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1.
Rev. Soc. Bras. Med. Trop ; 53: e20200032, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136877

ABSTRACT

Abstract INTRODUCTION: Essential oils can serve as novel sources of antibiotics for multidrug-resistant bacteria. METHODS: The multidrug-resistance profile of a Klebsiella aerogenes strain was assessed by PCR and sequencing. The antibacterial activity of Cinnamomum cassia essential oil (CCeo) against K. aerogenes was assessed by broth microdilution and time-kill methods. RESULTS: K. aerogenes showed high antibiotic resistance. The genes bla KPC-2, ampC, bla CTX-M-15, bla OXA-1, and bla TEM were present. CCeo exhibited an inhibitory effect with a minimum inhibitory concentration of 17.57 μg/mL. CONCLUSIONS: The antibacterial activity of CCeo makes it a potential candidate for treating carbapenem- and polymyxin-resistant K. aerogenes strains.


Subject(s)
Humans , Klebsiella Infections/drug therapy , Enterobacter aerogenes , Cinnamomum aromaticum , Anti-Bacterial Agents/therapeutic use , beta-Lactamases , Oils, Volatile , Carbapenems , Polymyxins , Klebsiella pneumoniae
2.
Mem. Inst. Oswaldo Cruz ; 114: e180555, 2019. tab
Article in English | LILACS | ID: biblio-1002680

ABSTRACT

BACKGROUND Polymyxins are currently used as a "last-line" treatment for multidrug-resistant Gram-negative infections. OBJECTIVES To identify the major mechanisms of resistance to polymyxin and compare the genetic similarity between multi-drug resistant Klebsiella pneumoniae strains recovered from inpatients of public hospitals in the Mid-West of Brazil. METHODS 97 carbapenems non-susceptible K. pneumoniae were studied. β-lactamases (bla OXA-48, bla KPC, bla NDM, bla CTX-M, bla SHV, bla TEM, bla IMP, bla VIM) and mcr-1 to mcr-5 genes were investigated by polymerase chain reaction (PCR). Mutations in chromosomal genes (pmrA, pmrB, phoP, phoQ, and mgrB) were screened by PCR and DNA sequencing. Clonal relatedness was established by using pulsed-field gel electrophoresis and multilocus sequence typing. FINDINGS K. pneumoniae isolates harbored bla KPC (93.3%), bla SHV (86.6%), bla TEM (80.0%), bla CTX-M (60%) genes. Of 15 K. pneumoniae resistant to polymyxin B the authors identified deleterious mutations in pmrB gene, mainly in T157P. None K. pneumoniae presented mcr gene variants. Genetic polymorphism analyses revealed 12 different pulsotypes. MAIN CONCLUSIONS Deleterious mutations in pmrB gene is the main chromosomal target for induction of polymyxin resistance in carbapenem-resistant K. pneumoniae in public hospitals in the Mid-West of Brazil.


Subject(s)
Humans , Colistin , Polymyxins , Drug Resistance, Multiple
3.
Article in English | WPRIM | ID: wpr-717696

ABSTRACT

Carbapenem-resistant Enterobacteriaceae (CRE) are now spread worldwide. In Korea, the number of CRE isolation is rapidly increasing, and impending endemicity is a concern. To cope well with CRE, thorough infection control, such as active surveillance, early detection, strict contact precaution, cleaning the environment, and antibiotic stewardship is very important. Therapeutic options include polymyxin, tigecycline, fosfomycin or the combination of them with carbapenem, which is currently the mainstay of treatment. In addition, various combination regimens with new carbapenemase inhibitors such as avibactam, vaborbactam, or relebactam, and other classes of antimicrobials such as plazomicin and siderophore cephalosporin are in the process of evaluation.


Subject(s)
Carbapenems , Enterobacteriaceae , Fosfomycin , Infection Control , Korea , Polymyxins
4.
Braz. j. microbiol ; 47(supl.1): 31-37, Oct.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-839327

ABSTRACT

ABSTRACT During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.


