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1.
Medicine (Baltimore) ; 99(8): e19250, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080131

RESUMO

Stenotrophomonas maltophilia (S. maltophilia) is an important nosocomial bacterial pathogen. However, the clinical features of children with S. maltophilia infection, the predisposing factors, and the antibiotic susceptibility of the bacteria have not been fully evaluated.In this study, the data of children with S. maltophilia infection from the West China Second University Hospital of Sichuan University (Chengdu, China) between July 2010 and October 2017 were collected and analyzed. The clinical features of enrolled children, the predisposing factors, and the antibiotic susceptibility were reported.In total, infection of S. maltophilia was identified in 128 patients. Most of these patients were under 1 year old (67.2%) and were mainly diagnosed as pneumonia (69%). A large proportion had underlying diseases (45.3%), received immunosuppressive therapy (53.1%), had undergone invasive operations (41.4%), had a history of carbapenem antibiotics use within 7 days before culture acquisition (54.7%), history of intensive care unit (ICU) hospitalization within previous 30 days (34.4%), and other risk factors. In particular, invasive operation (95% confidence interval [CI]: 1.125-14.324, P = .032), especially mechanical ventilation (95% CI: 1.277-20.469, P = .021), and ICU admission (95% CI: 1.743-22.956, P = .005) were independent risk factors for the children to develop severe S. maltophilia infection. As for antibiotic susceptibility, trimethoprim sulfamethoxazole (TMP-SMX), piperacillin tazobactam, ticarcillin clavulanate, and ceftazidime exhibited strong antibacterial activities against S. maltophilia, the susceptibility rates were 97.5%, 86.7%, 92.9%, and 81.5%, respectively.We report the clinical features of children with S. maltophilia infection, the predisposing factors and the antibiotic susceptibility. TMP-SMX can continue to be the first choice for the treatment of S. maltophilia infection. Piperacillin tazobactam, ticarcillin clavulanate, and the third generation cephalosporins can be used as alternative drugs.


Assuntos
Infecções por Bactérias Gram-Negativas/epidemiologia , Stenotrophomonas maltophilia , Distribuição por Idade , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Ceftazidima/uso terapêutico , Pré-Escolar , China/epidemiologia , Ácidos Clavulânicos/uso terapêutico , Comorbidade , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Humanos , Imunossupressores/uso terapêutico , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação/estatística & dados numéricos , Masculino , Combinação Piperacilina e Tazobactam/uso terapêutico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Ticarcilina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
2.
Surg Infect (Larchmt) ; 21(3): 284-292, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31770083

RESUMO

Background: Empirical antibiotherapy (EA) should target all bacteria in post-operative peritonitis (PP). Nevertheless, recent studies failed to prove a link between adequacy of EA and prognosis of PP. We sought to confirm this loss of association between adequate EA and prognosis and to analyze the evolution of patients' characteristics and antimicrobial strategies. Methods: This is was retrospective study. Patients with a positive fungal culture were excluded. The cohort was divided into two time periods. Data of survivors and non-survivors were compared within each time period. Differences between the two periods were assessed. A multivariable analysis searched for parameters associated with a higher hospital mortality rate. Results: Two hundred fifty-one patients were included, with 92 patients in the first period (P1) and 152 patients in the second period (P2). Inadequate EA was associated with a worse outcome only in P1. The multivariable analysis in the whole cohort showed that inadequate EA was associated with a higher mortality rate. When the differences noticed between the two periods were entered in the model (presence of resistant gram-positive cocci and EA comprising glycopeptides), inadequate EA was no longer associated with worse outcome. In P1, the most severe patients had more resistant bacteria, hence, had a higher rate of inadequate EA. This artifact disappeared in P2, during which broader antibiotherapies with triple EA were more often prescribed for the most severe patients. Conclusion: This study showed that the link between inadequate EA and outcome of patients with PP was at least partly artifactual in older studies.


