; 17(5): 511-515, Sept.-Oct. 2013. tab
Article in English | LILACS | ID: lil-689874

ABSTRACT

To assess the adequacy of medical prescriptions for community-acquired pneumonia at the emergency department of the Hospital de Clínicas de Porto Alegre, we conducted a prospective cohort study, from January through April 2011. All patients with suspected pneumonia were selected from the first prescription of antimicrobials held in the emergency room. Patients with a description of pneumonia, community-acquired pneumonia, respiratory infection, or other issues related to community-acquired pneumonia were selected for review. Two-hundred and fifteen patients were studied. Adherence to the hospital care protocol was: 11.2% for the initial recommended tests (chest X-ray and collection of sputum sample), 34.4% for blood cultures, and 92.1% for the antimicrobial choice. Sixty percent of the prescriptions consisted of a combination of drugs, and the association of beta-lactam and macrolide was the most common. The Hospital Infection Control Committee evaluated patients' prescriptions within a median time of 23.5h (IQR 25-75%, 8-24). Negative evaluations accounted for 10% of prescriptions (n = 59). Fourteen percent of the patients died during hospitalization. In the multivariate analysis, Pneumonia Severity Index Score and use of ampicillin + sulbactam alone were independently related to in-hospital mortality. There was a high adherence to the hospital's CAP protocol, in relation to antimicrobial choice. Severity score and use of ampicillin + sulbactam alone were independently associated to in-hospital death.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Guideline Adherence , Pneumonia, Bacterial/drug therapy , Anti-Bacterial Agents/administration & dosage , Cohort Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Community-Acquired Infections/mortality , Hospital Mortality , Prospective Studies , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/mortality , Severity of Illness Index
13.
J. bras. pneumol ; 39(3): 339-348, jun. 2013. tab
Article in English | LILACS | ID: lil-678261

ABSTRACT

OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP. .


OBJETIVO: Identificar fatores de risco para o desenvolvimento de pneumonia adquirida no hospital (PAH), não associada à ventilação mecânica e causada por bactérias multirresistentes (MR). MÉTODOS: Estudo de coorte observacional retrospectivo, conduzido ao longo de três anos em um hospital universitário terciário. Incluímos apenas pacientes sem ventilação mecânica, com diagnóstico de PAH e com cultura bacteriana positiva. Variáveis categóricas foram comparadas por meio do teste do qui-quadrado. A análise de regressão logística foi usada para determinar os fatores de risco para PAH causada por bactérias MR. RESULTADOS: Dos 140 pacientes diagnosticados com PAH, 59 (42,1%) apresentavam infecção por cepas MR. As taxas de mortalidade nos pacientes com cepas de Staphylococcus aureus resistentes e sensíveis à meticilina, respectivamente, foram de 45,9% e 50,0% (p = 0,763). As taxas de mortalidade nos pacientes com PAH causada por bacilos gram-negativos MR e não MR, respectivamente, foram de 45,8% e 38,3% (p = 0,527). Na análise univariada, os fatores associados com cepas MR foram DPOC, insuficiência cardíaca crônica, insuficiência renal crônica, diálise, cateterismo urinário, infecções extrapulmonares e uso de antimicrobianos nos 10 dias anteriores ao diagnóstico de PAH. Na análise multivariada, o uso de antimicrobianos nos 10 dias anteriores ao diagnóstico foi o único fator preditor independente de cepas MR (OR = 3,45; IC95%: 1,56-7,61; p = 0,002). CONCLUSÕES: Neste estudo unicêntrico, o uso de antimicrobianos de largo espectro 10 dias antes do diagnóstico de PAH foi o único preditor independente da presença de bactérias MR em pacientes ...


Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/therapeutic use , Cross Infection/mortality , Drug Resistance, Multiple, Bacterial/drug effects , Pneumonia, Bacterial/mortality , Brazil/epidemiology , Carbapenems/therapeutic use , Cephalosporins/therapeutic use , Cross Infection/drug therapy , Cross Infection/microbiology , Hospitals, Teaching , Logistic Models , Predictive Value of Tests , Penicillins/therapeutic use , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiology , Quinolones/therapeutic use , Retrospective Studies , Risk Factors , Tertiary Care Centers
14.
Neumol. pediátr ; 8(2): 91-94, 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-701695

ABSTRACT

In this review we describe the recommendations on the management of community acquired pneumonia in children over three months of age, driving directions at home, in hospital, the criteria for admission to intensive care and recommendations for use of antibiotics according to the management guidelines, taking into account risk factors, vaccination, sensitivity, duration of therapy. Streptococcus pneumoniae remains the most common etiologic agent acquired bacterial pneumonia in healthy community, school age and adolescents, the majority of patients with community-acquired pneumonia not requiring hospitalization. All guidelines recommend penicillin or ampicillin as first-line treatment for uncomplicated pneumonia. Amoxicillin remains the drug of choice as empiric therapy in non-severe pneumonia in patients with and complete vaccination scheme. We review management recommendations for patients with incomplete vaccination schedules and different combinations of antibiotics schemes and their effectiveness. Recommendations are given on the support measures, criteria for evaluation and monitoring. Adhering to clinical management guidelines have a positive impact on morbidity and mortality from pneumonia.


En esta revisión se describen recomendaciones sobre el manejo de la neumonía adquirida en la comunidad en niños mayores de tres meses de edad, indicaciones de manejo en domicilio, en hospitalización, los criterios de internación en unidad de cuidados intensivos y recomendaciones de uso de antibióticos de acuerdo a las guías de manejo, teniendo en cuenta factores de riesgo, vacunación, sensibilidad, duración de la terapia. El Streptococcus pneumoniae continua siendo el agente etiológico más común en neumonía bacteriana adquirida en la comunidad en niños sanos, en edad escolar y adolescentes, la mayoría de los pacientes con neumonía adquirida en la comunidad no requieren hospitalización. Todas las guías recomiendan penicilina o ampicilina como primera línea de tratamiento para neumonía no complicada. La amoxicilina sigue siendo la droga de elección como terapia empírica en neumonía no grave, en pacientes con esquema e vacunación completa. Se revisan las recomendaciones de manejo para pacientes con esquemas de vacunación incompleta y las diferentes combinaciones de esquemas de antibióticos y su efectividad. Se dan recomendaciones sobre las medidas de apoyo, los criterios de evaluación y de seguimiento. El adherirse a las guías de manejo clínico tiene un impacto positivo en la morbilidad y mortalidad por neumonía.


Subject(s)
Humans , Child , Community-Acquired Infections/drug therapy , Pneumonia/drug therapy , Algorithms , Anti-Bacterial Agents/therapeutic use , Pneumonia, Bacterial/drug therapy , Streptococcus pneumoniae
15.
Mem. Inst. Oswaldo Cruz ; 107(6): 813-815, set. 2012. ilus
Article in English | LILACS | ID: lil-649499

ABSTRACT

Coccidioidomycosis is a systemic mycosis with a variable clinical presentation. Misdiagnosis of coccidioidomycosis as bacterial pneumopathy leads to inappropriate prescription of antibiotics and delayed diagnosis. This report describes an outbreak among armadillo hunters in northeastern Brazil in which an initial diagnosis of bacterial pneumonia was later confirmed as coccidioidomycosis caused by Coccidioides posadasii. Thus, this mycosis should be considered as an alternative diagnosis in patients reporting symptoms of pneumonia, even if these symptoms are only presented for a short period, who are from areas considered endemic for this disease.