Subject(s)
Humans , Drug Resistance, Bacterial , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/epidemiology , Anti-Infective Agents/pharmacology , Plasmids/genetics , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , beta-Lactamases/genetics , beta-Lactamases/metabolism , Brazil/epidemiology , Polymyxins/therapeutic use , Polymyxins/pharmacology , beta-Lactams/therapeutic use , beta-Lactams/pharmacology , Enterobacteriaceae/enzymology , Enterobacteriaceae/genetics , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
5.
Article in English | WPRIM | ID: wpr-78041

ABSTRACT

Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.


Subject(s)
Adult , Cardiomyopathies , Endotoxins , Extracorporeal Membrane Oxygenation , Hemodynamics , Hemoperfusion , Humans , Membranes , Oxygen , Polymyxin B , Polymyxins , Pyelonephritis , Salvage Therapy , Sepsis , Shock , Shock, Septic
6.
Article in English | WPRIM | ID: wpr-770936

ABSTRACT

Although shock in sepsis is usually managed successfully by conventional medical treatment, a subset of cases do not respond and may require salvage therapies such as veno-arterial extracorporeal membrane oxygenation (VA ECMO) support as well as an attempt to remove endotoxins. However, there are limited reports of attempts to remove endotoxins in patients with septic shock on VA ECMO support. We recently experienced a case of septic shock with severe myocardial injury whose hemodynamic improvement was unsatisfactory despite extracorporeal membrane oxygenation (ECMO) support. Since the cause of sepsis was acute pyelonephritis and blood cultures grew gram-negative bacilli, we additionally applied polymyxin B direct hemoperfusion (PMX-DHP) to the ECMO circuit and were able to successfully taper off vasopressors and wean off ECMO support. To the best of our knowledge, this is the first adult case in which PMX-DHP in addition to ECMO support was successfully utilized in a patient with septic shock. This case indicates that additional PMX-DHP therapy may be beneficial and technically feasible in patients with septic shock with severe myocardial injury refractory to ECMO support.


Subject(s)
Adult , Cardiomyopathies , Endotoxins , Extracorporeal Membrane Oxygenation , Hemodynamics , Hemoperfusion , Humans , Membranes , Oxygen , Polymyxin B , Polymyxins , Pyelonephritis , Salvage Therapy , Sepsis , Shock , Shock, Septic
7.
Rev. Soc. Bras. Med. Trop ; 48(4): 483-487, July-Aug. 2015. tab, ilus
Article in English | LILACS | ID: lil-755967

ABSTRACT

INTRODUCTION:

Polymyxins are antimicrobial agents capable of controlling carbapenemase-producing Klebsiella pneumoniae infection.

METHODS:

We report a cluster of four patients colonized or infected by polymyxin-resistant and Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.

RESULTS:

Three patients were hospitalized in adjacent wards, and two were admitted to the intensive care unit. The index case maintained prolonged intestinal colonization by KPC-producing K. pneumoniae. Three patients received polymyxin B before the isolation of polymyxin-resistant K. pneumoniae.

CONCLUSIONS:

Colonization by KPC-producing K. pneumoniae and previous use of polymyxin B may be causally related to the development of polymyxin-resistant microorganisms.

.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Cross Infection/microbiology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Polymyxins/pharmacology , Carbapenems/pharmacology , Drug Resistance, Bacterial , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests
8.
Braz. j. infect. dis ; 19(2): 170-180, Mar-Apr/2015. tab, graf
Article in English | LILACS | ID: lil-746521