Assuntos
Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos do Sistema Digestório , Mortalidade Hospitalar , Peritonite/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Aminoglicosídeos/uso terapêutico , Fístula Anastomótica , Líquido Ascítico/microbiologia , Ácidos Clavulânicos/uso terapêutico , Estudos de Coortes , Técnicas de Cultura , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Bacteriana Múltipla , Feminino , Fluoroquinolonas/uso terapêutico , Humanos , Imipenem/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Peritonite/microbiologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/microbiologia , Ticarcilina/uso terapêutico , Resultado do Tratamento , Vancomicina/uso terapêutico
3.
Thorax ; 74(8): 740-748, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31203197

RESUMO

BACKGROUND: While Aspergillus detection rates in adults, adolescents and older children with cystic fibrosis (CF) have increased, the risk of acquiring this fungal pathogen in young children is unknown. AIM: To determine the risk and explanatory factors of acquiring Aspergillus in children with CF by age 5 years. METHODS: Cross-sectional analysis of clinical, bronchoalveolar lavage and treatment data from the Australasian Cystic Fibrosis Bronchoalveolar Lavage study was used to identify predictive factors for detecting Aspergillus at age 5 years. A parametric repeated time-to-event model quantitatively described the risk and factors associated with acquiring Aspergillus and Pseudomonas aeruginosa from birth until age 5 years. RESULTS: Cross-sectional analysis found that the number of P. aeruginosa eradication courses increased the odds of detecting Aspergillus at age 5 years (OR 1.61, 95% CI 1.23 to 2.12). The median (IQR) age for the first P. aeruginosa positive culture was 2.38 (1.32-3.79) years and 3.69 (1.68-4.74) years for the first Aspergillus positive culture. The risk of P. aeruginosa and Aspergillus events changes with time after the first year of study entry. It also decreases for P. aeruginosa after completing P. aeruginosa eradication (HR 0.15, 95% CI 0.00 to 0.79), but increases for Aspergillus events (HR 2.75, 95% CI 1.45 to 5.41). The risk of acquiring both types of events increases after having had a previous event. CONCLUSION: In young children with CF, completing P. aeruginosa eradication therapy and previous Aspergillus events are associated with increased risk of acquiring Aspergillus.


Assuntos
Antibacterianos/uso terapêutico , Fibrose Cística/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa , Aspergilose Pulmonar/epidemiologia , Antibacterianos/administração & dosagem , Lavagem Broncoalveolar , Ceftazidima/uso terapêutico , Pré-Escolar , Ciprofloxacina/uso terapêutico , Ácidos Clavulânicos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Prevalência , Aspergilose Pulmonar/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Fatores de Risco , Ticarcilina/uso terapêutico , Tobramicina/uso terapêutico
4.
Transplant Proc ; 48(5): 1411-3, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27496417

RESUMO

BACKGROUND: Blood infections with multidrug-resistant Gram-negative carbapenem-resistant bacilli are particularly dangerous and challenging to treat in organ transplant recipients. Resistance to carbapenems may be acquired, for example, in Enterobacteriaceae, Pseudomonas, or Acinetobacter spp. or innate, for example, in Stenotrophomonas maltophilia. The purpose of this study was to analyze blood infections caused by S maltophilia in organ transplant recipients and to compare drug susceptibility of these bacteria and the same species isolated from the blood of other inpatients. METHODS: A total of 26 S maltophilia strains isolated from blood samples of 26 patients (including 14 liver or kidney transplant recipients) hospitalized during 2011 to 2014 were evaluated in this study. Antibiotic susceptibility was determined via E-test and disk diffusion methods. RESULTS: Stenotrophomonas maltophilia strains isolated from blood exhibited sensitivity to trimethoprim/sulfamethoxazole (100%), levofloxacin (96.2%), ciprofloxacin (92.3%), ticarcillin/clavulanic acid (80.8%), and ceftazidime (53.9%). CONCLUSIONS: Because appropriate antibiotic therapy in the case of S maltophilia differs from the standard empirical therapy administered in the case of most other Gram-negative bacilli, early identification of this pathogen is of particular significance. The use of antibiotics to which this pathogen is sensitive eliminates the infection and helps avoid graft loss.


