Résumé
OBJECTIVE: The objective of this study was to evaluate whether the outcomes of carbapenem-resistant Acinetobacter infections treated with ampicillin/sulbactam were associated with the in vitro susceptibility profiles. METHODS: Twenty-two infections were treated with ampicillin/sulbactam. The median treatment duration was 14 days (range: 3-19 days), and the median daily dose was 9 g (range: 1.5-12 g). The median time between Acinetobacter isolation and treatment was 4 days (range: 0-11 days). RESULTS: The sulbactam minimal inhibitory concentration (MIC) ranged from 2.0 to 32.0 mg/L, and the MIC was not associated with patient outcome, as 4 of 5 (80%) patients with a resistant infection (MIC≥16), 5 of 10 (50%) patients with intermediate isolates (MIC of 8) and only 1 of 7 (14%) patients with susceptible isolates (MIC ≤4) survived hospitalization. CONCLUSION: These findings highlight the need to improve the correlation between in vitro susceptibility tests and clinical outcome. .
Sujets)
Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Enfant , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Infections à Acinetobacter/traitement médicamenteux , Acinetobacter/effets des médicaments et des substances chimiques , Ampicilline/administration et posologie , Antibactériens/administration et posologie , Sulbactam/administration et posologie , Infections à Acinetobacter/mortalité , Résistance aux bêta-lactamines , Carbapénèmes/administration et posologie , Mortalité hospitalière , Tests de sensibilité microbienne , Analyse multifactorielle , Résultat thérapeutiqueRésumé
To study resistance to antimicrobials, serotypes and clinical features of S. pneumoniae in S. Paulo, Brazil, 50 patients with a positive culture were evaluated: 7 were considered carriers and 43 had pneumococcal infections. Pneumonia and meningitis were the most common infections. Mortality was 34 and underlying diseases were present in 70. Relative resistance to penicillin occurred in 24 and complete resistance was not detected. Resistance to tetracycline was 32 and to sulfamethoxazole/trimethoprim 32; one strain had intermediate susceptibility to erythromycin; no resistance was present for chloramphenicol, rifampin or vancomycin. Resistance to at least one of the drugs tested occurred in 62. Results by the E-test for penicillin were similar to those by the agar dilution method. There were 24 different serotypes and 74 of the strains belonged to the 23-valent vaccine including all the penicillin-resistant strains. In this study S. pneumoniae caused severe infections and presented a high resistance rate to commonly used antimicrobials. Routine surveillance of resistance and the use of vaccination, as well as the restriction of inappropriate use of antimicrobials, are recommended in São Paulo, Brazil.
Sujets)
Humains , Mâle , Femelle , Nouveau-né , Nourrisson , Enfant d'âge préscolaire , Adulte , Adulte d'âge moyen , Streptococcus pneumoniae , Sujet âgé de 80 ans ou plus , Brésil , Infections à pneumocoques/traitement médicamenteux , Résistance microbienne aux médicaments , Sérotypie , Streptococcus pneumoniaeSujets)
Humains , Maladies de l'appareil respiratoire/prévention et contrôle , Maladies pulmonaires/prévention et contrôle , Vaccins , Vaccins antibactériens , Haemophilus influenzae/immunologie , Vaccins anti-Haemophilus , Orthomyxoviridae/immunologie , Streptococcus pneumoniae/immunologie , Vaccins antivirauxRésumé
Os autores descrevem o caso de um paciente com AIDS que durante período de observaçäo de cinco meses apresentou episódios de bacteremia por Salmonella enteritidis typhimurium näo respondendo satisfatoriamente à antibioticoterapia empregada. Durante a internaçäo näo foram detectadas lesöes focais por Salmonella mas a necropsia evidenciou infecçäo em trato intestinal. Comparam os dados referentes a este caso com os obtidos em revisäo de literatura