Resistencia antimicrobiana de Enterobacterias causante de infección del tracto urinario en pacientes ambulatorios

Las infecciones del tracto urinario son consideradas un problema de salud a nivel hospitalario y comunitario por el aumento de bacterias resistentes a los antibióticos. Objetivo: Analizar el patrón de susceptibilidad y resistencia antimicrobiana de Enterobacterias causante de infección del tracto urinario. Métodos: Se aplicó una investigación descriptiva de diseño documental. La población fue de 672 registros de urocultivos positivos, recopilados de la base de datos del Laboratorio San Pablo en el periodo 2021-2022. Para su tabulación y análisis los datos obtenidos fueron procesados en el Software SPSS versión 25.0. Resultados: Las ITU se presentan con mayor frecuencia en el género femenino 86,5%. El grupo etario con más afección es la edad adulta 50,4%. El agente etiológico con mayor incidencia fue Escherichia coli 75,74%, Citrobacter Freundii 8,93%, Klebsiella spp 6,10%. La producción de BLEE como mecanismo de resistencia predominaron en las cepas de E.coli y Klebsiella spp. Se encontró un mayor porcentaje de resistencia para Ampicilina y SXT. Los antibióticos con mejor sensibilidad destacaron nitrofurantoína, fosfomicina. Conclusión: La especie con mayor aislamiento, implicada en la etiología de infecciones urinarias sigue siendo E.coli con una sensibilidad alta para nitrofurantoína y fosfomicina.

Urinary tract infections are considered a health problem at hospital and community level due to the increase of antibiotic resistant bacteria. Objective: To analyze the pattern of susceptibility and antimicrobial resistance of Enterobacteriaceae causing urinary tract infection. Methods: A descriptive research of documentary design was applied. The population was 672 records of positive urine cultures, collected from the San Pablo Laboratory database in the period 2021-2022. For tabulation and analysis, the data obtained were processed in SPSS software version 25.0. Results: UTIs occur more frequently in females 86.5%. The age group with the highest incidence was adulthood 50.4%. The etiological agent with the highest incidence was Escherichia coli 75.74%, Citrobacter Freundii 8.93%, Klebsiella spp 6.10%. The production of BLEE as a mechanism of resistance predominated in the strains of E.coli and Klebsiella spp. A higher percentage of resistance was found for Ampicillin and SXT. The antibiotics with the best sensitivity were nitrofurantoin and fosfomycin. Conclusion: The species with the highest isolation, implicated in the etiology of urinary tract infections, continues to be E.coli with a high sensitivity to nitrofurantoin and fosfomycin.

As infecções do trato urinário são consideradas um problema de saúde a nível hospitalar e comunitário devido ao aumento de bactérias resistentes aos antibióticos. Objetivo: Analisar o padrão de suscetibilidade e resistência antimicrobiana das Enterobacteriaceae causadoras de infecções do trato urinário. Métodos: Foi aplicada uma metodologia de investigação documental descritiva. A população foi de 672 registros de culturas de urina positivas, coletados do banco de dados do Laboratório San Pablo no período de 2021-2022. Para tabulação e análise, os dados obtidos foram processados no software SPSS versão 25.0 Resultados: As ITUs ocorreram com maior frequência no sexo feminino 86,5%. A faixa etária com maior incidência foi a adulta 50,4%. O agente etiológico com maior incidência foi a Escherichia coli 75,74%, Citrobacter Freundii 8,93%, Klebsiella spp 6,10%. A produção de BLEE como mecanismo de resistência predominou em E. coli e Klebsiella spp. Foi encontrada uma maior percentagem de resistência para a ampicilina e o SXT. Os antibióticos com melhor sensibilidade foram a nitrofurantoína e a fosfomicina. Conclusão: A espécie com maior isolamento, implicada na etiologia das infecções do trato urinário, continua a ser a E. coli com uma elevada sensibilidade à nitrofurantoína e à fosfomicina.

Efectividad antimicrobiana de los sistemas adhesivos. Una alternativa eficaz: revisión bibliográfica / Antimicrobial effectiveness of adhesive systems. An effective alternative: literature review / Eficácia antimicrobiana dos sistemas adesivos. Uma alternativa eficaz: revisão da literatura

RESUMEN Los sistemas adhesivos se utilizan en la práctica clínica diaria; sin embargo, su principal desventaja es la contracción por polimerización que podría ocasionar la aparición de microfiltraciones, acumulo de placa, caries secundaria e hipersensibilidad. Por este motivo, se han venido incorporando agentes antimicrobianos, como el metacrilato de amonio cuaternario fotopolimerizable, los rellenos de vidrio que liberan iones de flúor, el pirogalol y las nanopartículas de plata, calcio y grafeno fluorado. En los últimos años, algunos de estos han demostrado tener una buena efectividad antimicrobiana, que, a su vez, no interfieren con la adhesión en las restauraciones. De tal manera, estos sistemas adhesivos antimicrobianos podrían favorecer a obtener mejores resultados a largo plazo. Las nanopartículas que presentaron mejores resultados fueron el fosfato de calcio amorfo y las compuestas de plata.

ABSTRACT Adhesive systems are used in daily clinical practice; however, the main disadvantage is polymerization shrinkage, which could lead to microleakage, plaque accumulation, secondary caries, and hypersensitivity. For this reason, antimicrobial agents have been incorporated, such as light-curing quaternary ammonium methacrylate, fluoride ion-releasing glass fillers, pyrogallol, and nanoparticles of silver, calcium, and fluorinated graphene. In recent years, some of these have been shown to have good antimicrobial effectiveness and, in turn, do not interfere with adhesion in restorations. Thus, these antimicrobial adhesive systems could contribute to better long-term results. The best-performing nanoparticles were amorphous calcium phosphate and silver nanoparticles.

RESUMO Os sistemas adesivos são utilizados na prática clínica diária; no entanto, a principal desvantagem é a contração da polimerização, que pode levar a microinfiltração, acumulação de placa, cáries secundárias e hipersensibilidade. Por este motivo, foram incorporados agentes antimicrobianos, como o metacrilato de amónio quaternário fotopolimerizável, cargas de vidro que libertam iões de flúor, pirogalol e nanopartículas de prata, cálcio e grafeno fluorado. Nos últimos anos, algumas destas substâncias demonstraram ter uma boa eficácia antimicrobiana e não interferem com a adesão nas restaurações. Assim, estes sistemas adesivos antimicrobianos poderiam conduzir a melhores resultados a longo prazo. As nanopartículas com melhor desempenho foram o fosfato de cálcio amorfo e as nanopartículas de prata.