Assuntos
Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Testes de Sensibilidade Microbiana , Transplante de Órgãos/efeitos adversos , Antibacterianos/uso terapêutico , Ceftazidima/uso terapêutico , Ciprofloxacina/uso terapêutico , Ácidos Clavulânicos/uso terapêutico , Farmacorresistência Bacteriana , Hospitais de Ensino , Humanos , Levofloxacino/uso terapêutico , Stenotrophomonas maltophilia , Ticarcilina/uso terapêutico , Transplantados/estatística & dados numéricos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
5.
Clin Infect Dis ; 60(2): 203-7, 2015 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-25301207

RESUMO

BACKGROUND: A series of cases of piperacillin-tazobactam (P/T)-associated neutropenia has been observed recently in children in our center. Because neutropenia was seldom observed in children treated with ticarcillin-clavulanic acid (T/C), we conducted a study to determine if there is an increased risk of neutropenia in children exposed to P/T in comparison with T/C. METHODS: Medical records of subjects aged <18 years who received at least 1 dose of P/T or T/C between 1 January 2008 and 30 June 2011 were reviewed. RESULTS: Two hundred ninety-nine episodes of treatment (65 P/T, 234 T/C) met inclusion criteria. Among those episodes, 213 had data allowing complete white blood cell count analysis and were included in the final analysis. Thirteen cases of neutropenia were observed during the study period. The average time to onset was 17.6 days and all patients were aged <13 years. Seven cases (10.8%) occurred in the P/T group and 6 (2.6%) in the T/C group (unadjusted odds ratio, 4.59; 95% confidence interval, 1.48-14.17). Although a statistically significant correlation was observed between age, treatment duration, and total dose and the development of neutropenia (r = -0.121, P = .037; r = 0.267, P < .001; r = 0.260, P < .001, respectively), this was not the case for sex, indications, neutrophil count at initiation, and concomitant drug treatments. CONCLUSIONS: Although our results need to be confirmed, they suggest that children receiving long courses of therapy (>2 weeks) with P/T may be at increased risk of neutropenia, compared with T/C.


Assuntos
Antibacterianos/efeitos adversos , Neutropenia/induzido quimicamente , Neutropenia/epidemiologia , Ácido Penicilânico/análogos & derivados , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Ácidos Clavulânicos/efeitos adversos , Ácidos Clavulânicos/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Ácido Penicilânico/efeitos adversos , Ácido Penicilânico/uso terapêutico , Piperacilina/efeitos adversos , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Estudos Retrospectivos , Medição de Risco , Ticarcilina/efeitos adversos , Ticarcilina/uso terapêutico
6.
Arch Pediatr ; 21(11): 1167-72, 2014 Nov.
Artigo em Francês | MEDLINE | ID: mdl-25282456

RESUMO

OBJECTIVE: Antibiotic administration during acute appendicitis in children continues to be debated. The purpose of this study was to compare efficacy of two prophylactic antibiotic treatment guidelines in acute appendicitis and peritonitis in children. MATERIEL AND METHODS: The infectious complication rate after appendicectomy was compared during two distinct periods (before/after study). During the first period, the guidelines for antibiotic administration were based on ticarcillin-clavulanic acid. During the second period, the guidelines were based on amoxicillin-clavulanic acid for non-perforated appendicitis or appendicitis with localized peritonitis, and clavulanic acid was reserved for general peritonitis. All children younger than 16 years of age who underwent appendicectomy during the periods studied were included. Data were retrospectively collected from surgical and anesthetics charts. RESULTS: Ninety-five children during the first period and 238 during the second were included. In the children with non-perforated appendicitis, no postoperative infectious complication occurred in 74 children during the first period versus two out of 153 (1%) during the second period. In cases of perforated appendicitis, postoperative infectious complications occurred two cases (10%) during the first period versus nine (11%) during the second. There were no significant differences between the two periods. CONCLUSION: In this population, antibiotic administration guidelines based on amoxicillin-clavulanic acid for stages I-III of appendicitis maintained a low rate of postoperative infectious complications and were not associated with a higher postoperative infectious complication rate than guidelines based on ticarcillin-clavulanic acid.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibioticoprofilaxia , Apendicectomia , Apendicite/tratamento farmacológico , Peritonite/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Criança , Pré-Escolar , Ácidos Clavulânicos/uso terapêutico , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Estudos Retrospectivos , Ticarcilina/uso terapêutico
7.
Pediatr Pulmonol ; 48(2): 107-22, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22949297

