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1.
Rev. esp. quimioter ; 37(2): 1-7, abr. 2024. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-ADZ-259

RESUMO

Introducción. Los programas de optimización de antimicrobianos (PROA) son herramientas clave en la adecuación de estos fármacos. La información disponible sobre la aplicación e indicadores para monitorizar estos programas en urgencias es limitada. El objetivo del estudio es conocer el grado de implantación de programas PROA en los servicios de urgencias, así como el uso de antimicrobianos en estas unidades. Material y métodos. Estudio multicéntrico retrospectivo. Se envió una invitación a todos los participantes del grupo de trabajo de farmacéuticos de urgencias REDFASTER-SEFH. Se utilizó un cuestionario de 21 ítems, contestado por un equipo formado por especialistas en los servicios de farmacia hospitalaria, urgencias, enfermedades infecciosas y microbiología. Resultados. 18 hospitales completaron la encuesta. Catorce (77,8%) disponían de un responsable PROA en la unidad. El valor de DDD por 1000 ingresos osciló entre 36,5 y 400,5 (mediana 100,4 [RIQ:57,2-157,3]). El grupo de carbapenémicos y macrólidos presentó una amplia variabilidad. Únicamente seis (33,3%) hospitales disponían de informe anual de resistencias específico para urocultivos y hemocultivos en urgencias. El porcentaje de multirresistentes en urocultivos fue del 12,5% y en hemocultivos del 12,2%. El porcentaje de adecuación en bacteremia de acuerdo con el resultado del hemocultivo fue del 81,0% (RIQ:74,6-85,0%), y en infección urinaria del 78,0% (RIQ:71,5-88,0%). Conclusiones. Pese a la existencia de responsables PROA, actividades formativas y guías de tratamiento en urgencias, la información sobre el uso de antimicrobianos y el perfil de resistencias en estas unidades es limitado. Futuras actividades han de ir encaminadas a mejorar la información sobre los resultados PROA propios para estas unidades. (AU)


Introduction. Antimicrobial stewardship programs (ASP) have become a key tool in the adaptation of these drugs to the health system. The information available on the application and indicators used in these programs in emergency departments is scarce. The objective of this study is to know theextent of ASP implementation in the emergency departments, as well as the use of antimicrobials in these units. Material and methods. Multicenter retrospective study. An invitation was sent to all participants of the REDFASTER-SEFH emergency pharmacist working group. A questionnaire was used consisting of 21 items, answered by a team made up of a pharmacist, emergency room specialist, infectious disease specialist and microbiologist. Results. Eighteen hospitals completed the survey. Fourteen (77.8%) had an ASP manager. The DDD value per 1000 admissions ranged between 36.5 and 400.5 (median: 100.4 [IQR:57.2-157.3]). Both carbapenem and macrolide group presented wide variability in use. Six (33.3%) hospitals had an annual report on the specific resistance profile for urine and blood cultures. The percentage of multi-drug resistant strains in urine cultures was 12.5% and in blood cultures 12.2%. The percentage of adequacy in the bacteremia treatment was 81.0% (IQR:74.6-85.0%), while in urinary tract infections was 78.0% (IQR:71.5-88.0). Conclusions: Despite the existence of ASP members in emergency services, as well as the training activity and local guidelines is common. knowledge of the use of antimicrobials and resistances is limited. Future activities must be aimed at improving information about the ASP results in these units. (AU)


Assuntos
Humanos , Anti-Infecciosos , Emergências , Gestão de Antimicrobianos , Farmacorresistência Bacteriana , Doenças Transmissíveis , Microbiologia , Estudos Retrospectivos
2.
Rev. esp. quimioter ; 36(5): 470-476, oct. 2023. tab
Artigo em Espanhol | IBECS | ID: ibc-225882

RESUMO

Introducción. En 2019, el Comité Europeo para el estudio de la sensibilidad antibiótica modificó las categorías de los test de sensibilidad antibiótica incluyendo el término “sensible con exposición incrementada”. Tras la difusión de protocolos locales recogiendo estas modificaciones, el objetivo de nuestro estudio fue analizar si los prescriptores se han adecuado a los mismos y el posible impacto clínico en los casos de inadecuación. Material y métodos. Estudio observacional y retrospecti vo de los pacientes con infección por pseudomonas aeruginosa y que hayan recibido antibiótico antipseudomónico desde ene ro a octubre de 2021 en un hospital terciario. Resultados. La inadecuación a las recomendaciones de la guía fueron un 57,6% en planta y un 40,4% en UCI (p<0,05). Tanto en planta como en UCI el grupo con más prescripción no ajustada a las recomendaciones de la guía fueron los amino glucósidos (92,9% y 64,9% respectivamente) por utilizar dosis subóptimas, seguido de los carbapenémicos (89,1% y 53,7% respectivamente) por no administrarlo en perfusión extendida. En planta, la tasa de mortalidad durante el ingreso o a los 30 días en el grupo de terapia inadecuada fue de 23,3% vs 11,5% en los que recibieron los tratamientos de forma adecuada (OR: 2,34; IC 95% 1,14-4,82); en UCI no hubo diferencias estadísti camente significativas. Conclusiones. Los resultados muestran la necesidad de implementar medidas para garantizar una mejor difusión y co nocimiento de los conceptos claves en el manejo de los antibió ticos, con el objetivo de garantizar exposiciones incrementadas y poder ofrecer una mejor cobertura de la infección, así como de evitar la amplificación de cepas resistente (AU)