Nuevas perspectivas en el estudio y tratamiento de la sepsis

La sepsis es una disfunción orgánica potencialmente mortal debida a una respuesta desregulada del hospedero a la infección. No sólo contribuye con el 20 % de todas las causas de muerte de forma global, sino que los sobrevivientes de esta también pueden experimentar una significativa morbilidad a largo plazo. La sepsis y el shock séptico son emergencias médicas que requieren reconocimiento rápido, administración de antimicrobianos apropiados, soporte hemodinámico cuidadoso y control de la fuente infecciosa. El objetivo de esta revisión fue describir la definición y los criterios diagnósticos, la epidemiología, los factores de riesgo, la patogenia y la conducta inicial ante la sepsis.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. It severely impacts global disease burden as it constates 20 % of all causes of death; its survivors may experience long-term morbidity. Sepsis and septic shock are medical emergencies that require rapid identification, administration of appropriate antimicrobials, careful hemodynamic support, and control of the infection source. This review aims to update the definition of sepsis and its diagnostic criteria, epidemiology, risk factors, pathogenesis, and baseline behavior.

Enterotoxigenic methicillin resistant Staphylococcus aureus contamination in salted fish from Gwadar Balochistan / Contaminação de Staphylococcus aureus resistente à meticilina enterotoxigênica em peixes salgados de Gwadar Balochistan

Staphylococcus aureus is an important foodborne pathogen associated to food intoxication and other multiple infections in human being. Its presence in salted food is a serious issue due to its salt tolerance potential. A study was conducted to analyze the presence of enterotoxins producing drug resistance S. aureus in salted sea fish from Gwadar. Freshly persevered samples (n=50) of salted fish were subjected to analyze the presence of S. aureus using 16S rRNA and Nuc genes primers. The isolates were then evaluated for drug resistance and enterotoxins producing potential using specific primers for MecA (methicillin resistance gene), (SEA) staphylococcal enterotoxin A and (SEB) staphylococcal enterotoxin B genes. Total 13/50 (26%) of the samples were found positive for the presence of S. aureus, preliminary confirmed with biochemical profiling and finally with the help of target genes presence. The isolates were found showing 100% resistant to methicillin, which were molecularly confirmed by the presence of MecA gene present in genome. The isolates 5/13 (38%) were positive for SEA and 3/13 (23%) for SEB genes, whereas 2/13 (15%) were confirmed having both SEA and SEB genes in its genome. It was also confirmed that all the isolates were capable to form biofilm over the glass surfaces. It was concluded that the study confirmed the presence of enterotoxigenic methicillin resistance Staphylococcus aurous (MRSA) in salted fish product, that poses gross food safety concern. Preventive and control measures are necessary to handle this serious food safety concern.

Staphylococcus aureus é um importante patógeno de origem alimentar associado à intoxicação alimentar e outras infecções múltiplas em seres humanos. Sua presença em alimentos salgados é um problema sério devido ao seu potencial de tolerância ao sal. Um estudo foi realizado para analisar a presença de enterotoxinas produtoras de resistência a drogas S. aureus em peixes salgados do mar de Gwadar. Amostras recém-perseveradas (n = 50) de peixes salgados foram submetidas à análise da presença de S. aureus usando os primers dos genes 16S rRNA e Nuc. Os isolados foram então avaliados quanto à resistência a drogas e potencial de produção de enterotoxinas usando primers específicos para os genes MecA (gene de resistência à meticilina), (SEA) enterotoxina A estafilocócica e (SEB) enterotoxina B estafilocócica genes. Um total de 13/50 (26%) das amostras foi considerado positivas para a presença de S. aureus, confirmadas preliminarmente com perfis bioquímicos e finalmente com a ajuda da presença de genes-alvo. Os isolados foram encontrados com 100% de resistência à meticilina, os quais foram confirmados molecularmente pela presença do gene MecA no genoma. Os isolados 5/13 (38%) foram positivos para SEA e 3/13 (23%) para genes SEB, enquanto 2/13 (15%) foram confirmados tendo os genes SEA e SEB em seu genoma. Também foi verificado que todos os isolados foram capazes de formar biofilme sobre as superfícies de vidro. Concluiu-se que o estudo confirmou a presença de Staphylococcus aurous resistente à meticilina enterotoxigênica (MRSA) em produtos de peixe salgado, o que representa uma grande preocupação para a segurança alimentar. Medidas preventivas e de controle são necessárias para lidar com essa grave preocupação com a segurança alimentar.

Enterotoxigenic methicillin resistant Staphylococcus aureus contamination in salted fish from Gwadar Balochistan

Abstract Staphylococcus aureus is an important foodborne pathogen associated to food intoxication and other multiple infections in human being. Its presence in salted food is a serious issue due to its salt tolerance potential. A study was conducted to analyze the presence of enterotoxins producing drug resistance S. aureus in salted sea fish from Gwadar. Freshly persevered samples (n=50) of salted fish were subjected to analyze the presence of S. aureus using 16S rRNA and Nuc genes primers. The isolates were then evaluated for drug resistance and enterotoxins producing potential using specific primers for MecA (methicillin resistance gene), (SEA) staphylococcal enterotoxin A and (SEB) staphylococcal enterotoxin B genes. Total 13/50 (26%) of the samples were found positive for the presence of S. aureus, preliminary confirmed with biochemical profiling and finally with the help of target genes presence. The isolates were found showing 100% resistant to methicillin, which were molecularly confirmed by the presence of MecA gene present in genome. The isolates 5/13 (38%) were positive for SEA and 3/13 (23%) for SEB genes, whereas 2/13 (15%) were confirmed having both SEA and SEB genes in its genome. It was also confirmed that all the isolates were capable to form biofilm over the glass surfaces. It was concluded that the study confirmed the presence of enterotoxigenic methicillin resistance Staphylococcus aurous (MRSA) in salted fish product, that poses gross food safety concern. Preventive and control measures are necessary to handle this serious food safety concern.