RESUMO

Acute pulmonary exacerbations (APE) are well-described complications of cystic fibrosis (CF) and are associated with progressive morbidity and mortality. Despite aggressive management with two or more intravenous anti-pseudomonal agents, approximately 25% of exacerbations will result in a loss of lung function. The aim of this review is to provide an evidence-based summary of pharmacokinetic/pharmacodynamic (PK/PD), tolerability, and efficacy studies utilizing anti-pseudomonal cephalosporins (i.e., ceftazidime and cefepime) and penicillins (i.e., piperacillin-tazobactam and ticarcillin-clavulanate) in the treatment of APE and to identify areas where further study is warranted. The ceftazidime and cefepime dosing ranges from the literature are 200-400 mg/kg/day divided every 6-8 hr, maximum 8-12 g/day, and 150-200 mg/kg/day divided every 6-8 hr, up to 6-8 g/day, respectively. The literature supported dosing ranges for piperacillin and ticarcillin are 350-600 mg/kg/day divided every 4 hr, maximum 18-24 g/day of piperacillin component, and 400-750 mg/kg/day divided every 6 hr, up to 24-30 g/day of ticarcillin component, respectively. As a large portion of CF patients will not regain their lung function following an APE, we suggest the need to optimize antibiotic dosing and dosing regimens used to treat an APE in efforts to improve outcomes for CF patients infected with Pseudomonas aeruginosa. Future studies are needed to determine the clinical efficacy of higher than FDA-approved doses of ceftazidime, cefepime, and ticarcillin-clavulanate in APE. The usefulness of high dose piperacillin (>600 mg/kg/day) may be limited due to treatment-related adverse effects. Further understanding of these adverse effects in CF patients is needed.


Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Fibrose Cística/complicações , Penicilinas/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Cefepima , Ceftazidima/uso terapêutico , Ácidos Clavulânicos/uso terapêutico , Progressão da Doença , Quimioterapia Combinada/métodos , Humanos , Testes de Sensibilidade Microbiana , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Infecções por Pseudomonas/complicações , Ticarcilina/uso terapêutico , Resistência beta-Lactâmica
8.
Vet Dermatol ; 23(2): 97-102, e22, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22050006

RESUMO

Topical compounded Timentin(®) diluted with an inactive vehicle has been reported to be effective in the treatment of otitis externa caused by Pseudomonas aeruginosa. The aims of this study were to determine the biological efficacy of Timentin(®) (ticarcillin and clavulanic acid) when diluted in the carrier vehicle Methopt(®) against P. aeruginosa and to determine the efficacy and stability of Timentin(®) aqueous stock concentrate solution. Timentin(®) stock concentrate was tested against four P. aeruginosa isolates on days 0, 7, 14, 21 and 28; then after 2, 3, 4, 5, 6, 9 and 12 months of storage at 4 or -20°C. The diluted Timentin(®)-Methopt(®) solutions were tested against all isolates after 0, 2, 4, 6, 8, 10, 12, 14, 17, 21, 24 and 28 days of storage at 24 or 4°C. Minimal inhibitory concentration (MIC) levels for all strains were determined using the broth microdilution method. The MIC of the stock solution remained relatively constant and acceptable throughout the study when stored at -20°C and was also acceptable for shorter time periods (6-9 months) when stored at 4°C. The MIC for the diluted Timentin(®)-Methopt(®) solution remained relatively constant and acceptable throughout the study for all four bacterial strains, with no difference between the solutions stored at 4 or 24°C. The results of this study indicate that storage of the Timentin(®) stock solution at -20°C does not compromise efficacy for at least 12 months and that Timentin(®) diluted in Methopt(®) was stable for 28 days when stored at either 4 or 24°C.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Pseudomonas aeruginosa/efeitos dos fármacos , Administração Tópica , Animais , Química Farmacêutica , Ácidos Clavulânicos/administração & dosagem , Ácidos Clavulânicos/uso terapêutico , Armazenamento de Medicamentos , Testes de Sensibilidade Microbiana , Ticarcilina/administração & dosagem , Ticarcilina/uso terapêutico
9.
Clin Ther ; 33(11): 1844-50, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22018680

