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1.
Chinese Medical Journal ; (24): 317-323, 2022.
Article in English | WPRIM | ID: wpr-927516

ABSTRACT

BACKGROUND@#Vancomycin treatment failure against vancomycin-susceptible gram-positive cocci is not rare in the intensive care unit (ICU). One of the reasons for this is the substandard drug trough concentration. We aimed to examine the hypothesis that the target serum concentration could be reached earlier with a loading dose of vancomycin.@*METHODS@#This retrospective cohort study was conducted at our ICU between June 2018 and June 2020 and involved patients who were suspected of having, or confirmed to have, gram-positive cocci infection and treated with vancomycin. One group of the patients was administered a loading dose of vancomycin (loading group) and compared with the group that did not receive a loading dose (control group). The baseline characteristics, vancomycin serum concentrations, and clinical outcomes were collected and analyzed.@*RESULTS@#Fifty-five patients were finally included, of which 29 received a loading dose of vancomycin. The serum concentration of vancomycin before the second dose was significantly higher for the loading group than for the control group (10.3 ± 6.1 mg/L vs. 5.7 ± 4.4 mg/L, P = 0.002). The results for both groups were similar before the fifth dose (12.4 ± 7.3 mg/L vs. 10.3 ± 6.3 mg/L in the loading and the control groups, respectively; P = 0.251). The 28-day mortality was lower for the loading group than for the control group (6.7% vs. 34.6% in the loading and control groups, respectively; P = 0.026). No significant differences were observed in serum creatinine (Cr) concentrations of the two groups.@*CONCLUSION@#With the loading dose of vancomycin, the target serum concentration of vancomycin may be reached earlier without increasing the risk of acute kidney injury.@*TRIAL REGISTRATION@#https://www.chictr.org.cn; ChiCTR2000035369.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Creatinine , Humans , Intensive Care Units , Retrospective Studies , Vancomycin
2.
Artrosc. (B. Aires) ; 29(1): 8-13, 2022.
Article in Spanish | LILACS, BINACIS | ID: biblio-1369634

ABSTRACT

Introducción: La artritis séptica (AS) posterior a la cirugía de reconstrucción del LCA (RLCA) es una complicación infrecuente pero potencialmente devastadora. Para disminuir el riesgo de esta complicación, en el 2019 comenzamos a utilizar el tratamiento local del injerto de LCA con vancomicina previo a su colocación. El objetivo de este estudio fue comparar la incidencia de AS postoperatoria en pacientes en los que se utilizó este protocolo con el período inmediatamente anterior, en el que no se usó. Materiales y métodos: Se efectuó un estudio de cohorte retrospectiva con inclusión de todos los pacientes a los que se les realizó una RLCA primaria. Se analizaron dos períodos consecutivos: enero de 2016 a febrero de 2019 (grupo sin tratamiento local con vancomicina) y marzo de 2019 a marzo de 2021 (grupo con protocolo con vancomicina). Se estimó la incidencia de AS postoperatoria en ambos grupos. Se registraron también los casos de infección superficial del sitio quirúrgico y los casos de rigidez postoperatoria. Resultados: se incluyeron un total de ochocientos ocho pacientes. El grupo sin vancomicina quedó conformado por quinientos cincuenta y un (68%) pacientes y el grupo con vancomicina por doscientos cincuenta y siete (32%). En total, siete de los quinientos cincuenta y un pacientes en los cuales no se utilizó vancomicina desarrollaron AS, lo que arrojó una incidencia del 1.27% (IC 95%: 0.5% - 2.5%), mientras que no se registraron casos de AS en el grupo de pacientes en los cuales se utilizó el protocolo con vancomicina (p = 0.07). Con respecto a las infecciones superficiales, se registraron cuatro casos, todas también en el grupo sin vancomicina (p = 0.17). En cuanto a los casos de rigidez postoperatoria se registraron en total catorce, doce del primer grupo (2.1%) y dos del segundo grupo (0.78%) (p = 0.156). Conclusión: El tratamiento local de los injertos con vancomicina previo a la RLCA evitó la AS postoperatoria durante el período de estudio, en comparación con el período inmediatamente anterior, en el que no se utilizó vancomicina. Nivel de Evidencia: III


Introduction: Postoperative septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating complication. To decrease this risk in 2019 we started presoaking ACL grafts with vancomycin prior to implantation. The purpose of this study was to compare the rate of postoperative SA with and without vancomycin presoaked grafts. Materials and methods: A retrospective cohort study was conducted including all patients who underwent primary ACLR. Consecutive periods were studied, inclusive of January 2016 through February 2019 (group without vancomycin) and March 2019 through March 2021 (group with vancomycin protocol). The final outcome studied was occurrence of postoperative SA in both groups. Cases of superficial wound infection and cases of postoperative arthrofibrosis were also recorded. Results: a total of 808 patients were included in the study: 551 (68%) in the group without vancomycin and 257 (32%) in the vancomycin protocol group. Seven cases of postoperative SA were noted in the first group (rate 1.27%, IC95%: 0,5% - 2,5%), while no cases of SA were noted in the vancomycin group during the study period (p = 0.07). Regarding superficial wound infection, four cases were noted, all of them in the first group (p = 0.17). A total of fourteen cases of arthrofibrosis were treated with a mobilization under anesthesia, twelve from the first group (2.1%) and two from the vancomycin group (0.78%) (p = 0.156). Conclusion: Presoaking of autografts in vancomycin for primary ACLR prevented the occurrence of postoperative SA during the study period as compared with no soaking of the grafts. Level of Evidence: III


Subject(s)
Adult , Postoperative Complications , Vancomycin , Arthritis, Infectious , Bone Transplantation , Anterior Cruciate Ligament Reconstruction , Infections
3.
Arch. pediatr. Urug ; 92(2): e212, dic. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1339132

ABSTRACT

Introducción: la sepsis tardía por estafilococo coagulasa negativo (SCoN) es una causa común de morbimortalidad en la unidad neonatal. Los SCoN son los microorganismos más frecuentemente involucrados con aproximadamente el 50% de los casos. El objetivo de este estudio es analizar la incidencia y las características de los neonatos portadores de sepsis tardía por SCoN. Materiales y métodos: se realizó un estudio descriptivo, longitudinal, retrospectivo. Se utilizaron las bases de datos del laboratorio de microbiología del hospital y las historias clínicas electrónicas para obtener la información. El período de estudio analizado fueron los años 2018 y 2019 en la unidad de cuidados intensivos e intermedios de recién nacidos del Centro Hospitalario Pereira Rossell. Resultados: obtuvimos una incidencia de 2,5% de los ingresos a cuidados intensivos e intermedios (25 pacientes). La edad gestacional al nacer fue de 28 semanas (25,0-35,0) y la mediana del peso fue de 1.070 g (730,0-2.365,0). La media de edad gestacional posmenstrual al momento del diagnóstico fue de 32,92±7,921 semanas. Por sospecha de sepsis precoz, 17 pacientes habían recibido un curso de antibióticos previo. El signo clínico más frecuentemente observado fue el deterioro del estado general, en 11 pacientes, seguido de distensión abdominal en 6 y fiebre en 5. Dentro de los SCoN, el más frecuentemente aislado fue el Staphylococcus epidermidis (13 pacientes); 22 pacientes recibieron tratamiento, 18 de ellos con vancomicina-meropenem y 4 con monoterapia con vancomicina. Conclusión: estos patógenos representan una causa importante de morbimortalidad en la unidad neonatal, particularmente en pacientes que presentan mayor gravedad y mayor necesidad de soporte vital. Se necesitan pautas claras de interpretación del rol de estos microorganismos y de abordaje de pacientes con riesgo de sepsis tardía, incluyendo el tratamiento antibiótico empírico.