Resumo Staphylococcus aureus é um importante patógeno de origem alimentar associado à intoxicação alimentar e outras infecções múltiplas em seres humanos. Sua presença em alimentos salgados é um problema sério devido ao seu potencial de tolerância ao sal. Um estudo foi realizado para analisar a presença de enterotoxinas produtoras de resistência a drogas S. aureus em peixes salgados do mar de Gwadar. Amostras recém-perseveradas (n = 50) de peixes salgados foram submetidas à análise da presença de S. aureus usando os primers dos genes 16S rRNA e Nuc. Os isolados foram então avaliados quanto à resistência a drogas e potencial de produção de enterotoxinas usando primers específicos para os genes MecA (gene de resistência à meticilina), (SEA) enterotoxina A estafilocócica e (SEB) enterotoxina B estafilocócica genes. Um total de 13/50 (26%) das amostras foi considerado positivas para a presença de S. aureus, confirmadas preliminarmente com perfis bioquímicos e finalmente com a ajuda da presença de genes-alvo. Os isolados foram encontrados com 100% de resistência à meticilina, os quais foram confirmados molecularmente pela presença do gene MecA no genoma. Os isolados 5/13 (38%) foram positivos para SEA e 3/13 (23%) para genes SEB, enquanto 2/13 (15%) foram confirmados tendo os genes SEA e SEB em seu genoma. Também foi verificado que todos os isolados foram capazes de formar biofilme sobre as superfícies de vidro. Concluiu-se que o estudo confirmou a presença de Staphylococcus aurous resistente à meticilina enterotoxigênica (MRSA) em produtos de peixe salgado, o que representa uma grande preocupação para a segurança alimentar. Medidas preventivas e de controle são necessárias para lidar com essa grave preocupação com a segurança alimentar.

Descarte de antimicrobianos vencidos e/ou em desuso: estudo de caso / Disposal of expired and/or discontinued antimicrobials - case study / Descarto de antimicrobiales muertos y/o desaparecidos: estudio de casos

A temática do descarte inadequado de medicamentos e sua relevância no desenvolvimento dos mecanismos de resistência aos antibióticos são os menos debatidos na literatura. Portanto, este trabalho tem como objetivo apresentar e discutir os dados obtidos sobre o recebimento de antimicrobianos vencidos e/ou sem uso descartados no ponto de coleta de medicamentos localizado no Departamento de Ciências Farmacêuticas, da Universidade Federal de Pernambuco, Campus Recife. Ao todo foram recolhidos 50,03 kg de medicamentos, dos quais 4,12 kg eram de antimicrobianos, sendo a terceira classe farmacológica mais frequente; destes, 93,07% (n=1.948 unidades) estavam vencidos e a forma farmacêutica mais encontrada foram os comprimidos (36,32%). Entre as classes de antibióticos predominaram, em relação ao mecanismo de ação, os que inibem a síntese proteica (29,33%), e pela estrutura química, as quinolonas (17,45%). A realização do descarte adequado desses medicamentos possibilita uma redução dos impactos que esse quantitativo recolhido causaria no meio ambiente. Portanto, deve-se investir em campanhas de conscientização sobre o uso correto dos medicamentos e seguimento da prescrição médica para evitar consumo indiscriminado destes fármacos. Com base o que estabelece o Decreto n° 10.388/2020, o descarte correto de medicamentos precisa ser divulgado, para que os estabelecimentos realizem a logística reversa dessas substâncias.

The issue of inappropriate disposal of medicines and its relevance in development of mechanisms of resistance to antibiotics is the least discussed in the literature. Therefore, this work aims to present and discuss the data obtained on the receipt of expired and/or unused antimicrobials discarded at the medication collection point located in the Department of Pharmaceutical Sciences, Federal University of Pernambuco, Campus Recife. In all, 50.03 kg of drugs were collected, of which 4.12 kg were antimicrobials, being the third most frequent pharmacological class; of these, 93.07% (n=1,948 units) were expired and the most common pharmaceutical form was pills (36.32%). Among the classes of antibiotics, in terms of mechanism of action, those that inhibit protein synthesis (29.33%) and chemical structure, quinolones (17.45%) predominated. Carrying out the proper disposal of these medicines makes it possible to reduce the impacts that this collected quantity would cause on the environment. Therefore, one should invest in awareness campaigns about the correct use of medicines and follow-up of medical prescriptions to avoid indiscriminate consumption of these drugs. Based on the provisions of Decree No. 10.388/2020, the correct disposal of medicines needs to be disclosed, so that establishments carry out the reverse logistics of these substances.

La cuestión de la eliminación inadecuada de los medicamentos y su relevancia en el desarrollo de mecanismos de resistencia a los antibióticos son los menos discutidos en la literatura. Por lo tanto, este trabajo tiene el objetivo de presentar y discutir los datos obtenidos sobre la recepción de antimicrobianos perdidos y/o no utilizados desechados en el punto de recolección de medicamentos ubicado en el Departamento de Ciencias Farmacéuticas de la Universidad Federal de Pernambuco, Campus Recife. En total, se tomaron 50,03 kg de medicamentos, de los cuales 4,12 kg fueron antimicrobianos, siendo la tercera clase farmacológica más común el 93,07% (n=1.948 unidades) retrasada y la forma farmacéutica más encontrada fueron los comprimidos (36,32%). Entre las clases de antibióticos predominaron, en relación con el mecanismo de acción, las que inhiben la síntesis de proteínas (29,33%), y por la estructura química, las quinolonas (17,45%). La eliminación adecuada de estos medicamentos permite reducir el impacto que esta cantidad recolectada podría causar en el medio ambiente. Por lo tanto, se deberían invertir en campañas de sensibilización sobre el uso correcto de medicamentos y el seguimiento de las recetas médicas para evitar el consumo indiscriminado de estos medicamentos. Sobre la base del Decreto no 10.388/2020, es necesario hacer pública la eliminación correcta de los medicamentos, para que los establecimientos realicen la logística inversa de estas sustancias.