RESUMO

BACKGROUND: The Intermountain Cystic Fibrosis Pediatric Center utilizes ticarcillin-clavulanate 400 mg/kg/d divided every 6 hours, (maximum 24 g/d). This dosing strategy is higher than the Food and Drug Administration (FDA)-approved package labeling. We evaluated the microbiologic efficacy of this dosing regimen. OBJECTIVES: The primary study objective was to predict the pharmacokinetic (PK) and pharmacodynamic (PD) MIC breakpoints (the highest MIC with a probability of target attainment [PTA] of at least 90%) for the bacteriostatic and bactericidal targets of ticarcillin activity against Pseudomonas aeruginosa using the study dosing regimen. A secondary objective was to evaluate the tolerability profile of the higher ticarcillin-clavulanate dosing regimen in children with cystic fibrosis (CF). METHODS: This was a population-based PK-PD modeling study of pediatric CF patients admitted from January 1, 2005 to December 31, 2009 who received the dosing regimen for at least 7 days. Population PK and PD models were used to estimate PK and PD parameters for 127 clinically evaluable patients. A 10,000-patient Monte Carlo simulation was performed to estimate the target time in which free drug concentrations exceeded the MIC of the infecting organism. The 2 PK-PD targets of microbiologic efficacy included ≥30% for bacteriostasis and ≥50% for bactericidal effects of ticarcillin-clavulanate at higher than FDA-approved doses. RESULTS: A total of 127 patients (age, 0-19 years) met inclusion criteria. Serum concentration levels were modeled in this patient population using published PK parameters with intermittent ticarcillin peak concentrations reaching 288 (93.4) mg/L. The model predicted the PTA of the MICs for P. aeruginosa with a near-maximal bactericidal PK-PD MIC breakpoint of 16 µg/mL and a bacteriostasis PK-PD MIC breakpoint of 32 µg/mL. CONCLUSIONS: The results of our simulation suggest that in this select pediatric population, higher than FDA-approved doses of ticarcillin-clavulanate were effective in achieving bactericidal effects among pseudomonal isolates with MICs <16 µg/mL. Bacteriostatic and bactericidal effects were not frequently achieved among P. aeruginosa isolates with MICs >32 µg/mL. Additional studies are warranted to determine the clinical effectiveness of this dosing regimen.


Assuntos
Antibacterianos/administração & dosagem , Fibrose Cística/tratamento farmacológico , Adolescente , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Área Sob a Curva , Criança , Pré-Escolar , Ácidos Clavulânicos/administração & dosagem , Ácidos Clavulânicos/farmacocinética , Ácidos Clavulânicos/farmacologia , Ácidos Clavulânicos/uso terapêutico , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Humanos , Lactente , Recém-Nascido , Testes de Sensibilidade Microbiana , Ticarcilina/administração & dosagem , Ticarcilina/farmacocinética , Ticarcilina/farmacologia , Ticarcilina/uso terapêutico
10.
Respirology ; 15(6): 923-9, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20573059

RESUMO

BACKGROUND AND OBJECTIVE: Earlier reports suggested that Pseudomonas aeruginosa frequent epidemic clones circulating in cystic fibrosis (CF) centres had increased virulence. However, recent data show no consistent associations with virulence, and suggest attenuation of virulence in chronic infection. Changes to infection control programmes in relation to frequent epidemic clones should be based on their frequency, virulence across all age groups and mode of acquisition. The Australian epidemic strain-1 (AES-1) (or the Melbourne epidemic strain) and AES-2 are common in CF clinics in mainland eastern Australia, but not in the environment. Both have shown increased virulence, but there are no data specifically in adults. This study examines the frequency and virulence of P. aeruginosa frequent epidemic clones in the adult CF clinic at Royal Prince Alfred Hospital, Sydney, Australia. METHODS: Two hundred and fifty-eight P. aeruginosa isolates from 112 participants were genotyped by pulsed field gel electrophoresis. Ninety-eight patients were followed up for 1 year and associations sought between infection with a frequent epidemic clone, clinical outcome and antibiotic resistance. RESULTS: Four frequent P. aeruginosa epidemic clones (AES-1, AES-2, S-1, S-2) affected almost 50% of participants. AES-1 predominated (38%). AES-1, AES-2 and S-1 were associated with increased exacerbations and hospital-admission days. AES-1 showed increased resistance to aminoglycosides and ticarcillin-clavulanate. CONCLUSIONS: This study supports the potential threat of frequent P. aeruginosa epidemic clones in adult CF populations.


