Dose regimen optimization of cephalothin for surgical prophylaxis against Staphylococcus aureus and coagulase negative staphylococci in dogs by pharmacokinetic/pharmacodynamic modeling.

First generation cephalosporins such cephalothin of cefazolin are indicated for antimicrobial prophylaxis for clean and clean contaminated surgical procedures because its antimicrobial spectrum, relative low toxicity and cost. Anesthesia and surgery could alter the pharmacokinetic behavior of different drugs administered perioperative by many mechanisms that affect distribution, metabolism or excretion processes. Intravenous administration of the antimicrobial within 30 and 60 min before incision is recommended in order to reach therapeutic serum and tissue concentrations and redosing is recommended if the duration of the procedure exceeds two half-life of the antimicrobial. To the author's knowledge there are no pharmacokinetic studies of cephalothin in dogs under anesthesia/surgery conditions. The aim of this study was (1) to evaluate the pharmacokinetics of cephalothin in anesthetized dogs undergoing ovariohysterectomy by a nonlinear mixed-effects model and to determine the effect of anesthesia/surgery and other individual covariates on its pharmacokinetic behavior; (2) to determine the MIC and conduct a pharmacodynamic modeling of time kill curves assay of cephalothin against isolates of Staphylococcus spp. isolated from the skin of dogs; (3) to conduct a PK/PD analysis by integration of the obtained nonlinear mixed-effects models in order to evaluate the antimicrobial effect of changing concentrations on simulated bacterial count; and (4) to determine the PK/PD endpoints and PK/PDco values in order to predict the optimal dose regimen of cephalothin for antimicrobial prophylaxis in dogs. Anesthesia/surgery significantly reduced cephalothin clearance by 18.78%. Based on the results of this study, a cephalothin dose regimen of 25 mg/kg q6h by intravenous administration showed to be effective against Staphylococcus spp. isolates with MIC values ≤2 µg/mL and could be recommended for antimicrobial prophylaxis for clean surgery in healthy dogs.

Postoperative Antibiotic Prophylaxis in Reduction Mammaplasty: A Randomized Controlled Trial.

BACKGROUND: Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on infection rates after reduction mammaplasty. METHODS: The authors conducted a randomized trial of noninferiority, with two parallel groups, with triple blinding. The participants were 124 women with breast hypertrophy, with reduction mammaplasty already scheduled, selected consecutively. All patients underwent reduction mammaplasty, performed by the same surgical team, using the superomedial pedicle technique for ascending the nipple-areola complex. All patients received cephalothin (1 g) intravenously at the anesthetic induction and every 6 hours for 24 hours. At hospital discharge, they were assigned randomly to either the placebo (n = 62) or antibiotic group (n = 62) and were instructed to take identical capsules containing 500 mg of cephalexin or placebo, respectively, every 6 hours, for 7 days. Patients were assessed weekly, for 4 weeks, regarding the occurrence of surgical-site infection, by a surgeon who was unaware of the allocation. The criteria and definitions of the Centers for Disease Control and Prevention were adopted. RESULTS: There was no statistical difference between groups regarding age, body mass index, or resected breast tissue weight. The overall surgical-site infection rate was 0.81 percent. Only one patient, allocated to the antibiotic, presented infection, classified as superficial incisional (p = 1.00). In the placebo group, surgery time was higher (p = 0.003). CONCLUSION: The maintenance of antibiotics in the postoperative period of reduction mammaplasty did not influence the rates of surgical-site infection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Cefalotin as antimicrobial prophylaxis in patients with known intraoperative anaphylaxis to cefazolin.

BACKGROUND: The most common trigger for intraoperative anaphylaxis in Western Australia for the period 2014-5 was an antibiotic used for surgical prophylaxis, cefazolin. In these patients who subsequently present for surgery, alternative cephalosporins are forbidden by current guidelines because of concerns regarding an increased risk of anaphylaxis. However, consideration of the structure-activity relationships relevant to anaphylaxis suggests that cefalotin is a safe alternative because of structural dissimilarities, although there are no pubished clinical data relevant to the perioperative setting. METHODS: Patients diagnosed with intraoperative anaphylaxis to cefazolin at the Western Australian Anaesthetic Allergy Clinic were tested with intradermal cefalotin and, if negative, subsequently challenged i.v. If tolerated, cefalotin was recommended for subsequent surgery, and subjects were followed up to determine the safety of subsequent intraoperative doses. RESULTS: Twenty-one subjects diagnosed with immediate hypersensitivity to cephazolin, including 19 subjects with confirmed anaphylaxis, participated. None tested positive to intradermal cefalotin, and all received a graded i.v. challenge to cefalotin without developing signs or symptoms of anaphylaxis. Three subjects subsequently received intraoperative cefalotin 12-139 days later without adverse events. CONCLUSIONS: A negative intradermal cefalotin skin test has a good negative predictive value in patients who have previously suffered anaphylaxis to cefazolin, allowing the rational and desirable use of this alternative cephalosporin for future surgery and the avoidance of less desirable antimicrobial agents.