Introduction. In 2019, the European Committee for the Study of Antibiotic Susceptibility modified the categories of antibiotic susceptibility tests to include the term “susceptible with increased exposure”. Following the dissemination of local protocols reflecting these modifications, the aim of our study was to analyse whether prescribers have adapted to them and the clinical impact in cases of inadequacy. Material and methods. Observational and retrospective study of patients with infection who received antipseudomonal antibiotics from January to October 2021 in a tertiary hospital.Results. Non adherence to the guideline recommendations was 57.6% in the ward and 40.4% in the ICU (p<0.05). In both the ward and ICU, the group with the most prescriptions not by the guideline ecommendations were aminoglycosides (92.9% and 64.9% respectively) for using suboptimal doses, followed by carbapenems (89.1% and 53.7% respectively) for not administering an extended infusion. On the ward, the mortality rate during admission or at 30 days in the inadequate therapy group was 23.3% vs 11.5% in those who received adequate treatment (OR: 2.34; 95% CI 1.14-4.82); in ICU there were no statistically significant differences.Conclusions. The results show the need to implement measures to ensure better dissemination and knowledge of key concepts in antibiotic management, to ensure increased exposures, and to be able to provide better infection coverage, as well as to avoid amplifying resistant strains (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Farmacorresistência Bacteriana , Antibacterianos/administração & dosagem , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções por Pseudomonas/tratamento farmacológico , Prescrições de Medicamentos/normas , Comitê de Profissionais , Estudos Retrospectivos
3.
Rev. esp. quimioter ; 36(4): 416-420, aug. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-223560

RESUMO

Introducción. Mycoplasma genitalium (MG) es un reconocido patógeno de transmisión sexual. El aumento de las resistencias asociadas a las principales líneas de tratamiento (macrólidos y quinolonas) justifican un estudio genético de mutaciones para mejorar las tasas de curación. Material y métodos. Un total de 8.508 muestras fueron analizadas entre abril de 2018 y julio de 2022 para la detección de MG mediante la técnica de PCR multiplex AllplexTM STI Essential Assay. En los casos positivos para MG se estudió el dominio V del gen 23S rRNA y los genes gyrA y parC. Se evaluó la importancia clínica de las mutaciones y se revisaron las historias clínicas para obtener información demográfica y de tratamiento. Resultados. Se realizó estudio de resistencias a 92 muestras (65 hombres y 27 mujeres). En lo relativo al estudio genotípico, 28 pacientes presentaban mutaciones a macrólidos (30,43%). La más habitual fue A2059G (18.48%). Para las quinolonas, 5 pacientes (5,43%) presentaron mutaciones clínicamente relevantes en el gen parC. Destaca un paciente con la mutación G295 en gyrA asociada a G248T en parC. Treinta individuos se sometieron al test de cura (TOC). La azitromicina fue el régimen empírico más común y el moxifloxacino la principal alternativa. Conclusiones. La elevada tasa de resistencias en nuestro entorno evidencia la necesidad de realizar una terapia dirigida por el estudio genotípico de resistencias a macrólidos, apoyándonos en la detección de mutaciones en parC y gyrA para predecir la susceptibilidad a quinolonas y en el uso del TOC para evaluar la respuesta al tratamiento (AU)


Introduction. Mycoplasma genitalium (MG) is a recognized sexually transmitted pathogen. Increasing resistance to main lines of treatment (macrolides and quinolones) justifies a genetic study of mutations to improve cure rates. Material and methods. A total of 8,508 samples from April 2018 to July 2022 were processed using AllplexTM STI Essential Assay. In MG positive cases 23S rRNA V domain, gyrA and parC genes were studied. Mutations detected were checked to assess their clinical significance and medical records were reviewed to obtain demographic and treatment information. Results. Resistance study was performed on 92 samples (65 men and 27 women). In relation to the genotypic study, 28 patients presented mutations to macrolides (30.43%). Most common was A2059G (18.48%). For quinolones, 5 patients (5.43%) had clinically relevant mutations in parC gene. Of note was a patient with G295 mutation in gyrA associated with G248T in parC. Thirty subjects underwent a test of cure (TOC). Azithromycin was the most common empirical regimen and moxifloxacin the main alternative. Conclusions. High rate of resistance in our environment evidences the need for targeted therapy by genotypic study of macrolide resistance, supported by the detection of mutations in parC and gyrA to predict quinolones susceptibility and the use of TOC to evaluate treatment response (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Fluoroquinolonas/farmacologia , Macrolídeos/farmacologia , Mycoplasma genitalium/efeitos dos fármacos , Infecções por Mycoplasma/microbiologia , Infecções por Mycoplasma/tratamento farmacológico , Antibacterianos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Macrolídeos/uso terapêutico
4.
Arch. esp. urol. (Ed. impr.) ; 76(3): 203-214, 28 may 2023. tab, graf
Artigo em Inglês | IBECS | ID: ibc-221856

