RESUMEN
BACKGROUND: Carbapenemase production is a global public health threat. Antimicrobial resistance (AMR) data analysis is critical to public health policy. Here we analyzed carbapenemase detection trends using the AMR Brazilian Surveillance Network. METHODS: Carbapenemase detection data from Brazilian hospitals included in the public laboratory information system dataset were evaluated. The detection rate (DR) was defined as carbapenemase detected by gene tested per isolate per year. The temporal trends were estimated using the Prais-Winsten regression model. The impact of COVID-19 on carbapenemase genes in Brazil was determined for the period 2015-2022. Detection pre- (October 2017 to March 2020) and post-pandemic onset (April 2020 to September 2022) was compared using the χ2 test. Analyses were performed with Stata 17.0 (StataCorp, College Station, TX). RESULTS: 83 282 blaKPC and 86 038 blaNDM were tested for all microorganisms. Enterobacterales DR for blaKPC and blaNDM was 68.6% (41 301/60 205) and 14.4% (8377/58 172), respectively. P. aeruginosa DR for blaNDM was 2.5% (313/12 528). An annual percent increase for blaNDM of 41.1% was observed, and a decrease for blaKPC of -4.0% in Enterobacterales, and an annual increase for blaNDM of 71.6% and for blaKPC of 22.2% in P. aeruginosa. From 2020 to 2022, overall increases of 65.2% for Enterobacterales, 77.7% for ABC, and 61.3% for P. aeruginosa were observed in the total isolates. CONCLUSIONS: This study shows the strengths of the AMR Brazilian Surveillance Network with robust data related to carbapenemases in Brazil and the impact of COVID-19 with a change in carbapenemase profiles with blaNDM rising over the years.
Asunto(s)
Acinetobacter baumannii , COVID-19 , Humanos , Pseudomonas aeruginosa/genética , Carbapenémicos/farmacología , Acinetobacter baumannii/genética , Brasil/epidemiología , Pandemias , COVID-19/epidemiología , Proteínas Bacterianas/genética , beta-Lactamasas/genética , Plásmidos , Antibacterianos/farmacología , Pruebas de Sensibilidad MicrobianaRESUMEN
Colonizations/Infections caused by carbapenem-resistant Enterobacterales are of great clinical and epidemiological importance due to their rapid dissemination and high mortality rates. In this scenario, the use of antibiotics intensified by the COVID-19 pandemic has brought about a great warning on the real impact that this pandemic could have on antimicrobial management programs and long-term antimicrobial resistance rates. The objective of this study was to evaluate the increase of New Delhi Metallo ß-Lactamase (NDM)-producing Enterobacterales cases in COVID-19 units of a complex Brazilian tertiary hospital. This retrospective observational study included all patients admitted to the hospital identified as colonized or infected by NDM-producing Gram negative bacilli (GNB), from January 2017 to April 2021. Forty-two NDM-producing Enterobacterales were identified in 39 patients. The rate of NDM cases per total surveillance cultures increased progressively between 2017 and 2021 (chi-2 for trend, p < 0.0001) and was associated with a higher occurrence specifically in COVID units (Fisher exact, p < 0.0001). The molecular investigation of the NDM-producing Klebsiella pneumoniae strains revealed the emergence of diverse clones during the COVID-19 period, also with possible evidence of horizontal transmission among patients within COVID units. NDM-producing Enterobacterales with multiple and different clonalities in the COVID-19 units also raised questions about the importance of other factors besides horizontal clonal transfer, including the increase of antimicrobial consumption by these patients.