Introduction: Coagulase Negative Staphylococci (CoNS) late onset sepsis is a common cause of morbidity and mortality in the neonatal intensive care unit (NICU). CoNS are the most frequently isolated microorganisms and total 50% of cases. The objective of this study is to analyze the incidence and characteristics of newborns carriers of late onset CoNS. Materials and methods: we performed a descriptive, retrospective, longitudinal study. Data was obtained from the hospital's microbiology laboratory database and electronic medical records. Patients included were those admitted to NICU during the period between 2018 and 2019. Results: we obtained an incidence of 2.5% of patients admitted to the NICU (25 patients). Median gestational age at birth was 28 weeks 25.0-35.0 and median birth weight was 1.070 g 730.0-2365.0. Mean gestational age at the time of diagnosis was 32.92±7.921 weeks. 17 patients had received an antibiotics course at birth because of early onset sepsis suspicion. The most frequently observed clinical symptom was deterioration of general condition, 11 patients, followed by abdominal distention in 6 and fever in 5. Among CoNS, the most frequently isolated pathogen was Staphylococcus epidermidis (13 patients). 22 patients received treatment, 18 a combination of vancomycin and meropenem and 4 received vancomycin monotherapy. Conclusion: these pathogens are a common cause of morbidity and mortality in the newborn intensive care unit, particularly in patients with more serious conditions and in those who require more advanced life support measures. Clearer interpretation of their role is needed as well as to determine a proper approach to patients at risk of late onset sepsis, including empiric antibiotic treatment.


Sepse tardia para Staphylococcus coagulase negativa (SCoN) é uma causa comum de morbidade e mortalidade na unidade neonatal. SCoNs são os microrganismos mais frequentemente envolvidos e representam aproximadamente 50% dos casos. O objetivo deste estudo é analisar a incidência e as características de neonatos com sepse tardia por SCoN. Materiais e métodos: foi realizado um estudo descritivo, longitudinal e retrospectivo. Usamos os bancos de dados do laboratório de microbiologia e prontuários médicos eletrônicos de nosso hospital para obter as informações. O período de estudo analisado foi de 2018 e 2019 na unidade de terapia intensiva e intermediária para recém-nascidos do Centro Hospitalar Pereira Rossell. Resultados: obtivemos uma incidência de 2,5% de internações em Terapia Intensiva e Intermediária (25 pacientes). A idade gestacional ao nascer foi de 28 semanas 25,0-35,0 e o peso médio foi de 1070g 730,0-2365,0. A média da idade gestacional pós-menstrual no momento do diagnóstico foi de 32,92 ± 7,921 semanas. 17 pacientes haviam recebido um curso anterior de antibióticos por suspeita de sepse precoce. O sinal clínico mais frequentemente observado foi deterioração do estado geral em 11 pacientes, seguido por distensão abdominal em 6 e febre em 5. Dentre os SCoN, o mais isolado foi o Staphylococcus Epidermidis (13 pacientes). 22 pacientes receberam tratamento, 18 deles com Vancomicina-Meropenem e 4 com Vancomicina em monoterapia. Conclusão: esses patógenos representam uma importante causa de morbimortalidade na unidade neonatal, principalmente em pacientes com maior gravidade e maior necessidade de suporte de vida. Orientações claras são necessárias para interpretar o papel desses microrganismos e para abordar pacientes com risco de sepse tardia, incluindo tratamento com antibióticos.


Subject(s)
Humans , Female , Infant, Newborn , Staphylococcal Infections/epidemiology , Neonatal Sepsis/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Uruguay/epidemiology , Vancomycin/therapeutic use , Cross Infection , Epidemiology, Descriptive , Incidence , Retrospective Studies , Longitudinal Studies , Coagulase , Staphylococcus haemolyticus/virology , Staphylococcus hominis/virology , Anti-Bacterial Agents/therapeutic use
4.
Arch. pediatr. Urug ; 92(2): e306, dic. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278306

ABSTRACT

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.


Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.


Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.


Subject(s)
Humans , Female , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Vancomycin/therapeutic use , Endocarditis/diagnosis , Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/complications , Coagulase , Infant, Very Low Birth Weight , Endocarditis/etiology , Infant, Extremely Premature
5.
Coluna/Columna ; 20(1): 38-41, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154021

ABSTRACT

ABSTRACT Objective: To identify the cost effectiveness of vancomycin powder in the prophylaxis of posterior lumbar spine instrumentation, seeking potential savings. Methods: A retrospective, observational study was performed to evaluate the cost effectiveness. Data were retrieved from patients' files from March 2016 to April 2017; costs were considered for the procedures, as well as which antibiotic was used. Results: A total of 184 patients were included. Of these, 102 received prophylactic treatment with 1g of cephalothin and 82 received 1g of cephalothin and 1g of vancomycin powder, which was applied to the wound prior to tissue closure. Of the 184 patients, 110 were women (59%) and 74 were men (41%), and the mean age was 55 years (24-77). The participants had a median BMI of 28.9 kg/m2 (19-39). The average cost per hospitalized patient was $3974 USD and the average cost of rehospitalization due to infection was, on average, $7700 USD. The use of vancomycin powder led to cost savings of $75,008.79 USD per 100 posterior spinal fusions performed for degenerative spine. Conclusion: The use of vancomycin powder is a cost-effective option for prophylaxis of surgical site infection in spine fusion. Level of evidence III; Economic and decision analysis.


RESUMO Objetivo: Identificar a relação de custo-eficácia da vancomicina em pó como profilaxia da instrumentação posterior da coluna lombar, buscando possíveis economias. Métodos: Foi realizado um estudo retrospectivo e observacional para avaliar a relação custo-eficácia. Os dados foram recuperados dos arquivos dos pacientes de março de 2016 a abril de 2017; foram considerados os custos dos procedimentos, bem como o antibiótico usado. Resultados: Um total de 184 pacientes foi incluído, dos quais 102 receberam tratamento profilático com 1 g de cefalotina e 82 receberam 1 g de cefalotina e 1 g de vancomicina em pó, que foi aplicada na ferida antes do fechamento do tecido. Dos 184 pacientes, 110 eram mulheres (59%) e 74 eram homens (41%), e a média de idade foi de 55 anos (24-77). Os pacientes tinham IMC médio de 28,9 kg m2 (19-39).O custo médio por paciente hospitalizado foi US$ 3.974 e o custo médio de reinternação por infecção foi, em média, US$ 7.700. O uso de vancomicina em pó levou a uma redução de custos de US$ 75.008,79 referentes a 100 fusões que seriam realizadas nos casos de degeneração da coluna. Conclusões: O uso de vancomicina em pó é uma opção de baixo custo para a profilaxia da infecção do sítio cirúrgico na artrodese de coluna. Nível de evidência III; Análise econômica e de decisão.