RESUMO

Objective: Determine the evolution of antibiotic resistance of symptomatic bacteriuria caused by Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in Granada. Material and Method: A descriptive retrospective study was carried out, including antibiograms of urine cultures in which microorganisms identified as E. coli and K. pneumoniae, were isolated in the Microbiology laboratory of the Hospital Universitario Virgen de las Nieves (Granada, Spain) between January 2016 and June 2021. Results: E. coli was the most frequent isolate (10,048) and its resistance to ampicillin (59.45%) and ticarcillin (59.59%), and the increase to cefepime (15.07%) and amoxicillin-clavulanic acid (17.67%) is noteworthy. K. pneumoniae (2222) is notable for resistance to Fosfomycin (27.91%) and an increase to ciprofloxacin (37.79%) and amoxicillin-clavulanic acid (36.63%). Resistance is generally higher in hospitalized patients, males, and adults. Conclusions: Antibiotic resistance to the studied Enterobacteriaceae is on the rise, requiring empirical treatment targeted to the population area (AU)


Assuntos
Humanos , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacos , Antibacterianos/farmacologia , Urina/microbiologia , Estudos Retrospectivos , Urinálise
6.
Rev. esp. salud pública ; 97: e202302013-e202302013, Feb. 2023. ilus
Artigo em Espanhol | IBECS | ID: ibc-216651

RESUMO

La resistencia bacteriana es una constante batalla que representa un problema de Salud Pública. Tan es así que la Organización Mundial de la Salud (OMS) la considera de sus prioridades en salud, debido al impacto que genera tanto en la salud (dado que proyecciones recientes indican que para 2050 se producirán más muertes por esta causa que las ocasionadas actualmente por elcáncer), como a su impacto económico (que, de acuerdo a un estudio reciente en el Reino Unido(1), costará a la economía mundialun estimado de 100 billones de dólares anualmente). La veloz aparición de bacterias multirresistentes y panresistentes es unfenómeno de índole mundial, cuestionando la eficacia antibiótica. Implementar protocolos y recomendaciones es vital, de igualforma que es necesario conciencias al personal sanitario, tomando como base el conocimiento de generación de resistencia y suimpacto a través de los años, potenciado por la actual pandemia de la COVID-19.(AU)


Bacterial resistance is a constant battle representing a Public Health trouble. So much, that the World Health Organization consi-derate Public Health as a priority in health, due to the impact that generates as much as in health (giving that recent projectionsindicate that by 2050 it’ll be produced more deaths because of this than the ones occasioned because of cancer) as its economicimpact (which, according to a recent study in the United Kingdom(1), it’ll cost the world’s economy an estimated of 100 trilliondollars). The quick appearance of multidrug-resistant and pandrug-resistant bacteria is a world nature phenomenon, questioningthe antibiotics efficiency. Implement protocols and recommendations is essential, just as essential and necessary as give aware-ness to health personnel, taking as base the knowledge of resistance generation and its impact through the years, empoweredby the actual pandemic of COVID 19.(AU)


Assuntos
Humanos , Resistência a Medicamentos , Antibacterianos , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Farmacorresistência Bacteriana , Saúde Pública , Anti-Infecciosos/história
7.
Med. intensiva (Madr., Ed. impr.) ; 47(1): 34-44, ene. 2023. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-214319

RESUMO

Enterobacteriaceae are the most frequent pathogens in the Intensive Care Unit. Due to their safety and activity, β-Lactams (BL) and carbapenems represented the most common strategy adopted against these germs. The increasing exposure to these molecules led to the development of several types of antimicrobial resistance as the expression of extended-spectrum β-lactamases (ESBLs) and carbapenemases. Great molecular variability exists among these enzymes, with significant clinical impact. To limit morbidity and mortality, old antibiotics were tested and represent viable alternatives for specific types of infections, or once the spectrum of susceptibility of each germ has been determined. Alongside, new molecules have been specifically designed but enzyme molecular variability prevents the existence of one single antibiotic which fits for all. Therefore, a quicker identification of the molecular identity of each germ, together with the knowledge of the activity spectrum of each antibiotic is crucial to tailor the therapy and make it effective. (AU)