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COVID-19 , Pandemias , Humanos , Centros de Atención Terciaria , Prevalencia , Pruebas de Sensibilidad Microbiana , COVID-19/epidemiología , Klebsiella pneumoniae , beta-Lactamasas , Antibacterianos/farmacologíaRESUMEN
Abstract Colonizations/Infections caused by carbapenem-resistant Enterobacterales are of great clinical and epidemiological importance due to their rapid dissemination and high mortality rates. In this scenario, the use of antibiotics intensified by the COVID-19 pandemic has brought about a great warning on the real impact that this pandemic could have on antimicrobial management programs and long-term antimicrobial resistance rates. The objective of this study was to evaluate the increase of New Delhi Metallo β-Lactamase (NDM)-producing Enterobacterales cases in COVID-19 units of a complex Brazilian tertiary hospital. This retrospective observational study included all patients admitted to the hospital identified as colonized or infected by NDM-producing Gram negative bacilli (GNB), from January 2017 to April 2021. Forty-two NDM-producing Enterobacterales were identified in 39 patients. The rate of NDM cases per total surveillance cultures increased progressively between 2017 and 2021 (chi-2 for trend, p < 0.0001) and was associated with a higher occurrence specifically in COVID units (Fisher exact, p < 0.0001). The molecular investigation of the NDM-producing Klebsiella pneumoniae strains revealed the emergence of diverse clones during the COVID-19 period, also with possible evidence of horizontal transmission among patients within COVID units. NDM-producing Enterobacterales with multiple and different clonalities in the COVID-19 units also raised questions about the importance of other factors besides horizontal clonal transfer, including the increase of antimicrobial consumption by these patients.
RESUMEN
OBJECTIVES: Consumption trends of four broad-spectrum antimicrobials and their correlation with antimicrobial resistance in Gram-negative bacilli (GNB) from 2013-2017 within intensive care units (ICUs) were explored. METHODS: Consumption of meropenem (MEM), polymyxin B (PMB), piperacillin/tazobactam (TZP) and cefepime (FEP) in defined daily doses per 1000 patient-days (DDD/1000PD) was measured. Infection-related GNB isolates were grouped according to specific resistance profiles. Time series of antimicrobial consumption and their parametric correlation with each grouped resistant GNB were explored. RESULTS: A total of 1423 GNB were evaluated. A significant linear decline in consumption was observed for MEM [slope -3.88, 95% confidence interval (CI) -4.96 to -2.81; P < 0.0001] and PMB (slope -3.51, 95% CI -5.528 to -1.495; P = 0.0009). A significant decline in MEM-non-susceptible Acinetobacter spp. (R2 = 0.476; P = 0.006) and an increase in FEP-non-susceptible Escherichia coli (R2 = 0.124; P = 0.006) was observed. A significant correlation between MEM consumption and MEM-non-susceptible Acinetobacter spp. (r = 0.43; P = 0.001) was observed. MEM consumption and MEM-non-susceptible Acinetobacter spp. showed a positive correlation. CONCLUSION: Reduction in the consumption of broad-spectrum antimicrobials may alter the frequency of infection-related isolates and their antimicrobial resistance profiles.
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Antiinfecciosos , Infecciones Bacterianas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Antiinfecciosos/farmacología , Infecciones Bacterianas/tratamiento farmacológico , Farmacorresistencia Bacteriana , Bacterias Gramnegativas , Humanos , Meropenem/farmacología , Pruebas de Sensibilidad MicrobianaRESUMEN
The modified carbapenemase inactivation method (mCIM) and EDTA-modified carbapenemase inactivation method (eCIM) are simple and cost-effective detection methods used for serine- and metallo-carbapenemase determination; however, poor test performance has been reported for IMP- and SPM-producing P. aeruginosa. Recently, we reported that 40 µM EDTA concentrations improved test sensitivity for IMP-producing P. aeruginosa. Herein, we assessed standard and high-concentration EDTA eCIM against SPM-producing P. aeruginosa. Twenty-four SPM-producing P. aeruginosa were evaluated, and 3 well-characterized P. aeruginosa (wild type, n = 1; KPC, n = 1; and VIM, n = 1) were used for quality control. mCIM was conducted as described by the Clinical and Laboratory Standards Institute. Concurrently, eCIM methods were performed at standard (5 µM) and high (40 µM) EDTA concentrations. All mCIM phenotypes responded concordant with its genotype. eCIM phenotype matched its genotype for 3 and 24 SPM-producing isolates using standard and high EDTA concentrations, respectively. The eCIM sensitivity increased from 12% using standard concentrations to 100% using high EDTA concentrations. No EDTA-related adverse effects were observed on bacteria growth. The combination mCIM with 40 µM EDTA eCIM properly captured SPM-producing P. aeruginosa. This methodology should be validated in a multi-center study with various enzymatic-producing P. aeruginosa.