Os desafios na conduta terapêutica em pacientes acometidos com feridas crônicas / Challenges in the therapeutic conduct in patients affected with chronic wounds / Retos en la conducta terapéutica en pacientes afectados de heridas crónicas

Considerado um grave problema em saúde pública, as feridas crônicas são patologias que desafiam o manejo terapêutico e infelizmente acometem milhares de pessoas em todo o mundo. Essa doença apresenta altos índices de morbidade impactando negativamente na qualidade de vida dos seus portadores, além de influenciar negativamente no domínio "bem-estar", principalmente quando associado aos fatores clínicos podendo estar relacionado há anos de tratamento sem cura da ferida. As feridas crônicas são caracterizadas por demora ou dificuldade nos processos de cicatrização e reparação ordenada da integridade anatômica e funcional da pele durante um período de no mínimo três meses. Porém, algumas lesões permanecem por anos e até décadas sem cicatrizar. Objetivo: O escopo dessa revisão é mostrar o limitado arsenal terapêutico bem como a dificuldade no manejo clínico e dessa forma proporcionar uma reflexão sobre sua fisiopatologia e a urgente necessidade de novas opções e condutas terapêuticas que possam auxiliar no tratamento desses pacientes. Metodologia: Trata-se de uma revisão integrativa da literatura sobre feridas crônicas, cujo critérios de inclusão foram artigos publicados no período de janeiro de 2005 a fevereiro de 2023. Conclusão: A problemática acerca dessa patologia é vasta, tratando de uma doença de difícil cura, com uma gama de fatores associados que dificultam a cura da lesão, estendendo essa doença a altos índices de morbidade. Novas condutas terapêuticas e novos fármacos, precisam ser desenvolvidos urgentemente. Destaca-se que o uso de probióticos e o emprego da nanotecnologia tem mostrado um grande potencial inovador no tratamento de pacientes portadores de feridas crônicas.

Considered a serious public health problem, chronic wounds are pathologies that defy therapeutic management and unfortunately affect thousands of people around the world. This disease has high morbidity rates, negatively impacting the quality of life of its patients, in addition to negatively influencing the "well-being" domain, especially when associated with clinical factors, which may be related to years of treatment without healing of the wound. Chronic wounds are characterized by delay or difficulty in healing processes and orderly repair of the anatomical and functional integrity of the skin over a period of at least three months. However, some injuries remain for years and even decades without healing. Objective: The scope of this review is to show the limited therapeutic arsenal as well as the difficulty in clinical management and thus provide a reflection on its pathophysiology and the urgent need for new options and therapeutic approaches that can help in the treatment of these patients. Methodology: This is an integrative review of the literature on chronic wounds, whose inclusion criteria were articles published from January 2005 to February 2023. Conclusion: The problem surrounding this pathology is vast, dealing with a difficult-to-cure disease, with a range of associated factors that make healing of the lesion difficult, extending this disease to high morbidity rates. New therapeutic approaches and new drugs need to be developed urgently. It is noteworthy that the use of probiotics and the use of nanotechnology have shown great innovative potential in the treatment of patients with chronic wounds.

Consideradas un grave problema de salud pública, las heridas crónicas son patologías que desafían el manejo terapéutico y que, lamentablemente, afectan a miles de personas en todo el mundo. Esta enfermedad presenta altas tasas de morbilidad, impactando negativamente en la calidad de vida de sus pacientes, además de influir negativamente en el dominio "bienestar", especialmente cuando se asocia a factores clínicos, que pueden estar relacionados con años de tratamiento sin curación de la herida. Las heridas crónicas se caracterizan por un retraso o dificultad en los procesos de cicatrización y reparación ordenada de la integridad anatómica y funcional de la piel durante un periodo de al menos tres meses. Sin embargo, algunas heridas permanecen durante años e incluso décadas sin cicatrizar. Objetivo: El alcance de esta revisión es mostrar el limitado arsenal terapéutico así como la dificultad en el manejo clínico y así aportar una reflexión sobre su fisiopatología y la urgente necesidad de nuevas opciones y enfoques terapéuticos que puedan ayudar en el tratamiento de estos pacientes. Metodología: Se trata de una revisión integradora de la literatura sobre heridas crónicas, cuyos criterios de inclusión fueron artículos publicados desde enero de 2005 hasta febrero de 2023. Conclusiones: La problemática que rodea a esta patología es amplia, tratándose de una enfermedad de difícil curación, con una serie de factores asociados que dificultan la cicatrización de la lesión, extendiendo esta enfermedad a altas tasas de morbilidad. Es urgente desarrollar nuevos enfoques terapéuticos y nuevos fármacos. Cabe destacar que el uso de probióticos y el empleo de nanotecnología han mostrado un gran potencial innovador en el tratamiento de pacientes con heridas crónicas.

Caracterización epidemio-molecular de la infección por Clostridioides difficile en pacientes hospitalizados con cuadro diarreico en instituciones de salud. 2019

La infección por Clostridioides difficile es una de las principales causas de diarrea nosocomial en hospitales del mundo, asociada a antibióticos de amplio espectro. Estudio descriptivo, retrospectivo, de corte transverso, de tipo censal. Se estudiaron 281 muestras de pacientes hospitalizados con la infección, se analizaron características socio-demográficas, clínicas y se caracterizó molecularmente al patógeno. Como resultado, se obtuvieron pacientes con la infección con una mediana de edad de 64 años siendo el 61,5 % del sexo masculino. El promedio de presentación del cuadro diarreico fue de 5 días, con tratamiento antimicrobiano de 8 días e internación de 15 días. El 94% tuvo tratamiento antimicrobiano previo, y el 6% estuvo expuesto a algún factor de riesgo. Los antimicrobianos más utilizados solos o en combinación fueron betalactámicos, fluoroquinolonas, vancomicina y carbapenémicos. Las áreas de internación con mayor frecuencia de presentación de la infección fueron las unidades de Clínica Médica, Traumatología, Geriatría y Unidad de Terapia Intensiva. La prevalencia de C. difficile toxigénico fue de 14%, y de esta frecuencia el 100% presentó toxinas TcdA y TcdB, con ausencia de toxinas binarias y deleción del gen tcdC. Se constató la presencia grupos clonales en la misma unidad de internación y misma institución de salud. El 100% de las cepas resultaron susceptibles a los antibióticos de elección para la infección. La prevalencia de la infección y presencia de perfiles clonales detectadas revelan la necesidad de un mejoramiento en el sistema de control de infecciones, así como del fortalecimiento y vigilancia de la resistencia antimicrobiana.

