Tratamiento antibiótico empírico inicial prolongado y riesgo de morbimortalidad en recién nacidos de muy bajo peso al nacer / Prolonged initial empirical antibiotic treatment and the risk of morbidity and mortality in very low birthweight infants

Resumen: Introducción: El objetivo de este estudio es evaluar la asociación entre la duración del tratamien to antibiótico empírico inicial y el desarrollo posterior de sepsis tardía, enterocolitis necrotizante (NEC) y muerte en recién nacidos de muy bajo peso al nacer (RNMBP). Pacientes y Método: Estudio cuantitativo, transversal analítico, en RNMBP ingresados a UCI neonatal durante un período de 5 años. Se consideró antibioterapia empírica inicial aquella que comenzó desde el nacimiento, sin conocer resultado de hemocultivos. Antibioterapia prolongada se estimó cuando la duración del tratamiento fue > 5 días. Se analizaron variables perinatales, e incidencia de sepsis tardía, NEC confirmada y mortalidad. Resultados: Se estudiaron un total de 266 RNMBP, con edad gestacional y peso de nacimiento promedios de 28,8 ± 2,5 semanas y 1.127 ± 264 g respec tivamente. Recibieron antibioterapia empírica inicial 213 (80,0%), siendo ésta prolongada en el 67,6%. Todos recibieron antibioterapia biasociada. Se pesquisaron 136 episodios de sepsis tardía, siendo los gérmenes más frecuentes el Staphylococcus coagulasa negativo y el Staphylococcus au reus. Del total de RN con antibioterapia empírica prolongada, hubo 20 casos de NEC confirmada y 15 fallecidos (10,4%) en el grupo analizado. Al comparar el uso de antibioterapia > 5 días ver sus tratamiento menor de 5 días, se observó una asociación estadísticamente significativa entre la antibioterapia prolongada y sepsis tardía (p = 0,03) y además de NEC confirmada (p = 0,03), pero no de mortalidad (p = 0,12). Conclusión: El uso de antibioterapia empírica inicial por 5 días o más se asoció a un riesgo aumentado de sepsis tardía y de NEC, pero no de la mortalidad en RNMBPN.

Abstract: Introduction: The objective of this study is to evaluate the association between the duration of ini tial empirical antibiotic treatment and the subsequent development of late-onset sepsis, necrotizing enterocolitis (NEC) and death in very low birth weight (VLBW) infants. Patients and Methods: Quantitative, cross-sectional, analytical study of VLBW infants admitted to the neonatal ICU were included over a period of five years. Initial empirical antibiotic therapy was that which started im mediately after birth, without knowing the results of blood cultures. It was considered prolonged antibiotic therapy when the treatment duration was > 5 days. Perinatal variables, as well as the inci dence of late-onset sepsis, confirmed NEC and mortality were analyzed. Results: 266 VLBW infants were studied, with an average gestational age and birth weight of 28.8 ± 2.5 weeks and 1.127 ± 264 g respectively. 213 infants received initial empiric antibiotic therapy (80.0%), which was prolonged in 67.6% of cases. All infants received two different antibiotics. 136 episodes of late-onset sepsis were described. The most common pathogens were coagulase-negative Staphylococcus and Staphylococcus aureus. Among the newborns with prolonged antibiotic therapy, there were 20 cases of confirmed NEC and 15 of the studied infants died (10.4%). When comparing the use of antibiotic therapy during > 5 days versus treatment less than 5 days duration, a statistically significant association was observed between prolonged antibiotic therapy and late-onset sepsis (p = 0.03) and confirmed NEC (p = 0.03), but not of mortality (p = 0.12). Conclusion: The use of empirical antibiotic therapy for five days or more was associated with an increased risk of late-onset sepsis and NEC, but not of mortality in VLBW infants.