Subject(s)
Adolescent , Animals , Humans , Male , Middle Aged , Armadillos/microbiology , Coccidioidomycosis/diagnosis , Lung Diseases, Fungal/diagnosis , Pneumonia, Bacterial/diagnosis , Pneumonia/diagnosis , Brazil/epidemiology , Coccidioides/isolation & purification , Coccidioidomycosis/epidemiology , Disease Outbreaks , Lung Diseases, Fungal/epidemiology , Pneumonia, Bacterial/drug therapy , Pneumonia/epidemiology , Soil Microbiology
16.
Braz. j. infect. dis ; 16(4): 393-395, July-Aug. 2012. ilus
Article in English | LILACS | ID: lil-645431

ABSTRACT

Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.


Subject(s)
Female , Humans , Middle Aged , Anti-Bacterial Agents/adverse effects , Ofloxacin/adverse effects , Shoulder Pain/chemically induced , Tendinopathy/chemically induced , Community-Acquired Infections/drug therapy , Magnetic Resonance Imaging , Pneumonia, Bacterial/drug therapy , Severity of Illness Index
18.
J. bras. pneumol ; 38(2): 148-157, mar.-abr. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-623393

ABSTRACT

OBJETIVO: Avaliar a concordância entre os critérios de hospitalização utilizados para a admissão de pacientes com pneumonia adquirida na comunidade (PAC) e aqueles da Sociedade Brasileira de Pneumologia e Tisiologia e avaliar a associação dessa concordância com a taxa de mortalidade em 30 dias. Secundariamente, avaliar a associação da concordância entre o tratamento instituído e as recomendações dessas diretrizes com duração da internação hospitalar, investigação microbiológica, mortalidade em 12 meses, complicações, internação em UTI, ventilação mecânica e mortalidade em 30 dias. MÉTODOS: Estudo retrospectivo que incluiu pacientes adultos internados entre 2005 e 2007 no Hospital das Clínicas da Universidade Federal de Minas Gerais, na cidade de Belo Horizonte (MG). Foram revisados prontuários e radiografias de tórax. RESULTADOS: Dentre os 112 pacientes incluídos, os critérios de internação e de tratamento foram concordantes com as diretrizes em 82 (73,2%) e 66 (58,9%), respectivamente. A taxa de mortalidade em 30 dias e em 12 meses foi de 12,3% e 19,4%, respectivamente. Pacientes com escore de CRP-65 (Confusão mental, frequência Respiratória, Pressão arterial e idade > 65 anos) de 1-2 e com antibioticoterapia concordante com as diretrizes foram associados a menor mortalidade em 30 dias (p = 0,01). Doença cerebrovascular e tratamento antibiótico adequado apresentaram associações independentes com mortalidade em 30 dias. Houve uma tendência de associação entre antibioticoterapia concordante e menor duração da internação hospitalar. CONCLUSÕES: Na população estudada, os critérios de hospitalização e de antibioticoterapia concordantes com as diretrizes associaram-se a desfechos favoráveis do tratamento de pacientes hospitalizados com PAC. Doença cerebrovascular, como fator de risco, e antibioticoterapia concordante, como fator protetor, associaram-se à mortalidade em 30 dias.


OBJECTIVE: To evaluate the agreement between the criteria used for hospitalization of patients with community-acquired pneumonia (CAP) and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. METHODS: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. RESULTS: Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2%) and 66 (58.9%), respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age > 65 years) score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01). Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guideline-concordant antibiotic therapy and shorter hospital stay. CONCLUSIONS: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/therapeutic use , Guideline Adherence , Pneumonia, Bacterial/drug therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/mortality , Hospital Mortality , Hospitalization , Hospitals, University , Intensive Care Units , Pneumonia, Bacterial/mortality , Retrospective Studies , Severity of Illness Index , Treatment Outcome
19.
Rev. cuba. invest. bioméd ; 31(1): 53-62, ene.-mar. 2012.
Article in Spanish | LILACS | ID: lil-644734