Assuntos
Fibrose Cística/epidemiologia , Fibrose Cística/microbiologia , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/patogenicidade , Adolescente , Adulto , Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Aspergillus fumigatus/isolamento & purificação , Austrália/epidemiologia , Ácidos Clavulânicos/uso terapêutico , Células Clonais , Comorbidade , Feminino , Seguimentos , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Escarro/microbiologia , Stenotrophomonas maltophilia/isolamento & purificação , Ticarcilina/uso terapêutico , Adulto Jovem
11.
Aust Vet J ; 88(4): 115-23, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20402698

RESUMO

OBJECTIVE: To present the technique for intra-articular catheter placement and report the clinical outcomes of 38 cases of equine synovial trauma and/or infection treated with broad-spectrum antimicrobials administered via an intrasynovial catheter (ISC). DESIGN: Retrospective study. PROCEDURE: Medical records of 38 horses treated for synovial trauma and sepsis with frequent antimicrobial administration through an ISC from 1995 to 2008 were reviewed. Follow-up information was obtained via clinical re-evaluation or telephone contact with the owners. RESULTS: The majority of horses (84%) received amikacin and Timentin(R) four times daily. In addition, synovial lavage through the ISC was carried out in 27 horses (71%). Only radiological evidence of osteolysis had a significant negative impact on both lameness at the time of hospital discharge and the long-term outcome. In total, 92% of horses treated with frequent antimicrobial administration through an ISC had clinical resolution of infection. Catheter obstruction occurred in three cases, necessitating replacement or removal, and two synovial fistulae developed at sites of open drainage. The majority of horses treated had a favourable outcome, with 86% being at least pasture sound and 43% returned to riding. CONCLUSION: Septic synovial structures treated with frequent antimicrobial administration through an ISC had a good prognosis for survival and 43% returned to riding, which is consistent with the results of other studies. The use of a simple ISC should be considered when broad-spectrum intrasynovial antimicrobial administration and lavage of a septic synovial structure are indicated.


Assuntos
Antibacterianos/administração & dosagem , Cateterismo/veterinária , Doenças dos Cavalos/tratamento farmacológico , Sinovite/veterinária , Amicacina/administração & dosagem , Amicacina/uso terapêutico , Animais , Antibacterianos/uso terapêutico , Ácidos Clavulânicos/administração & dosagem , Ácidos Clavulânicos/uso terapêutico , Feminino , Cavalos , Injeções Intra-Articulares/veterinária , Masculino , Prognóstico , Estudos Retrospectivos , Sinovite/tratamento farmacológico , Irrigação Terapêutica/veterinária , Ticarcilina/administração & dosagem , Ticarcilina/uso terapêutico , Resultado do Tratamento
12.
BMJ Case Rep ; 20102010 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-22798443

RESUMO

Septic arthritis in the elderly carries a high mortality. Underlying risk factors, such as diabetes, malignancy, chronic renal failure, rheumatoid arthritis, hepatobiliary disease and AIDS, should be assessed. Rare causative organisms are occasionally encountered. Here, we describe a case of an 80-year-old diabetic patient with liver cirrhosis who developed Klebsiella pneumoniae septic arthritis, which is a rare cause of joint infection. We postulate that this case supports the notion that the patient's knee effusion seeded during a primary K pneumoniae bacteraemia of intestinal origin and related to liver cirrhosis.


Assuntos
Artrite Infecciosa/diagnóstico , Infecções por Klebsiella/diagnóstico , Articulação do Joelho/microbiologia , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Artrite Infecciosa/complicações , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Carcinoma Hepatocelular/complicações , Ácidos Clavulânicos/uso terapêutico , Evolução Fatal , Humanos , Infecções por Klebsiella/complicações , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae , Cirrose Hepática/complicações , Neoplasias Hepáticas/complicações , Masculino , Ticarcilina/uso terapêutico
13.
J Chemother ; 21(2): 188-92, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19423472

RESUMO

The aim of cystic fibrosis (CF) care is to improve both the life expectancy and quality of life of patients. However, rising costs and limited resources of health services must be taken into account. There are many different antibiotic strategies for therapy of Pseudomonas aeruginosa infection in CF patients. In this 5-year retrospective study we found that the cost of treatment of initial infection is considerably lower than the cost of treating chronic P. aeruginosa infections. The percentage distribution of costs of antibiotic treatment in relationship to the administration route was considerably different between outpatients and inpatients. We observed an increase in antibiotic costs with the age of the patient and the decrease in FEV(1)values. The implementation of early eradication treatment, in addition to decreasing the prevalence of patients chronically infected by P. aeruginosa, might also bring about a notable decrease in costs.