RESUMEN Objetivo: Identificar la relación de costo-eficacia de la vancomicina en polvo como profilaxis de la instrumentación posterior de la columna lumbar, buscando posibles economías. Métodos: Fue realizado un estudio retrospectivo y observacional para evaluar la relación costo-eficacia. Los datos fueron recuperados de los archivos de los pacientes de marzo de 2016 a abril de 2017; fueron considerados los costos de los procedimientos, bien como el antibiótico usado. Resultados: Fue incluido un total de 184 pacientes, de los cuales 102 recibieron tratamiento profiláctico y 1 g de cefalotina y 82 recibieron 1 g de cefalotina y 1 g de vancomicina en polvo, que fue aplicada en la herida antes del cierre del tejido. De los 184 pacientes, 110 eran mujeres (59%) y 74 eran hombres (41%), y el promedio de edad fue de 55 años (24-77). Los pacientes tenían IMC promedio de 28,9 kg/m2 (19-39). El costo promedio por paciente hospitalizado fue de USD 3.974 y el costo promedio de reinternación por infección fue, en promedio, de USD 7700. El uso de vancomicina en polvo llevó a una reducción de costos de USD 75.008,79 referentes a 100 fusiones que serían realizadas en los casos de degeneración de la columna. Conclusiones: El uso de vancomicina en polvo es una opción de bajo costo para la profilaxis de la infección del sitio quirúrgico en la artrodesis de columna. Nivel de evidencia III; Análisis económico y de decisión.


Subject(s)
Humans , Spinal Fusion , Vancomycin , Cost-Benefit Analysis , Antibiotic Prophylaxis
6.
Rev. Hosp. Ital. B. Aires (2004) ; 41(1): 26-30, mar. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1178336

ABSTRACT

El pioderma gangrenoso ampollar es una variedad infrecuente de pioderma gangrenoso, que se asocia en el 50-70% de los casos con trastornos oncohematológicos. Se comunica el caso de una paciente de 59 años, que consultó por fiebre y ampollas purpúricas de rápida progresión, con compromiso cutáneo mucoso. Con sospecha de una enfermedad neutrofílica, ampollar, o infección por gérmenes oportunistas, se realizó biopsia de piel para estudio histopatológico, inmunofluorescencia directa y cultivo. Los cultivos y la inmunofluorescencia directa fueron negativos, y la anatomía patológica reveló un denso infiltrado inflamatorio con predominio neutrofílico en dermis. Ante el diagnóstico de pioderma gangrenoso ampollar, se realizó una punción-aspiración de médula ósea cuyo resultado fue compatible con leucemia mieloide aguda. Se instauró tratamiento con corticosteroides sistémicos, a pesar de lo cual la paciente evolucionó desfavorablemente y falleció a los 15 días de su ingreso hospitalario. Este caso ilustra la asociación de esta enfermedad cutánea con trastornos oncohematológicos y el mal pronóstico que esto implica a corto plazo. (AU)


Bullous pyoderma gangrenosum is an infrequent type of pyoderma gangrenosum, associated with onco hematological diseases in 50-70% of cases. We present the case of a 59-year-old patient with fever and mucocutaneous hemorrhagic bullous of rapid progression. A biopsy for histopathology, direct immunofluorescence (DIF) and skin culture was made, considering the possibility of neutrophilic dermatoses, bullous dermatosis or an opportunistic infection. The results of both the culture and the DIF were negative. The histopathological examination of the specimen revealed a dense dermal polymorphic infiltrate composed primarily of neutrophils. Considering bullous pyoderma gangrenosum as a potential diagnosis, a bone-marrow biopsy was performed. This study revealed an acute myeloid leukemia. Although systemic corticosteroid therapy was begun, the patient presented an unfavorable evolution that led to her death 15 days after her admission at the hospital. This case shows the association between bullous pyoderma gangrenosum and onco hematological diseases. In addition, it highlights the poor prognosis related to these diseases in the short term. (AU)


Subject(s)
Humans , Female , Middle Aged , Leukemia, Myeloid, Acute/pathology , Pyoderma Gangrenosum/diagnosis , Paraneoplastic Syndromes/pathology , Respiration, Artificial , Azacitidine/therapeutic use , Myelodysplastic Syndromes/pathology , Acyclovir/administration & dosage , Methylprednisolone/administration & dosage , Vancomycin/administration & dosage , Cardiotonic Agents/therapeutic use , Ceftazidime/administration & dosage , Amphotericin B/administration & dosage , Imipenem/administration & dosage , Sweet Syndrome/etiology , Pyoderma Gangrenosum/etiology , Pyoderma Gangrenosum/pathology , Pyoderma Gangrenosum/drug therapy , Adrenal Cortex Hormones/therapeutic use , Meropenem/administration & dosage
7.
Rev. cuba. estomatol ; 58(1): e2919, ene.-mar. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156427

ABSTRACT

Introducción: La osteomielitis mandibular crónica es considerada como una infección odontogénica que cursa con tumefacción de la cara, limitación de la abertura bucal y dolor. Pocas veces es tratada a través de gammagrafías con fijación a ciprofloxacino con la consiguiente obtención de resultados efectivos. Objetivo: Describir un caso clínico de osteomielitis mandibular crónica tratada con terapia antibiótica y quirúrgica. Presentación de caso: Paciente femenina de 63 años de edad que acudió al servicio de estomatología del Hospital María Auxiliadora, Lima, Perú; con un historial de tres meses de hinchazón creciente a nivel del borde inferior izquierdo de la mandíbula desde que le realizaron una extracción dentaria. Los exámenes tomográficos, gammagrafía, biopsia y antibiograma confirmaron la osteomielitis y la susceptibilidad bacteriana. La decorticación, debridamiento, exodoncia y la administración de metronidazol más vancomicina por dos meses permitió la remisión del cuadro. Conclusiones: El seguimiento clínico de dos años y las gammagrafías de evaluación permitieron verificar la presencia de regeneración ósea y ausencia de focos de reactivación. La osteomielitis crónica puede ser provocada por restos de exodoncias dentarias. Su diagnóstico y seguimiento clínico requiere de múltiples exámenes y controles a largo plazo(AU)


Introduction: Chronic mandibular osteomyelitis is considered to be an odontogenic infection manifesting as facial tumefaction, limited mouth opening and pain. It is not often enough treated with ciprofloxacin fixation gammagraphies with the consequent achievement of effective results. Objective: Describe a clinical case of chronic mandibular osteomyelitis treated with antibiotic and surgical therapy. Case presentation: A female 63-year-old patient attends the dental service at María Auxiliadora Hospital in Lima, Peru, with a history of three-months' swelling of the lower left edge of her mandible upon performance of a dental extraction. Tomographic examination, gammagraphy, biopsy and antibiograms confirmed the presence of osteomyelitis and bacterial susceptibility. Decortication, debridement, exodontia and administration of metronidazole plus vancomycin for two months led to remission of the patient's status. Conclusions: Two-year clinical follow-up and evaluation gammagraphies made it possible to verify the presence of bone regeneration and the absence of reactivation foci. Chronic osteomyelitis may be caused by remains of dental exodontias. Its diagnosis and clinical follow-up require a large number of long-term tests and controls(AU)


Subject(s)
Humans , Female , Middle Aged , Osteomyelitis/diagnostic imaging , Surgery, Oral/methods , Vancomycin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Metronidazole/therapeutic use
8.
Article in Chinese | WPRIM | ID: wpr-921923