Comparación de concentración mínima inhibitoria y concentración plasmática de cefalotina mediante un modelo matemático / Comparison of the minimal inhibitory concentration and the plasma cephalotin concentration through a mathematical model

Introducción: el uso de fármacos fuera de rangos terapéuticos es un problema hospitalario, pues pocas veces se tienen en cuenta parámetros antropométricos del paciente, determinantes en las concentraciones del medicamento. Objetivo: aplicar un modelo matemático basado en parámetros del paciente, para determinar las posibles concentraciones plasmáticas de cefalotina y compárarlas con las concentraciones mínimas inhibitorias de los microrganismos aislados. Métodos: se seleccionó un grupo de pacientes del sexo masculino entre 18 y 50 años de edad con tratamiento profiláctico posquirúrgico con cefalotina. Se recopiló la información: dosis de cefalotina, peso, talla, edad, hematócrito. Se calcularon volumen extracelular, plasmático y sanguíneo según el modelo informado por Hedin. Luego se calculó la concentración plasmática de cefalotina usando el modelo propuesto en el presente estudio y se comparó con la concentración mínima inhibitoria de los microorganismos aislados. Resultados: se analizaron 24 pacientes con promedio de edad 32,6 años ± 8, peso de 69 kg ± 7,51, talla de 168,87 cm ± 7,10. El 56,3 por ciento de los microorganismos presentó resistencia a concentraciones ³ 32 µg/mL. El agente más común fue Escherichia coli de 18 cepas aisladas. La comparación del volumen de distribución y la concentración plasmática de cefalotina calculada con el modelo informado por Hedin y el desarrollado en presente trabajo, no presentó diferencia significativa después de aplicar la prueba t de Student, con p< 0,05. Conclusiones: al comparar las concentraciones teóricas de cefalotina para uso profiláctico posquirúrgico intrahospitalario, calculadas con el modelo planteado, se encontró que estas no permitieron superar la concentración mínima inhibitoria de los microorganismos aislados(AU)

Introduction: the use of drugs out of therapeutic ranges is a hospital problem since the anthropometric parameters of patients, which are determinants in the drug concentrations, are rarely taken into consideration. Objectives: to implement a mathematical model based on the patient's parameters in order to determine the possible plasma cephalotine concentrations and to compare them with the minimum inhibitory concentrations for isolated microorganisms. Methods: a group of male patients aged 18 to 50 years under postsurgical prophylactic treatment with cephalotine was selected. Data was collected on cephalotin dosage, weight, size, age and hematocrit. Extracellular, plasma and blood volumes were estimated by the Hedin's informed model. Additionally, the plasma cephalotin concentration was measured by using the model suggested in this study and then compared with the minimum inhibitory concentration for the isolated microorganisms. Results: twenty four patients aged 32.6 years ± 8, weighing 69 kg ± 7.51, with size of 168.87 cm ± 7.10 were analyzed. Resistance to concentrations equal to or higher than 32 µg/mL was observed in 56.3 percent of microorganisms. The most common agent was Escherichia coli in 18 isolated strains. The comparison of the distribution volume and of the plasma cephalotin concentration estimated with the Hedin's informed model and with the model devised in the present paper did not show significant differences according to Student's t test result, with p< 0.05. Conclusions: the comparison of the theoretical concentrations of cephalotine for in-hospital postsurgical prophylactic use estimated by the model yielded that these concentrations did not allow overcoming the minimum inhibitory concentration for the isolated microorganisms(AU)

Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome.

OBJECTIVE: To evaluate the changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization in the ICU and their relation to outcome. DESIGN: Prospective observational study. SETTING: ICU of a veterinary university medical center. ANIMALS: Thirty dogs with severe sepsis or septic shock caused by pyometra who underwent surgery and were admitted to the ICU. MEASUREMENTS AND MAIN RESULTS: Severe sepsis was defined as the presence of sepsis and sepsis-induced dysfunction of one or more organs. Septic shock was defined as the presence of severe sepsis plus hypotension not reversed with fluid resuscitation. After the presumptive diagnosis of sepsis secondary to pyometra, blood samples were collected and clinical findings were recorded. Volume resuscitation with 0.9% saline solution and antimicrobial therapy were initiated. Following abdominal ultrasonography and confirmation of increased uterine volume, dogs underwent corrective surgery. After surgery, the animals were admitted to the ICU, where resuscitation was guided by the clinical parameters, central venous oxygen saturation (ScvO(2)), lactate, and base deficit. Between survivors and nonsurvivors it was observed that the ScvO(2), lactate, and base deficit on ICU admission were each related independently to death (P = 0.001, P = 0.030, and P < 0.001, respectively). ScvO(2) and base deficit were found to be the best discriminators between survivors and nonsurvivors as assessed via receiver operator characteristic curve analysis. CONCLUSION: Our study suggests that ScvO(2) and base deficit are useful in predicting the prognosis of dogs with severe sepsis and septic shock; animals with a higher ScvO(2) and lower base deficit at admission to the ICU have a lower probability of death.