Clostridioides difficile infection is one of the main causes of nosocomial diarrhea in hospitals worldwide, associated with broad-spectrum antibiotics. Descriptive, retrospective, cross-sectional, census-type study. Two hundred eighty-one samples from patients hospitalized with the infection were studied, sociodemographic and clinical characteristics were analyzed and the pathogen was characterized molecularly. As a result, patients with the infection had a median age of 64 years and 61.5% male. The average presentation of diarrhea was 5 days, antimicrobial treatment 8 days and hospitalization 15 days. Ninety four percent had previous antimicrobial treatment, and 6% were exposed to some risk factor. The most commonly used antimicrobials alone or in combination were beta-lactams, fluoroquinolones, vancomycin, and carbapenems. The hospitalization areas with the highest frequency of presentation of the infection were the Clinical Medicine, Traumatology, Geriatrics and Intensive Care Unit units. The prevalence of toxigenic C. difficile was 14%, and of this frequency, 100% presented TcdA and TcdB toxins, with the absence of binary toxins and deletion of the tcdC gene. The presence of clonal groups was verified in the same hospitalization unit and the same health institution. All the strains were susceptible to the antibiotics of choice for the infection. The prevalence of infection and the presence of clonal profiles detected reveal the need for improvement of the infection control system, as well as of the strengthening and surveillance of antimicrobial resistance.

Mecanismos plasmídicos de resistencia a quinolonas, betalactámicos y colistina en Salmonella enterica. Paraguay 2020-2021

Las bacterias son capaces de desarrollar mecanismos de resistencia a los antimicrobianos, aquellos adquiridos y transmisibles son los más significativos debido al potencial de diseminación. La aparición de Salmonella enterica con resistencia a C3aG, quinolonas y a colistina representa una amenaza progresiva. El objetivo fue determinar la resistencia a los antimicrobianos y la presencia de los mecanismos de resistencia plasmídicos a quinolonas, ß-lactámicos y colistina en aislados de Salmonella provenientes de la vigilancia integrada de enteropatógenos. Fueron estudiadas 501 cepas de Salmonella spp. colectadas entre los años 2020 y 2021, por la red de enteropatógenos del Laboratorio Central de Salud Pública. Se investigó la resistencia a las C3aG, quinolonas y colistina, en aislamientos de humanos, alimentos, animales de consumo y ambiente. Las cepas estudiadas exhibieron resistencia a tetraciclina (32,5%), ácido nalidíxico (29%), ampicilina (13,2%), nitrofurantoína (11,6%), C3aG (7,2%), cotrimoxazol (5,8%), ciprofloxacina (2,2%). El 18% (90/501) presentaron resistencia trasferible por plásmidos, fueron detectados 111 genes (71 cepas con un gen, 17 cepas dos genes y 2 cepas tres genes diferentes). Qnr B: 41,1% (37/90), mcr-1: 38,9% (35/90), CMY: 23,3% (21/90), CTX-M: 16,7% (15/90) y Qnr S: 3,3% (3/90). Heidelberg fue el serovar predominante en muestras de pollo y el mayor portador de genes de resistencia de tipo CMY y mcr-1. La detección de genes en alimentos y animales de consumo, que pueden transmitirse fácilmente al ser humano es motivo de alerta y resalta la importancia de continuar fortaleciendo la vigilancia multisectorial y multidisciplinaria.

Bacteria can develop antimicrobial resistance mechanisms, those acquired and transmissible being the most significant due to the potential for dissemination. The emergence of Salmonella enterica with resistance to third-generation cephalosporins, quinolones, and colistin represents a progressive threat. The objective was to determine antimicrobial resistance and the presence of plasmid resistance mechanisms to quinolones, ß-lactams, and colistin in Salmonella isolates from integrated surveillance of enteropathogens. Five hundred and one strains of Salmonella spp. collected between 2020 and 2021 were studied by the enteropathogen network of the Laboratorio Central de Salud Publica (Central Public Health Laboratory). Research was conducted on the resistance to third-generation cephalosporins, quinolones, and colistin, isolated from humans, foodstuffs, animals for consumption, and the environment. The strains studied exhibited resistance to tetracycline (32.5%), nalidixic acid (29%), ampicillin (13.2%), nitrofurantoin (11.6%), third-generation cephalosporins (7.2%), cotrimoxazole (5.8%), and ciprofloxacin (2.2%). Eighteen percent (90/501) presented plasmid-transferable resistance, 111 genes were detected (71 strains with one gene, 17 strains with two genes, and 2 strains with three different genes). Qnr B: 41.1% (37/90), mcr-1: 38.9% (35/90), CMY: 23.3% (21/90), CTX-M: 16.7% (15/90), and Qnr S: 3.3% (3/90). Heidelberg was the predominant serovar in chicken samples and the largest carrier of CMY and mcr-1 resistance genes. The detection of genes in foodstuffs and animals for consumption, which can be easily transmitted to humans, is a cause for alarm and highlights the importance of continuing to strengthen multisectoral and multidisciplinary surveillance.

The influence of sepsis on antimicrobials tissue penetration: The use of microdialysis technique to access free drug distribution

Abstract Sepsis is described as a life-threatening organ dysfunction caused by a host's response to infection, leading to an unbalance in body homeostasis. It is one of the leading causes of death in developed countries. Considering that in critically ill patients, such as those with sepsis, plasma concentrations do not necessarily reflect tissue concentrations, one way to assess tissue concentrations is through the microdialysis technique, which allows direct measurements of free drug at the site of action. This review was carried out after searching the Pubmed, Scielo and Web of Science databases, using the following descriptors: (microdialysis AND (sepsis OR septic shock OR severe sepsis OR septicemia)) OR (microdialysis AND (sepsis OR septic shock OR severe sepsis) OR septicemia) AND (antimicrobial OR antibiotic OR antifungal)). The physiological changes generated by sepsis may imply changes in pharmacokinetic parameters, such as in clearance, which may be reduced in these patients and in volume of distribution, which presents an expansion, mainly due to edema. Both events contribute to a high inter- individual variability in tissue penetration of antimicrobials which is generally observed in patients with sepsis.