ABSTRACT

In recent years, carbapenem-resistant Enterobacteriaceae has become endemic in many countries. Because of limited treatment options, the abandoned "old antibiotics", polymyxins, have been reintroduced to the clinic. To evaluate the clinical efficacy of polymyxins in the treatment of infections caused by carbapenem-resistant Enterobacteriaceae, we systemically searched the PubMed, Embase, and Cochrane Library databases and analyzed the available evidence. The Preferred Reporting Items for Systematic reviews and Meta-Analysis statement were followed, and the I2 method was used for heterogeneity. Nineteen controlled and six single-arm cohort studies comprising 1086 patients met the inclusion criteria. For controlled studies, no significant difference was noted for overall mortality (OR, 0.79; 95% CI, 0.58-1.08; p = 0.15), clinical response rate (OR, 1.24; 95% CI, 0.61-2.54; p = 0.55), or microbiolog- ical response rate (OR, 0.59; 95% CI, 0.26-1.36; p = 0.22) between polymyxin-treated groups and the control groups. Subgroup analyses showed that 28-day or 30-day mortality was lower in patients who received polymyxin combination therapy than in those who received monotherapy (OR, 0.36; 95% CI, 0.19-0.68; p < 0.01) and the control groups (OR, 0.49; 95% CI, 0.31-0.75; p < 0.01). The results of the six single-arm studies were in accordance with the findings of controlled studies. One controlled and two single-arm studies that evaluated the occurrence of nephrotoxicity reported a pooled incidence rate of 19.2%. Our results suggest that polymyxins may be as efficacious as other antimicrobial therapies for the treatment of carbapenem-resistant Enterobacteriaceae infection. Compared to polymyxin monotherapy, combination regimens may achieve lower 28-day or 30-day mortality. Future large-volume, well-designed randomized control trials are required to determine the role of polymyxins in treating carbapenem-resistant Enterobacteriaceae infections.


Subject(s)
Humans , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Enterobacteriaceae Infections/drug therapy , Polymyxins/therapeutic use , beta-Lactam Resistance , Anti-Bacterial Agents/adverse effects , Carbapenems/therapeutic use
9.
Rev. bras. anal. clin ; 47(1-2): 5-12, 2015.
Article in Portuguese | LILACS | ID: biblio-835823

ABSTRACT

Pseudomonas aeruginosa é uma bactéria de grande importância para indivíduos imunocomprometidos. No Brasil, ela é um dos principais agentes em infecções hospitalares e pode provocar diversos tipos de processos clínicos. Atualmente, um dos maiores desafios em infecções provocadas por P. aeruginosa é a resistência apresentada diante de inúmeros antimicrobianos. Além da resistência intrínseca de P.aeruginosa, essa bactéria facilmente desenvolve mecanismos de resistência adicionais, através de mutações e da aquisição de elementos genéticos móveis, por exemplo. Dessa forma, P. aeruginosa é considerada um patógeno multirresistente, o que limita as alternativas terapêuticas capazes de combatê-lo. Portanto, compreender osmecanismos que levam a essa resistência é de extrema importância para enfrentar as infecções por P. aeruginosa.


Pseudomonas aeruginosa is a bacterium of great importance forimmunocompromised individuals. In Brazil, it is one of the leadingcauses of hospital infections and can cause many types of infections.Currently, one of the biggest challenges in infections caused by P.aeruginosa is the resistance presented against numerousantimicrobials. In addition to the intrinsic resistance of P. aeruginosa,inherent in the species, this bacterium easily acquire additionalmechanisms of resistance via mutation and acquisition of mobilegenetic elements, for example. Accordingly, P. aeruginosa isconsidered a multidrug-resistant pathogen, which limits thetherapeutic alternatives able to fight it. Therefore, understanding themechanisms that lead to this resistance is of utmost importance totackle infections by P. aeruginosa.


Subject(s)
Humans , Cross Infection , Drug Resistance, Microbial , Drug Resistance, Multiple, Bacterial , Pseudomonas aeruginosa , Aminoglycosides , beta-Lactamases , Fluoroquinolones , Polymyxins , Porins
10.
Article in English | WPRIM | ID: wpr-96081

ABSTRACT

Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.