ABSTRACT

Las bacterias gramnegativas se consideran como causa frecuente de neumonía en pacientes VIH/sida. La emergente y elevada proporción de microorganismos resistentes obliga a utilizar el antibiograma como un método que definirá la terapéutica de estos pacientes. Objetivos: identificar las bacterias gramnegativas que causan neumonía en pacientes VIH/sida y determinar la sensibilidad antimicrobiana de los microorganismos aislados. Métodos: se realizó un estudio descriptivo prospectivo en el Instituto Pedro Kourí de 85 pacientes con VIH/sida y diagnóstico presuntivo de neumonía bacteriana por criterios clínicos y radiológicos. Se recogieron muestras de esputo y sangre para cultivo. Las bacterias aisladas y la sensibilidad antimicrobiana se determinaron por el sistema semiautomatizado miniApi (bioMérieux). Resultados: se aislaron 74 bacterias potencialmente patógenas de las que 32 (43,2 porciento) se clasificaron como gramnegativas. Predominaron Klebsiella pneumoniae (11 cepas: 34,3 porciento), Pseudomonas spp. (8 cepas: 25 porciento) y Escherichia coli (4 cepas: 12,5 porciento). Escherichia coli mostró el mayor porcentaje de resistencia y el 75 porciento de las cepas fue sensible frente a la amikacina. No se encontró resistencia al meropenem y más del 50 porciento de las enterobacterias identificadas con excepción de E.coli fueron sensibles a las cefalosporinas de tercera generación, ciprofloxacina, amikacina y cotrimoxazol. Pseudomonas spp. presentó resistencia al cotrimoxazol (87 porciento) y ticarcilina (75 porciento). Conclusiones: las bacterias gramnegativas causan en un porcentaje no despreciable neumonía en pacientes con VIH/sida. Aunque persisten cepas resistentes frente a diversos antimicrobianos, las cefalosporinas, quinolonas y los carbapenémicos muestran una adecuada actividad frente a estas bacterias


Gramnegative bacteria are considered to be a common cause of pneumonia in HIV/AIDS patients. The emergence of a large number of resistant microorganisms has made it necessary to use antibiograms to decide what treatment will be applied to these patients. Objectives: identify gramnegative bacteria causing pneumonia in HIV/AIDS patients and determine the antimicrobial sensitivity of the microorganisms isolated. Methods: a prospective descriptive study of 85 patients with HIV/AIDS and presumed diagnosis of bacterial pneumonia was carried out at Pedro Kourí Institute applying clinical and radiological criteria. Sputum and blood samples were collected to be cultured. The bacteria isolated and their antimicrobial sensitivity were determined using the mini-Api (bioMÚrieux) semiautomated system. Results: seventy-four potentially pathogenic bacteria were isolated, of which 32 (43.2 percent) were classified as gramnegative. The prevailing ones were Klebsiella pneumoniae (11 strains: 34.3 percent), Pseudomonas spp. (8 strains: 25 percent) and Escherichia coli (4 strains: 12,5 percent). Escherichia coli exhibited the highest resistance percentage. 75 percent of the strains were sensitive to amikacin. No resistance was found to meropenem, and more than 50 percent of the enterobacteria identified, with the exception of E. coli, were sensitive to third-generation cephalosporins, ciprofloxacin, amikacin and cotrimoxazol. Pseudomonas spp. showed resistance to cotrimoxazol (87 percent) and ticarcillin (75 percent). Conclusions: gramnegative bacteria cause pneumonia in HIV/AIDS patients to a considerable extent. There continue to be strains which are resistant to various antimicrobial drugs. However, cephalosporins, quinolones and carbapenemics exhibit adequate activity against these bacteria


Subject(s)
Gram-Negative Bacteria/pathogenicity , Drug Resistance, Bacterial , AIDS-Related Opportunistic Infections/diagnosis , Pneumonia, Bacterial/drug therapy , Microbial Sensitivity Tests/methods , Epidemiology, Descriptive , Prospective Studies
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