RESUMO
BACKGROUND: Chronic bacterial prostatitis (CBP) is a difficult-to-treat infection as only a few antibiotics achieve therapeutic concentrations in the prostate. Data on the efficacy and safety of oral fosfomycin for the treatment of CBP are limited. OBJECTIVES: To analyse the efficacy and safety of fosfomycin in CBP due to MDR pathogens. METHODS: In a prospective observational study, an oral regimen of 3 g of fosfomycin q24h for 1 week followed by 3 g q48h for a treatment duration of 6-12 weeks was administered. The outcome was clinical and microbiological cure rate at the end of treatment (EOT) and rate of relapse at 3 and 6 months. RESULTS: The study included 44 patients. The most common pathogen was Escherichia coli (66%), followed by Klebsiella spp. (14%) and Enterococcus faecalis (14%). Most strains were MDR (59%) and 23% had an ESBL phenotype; 33 of 44 strains were resistant to fluoroquinolones, but all were susceptible to fosfomycin (median MIC for Gram-negative pathogens 1.5 mg/L). In 25 patients, treatment was administered for 6 weeks, whereas in the remaining 19 patients it was prolonged to 12 weeks based on the presence of calcifications in the prostate. Cure rate was 82% at EOT and 80% and 73% at 3 and 6 months accordingly. Microbiological eradication was achieved in 86% and 77% at EOT and at 6 months, respectively. Failure was observed in 12 patients. The most common adverse event was diarrhoea (18%). CONCLUSIONS: Oral fosfomycin, particularly in the era of MDR prevalence, represents an attractive, safe and effective alternative to fluoroquinolones for the treatment of CBP.
Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Fosfomicina/uso terapêutico , Prostatite/tratamento farmacológico , Prostatite/microbiologia , Administração Oral , Adulto , Idoso , Antibacterianos/administração & dosagem , Doença Crônica , Enterococcus faecalis/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Fosfomicina/administração & dosagem , Humanos , Klebsiella/efeitos dos fármacos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.
Assuntos
Confiabilidade dos Dados , Sepse/classificação , Índice de Gravidade de Doença , Pressão Arterial , Consenso , Escala de Coma de Glasgow , Humanos , Escores de Disfunção Orgânica , Sensibilidade e Especificidade , Sepse/mortalidadeRESUMO
We describe the case of a patient with a clinical picture of heart failure, which appeared and worsened rapidly following a reported febrile respiratory infection. The echocardiogram and serological tests established the diagnosis of aortic valve disease from Coxiella Burnetii.