Subject(s)
Cause of Death , Critical Illness , Gram-Negative Bacteria , Hemoperfusion , Humans , Middle Aged , Polymyxin B , Polymyxins , Pseudomonas aeruginosa , Sepsis , Shock, Septic
11.
Article in English | WPRIM | ID: wpr-770885

ABSTRACT

Severe sepsis and septic shock are the main causes of death in critically ill patients. Early detection and appropriate treatment according to guidelines are crucial for achieving favorable outcomes. Endotoxin is considered to be a main element in the pathogenic induction of gram-negative bacterial sepsis. Polymyxin B hemoperfusion can remove endotoxin and is reported to improve clinical outcomes in patients with intra-abdominal septic shock, but its clinical efficacy for pneumonic septic shock remains unclear. Here, we report a case of a 51-year-old man with pneumonic septic shock caused by Pseudomonas aeruginosa, who recovered through polymyxin B hemoperfusion.


Subject(s)
Cause of Death , Critical Illness , Gram-Negative Bacteria , Hemoperfusion , Humans , Middle Aged , Polymyxin B , Polymyxins , Pseudomonas aeruginosa , Sepsis , Shock, Septic
13.
São Paulo; s.n; 2014. [139] p. tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-870773

ABSTRACT

Introdução: Infecções por Enterobactérias resistentes aos carbapenêmicos (ERC), em especial produtoras de Klebsiella pneumoniae carbapenamase tipo KPC hoje são endêmicas em diversas regiões do mundo, seu tratamento é ainda um grande desafio em particular de isolados resistentes à polimixina. Objetivos: Descrever as características clínicas, microbiológicas e moleculares das infecções por ERC. Método: Estudo de coorte prospectiva, realizado no Hospital Universitário de Londrina, Paraná, Brasil, entre março de 2011 a dezembro de 2012. Foram acompanhados pacientes >= 18 anos, que apresentaram infecção por ERC. Dados demográficos e clínicos como idade, sexo, diagnóstico à admissão e presença de co-morbidades de acordo com critérios de Charlson, internação em Unidade de Terapia intensiva e scores APACHE e SOFA desses pacientes, colonização prévia por ERC, cirurgia prévia à infecção, diálise, uso prévio de antimicrobianos e sítio de infecção foram coletados. Foram avaliados os antimicrobianos utilizados para tratamento das infecções por mais de 48 horas nos seguintes pontos: monoterapia ou terapia associada, tempo de início (menor e maior que 12 horas). A identificação do agente foi realizada por método automatizado (Vitek II - bioMerieuxR) e a concentração inibitória mínima dos antibióticos por técnica de microdiluição em caldo, pesquisa de gene blaKPC pela técnica de Polimerase Chain Reaction e sinergismo entre drogas utilizadas em tratamento combinado por meio do método Time Kill. A clonalidade, por Pulsed Field gel eletroforese e analisada por dendograma pelo Bionumerics. Foram realizadas análise bivariada e regressão logística multivariada com técnica de Forward Stepwise para detectar fatores de risco para resistência a polimixina e mortalidade. O nível de significância adotado foi de 5%, utilizando os programas Epi Info 7.0 e SPSS. Resultados: No período de estudo, 127 pacientes apresentaram infecções por ERC, idade média de 55,7 (± 18) anos e 88 (69.3%) do...


Introduction: Infections due to Carbapenem resistant Enterobacteriaceae (CRE), particularly Klebsiella pneumoniae producing carbapenemase type KPC, have been endemic in several regions around the world. Their treatment remains a major challenge, particularly for isolates resistant to polymyxin. Objectives: To describe the clinical, microbiological and molecular characteristics of infections by CRE. Methods: Prospective cohort conducted at the University Hospital of Londrina, Paraná, Brazil, from March 2011 to December 2012. All hospitalized patients >= 18 years old who developed infection by CRE were followed until death or discharge. We collected and analyzed the following clinical data: age, sex, diagnosis at admission, presence of comorbidities according to the Charlson criteria, admission in Intensive Care Unit, APACHE and SOFA scores, previous colonization by CRE, previous surgery, dialysis, prior antibiotic use and infection site; furthermore, we also evaluated the time between the blood culture collect and the first antimicrobial dose administration (start time - smaller or longer than 12 hours) as well as whether the treatment was monotherapy or combine therapy for more than 48 hours. The microbiological identification was performed by automated method (Vitek II - bioMerieuxR) and the minimum inhibitory concentration of antibiotics by broth microdilution technique, research blaKPC gene by the technique of Polymerase Chain Reaction and synergism between the drugs used in the combination therapy by Time Kill method. The clonality was carried out by pulsed-field gel electrophoresis and analyzed by dendrogram by BioNumerics. Bivariate analyses and multivariate logistic regression with forward stepwise technique were performed to detect risk factors for resistance to polymyxin and mortality. The level of significance was 5%, using Epi Info 7.0 and SPSS programs. Results: During the study period, 127 patients developed infections by CRE,...