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of vancomycin bone cement in the treatment of diabetic foot ulcer (DFU) ruptured Wagner gradeⅡ-Ⅳ.@*METHODS@#From March 2019 to April 2021, 32 patients with Wagner gradeⅡ-Ⅳ diabetic foot were divided into vacuum sealing drainage (VSD) group and bone cement group according to different treatment methods. There were 16 cases in VSD group, 8 males and 8 females;the age ranged from 66 to 81 (70.50±7.20) years, and the course of disease ranged from 8 to 40 (27.56±8.55) months;Wagner gradeⅡin 2 cases, grade Ⅲin 7 cases and grade Ⅳin 7 cases;debridement and VSD were used. There were 16 cases in the bone cement group, 9 males and 7 females;the age ranged from 63 to 79 (69.56±7.29) years, and the course of disease ranged from 11 to 39(22.75±11.43) months;Wagner gradeⅡ in 2 cases, grade Ⅲin 5 cases and grade Ⅳ in 9 cases;vancomycin loaded bone cement was used for treatment. The types of bacteria, negative time of bacterial culture, skin healing time, hospital stay, operation times and complications were observed and compared between two groups.@*RESULTS@#All patients were followed up for 3 to 6 (4.00±1.07) months. The bacterial negative time, skin healing time and hospital stay in bone cement group were significantly lower than those in VSD group (@*CONCLUSION@#Vancomycin loaded bone cement is effective in the treatment of Wagner grade Ⅱ-Ⅳ diabetic foot ulceration wounds. It can reduce the length of hospital stay, shorten the healing time of skin and kill pathogens as soon as possible. It is one of the effective methods to treat Wagner gradeⅡ-Ⅳdiabetic foot ulceration.


Subject(s)
Bone Cements/therapeutic use , Child , Child, Preschool , Diabetes Mellitus , Diabetic Foot/drug therapy , Female , Humans , Male , Treatment Outcome , Vancomycin , Wound Healing
9.
Artrosc. (B. Aires) ; 28(1): 92-96, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1252457

ABSTRACT

La artritis séptica es una complicación poco común después de una reconstrucción del ligamento cruzado anterior (LCA), por lo que las estrategias de prevención no han sido estudiadas extensamente. Esta revisión se enfocará en la recopilación de diferentes estrategias publicadas para la prevención de infección del LCA postoperatoria. Hay estudios que muestran aumento del riesgo de infección en consumidores de tabaco. El uso de antibióticos intravenosos preoperatorios profilácticos debería ser parte del manejo habitual de todos los pacientes que se sometan a una artroscopía de rodilla. No existe evidencia de los beneficios del uso de drenajes intraarticulares, por lo que deben evitarse. La literatura sugiere que el autoinjerto del tendón patelar tiene menor riesgo de infección que los otros injertos, por lo tanto, se recomienda su uso si se quiere minimizar la tasa de infección después una reconstrucción del LCA. La implementación de un protocolo clínico mejora significativamente la calidad del cuidado de los pacientes que se someten a una reconstrucción del LCA, disminuyendo las tasas de infección. La irrigación de gentamicina en solución podría tener un efecto protector para el desarrollo de artritis séptica después de la reconstrucción artroscópica del LCA, pero se necesitan más estudios para confirmar su efectividad. La inmersión previa de los injertos con vancomicina ha demostrado reducir drásticamente la tasa de infección después de una reconstrucción del LCA y especialmente cuando se realiza una reconstrucción del LCA con autoinjerto de tendones de los isquiotibiales


As septic arthritis after anterior cruciate ligament (ACL) reconstruction is an uncommon complication, information on prevention strategies has not been extensively studied before. This review will focus on collecting different published strategies for prevention of post-operative ACL infection. Regarding tobacco use, there is evidence that it increases the risk of infection; therefore, its use should be strongly discouraged. Preoperative intravenous antibiotics should be the standard of care of any patient undergoing an arthroscopic procedure in the knee. Intra-articular drains have no positive evidence for its use and therefore should be avoided. The literature suggests that patellar tendon autograft has the lowest risk of infection of any graft, recommending its use if the infection rate after ACL reconstruction wants to be minimized. Implementing a clinical pathway significantly improves the quality and consistency of care for patients undergoing ACL reconstruction and decreases the infection rates. Gentamicin irrigation solution may have a protective effect against septic arthritis development following arthroscopic ACL reconstruction, but more studies are needed to confirm its usefulness. Vancomycin presoaking of the grafts has shown to dramatically reduce the infection rate after ACL reconstruction and its use is strongly recommended especially when performing hamstrings autograft ACL reconstruction


Subject(s)
Postoperative Complications , Vancomycin , Arthritis, Infectious , Anterior Cruciate Ligament Reconstruction , Infections , Anti-Bacterial Agents
10.
Rev. colomb. ortop. traumatol ; 35(2): 119-125, 2021. ilus.
Article in Spanish | LILACS, COLNAL | ID: biblio-1378596

ABSTRACT

Introducción La incidencia de infección en cirugía de columna puede ser hasta el 12%; con el uso de vancomicina tópica, previo al cierre, se ha logrado disminuir el riesgo de esta condición. El objetivo del estudio es determinar la incidencia de infección en cirugía de columna a quienes se aplicó vancomicina tópica previo al cierre de incisión en una institución de alta complejidad Materiales y Métodos Se realizó un estudio observacional de tipo cohorte retrospectiva. Se incluyeron pacientes intervenidos en cirugía de columna con aplicación de vancomicina tópica previa al cierre entre el 2014 al 2018 en una institución de tercer nivel. Los pacientes fueron seguidos desde el momento de la cirugía hasta 3 meses postquirúrgico Se recolectó información sobre edad, comobilidades, índice masa corporal, tiempo quirúrgico, sangrado intraoperatorio, complicaciones, uso de drenajes. Resultados Se incluyeron 130 pacientes, 81 mujeres y 49 hombres con una edad pomedio de 64 años. 95.4% se les realizó vía posterior con laminectomía, artrodesis e instrumentación. El tiempo promedio fue de 207 minutos, con un sangrado de 400mL. Solo un paciente presentó ruptura de duramadre. Cinco pacientes presentaron infección del sitio operatorio para una incidencia de 3.8% (IC95% 1.5% - 8.9%). Discusión El uso de vancomicina parece reducir el riesgo de infección en cirugía de columna según la incidencia de esta infección reportada en la literatura; sin embargo, hacen falta estudios prospectivos o ensayos clínicos controlados que prueben las dosis ideales de esta terapéutica.


Background The incidence of infection in spine surgery can be up to 12%; With the use of topical vancomycin, prior to closure, the risk of this condition has been reduced. The aim of the study is to determine the incidence of infection in spinal surgery to which topical vancomycin was applied prior to the closure of an incision in a highly complex institution. Methods An observational retrospective cohort study was conducted. Patients undergoing spinal surgery with application of topical vancomycin prior to closure between 2014 and 2018 in a third-level institution were included. The patients were followed from the moment of surgery until 3 months post-surgery. Information was collected on age, comorbilities, body mass index, surgical time, intraoperative bleeding, complications, use of drainages. Results 130 patients were included, 81 women and 49 men with an average age of 64 years. 95.4% were performed posteriorly with laminectomy, arthrodesis and instrumentation. The average time was 207minutes, with a bleeding of 400mL. Only one patient presented a dura mater rupture. Five patients presented surgical site infection for an incidence of 3.8% (95% CI 1.5% - 8.9%). Discussion The use of vancomycin seems to reduce the risk of infection in spinal surgery according to the incidence of this infection reported in the literature; however, prospective studies or controlled clinical trials are needed to prove the ideal doses of this therapy.