Study of prescribing pattern of antimicrobials in a tertiary care hospital

Background: Antimicrobials are routinely prescribed in several disease conditions in which infections are established or suspected to be the reason for the illness. Excessive and irrational use of antimicrobials leads to development of drug resistance in microorganisms, besides increasing health-care expenditure. Antimicrobial resistance (AMR) leads to increase in morbidity and mortality. The rational use of antimicrobials is a major health need in all countries. Hence, assessment of prescribing pattern of antimicrobials is essential for clinical, educational, and economic purposes. Aims and Objectives: The objectives of the study were to evaluate and compare the prescribing pattern of antimicrobials by assessing – (i) commonly used antimicrobials; and (ii) disease conditions for which they were prescribed. Materials and Methods: It was a prospective observational study done for a period of 1 month. All the prescriptions in which antimicrobials were prescribed in the outpatient departments (OPD) and in-patient wards (IP) were included in the study. Prescriptions were analyzed for demographic and antibiotic data. Results: 1092 prescriptions were collected and analyzed. Among them, 690 prescriptions were from OPD and 382 prescriptions from in patient wards. Out patient data: Cefixime (21.30%) was commonly prescribed followed by fixed dose combination of Amoxicillin + Clavulanic acid (14.64%) and Ciprofloxacin (8.84%). Cefixime was commonly prescribed for URTI (13.43%). Oral route (82.17%) was the preferred route of administration. IP data: Cefotaxime (26.45%) was commonly prescribed followed by fixed dose combination of Piperacillin + Tazobactum (15.29%) and Ceftriaxone (14.46%). Cefotaxime was commonly prescribed preoperatively for most of the surgeries (76.56%). Intravenous route (46.86%) was the preferred route of administration. Single antimicrobial therapy (81.41%) was preferred followed by double (17.80%) and triple (0.79%) antimicrobial therapy. Conclusion: Cefixime and cefotaxime were commonly used in OPD and in patient wards, respectively. Oral route and intravenous route were the preferred route in OPD and IP wards, respectively. Single antimicrobial therapy was commonly preferred in both IP and out-patient wards. Although double and triple antimicrobial therapy was prescribed in small number of patients, it should be cautiously used to prevent AMR.

Escherichia coli biofilm formation and control by phenolic compounds from Salvia officinalis L. Extracts

Biofilm is recognized as one of the virulence factors of uropathogenic Escherichia coli. It offers bacteria significantly increased tolerance to antibiotics and makes difficulties in infection eradication. In this study, the biofilm formation ability of clinical isolates of uropathogenic E. coli as well as the antibiofilm activity of the common Garden sage, Salvia officinalis L. extracts were investigated in vitro. The influence of growth conditions (nutrient composition and incubation period) on biofilm formation of E. coli strains was evaluated using crystal violet staining procedure. The tested strains better formed biofilms after a longer incubation period (48 h). In addition, biofilm formation depended on nutrient medium composition. The eight strains were slime producers (Congo red agar assay). The water, ethanol, acetone and diethyl ether S. officinalis extracts were screened for their ability to inhibit the formation and metabolic activity of E. coli biofilms using crystal violet and resazurin assay, respectively. The water extract was not active, while ethanol, acetone and diethyl ether extract exhibited antibiofilm activity (MBIC= 2.5-10 mg/mL). The microscopic visualization of treated E. coli LM1 biofilm has shown morphological and density changes. In addition, the concentrations of phenolic compounds were determined spectrophotometrically. The highest content of total phenolics was found in acetone extract while the flavonoids in water extract

Knowledge, attitude, and practice toward antibiotic usage among general practitioners: A cross-sectional study

Background: In the developing countries like India, infections are still very common. About 50% of the patients presenting to general practitioners had fever as the complaint pointing that infective ailments still predominate. Aims and Objectives: The use of antimicrobials is very common in practice that leads to the development of antimicrobial resistance. Materials and Methods: A total of 120 GP’s were registered for the present study. Assessment was done based on the special questionnaire prepared for assessing the knowledge, attitude, and practice (KAP) of the GP’s. Results: Data were collected from the Google Forms, which was then analyzed using Statistical software. No statistical difference between KAP of all pathies was observed. There is a statistically significant positive correlation between number of patients attended per day and antibiotics prescribed. This correlation is strong between allopathy practitioners whereas it’s moderate in homeopathy and Ayurveda practitioners. There is a statistically significant association between KAP. Conclusion: Self-medication and modification in the treatment by the patients; unnecessary and improper use by physicians and pharmacists themselves giving antimicrobials without prescription are some of the common problems in irrational use of antimicrobials. From this study, we can conclude that KAP of GP’s has an association with usage of antibiotics and thus programs for promoting and improving KAP’s can be useful in managing the irrational use of antibiotics.

Patterns and outcomes of empirical antimicrobial use in elderly outpatients: A pilot observational study from North India

Introduction: Despite the rampant use of antimicrobials in health?care settings, the safety and clinical outcome data of antimicrobials are scarce in the elderly population. The main aim of this study is to assess the prescription pattern, therapeutic gains, and adverse reactions resulting out of antimicrobial use in elderly outpatients. Subjects and Methods: This was a prospective observational study conducted for 7 months from June 2019 to December 2019 in elderly patients visiting the geriatric outpatient department of a tertiary hospital of North India. Primary outcomes included clinical improvement as well as the incidence and type of adverse drug reactions (ADRs) observed with antimicrobial use. Results: Of 110 participants recruited, 107 were assessed for clinical outcomes. The common indications of antimicrobial use were lower respiratory tract infection (48.6%), urinary tract infection (18.7%), and worm infestations (14%). Macrolides (57%) and beta?lactams (43%) were the commonly prescribed individual antimicrobials. Outcome?wise, clinical improvement was seen in 91.3%, 88.5%, and 14.3% of patients receiving beta?lactams, macrolides, and antiprotozoals, respectively. ADRs occurred in 17.7% of participants and gastrointestinal disturbance was the commonly reported ADR. Beta?lactams and macrolides were responsible for the majority of ADRs, in 19.6% and 13.1% of participants, respectively. No association of antimicrobial?associated clinical responses or ADRs was observed with demographics and underlying comorbidities. Conclusions: Elderly patients with respiratory tract infections showed improvement with empirical extended-spectrum beta-lactams and azithromycin therapy. The response was suboptimal to empirically selected antiprotozoal therapy. Elderly patients are at increased risk of ADRs. Close to one out of every five elderly prescribed beta?lactams may develop ADR to the antimicrobial agent. Larger clinical studies are required to predict the risk factors of ADRs and poor responsiveness to antimicrobials.