Subject(s)
Humans , Adult , Carbapenems , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae , Polymyxins
14.
Infection and Chemotherapy ; : 149-164, 2014.
Article in English | WPRIM | ID: wpr-102293

ABSTRACT

The prevalence of carbapenem-resistant gram-negative bacterial pathogens (CRGNs) has increased dramatically during the last 10 years, but the optimal treatment for CRGN infections is not well established due to the relative scarcity of robust clinical data. The polymyxins remain the most consistently active agents against CRGNs in vitro. Tigecycline, based on its in vitro antibacterial spectrum, could also be considered as a therapeutic option in the treatment of infections caused by certain CRGNs. Other agents, including aminoglycosides, rifampin, trimethoprim-sulfamethoxazole, fosfomycin and fluoroquinolones, could be considered as monotherapy or combination therapy against CRGNs in appropriate contexts, as combination therapy with two or more in vitro active drugs appears to be more effective than monotherapy based on some clinical data. Several promising new agents are in late-stage clinical development, including ceftolozane-tazobactam, ceftazidime-avibactam and plazomicin. Given the shortage of adequate treatment options, containment of CRGNs should be pursued through implementation of adequate infection prevention procedures and antimicrobial stewardship to reduce the disease burden and prevent future outbreaks of CRGNs.


Subject(s)
Aminoglycosides , Colistin , Containment of Biohazards , Disease Outbreaks , Drug Therapy, Combination , Fluoroquinolones , Fosfomycin , Polymyxins , Prevalence , Rifampin , Trimethoprim, Sulfamethoxazole Drug Combination
15.
Acta méd. peru ; 30(3): 128-135, jul.-set. 2013. ilus, graf, mapas, tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-702422

ABSTRACT

Introducción: La vaginosis bacteriana (VB) es un síndrome polimicrobiano, en la cual la flora dominante de lactobacilos normales es sustituida por una flora polimicrobiana. La prevalencia de VB en Perú varía entre 27 y 43,7%. El Centro de Control y Prevención de Enfermedades (DCD) sugiere el tratamiento de VB en mujeres sintomáticas con metronidazol oral/gel o clindamicina crema. Se planteó en el presente estudio evaluar la eficacia, tolerancia y seguridad de la combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda para el tratamiento de VB. Material y Métodos: El presente estudio de tipo abierto, observacional, prospectivo, permitió evaluar la eficacia, tolerancia y seguridad en la aplicación de la combinación de metronidazol, miconazol, centella asiática, polimixina y neomicina en cápsula blanda. Resultados: Se incluyó a 61 pacientes con edad promedio de 29.28 años (rango 18-48) de las cuales 93,4% tenía historia previa de flujo vaginal anormal. Se realizaron dos visitas durante el estudio, la primera para diagnóstico e inicio de tratamiento y la segunda de control post tratamiento. Tres pacientes no tuvieron segunda visita y 8 no tenían registrada toda la información para definir la respuesta terapéutica. La segunda visita se realizó a los 21 días en promedio. Los principales signos y síntomas en la primera visita de diagnóstico fueron flujo vaginal (100,0%), disconfort vaginal (85,2%), dispareunia (70,5%) y dolor abdominal bajo (57,4%), las cuales disminuyeron en forma significativa (p<0,05) a la segunda visita post tratamiento. La prueba de aminas resultó positiva en el 93,4% de los casos en la primera visita y en el 15,5% de los casos en la segunda visita (p<0,05). De la población inicial de estudio, solo 53 mujeres son evaluables para eficacia terapéutica...