Asunto(s)
Carbapenémicos , Pseudomonas aeruginosa , Antibacterianos , Proteínas Bacterianas/genética , Ácido Edético/farmacología , Pruebas de Sensibilidad Microbiana , Pseudomonas aeruginosa/genética , beta-Lactamasas/genéticaRESUMEN
Minimal inhibitory concentrations (MICs) of ticarcillin/clavulanic acid (TLc), ceftolozane/tazobactam (C/T), and aztreonam (AT) were determined for 6 SPM-1-producing Pseudomonas aeruginosa (PSA) using Etest® strips and the synergistic effect of such antimicrobials against was evaluated by gradient diffusion strip crossing (GDSC) test. The fraction inhibitory concentration indexes (FICI) were calculated and showed a synergistic (nâ¯=â¯3) and additive (nâ¯=â¯2) effects of TLcâ¯+â¯AT against SPM-1 producers, while TLcâ¯+â¯C/T combination caused no effect. Average MIC reduction of TLc and AT by GDSC was 3-fold and 2-fold dilutions, respectively. Thus, TLcâ¯+â¯AT might be a candidate as a combination therapy to treat SPM-1-producing PSA infections.
Asunto(s)
Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Pseudomonas aeruginosa/efectos de los fármacos , beta-Lactamasas/metabolismo , Aztreonam/administración & dosificación , Aztreonam/farmacología , Cefalosporinas/farmacología , Ácidos Clavulánicos/administración & dosificación , Ácidos Clavulánicos/farmacología , Sinergismo Farmacológico , Regulación Bacteriana de la Expresión Génica/efectos de los fármacos , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Tazobactam/farmacología , Ticarcilina/administración & dosificación , Ticarcilina/farmacología , beta-Lactamasas/genéticaRESUMEN
OBJECTIVES: Carbapenem-resistant Pseudomonas aeruginosa (CR-PSA) imposes great limitations on empirical therapeutic choices, which are further complicated by metallo-ß-lactamase production. This study evaluated in vitro antimicrobial synergy of ceftolozane/tazobactam in combination with aztreonam and fosfomycin against MDR PSA. METHODS: MICs were determined by broth microdilution and gradient strips. The effect of ceftolozane/tazobactam+aztreonam and ceftolozane/tazobactam+fosfomycin combinations were tested against 27 MDR PSA isolates carrying blaSPM-1 (n = 13), blaIMP (n = 4), blaVIM (n = 3), blaGES-1 (n = 2) and blaCTX-M-like (n = 2), and 3 isolates with no acquired ß-lactamase production detected by gradient diffusion strip crossing (GDSC). Six genetically unrelated SPM-1-producing isolates were also evaluated by time-kill analysis (TKA). RESULTS: All CR-PSA isolates harbouring blaSPM-1, blaGES-1 and blaIMP-1 were categorized as resistant to ceftolozane/tazobactam, meropenem and fosfomycin, with 70% being susceptible to aztreonam. Synergism for ceftolozane/tazobactam+fosfomycin and ceftolozane/tazobactam+aztreonam combinations was observed for 88.9% (24/27) and 18.5% (5/27) of the isolates by GDSC, respectively. A 3- to 9-fold reduction in ceftolozane/tazobactam MICs was observed, depending on the combination. Ceftolozane/tazobactam+fosfomycin was synergistic by TKA against one of six SPM-1-producing isolates, with additional non-synergistic bacterial density reduction for another isolate. Aztreonam peak concentrations alone demonstrated a ≥3 log10 cfu/mL reduction against all six isolates, but all strains were within the susceptible range for the drug. No antagonism was observed. CONCLUSIONS: In the context of increasing CR-PSA and the genetic diversity of resistance mechanisms, new combinations and stewardship strategies may need to be explored in the face of increasingly difficult to treat pathogens.