Subject(s)
Humans , Spine , Infections , Arthrodesis , Vancomycin
11.
Artrosc. (B. Aires) ; 28(2): 106-111, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1282672

ABSTRACT

Introducción: El objetivo del trabajo es evaluar y comparar de manera retrospectiva la tasa de artritis séptica (AS) postquirúrgicas en reconstrucción de LCA entre dos grupos de estudio: A, sin el uso local de vancomicina en el injerto autólogo de isquiotibiales, versus grupo B, con profilaxis antibiótica local.Materiales y métodos: se trabajaron dos grupos compuestos por 683 pacientes en total, con diagnóstico primario de ruptura de LCA. Grupo A, operados entre 2016 y 2017, en los que no se utilizó profilaxis antibiótica del autoinjerto; y el grupo B, intervenidos entre 2018 y 2019, donde se sumergió el autoinjerto de isquiotibiales en 500 mg de vancomicina en 100 ml de solución fisiológica como profilaxis local. En ambos grupos se llevó a cabo el protocolo usual pre, intra y postquirúrgico. Resultados: se analizó la relación entre presencia de infección y las diferentes variables estudiadas, se observó que el uso local de vancomicina en el injerto autólogo de isquiotibiales está asociado a menor infección (p <0.05). La edad, el sexo y el sanatorio donde se realiza la cirugía no condicionan necesariamente la presencia de infección (p >0.05).Conclusión: presentamos este trabajo como prueba en nuestro medio del claro beneficio que se obtuvo, ya que los pacientes que fueron sometidos a la profilaxis local de vancomicina del autoinjerto mostraron una disminución notable de artritis séptica.Tipo de estudio: Artículo Original ­ Descriptivo-transversal. Nivel de evidencia: III


Introduction: The aim of the study is to evaluate and retrospectively compare the rate of postoperative septic arthritis (SA) in ACL reconstruction, between two study groups: A without local use of vancomycin in autologous hamstring graft versus group B with local antibiotic prophylaxisMaterials and methods: two groups composed of 683 patients in total, with a primary diagnosis of ACL rupture, were studied. Group A, operated on in 2016 and 2017, in which antibiotic prophylaxis of the autograft was not used; and the second group B, between 2018 and 2019, where the hamstring autograft was submerged in 500 mg of vancomycin in 100 ml of physiological solution as local prophylaxis. Preoperative intravenous antibiotic prophylaxis was carried out in both groups as the usual protocol.Results: it was obtained as a result that in group A, the two years that they worked without "pre-soaking" of antibiotics in the autograft and the relationship between the presence of infection and the different variables studied was analyzed, where they found that the use Local vancomycin in the autologous hamstring graft is associated with a minor infection (p <0.05). However, age, sex and the sanatorium where the surgery is performed do not necessarily determine the presence of infection (p >0.05)Conclusion: we present this work as proof in our environment of the clear benefit that we obtained, since the patients who underwent local prophylaxis of vancomycin of the autograft, showed a notable decrease in septic arthritis.Type of study: Original Article - Descriptive-cross-sectional. Level of Evidence: III


Subject(s)
Vancomycin/therapeutic use , Arthritis, Infectious/prevention & control , Antibiotic Prophylaxis , Anterior Cruciate Ligament Reconstruction
12.
Infectio ; 24(4): 248-254, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1114877

ABSTRACT

Resumen Introducción: las infecciones causadas por Enterococcus resistente a Vancomicina (EVR) presentan mayor mortalidad en pacientes críticos, asociado a un aumento gradual en este patrón de resistencia, especialmente en el continente americano, por lo cual la adecuada terapia antimicrobiana empírica es fundamental para mejorar los desenlaces. Objetivo: determinar los factores de riesgo asociados al desarrollo de infección por EVR en pacientes sépticos en la Unidad de Cuidados Intensivos (UCI) del Hospital San José en Bogotá, Colombia. Métodos: Estudio descriptivo de casos y controles en pacientes sépticos ingresados a la UCI durante 2016 y 2017. Los casos se definieron como pacientes con infección por EVR y los controles los pacientes con infección por otro germen. Resultados: se incluyeron 32 pacientes con aislamiento de EVR y 96 controles. Los factores de riesgo asociados a infección por EVR fueron: nutrición parenteral (OR 15,7 IC 4,2-71,4), lavado peritoneal (OR 8,9 IC 3,2-24,8), cultivo polimicrobiano (OR 19,9 IC 6,0-83,4). La mortalidad fue 56,2% en casos y 33,3% en controles. Conclusiones: Los factores de riesgo hallados con mayor frecuencia fueron: múltiples lavados peritoneales, nutrición parenteral y cultivos polimicrobianos. Encontramos una correlación significativa en el uso de antibiótico empírico adecuado y la reducción en la mortalidad.


Summary Introduction: infections caused by Vancomycin-resistant Enterococcus (VRE) have higher mortality in critically ill patients, associated with increase in this pattern of resistance, especially in the Americas, which is why adequate empirical antimicrobial therapy is essential to improve outcomes Objective: to determine the risk factors associated with the development of infection by VRE in septic patients in the Intensive Care Unit (ICU) of San José Hospital in Bogotá, Colombia. Methods: Case-control study in septic patients admitted to the ICU during 2016 and 2017. The cases were defined as patients with VRE infection and the controls were patients with infection by another germ. Results: 32 patients with EVR isolation and 96 controls were included. The risk factors associated with infection by EVR were: parenteral nutrition (OR 15.7 IC 4.2-71.4), peritoneal lavage (OR 8.9 IC 3.2-24.8), polymicrobial culture (OR 19,9 IC 6.0-83.4). Mortality was 56.2% in cases and 33.3% in controls. Conclusions: The risk factors found most frequently were: multiple peritoneal lavage, parenteral nutrition and polymicrobial cultures. We found a significant correlation in the use of adequate empirical antibiotic and the reduction in mortality


Subject(s)
Humans , Male , Female , Vancomycin , Mortality , Enterococcus , Sepsis , Infections , Intensive Care Units , Anti-Bacterial Agents
13.
Rev. epidemiol. controle infecç ; 10(3): 1-14, jul.-set. 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1247345