Mecanismos de expressão de resistência aos antibióticos e saúde pública / Mechanisms of expression of resistance to antibiotics and public health / Mecanismos de expresión de la resistencia a los antibióticos y salud pública

Com o avanço da medicina e o aumento do uso de antimicrobianos, a resistência microbiana vem se tornando um problema sério na saúde pública. Para que uma bactéria se torne resistente, são necessários vários fatores, entre eles, o uso indiscriminado e prolongado de antimicrobianos e as resistências intrínsecas e adquiridas. Nesse contexto, o objetivo do trabalho foi explorar os mecanismos de ação dos antimicrobianos, de resistência e a sua importância na saúde pública. Foram utilizadas para a presente pesquisa, as bases de dados Pubmed, Google acadêmico e Scielo. Segundo a Organização Mundial da Saúde define-se resistência ao antibiótico quando o mesmo não produz mais efeito. A inserção cada vez mais frequente de antimicrobianos favorece a resistência, onde provocam uma pressão seletiva sobre os microrganismos, tornando-os resistentes a diversas drogas. O uso indiscriminado de antimicrobianos é o principal fator de resistência microbiana, assim como o uso de antimicrobianos sem exame de cultura e teste de sensibilidade. Neste sentido, conclui-se que é de suma importância a atualização de protocolos que contenham os mecanismos de resistência bacteriana a fim de minimizar o uso indiscriminado de antimicrobianos, assim como capacitar os profissionais da saúde para este problema na saúde pública.

With the advance of medicine and the increase in the use of antimicrobials, microbial resistance has become a serious problem in public health. For a bacterium to become resistant, several factors are necessary, among them, the indiscriminate and prolonged use of antimicrobials and the intrinsic and acquired resistance. In this context, the objective of the work was to explore the mechanisms of action of antimicrobials, resistance and their importance in public health. Pubmed, Google academic and Scielo databases were used for this research. According to the World Health Organization, resistance to antibiotics is defined when it no longer has an effect. The increasingly frequent insertion of antimicrobials favors resistance, where they put selective pressure on microorganisms, making them resistant to various drugs. The indiscriminate use of antimicrobials is the main factor of microbial resistance, as well as the use of antimicrobials without culture examination and sensitivity test. In this sense, it is concluded that it is extremely important to update protocols that contain the mechanisms of bacterial resistance in order to minimize the indiscriminate use of antimicrobials, as well as to train health professionals for this problem in public health.

Con los avances de la medicina y el mayor uso de antimicrobianos, la resistencia microbiana se ha convertido en un grave problema de salud pública. Para que una bacteria se vuelva resistente son necesarios varios factores, entre ellos, el uso indiscriminado y prolongado de antimicrobianos y la resistencia intrínseca y adquirida. En este contexto, el objetivo de este trabajo fue explorar los mecanismos de acción de los antimicrobianos, la resistencia y su importancia en la salud pública. Para esta investigación se utilizaron las bases de datos Pubmed, Google Scholar y Scielo. Según la Organización Mundial de la Salud, la resistencia a un antibiótico se define cuando deja de producir efecto. El uso cada vez más frecuente de antimicrobianos favorece la resistencia, ya que provocan una presión selectiva sobre los microorganismos, haciéndolos resistentes a varios fármacos. El uso indiscriminado de antimicrobianos es el principal factor de resistencia microbiana, así como el uso de antimicrobianos sin pruebas de cultivo y sensibilidad. En este sentido, se concluye que es de suma importancia actualizar los protocolos que contienen los mecanismos de resistencia bacteriana para minimizar el uso indiscriminado de antimicrobianos, así como capacitar a los profesionales de la salud para este problema en la salud pública.

Knowledge, Attitude and Practice of People Using the Crude Extract of Andrographis paniculata (Buem. f) Nees. (Acanthaceae) on Salmonella typhi, Escherichia coli and Staphylococcus aureus

Data on Traditional Medicine Practice (TMP) in population with access to modern medicine is not clear, though, it has gained huge popularity in all regions of developing countries over decades. This research was conducted to investigate the Knowledge, Attitude and Practice (KAP) of people using Andrographis paniculata (Burm. f.) Nees as a medical herb and the effects of the crude extracts on some microbial isolates. Quantitative-based cross-sectional survey was carried out on 100 participants around Auta-Baleifi and Bingham University communities through the use of structured questionnaires. Data collected from the participants were analyzed using descriptive statistics. The plant species leaves were collected, washed and extracted by boiling, soaking and macerating using distilled water. The crude extracts were tested for its antimicrobial activities on Salmonella typhi, Escherichia coli and Staphylococcus aureus using ciprofloxacin as the control. From the result of the KAP analysis, majority (36%) of the participants were between 19-28 years old, followed by 29 � 38 years (32%) and only 5% were 59 years and above . 91% of the participants have good knowledge of traditional medicine, while only 9% were not aware of the practice , 32.0% of the participant claimed that the use of traditional medicine preparation had no adverse effects as compared to modern medicine,, while larger percentage (68%), do not agree that traditional medicine is safer than modern medicine., 36% of the participants claimed to have used A. paniculata, a traditional herb, for one medicinal purpose or the other, while 54% said they have never used it, but may considered using it in future,. The population in Auta-baleifi and Bingham University communities has good knowledge with high acceptability of the use of traditional medicine. Although the result of the antimicrobial showed that the crude extracts of A. paniculata had no clear zone of inhibition against the test organisms, but the plant have demonstrated effective used in traditional medicine against symptoms very similar to that of malaria.

