Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Estado Terminal , Surtos de Doenças , Farmacorresistência Bacteriana , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/classificação , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Antibacterianos/farmacologia , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Humanos , Incidência , Testes de Sensibilidade Microbiana , Minociclina/análogos & derivados , Minociclina/farmacologia , TigeciclinaRESUMO
Polyclonality is defined as the occurrence of different genotypes of a bacterial species. We are of the opinion that these different clones originate within the patient. When infections and outbreaks occur, the terms of polyclonal infections and polyclonal outbreaks have been used, respectively. The origin of polyclonality has never been reported, although some authors suggest the acquisition of different clones from different animate and inanimate sources. We think that the gut of the critically ill patient with microbial overgrowth is the ideal site for the de-novo development of new clones, following increased spontaneous mutation.
Assuntos
Antibacterianos/uso terapêutico , Bactérias/genética , Infecções Bacterianas/microbiologia , Estado Terminal , Sistema Digestório/microbiologia , Farmacorresistência Bacteriana/genética , Regulação Bacteriana da Expressão Gênica , Mutação , Bactérias/crescimento & desenvolvimento , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/transmissão , Genótipo , Humanos , FenótipoAssuntos
Sistema Digestório/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Antibacterianos/farmacologia , Sistema Digestório/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/enzimologia , Humanos , Unidades de Terapia Intensiva , Macrolídeos/farmacologia , beta-Lactamases/metabolismoRESUMO
Very low birthweight (VLBW) infants undergoing neonatal intensive care are at risk of infection with coagulase-negative staphylococci (CONS). This study investigates the efficacy of twice daily, 1 h infusions of vancomycin (5 mg kg) in reducing CONS infection in VLBW infants receiving parenteral nutrition. Of 72 infants in the study, 37 were randomized to vancomycin and 35 to the control group. Clinical variables and mortality were similar in both groups. In the vancomycin group, 11 infants had one or more episodes of CONS bacteraemia compared with 17 in the control group. Two babies in the treatment group had more than one episode of CONS bacteraemia, compared with nine in the control group (P = 0.02). There were 13 episodes of CONS bacteraemia in the vancomycin group compared with 29 in the control group. When only positive blood-cultures associated with a rise in C-reactive protein were considered, there were six episodes of CONS bacteraemia in the vancomycin group compared with 18 in the control group. Similarly there were five infants with one or more CONS infections compared with 11 in controls and one with more than one episode compared with six in the control group (P = 0.05). Prophylaxis with intermittent low-dose vancomycin infusions may help reduce recurrent CONS bacteraemia in VLBW infants receiving parenteral nutrition.