ABSTRACT

Justificativa e objetivos: A Monitorização Terapêutica de Fármacos (MTF) é uma importante ferramenta na otimização da terapia com vancomicina, utilizada no tratamento de infecções graves causadas por bactérias Gram-positivas. O objetivo deste estudo foi implementar um protocolo de monitoramento terapêutico de vancomicina em um hospital e descrever as características clínicas, laboratoriais e de uso deste medicamento após sua implementação. Métodos: Para o desenvolvimento do protocolo, foram utilizados os consensos internacionais sobre MTF de vancomicina. Os dados dos pacientes adultos foram coletados dos prontuários e das estimativas do software farmacocinético. Resultados: O protocolo de vancomicina foi implementado na instituição hospitalar e disponibilizado ao corpo clínico. Foram avaliados 49 pacientes. A vancomicina foi indicada principalmente para tratar pneumonia 15 (30,6%). Entre os microrganismos identificados, Staphylococcus aureus foi o mais presente ­ 8 (50%), e 9 (56,3%) das culturas eram resistentes à oxacilina. Média de uso de vancomicina foi 10,6 (± 6,6) dias, e dose de ataque foi administrada em 33 (67,3%) dos pacientes. Apresentaram insuficiência renal aguda 5 (11,1%) pacientes. O monitoramento das concentrações mínimas no vale (Cmin) de vancomicina ocorreu em 43 (87,8%) pacientes. Na primeira medição, 16 deles (37,2%) apresentaram Cmin inferiores a 10 mcg/dL, e 11 (25,6%), superiores a 20 mcg/dL, dados considerados fora da faixa terapêutica. Conclusão: A elaboração de um protocolo de MTF para a vancomicina orienta o uso racional e seguro desse antibiótico. Formação continuada em recursos humanos e investimento em softwares farmacocinéticos para ajustes de doses podem contribuir para a otimização da terapia com vancomicina.(AU)


Background and objectives: Therapeutic Drug Monitoring (TDM) is an important tool in optimizing vancomycin therapy, a drug used to treat serious infections caused by gram-positive bacteria. The aim of this study was to implement a protocol for the therapeutic monitoring of vancomycin in hospitals and to describe the clinical, laboratory and use characteristics of this drug after its implementation. Methods: The international consensus on vancomycin TDM was used for protocol development. Patient data were collected from medical records and pharmacokinetic software estimates. Results: The vancomycin protocol was implemented at a hospital and made available to the clinical staff. We evaluated 49 patients. Vancomycin was prescribed mainly to treat pneumonia 15 (30.6%). Among the identified microorganisms, Staphylococcus aureus was the most common with 8 cases (50%), and 9 (56.3%) patients were resistant to oxacillin. The average use of vancomycin was 10.6 (± 6.6) days and the loading dose was administered in 33 (67.3%) patients. A total of 5 (11.1%) patients had acute renal failure. Monitoring of Minimal Concentrations in the vancomycin valley (Cmin) occurred in 43 (87.8%) patients. In the first measurement, 16 of them (37.2%) presented Cmin below 10 mcg/dL and 11 (25.6%) above 20 mcg/dL, data considered outside the therapeutic range. Conclusion: The elaboration of an MTF protocol for vancomycin guides the rational and safe use of this antibiotic. Continued training in human resources and investment in dose-adjusting pharmacokinetic software may contribute to the optimization of vancomycin therapy.(AU)


Justificación y objetivos: La monitorización terapéutica de medicamentos (MTF) es una importante herramienta para optimizar la terapia con vancomicina, utilizada para tratar infecciones graves causadas por bacterias grampositivas. El objetivo de este estudio fue implementar un protocolo de MTF de vancomicina en el hospital y describir las características clínicas, de laboratorio y de uso de vancomicina después de su implementación. Métodos: El consenso internacional sobre vancomicina MTF se utilizó para el desarrollo del protocolo. Los datos de los pacientes adultos se obtuvieron de los registros médicos y las estimaciones del software farmacocinético. Resultados: El protocolo se implementó en el hospital y se puso a disposición al personal clínico. Se evaluaron 49 pacientes. La vancomicina fue indicada para pneumonía 15 (30,6%). Entre los microorganismos identificados, Staphylococcus aureus fue el más presente 8 (50%) y 9 (56,3%) de los cultivos fueron resistentes a oxacilina. El promedio del uso de vancomicina fue de 10,6 (± 6,6) días, y la dosis de ataque se administró en 33 (67,3%) pacientes. La insuficiencia renal aguda se encontró en 5 (11,1%) pacientes. El monitoreo de concentraciones mínimas en el valle de vancomicina (Cmin) ocurrió en 43 (87,8%) pacientes. En la primera medición, 16 de ellos (37,2%) presentaron Cmin por debajo de 10 mcg/dL, y 11 (25,6%), por encima de 20 mcg/dL, datos considerados fuera del rango terapéutico. Conclusión: La elaboración de un protocolo de MTF para vancomicina guía el uso racional y seguro de ese antibiótico. La capacitación continua en recursos humanos y la inversión en softwares farmacocinéticos de ajuste de dosis pueden contribuir a la optimización de la terapia con vancomicina.(AU)


Subject(s)
Humans , Vancomycin , Clinical Protocols , Drug Monitoring , Gram-Positive Bacterial Infections
14.
Rev. bras. ter. intensiva ; 32(3): 391-397, jul.-set. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138519

ABSTRACT

RESUMO Objetivo: Investigar a efetividade da vancomicina contra Gram-positivos com concentração inibitória mínima de 1mg/L em pacientes pediátricos com base na razão entre área sob a curva e concentração inibitória mínima > 400. Métodos: População de 22 pacientes pediátricos (13 meninos) internados no centro de terapia intensiva pediátrica, com função renal preservada, que foram distribuídos em dois grupos (G1 < 7 anos e G2 ≥ 7 anos). Após a quarta dose de vancomicina (10 - 15mg/kg a cada 6 horas), duas amostras de sangue foram colhidas (terceira e quinta horas), seguidas da dosagem sérica por imunoensaios para investigação da farmacocinética e da cobertura do antimicrobiano. Resultados: Não se registrou diferença entre os grupos com relação à dose, ao nível de vale ou ainda na área sob a curva. A cobertura contra Gram-positivos com concentração inibitória mínima de 1mg/L ocorreu em apenas 46% dos pacientes em ambos os grupos. A farmacocinética se mostrou alterada nos dois grupos diante dos valores de referência, mas a diferença entre grupos foi registrada pelo aumento da depuração total corporal e pelo encurtamento da meia-vida biológica, mais pronunciados nos pacientes mais novos. Conclusão: A dose empírica mínima de 60mg/kg ao dia deve ser prescrita ao paciente pediátrico de unidade de terapia intensiva com função renal preservada. A utilização da razão entre área sob a curva e concentração inibitória mínima na avaliação da cobertura da vancomicina é recomendada para se atingir o desfecho desejado, uma vez que a farmacocinética está alterada nesses pacientes, podendo impactar na efetividade do antimicrobiano.


Abstract Objective: To investigate the vancomycin effectiveness against gram-positive pathogens with the minimum inhibitory concentration of 1mg/L in pediatric patients based on the area under the curve and the minimum inhibitory concentration ratio > 400. Methods: A population of 22 pediatric patients (13 boys) admitted to the pediatric intensive care unit with preserved renal function was stratified in two groups (G1 < 7 years and G2 ≥ 7 years). After the fourth dose administered of vancomycin (10 - 15mg/kg every 6 hours) was administered, two blood samples were collected (third and fifth hours), followed by serum measurement by immunoassays to investigate the pharmacokinetics and antimicrobial coverage. Results: There was no difference between the groups regarding dose, trough level or area under the curve. Coverage against gram-positive pathogens with a minimum inhibitory concentration of 1mg/L occurred in only 46% of patients in both groups. The pharmacokinetics in both groups were altered relative to the reference values, and the groups differed in regard to increased total body clearance and shortening of the biological half-life, which were more pronounced in younger patients. Conclusion: A minimum empirical dose of 60mg/kg per day should be prescribed for pediatric patients in intensive care units with preserved renal function. The use of the ratio between the area under the curve and minimum inhibitory concentration in the evaluation of vancomycin coverage is recommended to achieve the desired outcome, since the pharmacokinetics are altered in these patients, which may impact the effectiveness of the antimicrobial.