Las enterobacterias son patógenos cada vez más frecuentes en las unidades de cuidados intensivos. Los antibióticos beta lactámicos y carbapenémicos representan las estrategias más comunes contra estos gérmenes, debido a sus mecanismos de acción y seguridad clínica. La exposición cada vez mayor de los patógenos a dichas moléculas ha llevado al desarrollo de nuevas diferentes resistencias a los antibióticos, representadas por la expresión de las beta lactamasas de espectro extendido y de las carbapenemasas. Esas enzimas manifiestan mucha variabilidad molecular, que resulta en un sustancial impacto clínico. Una opción disponible y válida para limitar la morbilidad y la mortalidad de estas infecciones es volver a utilizar los viejos antibióticos, una vez que se haya averiguado el espectro de sensibilidad de los gérmenes. Además, nuevos antibióticos han sido específicamente diseñados para solucionar el problema de las resistencias. Sin embargo, la variabilidad molecular de las enzimas hace que sea muy difícil encontrar una única molécula que funcione para todas. Por lo tanto, una rápida identificación de la identidad molecular de los gérmenes, junto a la comprensión detallada del espectro de actividad de cada antibiótico, es de vital importancia para adaptar el tratamiento y hacerlo más efectivo (AU)


Assuntos
Humanos , Índice de Gravidade de Doença , Enterobacteriáceas Resistentes a Carbapenêmicos , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Farmacorresistência Bacteriana , Antibacterianos/uso terapêutico , Resistência beta-Lactâmica , Farmacorresistência Viral Múltipla
8.
Int. microbiol ; 26(1): 59-68, Ene. 2023. graf
Artigo em Inglês | IBECS | ID: ibc-215917

RESUMO

An increasing number of infections caused by multidrug-resistant (MDR) Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) have severely affected human society. Thus, it is essential to develop an alternative type of antibacterial agents that has a different bacterial resistance mechanism from that of traditional antibiotics. After the synthesis and structural characterization of a cationic pillar[5]arene with pyridinium groups (PP5), the antibacterial and antibiofilm activities as well as its microbial resistance were systematically investigated. In-depth evaluation of biological studies revealed that PP5 was an active antibacterial agent, with surprising antibiofilm formation ability against E. coli and S. aureus. From the results of differential scanning calorimetry and transmission electron microscopy, it was concluded that the microbicidal activity of PP5 was due to the physical disruption of the pathogen’s membrane and the subsequent leakage of cytoplasmic components, which could greatly reduce the rapid generation of resistance. It was presented that the easily available PP5 has high activity to inhibit Gram-positive and Gram-negative bacteria and/or their biofilms with low cytotoxicity. This pillar[5]arene derivative can be used as a good candidate for controlling drug-resistant pathogenic bacterial infections and treating MDR bacteria.(AU)


Assuntos
Humanos , Staphylococcus aureus , Escherichia coli , Antibacterianos , Farmacorresistência Bacteriana , Calorimetria , Microscopia Eletrônica , Biofilmes , Microbiologia , Infecções Bacterianas
9.
Med. intensiva (Madr., Ed. impr.) ; 46(12): 700-710, dic. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-213383

RESUMO

El Acinetobacter baumannii es un patógeno gramnegativo, multirresistente (MR) que causa infecciones nosocomiales, especialmente en las unidades de cuidados intensivos (UCI) y en los pacientes inmunocomprometidos. El A. baumannii ha desarrollado una resistencia antibiótica de amplio espectro, asociada con alta tasa de mortalidad entre los pacientes infectados comparada con las otras especies de Acinetobacter no baumannii. En relación con el impacto clínico, las cepas resistentes están asociadas con incremento de la estadía hospitalaria y de la mortalidad. El A. baumannii puede causar diferentes infecciones, especialmente neumonía asociada a la ventilación mecánica, bacteriemia, e infección de piel y partes blandas, entre otras. Los factores de riesgo más frecuentes para la adquisición de A. baumannii MR son el uso previo de antibióticos, la asistencia respiratoria mecánica, la estadía en la UCI y en el hospital, la severidad de la enfermedad y el uso de dispositivos médicos. Los esfuerzos actuales están focalizados en determinar todos los mecanismos de resistencia descritos en el A. baumannii, con el objetivo de identificar esquemas terapéuticos más efectivos (AU)