Assuntos
Antibacterianos/economia , Efeitos Psicossociais da Doença , Fibrose Cística/tratamento farmacológico , Fibrose Cística/economia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/economia , Adulto , Antibacterianos/uso terapêutico , Ceftazidima/economia , Ceftazidima/uso terapêutico , Pré-Escolar , Doença Crônica , Ciprofloxacina/economia , Ciprofloxacina/uso terapêutico , Ácidos Clavulânicos/economia , Ácidos Clavulânicos/uso terapêutico , Colistina/economia , Colistina/uso terapêutico , Fibrose Cística/complicações , Humanos , Meropeném , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa , Estudos Retrospectivos , Tienamicinas/economia , Tienamicinas/uso terapêutico , Ticarcilina/economia , Ticarcilina/uso terapêutico , Tobramicina/economia , Tobramicina/uso terapêutico
14.
Rev. Asoc. Odontol. Argent ; 95(4): 331-334, ago.-sept. 2007. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-475004

RESUMO

Los bifosfonatos son drogas que se utilizan para el tratamiento de distintas patologías correspondientes al área médica, ha sido relativamente incrementada en los últimos tiempos. A partir de ello se ha detectado un efecto secundario agresivo, comparable a la osteomielitis y que es una verdadera osteonecrosis de los maxilares. Su etiología es desconocida y su terapia incierta, motivos por los cuales el diagnóstico y las medidas preventivas se tornan imprescindibles en la odontología actual.


Assuntos
Humanos , Feminino , Idoso , Difosfonatos/efeitos adversos , Difosfonatos/farmacologia , Difosfonatos/uso terapêutico , Doenças Maxilomandibulares/etiologia , Osteonecrose/induzido quimicamente , Ácidos Clavulânicos/uso terapêutico , Amoxicilina/uso terapêutico , Extração Dentária , Maxila , Osteonecrose/prevenção & controle , Fatores de Risco
15.
Rev. Asoc. Odontol. Argent ; 95(4): 331-334, ago.-sept. 2007. ilus, tab
Artigo em Espanhol | BINACIS | ID: bin-122653

RESUMO

Los bifosfonatos son drogas que se utilizan para el tratamiento de distintas patologías correspondientes al área médica, ha sido relativamente incrementada en los últimos tiempos. A partir de ello se ha detectado un efecto secundario agresivo, comparable a la osteomielitis y que es una verdadera osteonecrosis de los maxilares. Su etiología es desconocida y su terapia incierta, motivos por los cuales el diagnóstico y las medidas preventivas se tornan imprescindibles en la odontología actual.(AU)


Assuntos
Humanos , Feminino , Idoso , Difosfonatos/efeitos adversos , Difosfonatos/farmacologia , Difosfonatos/uso terapêutico , Osteonecrose/induzido quimicamente , Doenças Maxilomandibulares/etiologia , Fatores de Risco , Amoxicilina/uso terapêutico , Ácidos Clavulânicos/uso terapêutico , Osteonecrose/prevenção & controle , Extração Dentária , Maxila/diagnóstico por imagem
16.
Am J Surg ; 194(3): 367-74, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17693284

RESUMO

BACKGROUND: Ertapenem, a group I carbapenem antibiotic, has been shown to be safe and effective in treating adults with complicated intra-abdominal (cIAI) or acute pelvic infection (API). This study evaluated ertapenem for treating these infections in children. METHODS: In an open-label study, children aged 2 to 17 years with cIAI or API were randomized 3:1 to receive ertapenem or ticarcillin/clavulanate. Children 13 to 17 years of age received 1 g parenterally daily, and those 2 to 12 years of age received 15 mg/kg twice daily. Patients < 60 kg received ticarcillin/clavulanate 50 mg/kg 4 to 6 times daily and 3.1 g 4 to 6 times daily for those > or = 60 kg. Patients were assessed for safety and tolerability throughout the study and for efficacy after the completion of therapy. RESULTS: One hundred five patients, 72 (69%) with cIAI, received > or = 1 dose of study drug and were included in the safety analysis. Eighty-one patients were treated with ertapenem. Infusion site pain was the most common drug-related adverse event in both groups. In the modified intent-to-treat analysis, the age-adjusted posttreatment clinical response rates were 87% (43/50 patients) and 100% (25/25 patients) in the cIAI and API patients, respectively, for ertapenem and 73% (11/15 evaluable patients) and 100% (8/8 evaluable patients), respectively, for ticarcillin/clavulanate. Overall age-adjusted response rates were 91% (68/75 evaluable patients) for ertapenem and 83% (19/23 evaluable patients) for the comparator. CONCLUSIONS: This study suggests that ertapenem is generally safe and efficacious for treating cIAI or API in pediatric patients.