Introduction: Bacterial vaginosis (BV) is a polymicrobial syndrome, in which the normal dominant flora consisting in Lactobacillus is replaced by polymicrobial flora. The prevalence of BV in Peru varies between 27 and 43.7%. The Centers for Disease Control and Prevention suggest therapy for BV in symptomatic women should include oral/gel metronidazole or clindamycin cream. We proposed in this study to evaluate the efficacy, tolerability and safety of the combination of metronidazole, miconazole, Gotu kola (Centella asiatica), polymixin, and neomycin in soft capsules, for the treatment of BV. Material and Methods: This investigation was an open, observational, and prospective study, which allowed us to evaluate the efficacy, tolerability and safety of the aforementioned combined therapy administered in soft capsules. Results: The study included 61 patients with a mean age of 29.28 years (range, 18-48) and 93.4% had a history of abnormal vaginal discharge. Two visits took place during the study, the first for making the diagnosis and initiating therapy, and the second was the post-treatment control. Three patients did not have a second visit and 8 did not record all the information required to define the therapeutic response. The second visit took place after 21 days on average. The main signs and symptoms at the first visit were vaginal discharge at diagnosis (100.0%), vaginal discomfort (85.2%), dyspareunia (70.5%) and lower abdominal pain (57.4%), which were significantly reduced (p <0.05) in the second visit after treatment. The amine test was positive in 93.4% of cases in the first visit and in 15.5% of cases in the second visit (p <0.05). From the initial population in the study, only 53 women are evaluable for efficacy. An overall response rate in 44 women (83.02%) was achieved with the soft capsule combination treatment. Adverse events were reported in only one case...


Subject(s)
Humans , Adolescent , Adult , Female , Young Adult , Middle Aged , Centella/therapeutic use , Metronidazole/therapeutic use , Miconazole/therapeutic use , Neomycin/therapeutic use , Polymyxins/therapeutic use , Vaginosis, Bacterial/therapy , Observational Studies as Topic , Prospective Studies
16.
Chinese Journal of Pediatrics ; (12): 298-301, 2013.
Article in Chinese | WPRIM | ID: wpr-359751

ABSTRACT

<p><b>OBJECTIVE</b>To study the characteristics of community-acquired urinary tract infections (CAUTIs) in children, analyze the risk factors and the susceptibility of antibiotics, thus to provide references to the diagnosis and medication of Pseudomonas aeruginosa (PA)-CAUTIs. Mothod Totally 22 cases of PA-CAUTIs were selected in one hospital from Jan, 2006 to Jan, 2012, their clinical information, laboratory results and radiological images were collected, and were compared with the CAUTIs cased by E. coli of those randomly selected over the same period.</p><p><b>RESULT</b>In those 22 cases with PA-CAUTIs, the mean value of protein level was (32.25 ± 13.81) mg/ml, 19 of them were hospitalized, 6 had urinary operation history, 7 of them had long-term usage of glucocorticoids or immunosuppressive agents, and 20 had underlying diseases. A total of 22 children with 26 PA-CAUTIs episodes were compared to E. coli-CAUTIs. Compared with E. coli-CAUTIs patients, children with PA-CAUTIs more often presented with a lower albumin (P = 0.017), a history of urinary operation(P = 0.03), more cases had a history of urinary operation (P = 0.03), a long-term usage of glucocorticoids or immunosuppressive medication (P = 0.044). Through multivariate logistic regression of variables that were significant in univariate analysis (with hospitalizations, long-term usage of glucocorticoids or immunosuppressive, albumin, underlying disease and urinary operation histories), and it turned out that underlying diseases (odds ratio 8.500, 95% CI 1.513 - 47.761, P = 0.037) and with urinary operation histories (odds ratio 6.196, 95% CI 1.120 - 34.273, P = 0.037) were proved as the independent risk factors for PA-CAUTIs. Those PA bacterial strains had a 36.36% resistance rate to piperacillin, aztreonam and gentamicin, a 31.82% resistance rate to cefepime and ceftazidime, while the resistance rate (4.55%) to carbapenem antibiotics was relatively low, only to bacillosporin all the strains were sensitive.</p><p><b>CONCLUSION</b>Underlying diseases and the urinary operation histories are the independent risk factors of the occurrence of PA-CAUTIs, carbapenem antibiotics and bacillosporin can be considered as the drugs of choice for its treatment.</p>