Acinetobacter baumannii is a Gram-negative, multidrug-resistant (MDR) pathogen that causes nosocomial infections, especially in intensive care units (ICUs) and immunocompromised patients. A. baumannii has developed a broad spectrum of antimicrobial resistance, associated with a higher mortality rate among infected patients compared with other non-baumannii species. In terms of clinical impact, resistant strains are associated with increases in both in-hospital length of stay and mortality. A. baumannii can cause a variety of infections, especially ventilator-associated pneumonia, bacteremia, and skin wound infections, among others. The most common risk factors for the acquisition of MDR A. baumannii are previous antibiotic use, mechanical ventilation, length of ICU and hospital stay, severity of illness, and use of medical devices. Current efforts are focused on addressing all the antimicrobial resistance mechanisms described in A. baumannii, with the objective of identifying the most promising therapeutic scheme (AU)


Assuntos
Humanos , Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Índice de Gravidade de Doença
10.
Pediatr. aten. prim ; 24(96)oct.- dic. 2022. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-214390

RESUMO

Introducción: la infección del tracto urinario (ITU) es una de las enfermedades más prevalentes en la práctica clínica. Con el fin de mejorar el tratamiento empírico, se ha estudiado la etiología de las infecciones urinarias en Pediatría y el perfil de sensibilidad antibiótica de los microorganismos responsables. Material y métodos: estudio transversal, descriptivo y retrospectivo (2020-2021), en el que se incluyeron los microorganismos aislados con recuento significativo en muestras de orina de pacientes con ITU. Se analizó la etiología global y en función de la edad y el sexo. Se consideró únicamente una muestra de orina por paciente y episodio de ITU. Resultados: Escherichia coli fue el microorganismo más aislado tanto en el conjunto de la población (62%) como en cada uno de los grupos analizados según edad y sexo. Su aislamiento en mujeres fue significativamente superior que en hombres (χ², p = 0,043). Su sensibilidad fue: 94% a fosfomicina y 86% a amoxicilina-ácido clavulánico. Conclusiones: Escherichia coli continúa siendo el microorganismo más frecuentemente aislado en ITU. Por ello, para las ITU bajas, la amoxicilina-clavulánico y la nitrofurantoína podrían ser opciones adecuadas. Nuestro medio debería recomendar fosfomicina, ya que muestra varias ventajas para su uso, como la dosificación una vez al día, bajos efectos secundarios, resultados clínicos y microbiológicos adecuados y poco efecto sobre la microbiota intestinal (AU)


Introduction: urinary tract infection (UTI) is one of the most prevalent diseases in clinical practice. In order to improve empirical treatment, the etiology of pediatric urinary tract infections and the antibiotic sensitivity profile of the responsible microorganisms have been studied.Material and methods: cross-sectional, descriptive and retrospective study (2020-2021) in which isolated microorganisms with significant counts in urine samples from patients with UTI were included. The global etiology and according to age and sex were analyzed. Only one urine sample per patient and UTI episode was considered.Results: Escherichia coli was the most isolated microorganism both in the population as a whole (62%) and in each of the groups analyzed according to age and sex. It was isolated in women significantly higher than in men (χ², p=0.043). Their sensitivity was: 94% fosfomycin and 86% amoxicillin-clavulanic acid.Conclusions: Escherichia coli continues to be the most frequently isolated microorganism in UTI. Therefore, for lower UTIs, amoxicillin-clavulanic acid and nitrofurantoin could be suitable options. Our environment should recommend fosfomycin, since it shows several advantages for its use, such as once-daily dosing, low side effects, adequate clinical and microbiological results, and little effect on the intestinal microbiota. (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Infecções por Bactérias Gram-Positivas , Infecções por Bactérias Gram-Negativas , Antibacterianos/uso terapêutico , Estudos Transversais , Estudos Retrospectivos , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , Antibacterianos/farmacologia , População Rural
11.
Arch. esp. urol. (Ed. impr.) ; 75(9): 791-797, 28 nov. 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-212773

RESUMO

Introduction: Resistance to antibiotics is a growing problem with repercussions on the choice of first-line treatment in urinary tract infection (UTI) in childhood. Objectives: To know the current pattern of antibiotic susceptibility/resistance of the most frequent germs that cause UTI in our healthcare area. Secondary objective is to know the evolution of these patterns over time. Patients and Methods: A cross-sectional retrospective study of UTI episodes in a first-level hospital in two periods: 1st January 2008-31th December 2010 and 1st January 2017-31th December 2019 through a review of medical records, recording the following variables: Age, sex, fever, hospital admission, uropathy/bladder dysfunction, antibiotic prophylaxis. Results: First period: 174 UTI episodes (156 patients); Second period: 266 UTI episodes (218 patients). The most frequently isolated germ was E. coli, but in patients with uropathy or bladder dysfunction, the percentage of different germs is greater. A significant increase in resistance to amoxicillin/clavulanate (from 12.2 to 24%) is observed between both periods, it remains stable and in an acceptable range for gentamicin, cotrimoxazole and slightly increases to first-generation cephalosporins. In patients with uropathy/bladder dysfunction, resistance to all these antibiotics is significantly increased. Conclusions: The increased resistance of the most frequent uropathogens in the UTI of the pediatric population of our healthcare area to amoxicillin/clavulanate makes it unsuitable as empirical therapy. First-generation cephalosporins are an adequate alternative in patients without risk factors (AU)