Asunto(s)
Fosfomicina , Infecciones por Pseudomonas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Aztreonam/farmacología , Cefalosporinas/farmacología , Fosfomicina/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa , Tazobactam/farmacologíaAsunto(s)
Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , beta-Lactamasas/aislamiento & purificación , Brasil/epidemiología , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Farmacorresistencia Bacteriana Múltiple , Humanos , Infecciones por Klebsiella/epidemiología , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/genéticaRESUMEN
BACKGROUND: Population antimicrobial use may influence resistance emergence. Resistance is an ecological phenomenon due to potential transmissibility. We investigated spatial and temporal patterns of ciprofloxacin (CIP) population consumption related to E. coli resistance emergence and dissemination in a major Brazilian city. A total of 4,372 urinary tract infection E. coli cases, with 723 CIP resistant, were identified in 2002 from two outpatient centres. Cases were address geocoded in a digital map. Raw CIP consumption data was transformed into usage density in DDDs by CIP selling points influence zones determination. A stochastic model coupled with a Geographical Information System was applied for relating resistance and usage density and for detecting city areas of high/low resistance risk. RESULTS: E. coli CIP resistant cluster emergence was detected and significantly related to usage density at a level of 5 to 9 CIP DDDs. There were clustered hot-spots and a significant global spatial variation in the residual resistance risk after allowing for usage density. CONCLUSIONS: There were clustered hot-spots and a significant global spatial variation in the residual resistance risk after allowing for usage density. The usage density of 5-9 CIP DDDs per 1,000 inhabitants within the same influence zone was the resistance triggering level. This level led to E. coli resistance clustering, proving that individual resistance emergence and dissemination was affected by antimicrobial population consumption.
Asunto(s)
Ciprofloxacina/uso terapéutico , Farmacorresistencia Bacteriana/fisiología , Escherichia coli/efectos de los fármacos , Fluoroquinolonas/uso terapéutico , Características de la Residencia , Población Urbana/tendencias , Brasil/etnología , Ciprofloxacina/farmacología , Escherichia coli/fisiología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/etnología , Femenino , Fluoroquinolonas/farmacología , Humanos , Estudios LongitudinalesRESUMEN
During investigation of susceptibility testing methods for polymyxins, 24 multidrug-resistant clinical isolates of Pseudomonas aeruginosa were observed to have a distinct, reproducible phenotype in which skipped wells were observed during broth microdilution testing for polymyxin B. Possible mechanisms underlying this phenotype were investigated. The effects of various concentrations of polymyxin B on growth, the expression of resistance genes, and outer-membrane permeability were observed. Real-time PCR was performed to compare the expression, in response to selected concentrations of polymyxin B, of genes related to the PhoP-PhoQ and PmrA-PmrB two-component regulatory systems in polymyxin B-susceptible isolate PAO1, polymyxin B-resistant isolate 9BR, and two isolates (19BR and 213BR) exhibiting the skipped-well phenotype. 19BR and 213BR appeared to have similar basal levels of expression compared to that of PAO1 for phoQ, arnB, and PA4773 (from the pmrAB operon), and in contrast, 9BR had 52- and 280-fold higher expression of arnB and PA4773, respectively. The expression of arnB and PA4773 increased in response to polymyxin B in a concentration-dependent manner for 9BR but not for 19BR and 213BR. For these isolates, expression was significantly increased for arnB and PA4773, as well as phoQ, only upon exposure to 2 mug/ml polymyxin B but not at a lower concentration of 0.125 microg/ml. The sequencing of the pmrAB and phoPQ operons for all three isolates revealed a number of unique mutations compared to that for PAO1. 1-N-phenylnaphthylamine (NPN) was used to study the effect of preincubation with polymyxin B on the self-promoted uptake of polymyxin B across the outer membrane. The preincubation of cells with 2 microg/ml polymyxin B affected baseline membrane permeability in 19BR and 213BR and also resulted in a reduced rate of NPN uptake in these isolates and in PAO1 but not in 9BR. The results presented here suggest that the skipped-well isolates have the ability to adapt to specific concentrations of polymyxin B, inducing known polymyxin B resistance genes involved in generating alterations in the outer membrane.
Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/fisiología , Polimixina B/farmacología , Pseudomonas aeruginosa/efectos de los fármacos , Factores de Transcripción/fisiología , Proteínas Bacterianas/genética , Fibrosis Quística/microbiología , Farmacorresistencia Bacteriana Múltiple/genética , Farmacorresistencia Bacteriana Múltiple/fisiología , Genotipo , Pruebas de Sensibilidad Microbiana , Regiones Promotoras Genéticas/genética , Pseudomonas aeruginosa/genética , Factores de Transcripción/genéticaRESUMEN
Pharmacodynamic analyses were proposed to determine optimal empirical antibiotic therapy against Gram-negative bacteria isolated in a Brazilian ICU. Due to high resistance rates, standard regimens of cefepime, ciprofloxacin, meropenem, and piperacillin/tazobactam were not able to attain significant bactericidal CFR. Prolonged infusion of meropenem achieved 88% CFR, making it a possible empirical regimen in this ICU until susceptibilities become available. Still, even through administration of high dose prolonged infusions, 12.0% of simulated subjects did not achieve bactericidal exposure, suggesting that combination therapy would frequently be required in this setting. In conclusion, we recommend that in the presence of identified resistance problems among Gram-negative bacteria in a unit or hospital, MIC testing of formulary agents should be conducted along with pharmacodynamic simulation to assist in choosing an optimal antibiotic and dosage regimen for empirical use of severe infections until cultures and susceptibilities become available.
Asunto(s)
Antibacterianos/administración & dosificación , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Antibacterianos/farmacología , Brasil , Relación Dosis-Respuesta a Droga , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Infusiones Intravenosas , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Método de MontecarloRESUMEN
Pharmacodynamic analyses were proposed to determine optimal empirical antibiotic therapy against Gram-negative bacteria isolated in a Brazilian ICU. Due to high resistance rates, standard regimens of cefepime, ciprofloxacin, meropenem, and piperacillin/tazobactam were not able to attain significant bactericidal CFR. Prolonged infusion of meropenem achieved 88 percent CFR, making it a possible empirical regimen in this ICU until susceptibilities become available. Still, even through administration of high dose prolonged infusions, 12.0 percent of simulated subjects did not achieve bactericidal exposure, suggesting that combination therapy would frequently be required in this setting. In conclusion, we recommend that in the presence of identified resistance problems among Gram-negative bacteria in a unit or hospital, MIC testing of formulary agents should be conducted along with pharmacodynamic simulation to assist in choosing an optimal antibiotic and dosage regimen for empirical use of severe infections until cultures and susceptibilities become available.
Asunto(s)
Humanos , Antibacterianos/administración & dosificación , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Antibacterianos/farmacología , Brasil , Relación Dosis-Respuesta a Droga , Infecciones por Bacterias Gramnegativas/microbiología , Infusiones Intravenosas , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Método de MontecarloRESUMEN
The pharmacodynamic potency of imipenem, meropenem and ertapenem against extended-spectrum beta-lactamase (ESBL)-producing isolates was investigated. Minimal inhibitory concentration (MIC) determination, confirmation of ESBLs by Etest and the disk approximation test were performed for 133 ESBL-producing isolates of Escherichia coli and Klebsiella spp. Pharmacodynamic exposure, measured as percent of the dosing interval during which free drug was above the MIC (% fT>MIC), was modelled via a 5000-subject Monte Carlo simulation. Bactericidal cumulative fraction of response (CFR), defined as 40% fT>MIC, was calculated against each bacterial population. All agents achieved high bactericidal CFR against all ESBL isolates as a group, but ertapenem (96.26%) was slightly less effective than imipenem (99.96%) and meropenem (99.90%) (P<0.05). Similar results were observed against Klebsiella spp. only (P<0.05). Against E. coli, CFRs were close to 100%. Ertapenem is probably an effective agent against ESBL-producing bacteria, although its ability to achieve bactericidal pharmacodynamic exposures will depend on the bacterial susceptibility.
