Antibioticoterapia para infecções por bactérias gram-positivas no paciente grave / Antibioticotherapy for gram-positive bacteria infections in serious patient

O aumento importante do número de infecções causadas por bactérias Gram-positivas e o surgimento de resistência aos antibióticos destinados a tratar estas infecções são motivos de preocupação das autoridades internacionais em infecção hospitalar. O presente artigo tem como objetivo revisar os principais antibióticos utilizados para o tratamento destes agentes, como oxacilina, vancomicina, teicoplanina, linezolida, quinupristina-dalfopristina, daptomicina e tigeciclina.

In vitro antimicrobial activity against enterococci isolated in a university hospital in Säo Paulo, Brazil

The prevalence of multiresistant enterococci (MRE) is rapidly increasing and becoming an important problem in several countries. Säo Paulo Hospital is a 600-bed tertiary hospital located in Säo Paulo, Brazil. The use of vancomycin is very high in the hospital due to the high prevalence of multi-resistant S. aureus (around 70 percent). We susceptibillity tested 250 isolates were of Enterococci consecutively collected between March, 1994 and june, 1995. Isolates were susceptibility tested using agar dilution disc diffusion BHI screen plating, and E. test. In addition to vancomycin and teicoplanin, the isolates were tested against amplicillin, gentamicin, streptomycin and RP 59-500. Methods used for susceptibility testing were compared. None of the isolates showed high-level resistence to vancomycin or teicoplanin. The MIC9Os for teicoplanin were menor igual que 1µg/mL for E. faecalis (EF,n-216), E. faecium (EFM,n=23) and for the non-faecalis-non-faecium (NFNF,n=11) species. The MIC90s for vancomycin were 2µg/mL, 4µg/mL and 4µg/mL for EF, EFM and NFNF respectively. Eight isolates (3.2 percent), 5 E. faecalis, 2 E. caseliflavus and 1 E. gallinarum presented intermediate MICs for vancomycin (6 - 12µg/mL), but they were highly susceptible to teicoplanin (MIC0.19 - 1µg/mL). The percentage of resistence to amplicillin and high-level resistence to gentamicin and streptomycin were, respectively: 4.8 percent, 26.4 percent, and 24.8 percent. In spite of the high usage of vancomycin in our hospital, the prevalence of glycopeptide resistence among enterococci seems to be low. Teicoplanin appears to be more potent than vancomycin, RP59-500, gentamicin, streptomycin and amplicillin against this genus, especially EFM and NFNF species.

Teicoplanina: uma nova opçäo para os gram-positivos / Teicoplanin: a new option to the gram-positives

Os autores fazem uma revisao da literatura e analisam as atividades da Teicoplanina em comparaçao principalmente com a Vancomicina. Ficou evidente que o espectro de açao destes dois fármacos é semelhante. A Teicoplanina mostrou-se eficaz contra a grande maioria dos cocos Gram-positivos. Porém, devido ao seu elevado custo, seu uso fica restrito a infecçoes hospitalares graves por Staphylococcus resistentes à Vancomicina.