Assuntos
Cavidade Abdominal , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Pelve , beta-Lactamas/uso terapêutico , Doença Aguda , Adolescente , Criança , Pré-Escolar , Ácidos Clavulânicos/uso terapêutico , Ertapenem , Feminino , Humanos , Masculino , Estudos Prospectivos , Ticarcilina/uso terapêutico
17.
Cornea ; 26(7): 868-9, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17667625

RESUMO

PURPOSE: To report a case of chronic unilateral conjunctivitis caused by Alcaligenes xylosoxidans. METHODS: A previously healthy 47-year-old woman presented with left eye purulent discharge and irritation beginning 3 months earlier. The patient had previously been treated with bacitracin and olopatadine without improvement. Bacterial staining, culture, and antibiotic sensitivities were performed from a conjunctival swab. RESULTS: The cultures revealed heavy growth of A. xylosoxidans. The organism was resistant to aminoglycosides, fluoroquinolones, and cephalosporins. The patient was started on polytrim, but an allergic reaction forced the use of topical Timentin 2%. After 14 days of treatment, the infection completely resolved. CONCLUSIONS: To our knowledge, this is the first case report of an external ocular infection caused by A. xylosoxidans in a host without predisposing risk factors and the first case report of isolated conjunctivitis caused by A. xylosoxidans. A. xylosoxidans should be considered a rare but potential pathogen capable of producing chronic conjunctivitis in an otherwise healthy host.


Assuntos
Alcaligenes/isolamento & purificação , Conjuntivite Bacteriana/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Antibacterianos/uso terapêutico , Ácidos Clavulânicos/uso terapêutico , Conjuntivite Bacteriana/diagnóstico , Conjuntivite Bacteriana/tratamento farmacológico , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Ticarcilina/uso terapêutico , Inibidores de beta-Lactamases
18.
Acta odontol. venez ; 45(1): 113-115, 2007. ilus
Artigo em Espanhol | LILACS | ID: lil-483962

RESUMO

La cetoacidosis diabética (CD) es un estado de deficiencia relativa o absoluta de insulina. Se da principalmente en pacientes con diabetes tipo 1. La causas más comunes son infecciones subyacentes, interrupción del tratamiento con insulina y el inicio de una diabetes. La CD está típicamente caracterizada por hiperglicemia y acidosis con cetonemia y cetonuria. Presentamos un caso de absceso dentoalveolar en un paciente con CD. El reconocimiento y tratamiento de los factores desencadenantes y monitoreo frecuente de los pacientes son considerados los aspectos más cruciales del manejo de la CD.


Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency. It is seen primarily in patients with type 1 diabetes. The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes. DKA is typically characterized by hyperglycemia and acidosis with ketonemia and ketonuria. We reported a case of dental abscess in a patient with DKA. Recognition and treatment of precipitating factors and frequent monitoring of patients are considered the most crucial aspects of the management of DKA.


Assuntos
Humanos , Feminino , Adulto , Abscesso Periapical/etiologia , Abscesso Periapical/tratamento farmacológico , Cetoacidose Diabética/complicações , Cetoacidose Diabética/etiologia , Cetoacidose Diabética/terapia , Abscesso Periapical/cirurgia , Ácidos Clavulânicos/uso terapêutico , Antibacterianos/uso terapêutico , Amoxicilina/uso terapêutico , Drenagem/métodos , Extração Dentária/métodos
20.
Clin Exp Dermatol ; 30(3): 256-8, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15807684

RESUMO

Gram-negative folliculitis usually involves the face and develops in patients with acne or rosacea during long-term antibiotic therapy. Numerous pathogens have been found, but not, until now, Acinetobacter baumanii which has previously been recognized as an important cause of nosocomial infections and hospital outbreaks. We report here a case of A. baumanii folliculitis of the face, neck, arms and upper part of trunk in a patient with AIDS responding to intravenous treatment with ticarcillin-clavulanic acid. The bacterium was not found on healthy skin and the source of the infection remained unknown.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/isolamento & purificação , Foliculite/microbiologia , HIV-1 , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções por Acinetobacter/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Ácidos Clavulânicos/uso terapêutico , Feminino , Humanos , Ticarcilina/uso terapêutico
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