Treating Staphylococcus aureus infections in an intensive care unit at a University Hospital in Brazil.

BACKGROUND: Optimizing antimicrobial therapy is important for treating patients who are critically ill with Staphylococcus aureus infection, and susceptibility tests are necessary. OBJECTIVE: The aim of the present study was to evaluate antibacterial therapy after susceptibility testing of S. aureus infections. Setting The setting was an intensive care unit at a University Hospital in Brazil. METHODS: An observational and retrospective study was conducted over 6 years. The antimicrobials that were used for S. aureus infection treatment were calculated as the defined daily dose per 1000 patient-days (DDD1000). Antimicrobial susceptibility data were obtained by reviewing bacteriological tests. Patient profiles and treatment were determined by analyzing patient charts. RESULTS: Methicillin-resistant S. aureus (MRSA) was prevalent in this study (76.13 %). Patients who were infected with MRSA had total antimicrobial consumption that was three-times higher (9567.2 DDD1000) than patients who were infected with methicillin-susceptible S. aureus (MSSA; 3101.1 DDD1000). The average length of stay in the intensive care unit was 19 days (interquartile range 17 days) for MSSA and 20 days (interquartile range 20 days) for MRSA. Mortality in patients who were infected with MSSA was higher (52.17 %) than in patients who were infected with MRSA (33.80 %), and de-escalation was not identified in 73.90 % of MSSA patients.

Problems related to antifungal prescription: a qualitative study of the views of intensivists.

RATIONALE AND OBJECTIVE: The choice of the appropriate antifungal medication is essential for therapeutic success. Although guidelines are available in the literature that regulate the consistent use of antifungal, no previous qualitative studies have addressed the difficulties related to the use of antifungal medication, especially in the intensive care unit (ICU). Our objective was to qualitatively investigate how intensivists consider antifungal prescriptions in an adult ICU. METHODS: The Grounded Theory analytical method was used for the data analysis. Physicians who worked in the adult ICU and prescribed antifungal medications were individually interviewed. A semi-structured interview was used to ask core questions, followed by follow-up questions at the discretion of the interviewer. RESULTS: Our analysis generated eight main emerging themes that were classified into three related groups. The main insights were that various interconnected reasons were given for the lack of conformity with regard to prescription patterns for antifungals. A negative cycle was perceived based on issues related to prescriptions and the search for knowledge. If problems related to individual actions and multidisciplinary team integration are resolved and local protocols are implemented based on local epidemiology, then barriers to proper prescriptions can be overcome when intensivists are faced with the unusual practice of prescribing antifungals. CONCLUSIONS: Our investigation indicates the need for prescription assistance with support from a well-trained multidisciplinary team and consensus among its members and the importance of well-designed protocols.

Utilization of fluconazole in an intensive care unit at a university hospital in Brazil.

BACKGROUND: Fungi have been developing resistance and merit greater attention because these microorganisms are among the major causes of hospital infection. OBJECTIVE: The aim of the present study was to characterize the pattern of fluconazole use in an adult intensive care unit. SETTING: The setting was an intensive care unit at a university hospital in Brazil. METHOD: An observational retrospective study was performed between 2007 and 2010. The use of antifungal drugs was calculated as the defined daily dose per 1,000 patient-days. The pattern of fluconazole use was determined by analyzing patient charts. RESULTS: Fluconazole accounted an average of 66.6 % of the antifungal agents prescribed. All of the patients exhibited important risk factors for the development of fungal infection. Treatment was empirical in 45.2 % of the cases and therapeutic in 54.8 % of the cases. The dose interval was inadequate in 51.1 % of the treatments. Fluconazole at doses ≥400 mg/day was related to a greater likelihood of survival. C. albicans was the most prevalent species (31.3 %). Urine was the biological material with the greatest number of positive mycological exams (71.9 %). CONCLUSION: This study found a high utilization of fluconazole and, in most cases, its administration at intervals that were different from the recommended intervals.

Riscos da interação droga-nutriente em idosos de instituição de longa permanência / Riesgos de interacción droga-nutriente en ancianos de institución de larga permanencia / Risks of drug-nutrient interaction for the elderly in long-term care institutions

O objetivo do estudo foi verificar riscos da interação droga-nutriente nos idosos residentes em Instituição de Longa Permanência. Trata-se de estudo descritivo, de abordagem quantitativa, realizado em 73 idosos. A coleta dos dados ocorreu em 2008, através da análise dos prontuários, história dietética e avaliação do IMC. Os dados evidenciaram que os medicamentos mais utilizados foram do sistema nervoso e cardiovascular, totalizando 66% das prescrições. Entre 375 medicamentos prescritos, 166 fazem algum tipo de interação, 32,0% diminuem o efeito de absorção do fármaco quando há utilização de cafeína e 14,3% diminuem absorção de vitamina B12. A utilização de diversos medicamentos de uso contínuo pode acarretar prejuízo na absorção de nutrientes, aumentando o risco de desnutrição em idosos. Torna-se indispensável a ação da equipe de saúde, através da avaliação criteriosa dos medicamentos administrados, dietoterapia e a interação entre os mesmos, para beneficiar idosos com melhor aproveitamento da terapêutica e melhoria das condições nutricionais.