Subject(s)
Anti-Bacterial Agents , Therapeutic Uses , Case-Control Studies , Child , Child, Preschool , Community-Acquired Infections , Drug Therapy , Epidemiology , Pathology , Drug Resistance, Bacterial , Escherichia coli , Escherichia coli Infections , Drug Therapy , Epidemiology , Pathology , Female , Humans , Male , Polymyxins , Therapeutic Uses , Pseudomonas Infections , Drug Therapy , Epidemiology , Pathology , Pseudomonas aeruginosa , Risk Factors , Urinary Tract Infections , Drug Therapy , Epidemiology , Pathology
17.
Article in English | WPRIM | ID: wpr-77065

ABSTRACT

Antimicrobial resistance in bacteria is problematic in clinical settings and is a growing threat to public health. Multidrug-resistant and pandrug-resistant non-fermenters such as Acinetobacter spp. and Pseudomonas aeruginosa have recently emerged as a great concern worldwide. Particularly, the prevalence of carbapenem resistance in Acinetobacter spp. and P. aeruginosa is problematic, and emergence of polymyxin resistance is ominous. In this review, we discuss carbapenem and polymyxin resistance in Acinetobacter spp. and P. aeruginosa isolates and their major clones.


Subject(s)
Acinetobacter , Bacteria , Carbapenems , Clone Cells , Polymyxins , Prevalence , Pseudomonas , Pseudomonas aeruginosa , Public Health
18.
Indian J Med Microbiol ; 2011 Jul-Sept; 29(3): 230-242
Article in English | IMSEAR | ID: sea-143823

ABSTRACT

The increasing prevalence of multidrug-resistant nosocomial pathogens such as Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae poses a great challenge to the treating physicians. The paucity of newer effective antimicrobials has led to renewed interest in the polymyxin group of drugs, as a last resort for treatment of gram-negative bacterial infections. There is a dearth of information on the pharmacological properties of colistin, leading to difficulties in selecting the right dose, dosing interval, and route of administration for treatment, especially in critically-ill patients. The increasing use of colistin over the last few years necessitates the need for accurate and reliable in vitro susceptibility testing methods. Development of heteroresistant strains as a result of colistin monotherapy is also a growing concern. There is a compelling need from the clinicians to provide options for probable and possible colistin combination therapy for multidrug-resistant bacterial infections in the ICU setting. Newer combination drug synergy determination tests are being developed and reported. There are no standardized recommendations from antimicrobial susceptibility testing reference agencies for the testing and interpretation of these drug combinations. Comparison and analysis of these reported methodologies may help to understand and assist the microbiologist to choose the best method that produces accurate results at the earliest. This will help clinicians to select the appropriate combination therapy. In this era of multidrug resistance it is important for the microbiology laboratory to be prepared, by default, to provide timely synergistic susceptibility results in addition to routine susceptibility, if warranted. Not as a favour or at request, but as a responsibility.