Asunto(s)
Escherichia coli/metabolismo , Imipenem/farmacocinética , Klebsiella/metabolismo , Tienamicinas/farmacocinética , beta-Lactamasas/metabolismo , beta-Lactamas/farmacocinética , Brasil , Farmacorresistencia Bacteriana Múltiple , Ertapenem , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Escherichia coli/aislamiento & purificación , Humanos , Imipenem/farmacología , Klebsiella/efectos de los fármacos , Klebsiella/enzimología , Klebsiella/aislamiento & purificación , Meropenem , Pruebas de Sensibilidad Microbiana , Modelos Biológicos , Método de Montecarlo , Tienamicinas/farmacología , beta-Lactamas/farmacologíaRESUMEN
Meropenem and imipenem are often the drugs of choice for the treatment of infections due to multidrug-resistant Acinetobacter baumannii. The present study aimed at evaluating the interaction between meropenem and sulbactam through microdilution and checkerboard methods against 48 clinical isolates of A. baumannii collected from Brazilian hospitals. All the isolates presented elevated minimum inhibitory concentration (>or=2 microg/mL) to either meropenem or sulbactam. The checkerboard method with the combination of meropenem and sulbactam demonstrated 29.2% (14/48) synergism, 47.9% (23/48) partial synergism, 10.5% (5/48) additive, 6.2% (3/48) indifference, and 6.2% (3/48) antagonism (SigmaFIC(min)=0.09 and SigmaFIC(max)=8). Thus, combinations of meropenem and sulbactam may show synergism or partial synergism for most A. baumannii isolates. Further studies may help identify treatment options for patients with infections caused by these organisms, particularly with this combination, where both drugs have time-dependent activities and might be suitable for therapy optimization studies.
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Acinetobacter baumannii/efectos de los fármacos , Antibacterianos/farmacología , Sulbactam/farmacología , Tienamicinas/farmacología , Acinetobacter baumannii/enzimología , Acinetobacter baumannii/crecimiento & desarrollo , Sinergismo Farmacológico , Humanos , Meropenem , Pruebas de Sensibilidad Microbiana/métodos , beta-Lactamasas/metabolismoRESUMEN
The OPTAMA (Optimizing Pharmacodynamic Target Attainment using the MYSTIC [Meropenem Yearly Susceptibility Test Information Collection] Antibiogram) Program provides insight into the appropriate antibiotic options for empiric therapy for common nosocomial pathogens. In this report, South America is represented by Brazil, Colombia, Peru, and Venezuela. A 5000-subject Monte Carlo Simulation estimated pharmacodynamic target attainment for meropenem, imipenem, ceftazidime, cefepime, piperacillin/tazobactam, and ciprofloxacin against Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Pharmacokinetic parameter variability was derived from existing healthy volunteer data, and minimum inhibitory concentration (MIC) data came from the 2002 MYSTIC program. Piperacillin/tazobactam and ciprofloxacin displayed the lowest target attainment against all bacterial species (14% to 24% for A. baumannii, 26% to 37% for P. aeruginosa, and 48% to 66% for the Enterobacteriaceae). Overall, the carbapenems had the highest probabilities of attainment against the Enterobacteriaceae (98% to 100%) and A. baumannii (73% to 74%), whereas cefepime obtained the greatest target attainment against P. aeruginosa (65%). Because no single regimen had high target attainment against A. baumannii and P. aeruginosa, the use of combination therapy to treat these pathogens in South America may be justified. Because of the lack of agreement with percent susceptibility for certain antimicrobial regimens, the use of pharmacodynamic target attainment may be a more accurate predictor of microbiologic success.