Introducción: La resistencia a antibióticos es unproblema creciente con repercusión en la elección deltratamiento empírico en la infección del tracto urinario(ITU) en la infancia.Objetivos: Conocer cómo ha evolucionado la incidencia de uropatógenos causantes de ITU en poblaciónpediátrica y su patrón de resistencia antibiótica en el área11 de salud de la Comunidad de Madrid. Secundariamente,patrón de resistencia actual.Materiales y Métodos: Estudio de corte transversal retrospectivo de los episodios de ITU de un hospitalde Nivel I en dos periodos: 1 enero 2008 a 31 diciembre2010 y 1 enero 2017 a 31 diciembre 2019. Se recogió:Edad, sexo, fiebre, uropatía/disfunción vesical, profilaxisantibiótica, microorganismo aislado y su antibiograma. Serealizó estudio descriptivo de todas las variables recogidas ycomparación de proporciones independientes, utilizando laprueba chi cuadrado,tomando como variable de agrupación cada periodo. El análisis estadístico fue realizado con elprograma EPIDAT v 4.2.Resultados: Primer periodo: 174 episodios de ITU(156 pacientes); Segundo periodo: 266 episodios de ITU(218 pacientes). El germen más frecuentemente aisladofue E. coli, siendo mayor el aislamiento de gérmenes distintos en pacientes urópatas/disfunción vesical. Se observa un aumento significativo de la resistencia a amoxicilina/clavulánico, se mantiene estable y en rango aceptablepara gentamicina, cotrimoxazol y aumenta levemente a cefalosporinas de primera generación. En los pacientes conuropatía/disfunción vesical las resistencias a todos estos antibióticos se incrementansignificativamente.Conclusiones: El aumento de la resistencia de losuropatógenos más frecuentes en la ITU de la poblaciónpediátrica a amoxicilina/clavulánico del área sanitaria estudiada, lo hace no apto como terapia empírica. Las cefalosporinas de primera generación suponen una adecuadaalternativa en pacientes sin factores de riesgo (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Farmacorresistência Bacteriana , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Estudos Transversais , Estudos Retrospectivos , Estudos de Coortes , Espanha
12.
Rev. esp. quimioter ; 35(Supl. 3): 37-40, Oct. 2022. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-210746

RESUMO

Antimicrobial resistance is one of the major health problems we face in the 21st century. Nowadays we cannot understand global health without the interdependence between the human, animal and environmental dimensions. It is therefore logical to adopt a “One Health” approach to address this problem. In this review we show why a collaboration of all sectors and all professions is necessary in order to achieve optimal health for people, animals, plants and our environment. (AU)


Assuntos
Humanos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Antibacterianos , Anti-Infecciosos , Saúde Única
13.
Med. intensiva (Madr., Ed. impr.) ; 46(7): 392-402, jul. 2022. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-207850

RESUMO

Los Enterobacterales resistentes a carbapenémicos o productores de betalactamasas de espectro extendido (BLEE) y los no fermentadores resistentes a carbapenémicos presentan resistencia a muchos de los antimicrobianos comúnmente empleados en la práctica clínica, y han sido reconocidos por la Organización Mundial de la Salud como una prioridad crítica para el desarrollo de nuevos antimicrobianos. En esta revisión se abordarán los principales mecanismos de resistencia de los Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii y Stenotrophomonas maltophilia a betalactámicos, quinolonas, aminoglucósidos y polimixinas. Se presentará información actualizada sobre la importancia en la resistencia de mecanismos de modificación de antimicrobianos (incluyendo betalactamasas de claseC de espectro extendido, carbapenemasas y enzimas modificadoras de aminoglucósidos), alteraciones de la permeabilidad por trastornos en la expresión de porinas o del lipopolisacárido, producción de bombas de expulsión activa, alteraciones de la diana o protección de la misma y expresión de sistemas de doble componente (AU)


Enterobacterales resistant to carbapenems or producing extended-spectrum β-lactamases (ESBL) and non-fermenters resistant to carbapenems present resistance to many of the antimicrobials commonly used in clinical practice, and have been recognized by the World Health Organization as a critical priority for the development of new antimicrobials. In this review, the main mechanisms of resistance of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia to β-lactams, quinolones, aminoglycosides and polymyxins will be addressed. Updated information will be presented on the importance in resistance of antimicrobial modification mechanisms (including classC or extended-spectrum β-lactamases, carbapenemases and aminoglycoside-modifying enzymes), permeability alterations due to porin or lipopolysaccharide expression disorders, production of active efflux pumps, target alterations or protection, and expression of two-component systems (AU)