Evaluation of Effectiveness of Doxycycline as Empirical Therapy for Treatment in Acute Undifferentiated Febrile Illnesses in Routine Clinical Practice: A Retrospective, EMR-based, Real-world Study

Background: Tetracyclines, in particular doxycycline, are recommended for the treatment of patients with acute undifferentiated febrile illness (AUFI); however, real-world studies are scarce. Methods: This retrospective, multicenter, observational study reviewed electronic medical records (April 2018 to March 2021) of adult patients (outpatient and inpatient departments [OPD and IPD]) with AUFI, treated with doxycycline monotherapy (doxycycline group) or doxycycline in combination with other antimicrobials (combination therapy group), from 7 tertiary hospitals and clinics in India. Results: Overall, 473 patients were included; 73.8% and 26.2% patients were prescribed doxycycline alone or in combination with other antimicrobials, respectively. Defervescence was achieved in 65.6% and 57.3% patients, respectively at the second (8-14 days) follow-up visit. Clinical cure rate for symptomatic resolution varied between 89.6% and 100% in OPD settings. Time taken from treatment initiation to defervescence was 3.51 ± 3.16 days for the doxycycline group and 3.46 ± 3.07 days for the combination therapy group. Both groups showed improvements in body temperature in OPD settings (84.2% and 84.5%) as well as IPD settings (97.4% and 94.1%). Adverse events in OPD patients in both groups were nausea (7.8% and 8.7%), anorexia (1.6% and 33.0%) and dyspepsia (1.6% and 67.9%). Conclusion: Doxycycline appears to be a promising candidate for treating patients with AUFI due to its demonstrated real-world effectiveness and safety profile.

Resistencia antimicrobiana y producción porcina de cría intensiva / Antimicrobial resistance and intensive swine production: mini review

Introducción: el impacto de la resistencia antimicrobiana (RAM) generará un aumento de las muertes relacionadas de 10 millones anuales hacia 2050. El 70% de la dispensación de antimicrobianos (ATB) se utiliza en la agroveterinaria y no en salud humana. Es fundamental conocer la portación de RAM en trabajadores de cría de animales y en los animales, para acciones tempranas de salud pública. Métodos: bajo metodología PRISMA se realizó la búsqueda bibliográfica en distintas fuentes disponibles hasta octubre de 2020. Se priorizaron revisiones sistemáticas, metanálisis, ensayos clínicos y estudios observacionales para determinar la RAM en trabajadores de cría de cerdos. De 990 artículos identificados se incluyeron 8 estudios. Resultados: la tasa de colonización por Staphylococcus aureus resistente a la meticilina (SAMR) en trabajadores fue mayor que la de la población general. La prevalencia de SAMR fue significativamente mayor en trabajadores en contacto directo con animales y los de granjas de cría intensiva con respecto a los de extensiva. En cerdos, la prevalencia de RAM en cría intensiva fue significativamente mayor que la de los de cría extensiva. También fue significativa la asociación entre el suministro de antibióticos en la cría intensiva y la presencia de RAM. Las granjas de más de 1250 cerdos presentaron mayor prevalencia de RAM (p < 0,001). El fenotipo de SAMR en cerdos, trabajadores y el ambiente fue el mismo. Conclusiones: existe evidencia de asociación entre la producción agrícola de cría intensiva y la RAM en cerdos y trabajadores. No se encontraron estudios de vigilancia epidemiológica en la Argentina en trabajadores de cría de animales. (AU)

Introduction: it is estimated that the impact of antimicrobial resistance (AMR) will generate an increase of 10 million deaths by 2050, being reflected to a greater extent in low-income countries. 70% of the annual use of antimicrobials is concentrated in agroveterinary but not in human health. Considering the presence of AMR in ranchers and agricultural workers is essential for early public health actions. Methods: using the PRISMA methodology, bibliography was searched in different sources until October 2020. Systematic reviews, meta-analyses, clinical trials and observational studies were prioritized to determine AMR in pig workers. Eight studies of the 990 found have been included. Results: the rate of colonization by methicillin-resistant Staphylococcus aureus (MRSA) in farming workers was higher than the general population. MRSA prevalence was significantly higher in workers who reported direct contact with animals. And also in those workers of intensive farms compared to those of extensive farms. The same situation is observed in swines, in which the prevalence of AMR in intensive farming was significantly higher than in extensive farming. The association between the supply of antibiotics in intensive farming workers and the presence of AMR was also significant. Farms with more than 1,250 swines had a higher prevalence of AMR (p<0.001). The MRSA phenotype found in swine, agricultural workers, and the environment was the same. Conclusions: there is scientific evidence of an association between agricultural production in intensive livestock farming and AMR in swine and farming workers. There aren't Argentine studies of epidemiological surveillance in farming workers. (AU)

Assessment of Rational Antibiotic Use in Pediatric Ward in A Teaching Hospital

Introduction:Antibiotics are a class of natural and synthetic compounds that inhibit the growth of or kill other microorganisms. These are among the most frequently prescribed medications in modern medicine. The use of antibiotics has contributed to the dramatic fall in morbidity from communicable and infectious diseases over the last 50 years globally. Overuse of antibiotic is one of the most important factors for the development and spread of resistance in the hospital, as well as in the community. Methodology:The present study was conducted in pediatric ward of a tertiary care institute. The study population included 250 children. The group consisted of 250 consecutive children admitted in one unit of the pediatric ward and they were analyzed for antibiotic use without any prior priming of the members of the unit regarding rationality of antibiotic use. Results: Age and sex wise distribution of 250 children included in the study. Of these 166(57%) were males and 84 (43%) were females. 60 received antibiotics for respiratory tract infections, this being the commonest disease for which antibiotics were received. 55 (44%) children received antibiotics in rational way. Conclusion: From this study it is clear that there is lack of proper rational antibiotic usage by unit doctors. To conclude it can be stated that inappropriate use of antibiotics is increasing and is responsible for rapidly developing antimicrobial resistance. To increase rational use of antibiotics the members of the unit (treating physicians) should be motivated regarding correct uses of antibiotics and hazards of their inappropriate use. A proper workshop should be arranged for this

Antivitamins: A Silver Lining in the Era of Antimicrobial Resistance

Antivitamins are compounds that negate the biological effects of vitamins. They have been successfully exploited for the development of various classes of drugs. In the early 19th century, the antifolate prontosil was developed for the treatment of puerperal fever. Since then, numerous other antifolates have been used to treat a wide range of infections. Antifolates, such as methotrexate, are potent anticancer agents and antivitamin K, such as warfarin, are used as anticoagulants. Despite several years of research, most antivitamin-based drugs are limited to vitamin K and B9, and the development of antagonists for other vitamins is still in the nascent stage. In the era of antimicrobial resistance, antivitamins can be considered as a promising alternative to develop newer antimicrobials and are worth exploring further. This review discusses key antivitamins at different stages of development which have potential utility as antibiotic drug candidates. The summary of studies of antivitamins in clinical development is also narrated.