Subject(s)
Humans , Male , Infant , Child, Preschool , Child , Adolescent , Vancomycin/administration & dosage , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacteria/drug effects , Anti-Bacterial Agents/administration & dosage , Vancomycin/pharmacology , Vancomycin/pharmacokinetics , Intensive Care Units, Pediatric , Microbial Sensitivity Tests , Pilot Projects , Age Factors , Area Under Curve , Dose-Response Relationship, Drug , Half-Life
15.
Rev. cuba. invest. bioméd ; 39(3): e612, jul.-set. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1138925

ABSTRACT

Introducción: Las infecciones asociadas a los cuidados sanitarios en los servicios de atención al paciente crítico se asocian a un alto riesgo de muerte y costos significativos. Objetivo: Identificar los gérmenes más frecuentes en los cultivos y su resistencia a los antimicrobianos en la terapia intensiva del Hospital Clínico Quirúrgico Provincial Dr. Joaquín Albarrán. Métodos: Se realizó un estudio descriptivo, retrospectivo, en la terapia intensiva del Hospital Clínico Quirúrgico Provincial Dr. Joaquín Albarrán, de enero del 2015 a diciembre del 2018, el universo estuvo constituido por 1847 cultivos realizados seleccionándose 654 en los que se obtuvo crecimiento; para el análisis estadístico se utilizó el SPSS 22.0. Resultados: De los gérmenes aislados, la Klebsiella spp fue la más frecuente (31 por ciento), seguida del Staphylococcus spp (24,5 por ciento) y de la E. coli (9,8 por ciento). En los esputos se mantuvo la Klebsiella spp (45,1 por ciento), en los hemocultivos el Staphylococcus spp (53,6 por ciento) y en los urocultivos la Candida (41,1 por ciento), seguida de la E. coli (27 por ciento). De los antimicrobianos usados en terapia para tratar la Klebsiella spp, la E. coli, el Acinetobacter y la pseudomona spp, el más recomendado es la colistina (0-25 por ciento de resistencia) y para el Staphylococcus spp, la vancomicina (1,8 por ciento). Conclusiones: Los gérmenes Gram negativos siguen siendo los más frecuentemente aislados en los cultivos de los pacientes hospitalizados en terapia, con un alto nivel de resistencia para la mayoría de los antibióticos(AU)


Introduction: Infections related to critical care settings are associated to high death risk and significant costs. Objective: Identify the germs most commonly found in cultures and their resistance to antimicrobials in the intensive care service of Dr. Joaquín Albarrán Provincial Clinical Surgical Hospital. Methods: A retrospective descriptive study was conducted at the intensive care service of Dr. Joaquín Albarrán Provincial Clinical Surgical Hospital from January 2015 to December 2018. The study universe was 1 847 cultures, from which 654 were selected in which growth was obtained. Data were processed with the statistical software SPPS 22.0. Results: Of the germs isolated, Klebsiella spp. were the most common (31 percent, followed by Staphylococcus spp. (24.5 percent) and E. coli (9.8 percent). Klebsiella spp. were frequent in sputum cultures (45.1 percent), Staphylococcus spp. in blood cultures (53.6 percent) and Candida in urine cultures (41.1 percent), followed by E. coli (27 percent). Among the antimicrobials used to treat Klebsiella spp., E. coli, Acinetobacter and Pseudomonas spp., the most recommended is colistin (0-25 percent resistance) and vancomycin for Staphylococcus spp. (1.8 percent). Conclusions: Gram-negative germs continue to be the most commonly isolated in cultures from intensive care patients, with a high level of resistance to most antibiotics(AU)


Subject(s)
Humans , Male , Female , Klebsiella Infections/prevention & control , Vancomycin/therapeutic use , Cross Infection/prevention & control , Colistin/therapeutic use , Intensive Care Units/statistics & numerical data , Epidemiology, Descriptive , Retrospective Studies
16.
Rev. chil. infectol ; 37(4): 349-355, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138558

ABSTRACT

Resumen Introducción: La vigilancia de la administración de los antimicrobianos mejora su prescripción. Objetivo: Disminuir el escalamiento en el uso de antimicrobianos a las 48 h del inicio, en la unidad de cuidados intensivos pediátricos (UCIP). Material y Métodos: Estudio de cohortes ambispectivo, realizado en una UCIP e incluyó pacientes ingresados que recibieron antibioterapia, implementando una lista de verificación del uso de antimicrobianos (checklist) en forma prospectiva, Se comparó con una cohorte histórica previa al checklist. Fueron evaluados el escalamiento de antimicrobianos a las 48 h, la consulta con infectólogos y la indicación de vancomicina .La comparación de las variables entre las dos cohortes se realizó con la prueba de χ2, el test de Fischer y la U de Mann Whitney. Los resultados principales se expresaron en RR y RAR. Estudio aprobado por el Comité de Ética institucional. Resultados: Ingresaron 70 pacientes en la etapa del checklist, y fueron comparados con 124 pacientes de la cohorte histórica. La introducción del checklist redujo el escalamiento de antimicrobianos a las 48 h, desde 56,4 a 21,4% (p < 0,0001) con una RAR de 35%; la prescripción de la vancomicina desde 64,5 a 40% (p < 0,001), RAR 24,5% e incrementó la consulta con infectólogo en 23%, (desde 9,6 a 32,8%) (p < 0,0001). No hubo diferencias en la mortalidad y duración de la antibioterapia a los 10 días. Conclusiones: El checklist permitió disminuir el escalamiento de antimicrobianos a las 48 h del inicio, la indicación de vancomicina y aumentó la consulta con infectólogos.


Abstract Background: Antibiotic surveillance improves the appropriate antibiotic therapy. Aim: To decrease the antibiotic scaling, 48 hours after starting prescription in the pediatric intensive care unit (PICU). Methods: A ambispective cohort study was performed in the PICU including patients admitted in whom antibiotic therapy was started and a checklist was applied prospectively. They were compared with a historical cohort, prior the checklist. The main outcome was the antibiotic scaling 48 hours after starting and the secondary endpoints were consultation with infectious diseases (ID) specialist and vancomycin prescription. To compare the variables between the two cohorts, the χ2 test, Fischer test and U Mann-Whitney test were used. The results of the main variables were expressed in RR and RAR. The study was approved by the institution's Ethics Committee. Results: 70 patients were admitted in the checklist cohort and they were compared with 124 patients of the historical cohort. The checklist implementation decreased the antibiotic scaling at 48 h after starting from 56.4 to 21.4% (p < 0.0001) ARR = 35% and vancomycin prescription from 64.5 to 40% (p < 0.001) ARR =24.5%. The consultation with ID specialist increased from 9.6 to 32.8% (p < 0.0001). There were no differences in mortality and duration of antibiotic therapy at 10 days of hospitalization. Conclusion: The checklist implementation decreased the antibiotic scaling,48 hs after starting and the vancomycin prescription while the ID specialist consultation increased.


