ABSTRACT
BACKGROUND: Ventilator-associated pneumonia (VAP) is considered the most common nosocomial infection in the intensive care unit (ICU), but its features are not fully known in many hospitals in Brazil. We identified clinical and epidemiological aspects associated with VAP in an intensive care unit (ICU) in a general public hospital in northern Brazil and performed an analytical descriptive prospective cohort study. METHODS: We analyzed data from thirty-three patients who developed VAP while in the ICU. Clinical and epidemiological data of patients were obtained and tracheal secretions were submitted to culture. Microbial isolates were identified and evaluated for resistance against antimicrobial agents by using the automated Vitek 2 system. RESULTS: The frequency of VAP was 26.2% in patients submitted to invasive mechanical ventilation for at least 48 hours, and death occurred in 78.8% of cases. Only the presence of comorbidity showed a significant association (P = 0.029) with death. The most commonly found bacteria were Pseudomonas aeruginosa, Acinetobacter spp., and Enterobacteriaceae. We also found a frequency of 54.5% of multiresistant bacteria associated with VAP, and previous antibiotic therapy was used in 97% of patients. CONCLUSIONS: VAP in our ICU presented with a high frequency and was mainly caused by multiresistant bacteria. Implementation of rational protocols for the use of antibacterial agents and rapid delivery of culture and susceptibility test results are essential. This may help decrease VAP-related mortality rates by multiresistant bacteria in the ICU.
Subject(s)
Pneumonia, Ventilator-Associated/epidemiology , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Brazil/epidemiology , Drug Resistance, Multiple, Bacterial , Female , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacterial Infections , Humans , Intensive Care Units , Male , Microbial Sensitivity Tests , Middle Aged , Pneumonia, Ventilator-Associated/drug therapy , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/mortality , Prospective Studies , Statistics, Nonparametric , Treatment OutcomeABSTRACT
In this work, the anti-tumor properties of the volatile oil from Zanthoxylum rhoifolium Lam leaves and some terpenes (alpha-humulene, beta-caryophyllene, alpha-pinene and beta-pinene) were investigated in vitro and in vivo using the Ehrlich ascites tumor model. Treatment of Ehrlich ascites tumor-bearing mice with 20 mg/kg of the volatile oil and beta-caryophyllene for 4 days has significantly increased survival, whereas administration of alpha-humulene, alpha-pinene and beta-pinene were ineffective in affording protection. Volatile oil and beta-caryophyllene exhibited little direct activity against Ehrlich tumor cells in vitro, while alpha-humulene, alpha-pinene and beta-pinene did not such activity. Investigation of the effects of the volatile oil (and terpenes) treatment on total natural killer cells (NK cell) activity from tumor-bearing mice as a possible mechanism of these compounds in vivo revealed that volatile oil and beta-caryophyllene significantly improved NK cell cytotoxicity against YAC-1, a Moloney virus-induced mouse T-cell lymphoma of A/SN origin and Ehrlich ascites cells. As expected, tumor growth in non-treated mice markedly suppressed NK cell cytolysis while the volatile oil and beta-caryophyllene reversed this effect when mice were treated with 20-mg/kg dosages of these compounds for 4 days. Summing up, volatile oil exhibits anti-tumor efficacy and significative immunomodulatory action in vivo, which may be related to beta-caryophyllene associated to the synergism of other natural compounds presented in volatile oil from Z. rhoifolium Lam leaves.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Ehrlich Tumor/drug therapy , Oils, Volatile/therapeutic use , Zanthoxylum/chemistry , Animals , Carcinoma, Ehrlich Tumor/immunology , Cell Line, Tumor , Cell Survival/drug effects , Killer Cells, Natural/drug effects , Killer Cells, Natural/immunology , Male , Mice , Mice, Inbred BALB C , Oils, Volatile/pharmacokinetics , Oils, Volatile/pharmacology , Plant Leaves/chemistry , Rats , Rats, Sprague-Dawley , Terpenes/blood , Terpenes/pharmacology , Terpenes/therapeutic use , Tumor Cells, CulturedABSTRACT
Enterohemolysin (EHly) produced by Escherichia coli shows hemolytic activity towards washed erythrocytes from different animal species on blood agar plates. It has been shown recently that EHly activity is inhibited by normal mammalian serum and by cholesterol in vitro. Plasma lipoproteins can interact with bacterial toxins, such as endotoxin, to reduce their toxicity. In this work, we examine the ability of human purified chylomicrons, very low-density lipoproteins, intermediate-density, low-density and high-density lipoproteins, to inhibit the hemolytic activity of EHly. Our results show that these lipoproteins are hemolysin inactivators, and that high-density lipoprotein is the most potent inhibitor of enterohemolytic activity.