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Acinetobacter baumannii/efectos de los fármacos , Antibacterianos/farmacocinética , Escherichia coli/efectos de los fármacos , Klebsiella pneumoniae/efectos de los fármacos , Pseudomonas aeruginosa/efectos de los fármacos , Antibacterianos/farmacología , Brasil , Colombia , Intervalos de Confianza , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Recolección de Datos , Farmacorresistencia Bacteriana , Humanos , Pruebas de Sensibilidad Microbiana , Método de Montecarlo , Perú , Probabilidad , Sensibilidad y Especificidad , América del Sur , VenezuelaRESUMEN
This study aimed at evaluating the efficacy and safety of meropenem as first choice treatment for nosocomial pneumonia (NP) in intensive care units (ICU) in Hospital das Clínicas (HC) - University of Säo Paulo; a hospital with high incidence of antimicrobial resistence. Prospective, open, and non-comparative trial with meropenem were done in patients with ventilator-assiciated or aspiration NP in 2 ICUs at HC - University od Säo Paulo. Etiologic investigation was done through bronchoalveolar lavage and blood cultures prior to study entry. Twenty-five (25) critically ill patients with NP were enrolled (mean age 40 years). Ventilator-acquired pneumonia was responsible for 76 percent of cases and aspiration NP for 24 percent. Specific etiologic agents were identified and considered to be clinically and temporally responsible for NP in 11 (44 percent) patients. A.baumanii was responsible for 6 cases (55 percent), P.aeruginosa for 3 (27 percent), and S.aureus for 2 (18 percent). At completion of treatment, 19 patients (76 percent) showed either cure (48 percent) or improvement (28 percent) after use of meropenem therapy. Mortality was 12 percent at the end therapy (8 perecent after excluding 1 non-evaluable patient). After 4 to 6 weeks of follow-up, 12 (48 percent) patients has improved or been totally cured, and overall mortality was 24 percent. Clinical complications were observed in 11 patients (44 percent), with none of them definitely related to the study drug. Meropenem as monotherapy was effective and well-tolerated in most NP patients in our ICU. The low mortality rate in this study might have been due to first choice use of this drug. Controlled, drug comparative clinical trials are needed to support this preliminary observation.
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Humanos , Adulto , Persona de Mediana Edad , Carbapenémicos , Unidades de Cuidados Intensivos , Neumonía , Neumonía Bacteriana , Pseudomonas aeruginosa , Staphylococcus aureus , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Infección Hospitalaria/tratamiento farmacológico , Estudios Prospectivos , Farmacorresistencia Microbiana , Resistencia VascularRESUMEN
The present study was done to estimate the prevalence of Hepatitis A (HAV), B (HBV), C (HCV), and E (HEV) infection in the general population residing in the municipality of Säo Paulo, and to evaluate the level of knowledge related to the various modes of infection transmission by and protection against the different viruses. Blood samples and health questionnaires were collected from 1,059 individuals. The study design used an inductive metod of predictive statistical inferences through randomized sampling stratifield by sex, age and residence region. The estimated prevalence rated found were: Hepatitis A = 66.59 percent (63.75 percent - 69.44 per cent CI); Hepatitis B = 5.94 percent (4.50 percent-7.35 percent); Hepatitis C =1.42 percent (0,70 percent - 2.12 percent); Hepatitis E = 1.68 percent (0.91 percent - 2.46 percent). The frequency of hepatitis was similar in males and females. HAV showed an estimated prevalence of 56.16 percent in the population up to 17 years old, increasing to 65.30 percent in individuals between 18 and 29 years. The infection reached its peak of 90 percent in individuals 40 years of age or older. The study showed a greater tendency of dissemination of HBV among the population between 15 and 17 years. This specific age group showed an estimated prevalence of active infection of 1.04 percent (0.43 percent - 1.65 percent CI), and also demonstrated an ascending level of acquired immunity with an estimated prevalence of 4.90 percent (3.60 percent - 6.20 percent CI). HCV demonstrated an estimated prevalence of 1.42 percent (0.70 percent - 2.12 percent CI). This specific infection occurred more frequently among adults 30 years of age or older, with the prevalence reaching a peak of 3.80 percent among the group aged 50 to 59 years. HEV showed zero prevalence among the age group between 2 and 9 years. This was followed by a slighty ascending rate starting from age 10, with an estimated prevalence of 1.05 percent (0.94 percent - 3.04 percent CI) among those 10 to 14 years of age....