RESUMO
As a cost-saving measure, the Drug and Therapeutics Committee (DTC) removed ceftriaxone from the list of restricted antibiotics in May, 2008, which permitted its use as a first-line antibiotic. To evaluate the impact of this change, the occurrence of extended-spectrum beta-lactamase (ESBL)-positive bacterial strains and antibiotic consumption were monitored for 2 years before and after the intervention. In the post-intervention period, ceftriaxone utilization increased, while total antibiotic utilization did not change significantly. The utilization of all restricted antibiotics decreased (p <0.05) in the post-intervention period. Utilization of carbapenems increased (p <0.05), while utilization of quinolones increased nonsignificantly. The density of resistant ESBLs increased (p = 0.001) from 0.99 to 1.34 per 1000 bed-days from the pre- to the postintervention period. Ceftriaxone use was significantly correlated with ESBL occurrence (p <0.005). It can be concluded that ceftriaxone de-restriction increased the occurrence of ESBLs and the utilization of carbapemens.
Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/enzimologia , Ceftriaxona/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , beta-Lactamases/biossíntese , Revisão de Uso de Medicamentos , HumanosRESUMO
Aspergillosis of the central nervous system (CNS) is a rare, but well described disease in immuno-competent patients. We present a 65-year-old patient who developed neuro-aspergillosis 10 months after severe cranio-facial trauma (Le Fort III). He was treated successfully with surgery including stereotactic drainage and, with Amphotericin B, Liposomal Amphotericin B, and Itraconazol.
Assuntos
Abscesso Encefálico/imunologia , Traumatismos Faciais/cirurgia , Imunocompetência/imunologia , Fraturas Maxilares/cirurgia , Meningite Fúngica/imunologia , Neuroaspergilose/imunologia , Complicações Pós-Operatórias/imunologia , Fraturas Cranianas/cirurgia , Idoso , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano , Terapia Combinada , Esquema de Medicação , Humanos , Hidrocefalia/cirurgia , Itraconazol/administração & dosagem , Masculino , Meningite Fúngica/diagnóstico , Meningite Fúngica/tratamento farmacológico , Meningite Fúngica/cirurgia , Microcirurgia , Córtex Motor/cirurgia , Neuroaspergilose/diagnóstico , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/cirurgia , Neuronavegação , Osteotomia de Le Fort , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/cirurgia , Reoperação , Tomografia Computadorizada por Raios XRESUMO
Three Escherichia coli isolates resistant to third-generation cephalosporins but negative for extended-spectrum beta-lactamase production were isolated from hospitalised patients in Zagreb, Croatia, during June 2003 to February 2004. Resistance was due to the inducible production of a DHA-1 cephalosporinase. Each isolate contained an integron-associated bla(DHA-1)-ampR sequence carried by similar-sized plasmids, of which one was self-transferable. Serotyping and polymerase chain reaction typing using ERIC2 primer indicated that the isolates were distinct. This is the first description of DHA beta-lactamase production in E. coli.
Assuntos
Resistência às Cefalosporinas/genética , Cefalosporinase/genética , Proteínas de Escherichia coli/genética , Escherichia coli/genética , Proteínas de Bactérias/genética , Cefalosporinas/farmacologia , Conjugação Genética , Croácia , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Transferência Genética Horizontal , Testes de Sensibilidade Microbiana , Plasmídeos/genética , Reação em Cadeia da Polimerase/métodos , beta-Lactamas/farmacologiaRESUMO
Bacterial contamination of blood products causes significant patient morbidity and mortality. Contaminated platelet transfusion is a frequent cause of bacteraemia and sepsis because of the storage conditions of platelets. A fatal case of Morganella morganii platelet transfusion associated with sepsis is described, along with procedures traced back to the isolation of M. morganii from a donor's stool. Molecular typing was performed, and the same M. morganii strain was found in blood and post-mortem organ cultures of platelet recipient and platelet bag and in the donor's stool. The route of contamination is unknown. The contamination could be due to either insufficient venipuncture site disinfection or the donor's transient bacteraemia. Patient died 5 days after the transfusion.
Assuntos
Infecções por Enterobacteriaceae/transmissão , Morganella morganii/isolamento & purificação , Transfusão de Plaquetas/efeitos adversos , Sepse/microbiologia , Adulto , Técnicas de Tipagem Bacteriana , Doadores de Sangue , Infecções por Enterobacteriaceae/diagnóstico , Evolução Fatal , Fezes/microbiologia , Feminino , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Sepse/etiologiaRESUMO
In laryngectomized patients, the nose does not function. The absence of a physiological airflow stimulus leads to clinical, cytologic and histologic changes of the nasal mucosa. The aim of this study was to identify the nasal cavity bacterial flora in these patients and to determine whether or not it undergoes changes with time. In a group of 25 patients, the nasal mucosa swabs were taken before, and 8 days and 1 month after the surgery. In a group of 15 patients, the nasal mucosa swabs were taken 1 to 2 years postoperatively.