Perfil eletroforético e concentração de imunoglobulinas G (IgG) do soro sanguíneo de cabras Saanen com mastite experimental induzida por Staphylococcus aureus suplementadas com vitamina E / Electrophoretic profile and concentration of immunoglobulins G (IgG) in blood serum of Saanen goats with experimental mastitis induced by Staphylococcus aureus suplemented with vitamin E

O objetivo do trabalho foi avaliar o perfil eletroforético das proteínas e a concentração sérica de imunoglobulina G (IgG) em cabras da raça Saanen com mastite induzida experimentalmente por Staphylococcus aureus e suplementadas com vitamina E (acetato de dl-α-tocoferol). Utilizaram-se 14 cabras adultas, gestantes, primíparas, com sorologia negativa para Artrite Encefalite Caprina (CAEV), clinicamente sadias, divididas em dois grupos experimentais de sete animais. Grupo não suplementado (G1) e grupo suplementado com 2.000 U.I. de acetato de dl-α-tocoferol (G2 Vit E) via intramuscular no dia do parto e sete dias após o parto. Ao nono dia do pós-parto foram inoculados 300 UFCs da cepa de S. aureus ATCC 225923, na metade esquerda da glândula mamária de cada animal. A mastite foi determinada pela colheita das amostras de leite para a comprovação da infecção, por meio de exames bacteriológicos, contagem de células somáticas (CCS) e California Mastitis Test (CMT), a partir deste momento foram efetuadas colheitas às 12, 24, 48 e 72 horas, sendo posteriormente instituído o tratamento intramamário com antimicrobiano e nova avaliação 48 horas após o tratamento. O perfil eletroforético em gel de agarose das proteínas séricas das cabras, apresentaram cinco frações, sendo: albumina e globulinas (α, β1, β2 e γ). Houve aumento na produção de γ-globulina e menor produção da fração β2-globulina 12 horas após a infecção, com os valores reduzindo mais rapidamente no grupo suplementado, evidenciando a influência da vitamina E na diminuição da produção das proteínas de fase aguda. Não houve influência da vitamina E na concentração sérica de imunoglobulina G (IgG) nos animais suplementados. A suplementação com vitamina E aumentou a concentração de imunoglobulinas e diminuiu a produção de proteínas de fase aguda, provavelmente pelo efeito antioxidante minimizando a lesão tecidual durante o processo inflamatório localizado ...

The objective was to evaluate the electrophoretic profile of proteins and serum concentration of immunoglobulin G (IgG) in Saanen goats with mastitis experimentally induced by Staphylococcus aureus (dl-α-tocopherol acetated). 14 adult goats, (supplemented with vitamin E DL-α-tocopherol) primiparous pregnant, seronegative for caprine arthritis encephalitis (CAEV), clinically healthy, were divided into two groups of seven animals: Not supplemented group (G1) and group supplemented with 2.000 UI of DL-α-tocopherol (G2 Vit E), by intramuscular injection on the day of the parturition and seven days later. At the 9th day after delivery 300 UFCs of the S. aureus ATCC 225923 strain were inoculated into the left half of the mammary gland of each animal. The mastitis was determined through collection of milk samples for evidence of infection by means of bacteriological examination, somatic cell count (SCC) and California Mastitis Test (CMT). Then samples were collected after 12, 24, 48 and 72 hours, antimicrobial intra-mammary gland treatment was initiated, with new evaluation 48 hours after treatment. The electrophoretic profile of serum protein of the goats, showed five fractions, as follows: albumin and globulin (α, β1, β2 e γ-globulin). There was an increase in the production of γ-globulin and lower production of β2-globulin fraction 12 hours after infection, and faster decrease in the supplemented group, showing the influence of vitamin E in the production of acute phase proteins. There was no influence of vitamin E in the serum concentration of immunoglobulin G (IgG) in supplemented animals. The supplementation with vitamin E increased the concentration of immunoglobulin and decreased the production of acute phase proteins, probably the antioxidant effect minimizing the tissue injury during the inflammatory process in the mammary gland.

Cancrum oris (noma) in a patient with acute lymphoblastic leukaemia. A complication of chemotherapy induced neutropenia

Cancrum oris (noma) has been most commonly described in malnourished debilitated children with poor oral hygiene following systemic childhood infections such as measles, pertussis or scarlet fever. We describe a patient who developed this condition during a period of profound neutropenia following cytotoxic chemotherapy for acute lymphoblastic leukaemia.