El objetivo fue verificar el riesgo de interacciones fármaco-nutriente en los ancianos residentes en Institución de Larga Permanencia. Estudio descriptivo, cuantitativo, realizado en 73 ancianos. La recolección de datos se realizó en 2008 a través del análisis de los registros médicos, historia dietética y la evaluación del IMC. Los datos evidenciaron que los medicamentos más utilizados fueron del sistema nervioso y cardiovascular, totalizando el 66% de las prescripciones; entre los 375 medicamentos prescriptos, 166 hacen algún tipo de interacción, el 32,0% disminuye el efecto de absorción del fármaco cuando hay utilización de cafeína y el 14,3% disminuye la absorción de vitamina B12. La utilización de diversos medicamentos de uso continuo puede acarrear perjuicio en la absorción de nutrientes. Vuelve indispensable la acción del equipo de salud a través de una cuidadosa evaluación de los medicamentos, la dieta y la interacción entre ellos, para beneficiar a los ancianos con mejor aprovechamiento de la terapéutica.

This study was aimed at verifying the risks of drug-nutrient interactions in the elderly residents of a Long-Term Care Institution. Descriptive study of quantitative approach, performed in 73 elderly people. Data collection occurred in 2008 through analysis of medical records, diet history and evaluation of the BMI. Data evidenced that the drugs more frequently used were the ones for nervous and cardiovascular systems, totaling approximately 66% of the prescriptions; among the 375 drugs prescribed, 166 make some type of interaction, 32.0% reduce the effect of drug absorption when there is use with caffeine and 14.3% reduce the B12 vitamin absorption. Taking several drugs of continuous use may cause damage to the absorption of nutrients. The action of the health team becomes vital, through careful evaluation of the administered drugs, diet and interaction between them, to benefit the elderly with a better use of the therapeutics and improvement of the nutritional conditions.

[Risks of drug-nutrient interaction for the elderly in long-term care institutions]. / Riscos da interação droga-nutriente em idosos de instituição de longa permanência.

This study was aimed at verifying the risks of drug-nutrient interactions in the elderly residents of a long-term care institution. Descriptive study of quantitative approach, performed in 73 elderly people. Data collection occurred in 2008 through analysis of medical records, diet history and evaluation of the BMI. Data evidenced that the drugs more frequently used were the ones for nervous and cardiovascular systems, totaling approximately 66% of the prescriptions; among the 375 drugs prescribed 166 make some type of interaction, 32.0% reduce the effect of drug absorption when there is use with caffeine and 14.3% reduce the B12 vitamin absorption. Taking several drugs of continuous use may cause damage to the absorption of nutrients. The action of the health team becomes vital, through careful evaluation of the administered drugs, diet and interaction between them, to benefit the elderly with a better use of the therapeutics and improvement of the nutritional conditions.

Trichophyton tonsurans in a family microepidemic.

Trichophyton tonsurans is a highly transmissible anthropophilic dermatophyte fungus, which invades keratinized tissues. This study reports a case of family microepidemic caused by this dermatophyte. Despite their excellent hygiene conditions, it remained active for several years, spreading to all family members. The hypothesis that the fungus was being kept alive in the family home was confirmed after samples collected from it were analyzed. Pure cultures of the fungus were isolated and identified. After diagnosis, the house was disinfected with concomitant oral treatment for all family members.

Microepidemia familiar por Trichophyton tonsurans / Trichophyton tonsurans in a family microepidemic

Trichophyton tonsurans é um fungo dermatófito antropofílico de alta transmissibilidade que invade tecidos queratinizados. Relatamos um caso de microepidemia familiar causada por esse dermatófito no qual, apesar das ótimas condições de higiene, o fungo se manteve viável por vários anos, disseminando-se para todos os membros da família. A hipótese de que estivesse sendo mantido na residência da família foi confirmada após análise de amostras do domicílio, em que foram isoladas e identificadas culturas puras do fungo. Após o diagnóstico, a residência foi desinfetada e todos os membros da família receberam tratamento oral concomitantemente.

Trichophyton tonsurans is a highly transmissible anthropophilic dermatophyte fungus, which invades keratinized tissues. This study reports a case of family microepidemic caused by this dermato phyte. Despite their excellent hygiene conditions, it remained active for several years, spreading to all family members. The hypothesis that the fungus was being kept alive in the family home was confirmed after samples collected from it were analyzed. Pure cultures of the fungus were isolated and identified. After diagnosis, the house was disinfected with concomitant oral treatment for all family members.

Metabolic extract of Fusarium oxysporum induces histopathologic alterations and apoptosis in the skin of Wistar rats.

BACKGROUND: Most patients with Fusarium infection present with affection of the tegumentary system, with the presence of necrotic and/or inflammatory lesions associated with pain. AIM: To evaluate the effect of the intradermal application of a metabolic extract of Fusarium oxysporum in the skin of Wistar rats. METHODS: The extract was obtained from fungal cultivation in Czapek-Dox medium. It was sterilized by filtration through a Millipore membrane, and injected (0.5 mg/mL) intradermally into the skin of rats, which were killed 3, 6, 12, and 24 h after inoculation. Skin specimens were placed in paraffin and stained using hematoxylin and eosin, and toluidine blue, for the evaluation of the inflammatory response, and Sirius red for the quantification of collagen. Terminal deoxynucleotidyl transferase-mediated UTP nick end labelling (TUNEL) was used for the identification of apoptosis. Tissue reactions were graded and compared over time and compartment. RESULTS: The inflammatory reaction reached a peak at 12 h for both the dermis and subcutaneous region, being graded as moderate and moderate to severe, respectively. There was an influx of granulocytes, lymphocytes, and macrophages. A significant increase in the number of mast cells, as well as the presence of hyperemic vessels and apoptotic bodies, was observed. There was TUNEL staining in keratinocytes, fibroblasts, endothelial cells, muscles, and in the cells of the inflammatory infiltrate. There was a significant decrease in the area occupied by collagen after 12 h. CONCLUSIONS: The extract induced histopathologic alterations in the skin, probably as a result of the presence of active toxic metabolites.