Assuntos
Humanos , Farmacorresistência Bacteriana , Bactérias Gram-Negativas/efeitos dos fármacos , Antibacterianos/farmacologia
15.
Pharm. pract. (Granada, Internet) ; 19(1): 0-0, ene.-mar. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-201715

RESUMO

BACKGROUND: Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program. OBJECTIVES: To examine physicians' attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals. METHODS: A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians' attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements. RESULTS: 158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians' autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents. CONCLUSIONS: Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Gestão de Antimicrobianos/organização & administração , Doenças Transmissíveis/tratamento farmacológico , Antibacterianos/uso terapêutico , Atitude do Pessoal de Saúde , Líbano/epidemiologia , Estudos Transversais , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Farmacorresistência Bacteriana , Estatísticas Hospitalares , Prescrição Inadequada/estatística & dados numéricos
16.
Pharm. pract. (Granada, Internet) ; 19(1): 0-0, ene.-mar. 2021. tab, graf
Artigo em Inglês | IBECS | ID: ibc-201716

RESUMO

OBJECTIVE: This study examined the effects of a national policy advocating rational drug use (RDU), namely, the 'RDU Service Plan', starting in fiscal year 2017 and implemented by the Thai Ministry of Public Health (MOPH), on trends in antibiotic prescribing rates for outpatients. The policy was implemented subsequent to a voluntary campaign involving 136 hospitals, namely, the 'RDU Hospital Project', which was implemented during fiscal years 2014-2016. METHODS: Hospital-level antibiotic prescribing rates in fiscal years 2014-2019 for respiratory infections, acute diarrhea, and fresh wounds were aggregated for two hospital groups using equally weighted averages: early adopters of RDU activities through the RDU Hospital Project and late adopters under the RDU Service Plan. Pre-/post-policy annual changes in the prescribing levels and trends were compared between the two groups using an interrupted time-series analysis. RESULTS: In fiscal years 2014-2016, decreases in antibiotic prescribing rates for respiratory infections and acute diarrhea in both groups reflected a trend that existed before the RDU Service Plan was implemented. The immediate effect of the RDU Service Plan policy occurred in fiscal year 2017, when the prescribing level among the late adopters dropped abruptly for all three conditions with a greater magnitude than in the decrease among the early adopters, despite nonsignificant differences. The medium-term effect of the RDU Service Plan was identified through a further decreasing trend during fiscal years 2017-2019 for all conditions in both groups, except for acute diarrhea among the early adopters. CONCLUSIONS: The national policy on rational drug use effectively reduced antibiotic prescribing for common but questionable outpatient conditions


No disponible


Assuntos
Humanos , Gestão de Antimicrobianos/organização & administração , Doenças Transmissíveis/tratamento farmacológico , Antibacterianos/uso terapêutico , 50207 , Farmacorresistência Bacteriana , Estatísticas Hospitalares , Prescrição Inadequada/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Análise de Séries Temporais Interrompida
17.
Pharm. pract. (Granada, Internet) ; 19(1): 0-0, ene.-mar. 2021. tab
Artigo em Inglês | IBECS | ID: ibc-201717

RESUMO

BACKGROUND: In Low-and Middle-Income Countries, including India, consumers often purchase antibiotics over-the-counter (OTC) from retail pharmacies. This practice leads to the inappropriate use of antibiotics in the community which is an important driver for the development of antimicrobial resistance. A better understanding of consumers' views towards this grave public health concern is critical to developing evidence-based intervention programs for awareness among the general population. OBJECTIVE: To explore knowledge, practice and, behavior of consumers towards antibiotics, antibiotic use, antimicrobial resistance, purchasing behavior of consumers for antibiotics, and to gain insight which will help in developing evidence-based policy interventions. METHODS: 72 in-depth consumer interviews were conducted in all 11 districts of the National Capital Territory of Delhi. The qualitative data were analyzed using thematic analysis. RESULTS: Our study found that retail pharmacies were the first point of consultation for common ailments for patients/consumers once home remedies failed; they were largely unaware of the threat of antimicrobial resistance. Consumers' knowledge of antibiotic use and about antimicrobial resistance was low, they used old prescriptions, and bought antibiotics OTC to save time and money. Despite the presence of regulations constituted to regulate the sale of antibiotics by the Government and the implementation of national campaigns, the practice of self-medication and behaviors such as OTC purchase, non-adherence to prescribed antibiotics was prevalent. Consumers perceive that antibiotics provide quick relief and accelerate the curing process and retail pharmacy shops try to protect their retail business interests by honoring old prescriptions and self-medication for antibiotics. CONCLUSIONS: The lack of awareness and insufficient knowledge about what antibiotics are and issues such as antimicrobial resistance or antibiotic resistance resulted in misuse of antibiotics by consumers. Limited access to public healthcare and affordability of private healthcare are factors that contribute towards the self-medication/OTC purchase of antibiotics. The regular misuse of antibiotics through irrational use reinforces the need for strong enactment of strategies like continuous community awareness campaigns. Mitigation efforts should focus upon educating consumers continuously and sustainably for the understanding of antibiotic misuse, antimicrobial resistance, and promote better compliance with regulations