Subject(s)
Humans , Child , Checklist , Vancomycin , Intensive Care Units, Pediatric , Retrospective Studies , Cohort Studies , Anti-Bacterial Agents/therapeutic use
17.
Brasília; s.n; 17 jul. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1117678

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, referentes 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 14 artigos e 13 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Ribavirin/therapeutic use , Technology Assessment, Biomedical , Dexamethasone/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Vancomycin/therapeutic use , Ganciclovir/therapeutic use , Cohort Studies , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Ritonavir/therapeutic use , Oseltamivir/therapeutic use , Adrenergic beta-1 Receptor Antagonists/therapeutic use , Lopinavir/therapeutic use , Linezolid/therapeutic use , Darunavir/therapeutic use , Cobicistat/therapeutic use , Interferon beta-1a/therapeutic use , Adalimumab/therapeutic use , Abatacept/therapeutic use , Etanercept/therapeutic use , Cefepime/therapeutic use , Meropenem/therapeutic use , Hydroxychloroquine/therapeutic use
19.
Rev. chil. infectol ; 37(2): 99-105, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1126095

ABSTRACT

Resumen Introducción: Vancomicina es un antimicrobiano ampliamente utilizado para infecciones por Staphylococcus coagulasa negativa en neonatos; sin embargo, no existe claridad sobre la dosis empírica que asegure su eficacia terapéutica. Objetivo: Evaluar la relación entre las dosis iniciales de vancomicina utilizadas en una Unidad de Cuidado Intensivo Neonatal (UCIN) con la eventualidad de alcanzar el objetivo terapéutico de área bajo la curva sobre concentración inhibitoria mínima (ABC/CIM) mayor a 400 µg/h/mL. Materiales y Método: Estudio descriptivo y retrospectivo, realizado entre febrero 2016 y marzo 2018. Se incluyeron neonatos en tratamiento con vancomicina por sospecha/confirmación de infección por cocáceas grampositivas y medición de concentraciones plasmáticas de vancomicina al inicio del tratamiento. La probabilidad de alcanzar el objetivo terapéutico se evaluó mediante re-muestreo de valores de ABC y CIM. Resultados: Se incluyeron 38 pacientes con 49 concentraciones plasmáticas de vancomicina. Los aislados microbiológicos se confirmaron en 94,7% de los pacientes (n = 36). Los valores de ABC/CIM en dos grupos (según niveles valle de vancomicina < 10 µg/mL y ≥ 10 µg/mL), fueron de una mediana de 327 (IQ 25-75 = 174-395) y 494 (IQ 25-75 = 318-631), respectivamente (p = 0,035). Las dosis empíricas utilizadas logran logran un objetivo terapéutico (ABC/CIM > 400) de sólo 47,7% considerando CIMs en nuestra institución. Conclusiones: Teniendo en cuenta las sensibilidades institucionales, no es posible asegurar alcanzar ABC/CIM > 400 µg/h/mL. Se debe seguir investigando para replantear las actuales estrategias de dosificación y así determinar la más apropiada para neonatos.


Abstract Background: Vancomycin is used for treating coagulase-negative staphylococcus infections in neonates. However, concerns about the appropriate empirical dosing required for optimal efficacy, still remain. Aim: To assess the relationship between the initial doses of vancomycin used in a Neonatal Intensive Care Unit (NICU) with the possibility of achieving therapeutic target of AUC024h/MIC > 400 µg/h/mL. Methods: Retrospective and descriptive study carried out between February 2016 and March 2018. All neonates treated with vancomycin for suspected/proven Gram-positive infection and with at least one trough serum concentration level were included. Probability of target attainment (PTA) was evaluated through resampling of AUC and MIC values. Results: Final dataset included 38 patients and 49 trough vancomycin levels; 94.7% of these cases (n = 36) were confirmed Gram-positive infections. The median AUC/MIC values for the trough values vancomycin < 10 µg/mL group and for the ≥ 10 µg/mL group were 327 (IQR 174-395) and 494 (IQR 318-631) respectively (p = 0.035). Current empirical dosing strategy has a 47.7% PTA (AUC/MIC > 400) when taking institutional MICs into account. Conclusions: It is not possible to assure achieving a AUC/MIC > 400 µg/h/mL when considering institutional sensibilities. Current empiric dosing strategies should be reconsidered and further investigation needs to be done to help determine the appropriate empirical dosing required for optimal efficacy in neonates.


Subject(s)
Humans , Infant, Newborn , Vancomycin/administration & dosage , Staphylococcal Infections , Microbial Sensitivity Tests , Retrospective Studies , Area Under Curve , Anti-Bacterial Agents
20.
J. pediatr. (Rio J.) ; 96(supl.1): 80-86, Mar.-Apr. 2020.
Article in English | LILACS | ID: biblio-1098352

ABSTRACT

Abstract Objectives To present current evidence on the etiology, risk factors, diagnosis, and management of early and late neonatal sepsis. Source of data Non-systematic review of the Medline (PubMed), Scopus, Web of Science, Cochrane, and Google Scholar databases regarding the following terms: neonatal sepsis, early neonatal sepsis, late neonatal sepsis, empirical antibiotic therapy, sepsis calculator, vancomycin, newborn, preterm newborn. Data synthesis Neonatal sepsis is a frequent cause of neonatal morbidity and mortality. Its diagnosis is difficult. Continuous observation of the patient is critical to diagnostic suspicion. When neonatal sepsis is suspected, bacteriological tests should be collected. Vancomycin should not be routinely using in the empirical antibiotic regimen in late neonatal sepsis, and the main protective mechanisms against neonatal sepsis are handwashing and the use of breast milk. Conclusions Newborns constitute a group that is more vulnerable to sepsis. Knowledge of risk factors and etiological agents allows a better approach to the newborn with sepsis.


Resumo Objetivos Apresentar evidências atuais na etiologia, fatores de risco, diagnóstico e manejo da sepse neonatal precoce e tardia. Fontes de dados Revisão não sistemática feita nas bases de dados Medline (PubMed), Scopus, Web of Science, Cochrane, Google Scholar sobre os temas sepse neonatal, sepse neonatal precoce, sepse neonatal tardia, antibioticoterapia empírica, sepsis calculator, vancomicina, recém-nascido, recém-nascido pré-termo. Síntese de dados A sepse neonatal é uma causa frequente de morbimortalidade neonatal. O seu diagnóstico é difícil. A observação contínua do paciente é fundamental para uma suspeição diagnóstica. Ao se suspeitar de sepse neonatal devem-se coletar exames bacteriológicos. Não usar, rotineiramente, vancomicina no esquema empírico de antibiótico na sepse neonatal tardia. Os principais mecanismos protetores da sepse neonatal são a lavagem de mãos e o uso do leite materno. Conclusões Os recém-nascidos constituem um grupo mais vulnerável à sepse. O conhecimento dos fatores de risco e dos agentes etiológicos permite uma melhor abordagem do recém-nascido séptico.


Subject(s)
Humans , Female , Infant, Newborn , Neonatal Sepsis/diagnosis , Neonatal Sepsis/etiology , Neonatal Sepsis/drug therapy , Vancomycin , Anti-Bacterial Agents/therapeutic use
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