Subject(s)
Acinetobacter baumannii/drug effects , Acinetobacter baumannii/isolation & purification , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/microbiology , Humans , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests/methods , Polymyxins/pharmacology , Polymyxins/therapeutic use , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/isolation & purification
19.
Journal of Basic and Applied Sciences. 2011; 7 (2): 169-174
in English | IMEMR | ID: emr-110420

ABSTRACT

Two pesticides one from OP compound [Chlorpyrifos] and other from Biopesticides [Neem extract] were applied against 3[rd] instar larvae of house flies by contact method. LC[50 of Chlorpyrifos and Neem extract was calculated as 0.25% for chlorpyrifos and 0.42% for Neem Extract. Treated larvae when succeeded to reach the adult stage, the effects of the mentioned insecticides were noted on fecundity of adults of Musca domestica. Chlorpyrifos delayed egg-laying while Neem extract completely inhibited the egg-laying. Moreover, the treated larvae when succeeded to pupate, they failed to emerge from the pupal case completely and the larvae got heavy melanization after 48 hours of treatment


Subject(s)
Insecta , Pesticides , Chlorpyrifos , Muscidae/drug effects , Fertility/drug effects , Polymyxins , Oviposition/drug effects , Larva/drug effects
20.
Braz. dent. sci ; 12(3): 38-43, jul.-set. 2009. tab
Article in Portuguese | LILACS, BBO | ID: lil-587927

ABSTRACT

A proposta deste estudo foi avaliar a efetividade da solução de clorexidina 2% e medicações intracanais sobre Eschericha coli e endotoxina em canais radiculares. Os canais radiculares de 48 dentes unirradiculados foram contaminados com E. coli por 14 dias, instrumentados com solução de clorexidina 2% e divididos em 3 grupos de acordo com a medicação intracanal (MIC) utilizada: pasta de Ca(OH)2, polimixina B, Ca(OH)2 + clorexidina gel 2% (CLX). No grupo controle foi utilizada somente solução fisiológica. Foram realizadas coletas do conteúdo do canal radicular imediatamente após a instrumentação (S1), após 7 dias da instrumentação (S2), imediatamente após 14 dias da ação da MIC (S3) e 7 dias após remoção da MIC (S4). Para todas as coletas foram realizados os seguintes testes: a) análise microbiológica; b)quantificação de endotoxina pelo teste cromogênico do lisado de amebócitos do Limulus. Os resultados foram analisados pelo teste de ANOVA e Dunn (5%). Na amostra S2 a sol. CLX 2% apresentou melhores resultados em relação à solução fisiológica. Na amostra S3 houve diferença estatística do Ca(OH)2 + CLX em relação ao Ca(OH)2 e polimixina B. Na amostra S4 não houve diferenças estatísticas significantes entre os grupos. Conclui-se que somente as medicações intracanais são capazes de diminuir significativamente a quantidade de endotoxinas.


The aim of this study was to evaluate the effectiveness of the 2% chlorhexidine solution and medications on Eschericha coli and endotoxin in root canals. The root canals of 48 single-rooted teeth were contaminated with E. coli for 14 days, instrumented with 2% chlorhexidine solution and divided into 3 groups according to the intracanal medication (ICM) used: Ca(OH)2 paste, polymyxin B (PB), Ca(OH)2 + 2% chlorhexidine gel (CLX). The control group it was only used physiological solution. Samples of the root canal content were collected immediately after PBM (S1), at 7 days after PBM(S2), immediately after 14 days of ICM activity (S3), and 7 days after removal of ICM (S4). The following aspects wereevaluated for all collections: a) antimicrobial activity; b) quantification of endotoxin by the Limulus amebocyte lysate Test. The results were analyzed by ANOVA and Dunn (5%) statistical tests. In the S2 sample the 2% CLX presented better resulted in relation to the physiological solution. In the S3 sample the Ca(OH)2 was statistically different from Ca(OH)2 and polymyxin B. In the S4 sample it did not have significant statistical differences between the groups. It was conclude that only the intracanals medications are capable to reduce the amount of endotoxins significantly.


Subject(s)
Dental Pulp Cavity , Chlorhexidine , Escherichia coli , Calcium Hydroxide , Root Canal Irrigants , Polymyxins
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