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Doenças Transmissíveis/tratamento farmacológico , Antibacterianos/uso terapêutico , Medicamentos sem Prescrição/uso terapêutico , Automedicação/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Índia/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários/estatística & dados numéricos , Farmacorresistência Bacteriana
20.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(9): 761-767, nov. 2020. graf
Artigo em Espanhol | IBECS | ID: ibc-201005

RESUMO

INTRODUCCIÓN: Las infecciones de transmisión sexual siguen siendo un problema mundial de salud pública. Aunque tradicionalmente se considera una infección tratable, la aparición de resistencias de la Neisseria gonorrhoeae (N. gonorrhoeae) a los agentes antimicrobianos se ha convertido en un tema de vital importancia. El objetivo del presente estudio fue valorar tanto la incidencia como la resistencia frente a los agentes antimicrobianos desarrollada por las cepas de N. gonorrhoeae en un hospital portugués durante 10 años. MÉTODOS: Se incluyeron aquellos casos con confirmación en laboratorio de infecciones por N. gonorrhoeae diagnosticados entre los años 2009 y 2018. Se estudió además la sensibilidad frente a la penicilina, las tetraciclinas, el ciprofloxacino, la azitromicina y la cefotaxima, así como las características clínicas y demográficas relacionadas. RESULTADOS: Desde el año 2009 al 2018, en nuestro centro fueron detectados un total de 440 casos de infecciones por N. gonorrhoeae, evidenciándose además un incremento anual significativo en el número de casos (p < 0,05). La mayoría de los casos se observaron en pacientes del sexo masculino (97,9%), con una media de edad de 25 años. En el 88,7% de los casos el tratamiento utilizado fue la asociación de ceftriaxona con azitromicina. La resistencia objetivada frente a la penicilina, las tetraciclinas y el ciprofloxacino permaneció elevada durante todo el período del estudio. CONCLUSIONES: La resistencia antimicrobiana de la infección por N. gonorrhoeae apareció al poco tiempo después de la introducción del tratamiento antimicrobiano. Para poder combatir esta situación es necesario implantar una mayor vigilancia, así como realizar más estudios que busquen combinar tanto datos epidemiológicos como de sensibilidad. En nuestra población, la N. gonorrhoeae sigue siendo muy sensible a los tratamientos antibióticos que se recomiendan actualmente. Sin embargo, el tratamiento con ciprofloxacino, azitromicina (en monoterapia) y la penicilina se deben de evitar como tratamiento empírico


BACKGROUND: Sexually Transmitted Infections remain a major public health concern worldwide. Although traditionally considered treatable, the emergence of Neisseria gonorrhoeae resistance to antimicrobials is currently a serious problem. The goal of this study was to evaluate the incidence and trends of antimicrobial resistance over the last 10 years in N. gonorrhoeae isolates from a Portuguese Centre. METHODS: Laboratorial confirmed N. gonorrhoeae infections diagnosed between 2009 and 2018 were evaluated. Susceptibilities to penicillin, tetracycline, ciprofloxacin, azithromycin and cefotaxime were studied, along with demographic and clinical characteristics. RESULTS: From 2009 to 2018, 440 cases of N. gonorrhoeae infection were diagnosed in our center, with a significant yearly increase (p < 0.05). Most cases occurred in males (97.9%), with a median age of 25 years. In 88.7% of the cases, treatment with ceftriaxone plus azithromycin was used. Resistances to penicillin, tetracycline and ciprofloxacin remained high throughout the study period. CONCLUSIONS: Antimicrobial resistance of N. gonorrhoeae appeared shortly after the introduction of antimicrobials. To combat this problem, improved surveillance and more studies combining susceptibility and epidemiological data are needed. In our population, N. gonorrhoeae remains highly susceptible to the antibiotics currently recommended for its treatment, whereas ciprofloxacin, azithromycin (in monotherapy) and penicillin should be avoided as empirical treatment


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Gonorreia/tratamento farmacológico , Farmacorresistência Bacteriana , Neisseria gonorrhoeae/efeitos dos fármacos , Antibacterianos/farmacologia , Resistência às Penicilinas , Neisseria gonorrhoeae/isolamento & purificação , Portugal , Sensibilidade e Especificidade , Estudos Retrospectivos , Cefotaxima/uso terapêutico , Azitromicina/uso terapêutico , Tetraciclinas/uso terapêutico , Ciprofloxacina/uso terapêutico
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