Pyodermatitis-pyostomatitis vegetans: case report and review of medical literature.

Pyodermatitis-pyostomatitis vegetans is a rare inflammatory dermatosis of unknown etiology, with a typical mucocutaneous involvement. We report the case of a woman with pustular and vesicular lesions in the axillae, evolving with vegetating plaques and pustules with annular grouping. The disease progressed with vulvar and inguinal involvement as well as involvement of the oral, nasal and ocular mucous membranes. She started the treatment with prednisone (40 mg/day), with remission of the lesions after one month of use of such medication. Association with inflammatory bowel disease occurs in 70% of the cases. Immunofluorescence, which is typically negative, helps to characterize the disease. A rapid response to systemic steroids is expected.

Piodermatite-pioestomatite vegetante: relato de caso e revisão de literatura / Pyodermatitis-pyostomatitis vegetans: case report and review of medical literarture

A piodermatite-pioestomatite vegetante é uma rara dermatose inflamatória de etiologia desconhecida, com típico comprometimento mucocutâneo. Relatamos caso de paciente feminina com lesões pustulosas e vesiculosas em axilas, evoluindo com placas vegetantes e pústulas com agrupamento anular. Houve progressão com comprometimento vulvar, inguinal e mucosas oral, nasal e ocular. Proposto o diagnóstico, optou-se por iniciar prednisona 40mg ao dia, com remissão das lesões após um mês de uso da medicação. A associação com doença inflamatória intestinal ocorre em 70 por cento dos casos. A imunofluorescência é um fator que ajuda a caracterizar a doença, sendo tipicamente negativa. A rápida resposta à terapêutica com corticosteroides sistêmicos é esperada.

Pyodermatitis-pyostomatitis vegetans is a rare inflammatory dermatosis of unknown etiology, with a typical mucocutaneous involvement. We report the case of a woman with pustular and vesicular lesions in the axillae, evolving with vegetating plaques and pustules with annular grouping. The disease progressed with vulvar and inguinal involvement as well as involvement of the oral, nasal and ocular mucous membranes. She started the treatment with prednisone (40 mg/day), with remission of the lesions after one month of use of such medication. Association with inflammatory bowel disease occurs in 70 percent of the cases. Immunofluorescence, which is typically negative, helps to characterize the disease. A rapid response to systemic steroids is expected.

Utilidad de los antimicrobianos en la toracostomía cerrada por trauma / Are antimicrobials useful in closed thoracostomy due to trauma?

Introducción: Una cuarta parte de las muertes en trauma son por trauma torácico. El paciente con trauma torácico generalmente presenta neumotórax o hemotórax, los cuales predisponen a complicaciones infecciosas que dependen de múltiples factores. El manejo en muchas instituciones incluye antimicrobianos para prevenir complicaciones infecciosas, si bien no está demostrada la reducción de la incidencia de infecciones. El objetivo de nuestra investigación fue evaluar la utilidad de los antimicrobianos en trauma torácico. Material y métodos: Estudio clínico controlado, doble ciego, analítico, longitudinal, prospectivo, comparativo, de dos grupos: A recibió cefalotina y B, placebo. Rango de edad de 15 a 65 años. El análisis estadístico se llevó a cabo con χ2 o prueba exacta de Fisher. Resultados: 126 pacientes fueron incluidos en el estudio, 63 en cada grupo, con similares características demográficas. La media de días con pleurostomía fue de 6.56, pero en quienes desarrollaron empiema fue de 11; la incidencia del empiema fue de 6.4 % (n = 8). Tres pacientes con empiema fueron del grupo A y cinco del B; tres empiemas fueron complejos y cinco simples; dos requirieron toracoscopia y uno toracotomía; cinco curaron con sonda endopleural. Al relacionar en el análisis bivariado el uso de antimicrobiano versus empiema y días de estancia, no se identificó diferencia estadísticamente significativa. Conclusiones: Este estudio no demostró que los antimicrobianos sean útiles para prevenir infecciones pleurales en trauma torácico.

BACKGROUND: Thoracic trauma accounts for 25% of deaths due to trauma. Chest trauma patients generally present to the emergency room with pneumo- or hemothorax. According to the majority of the studies, management of closed thoracostomy for trauma includes the use of antimicrobial drugs to prevent infectious complications, but this has not been proven to be beneficial. We undertook this study to evaluate antimicrobial use in thoracic trauma patients with closed thoracostomy and its impact on the development of infectious complications. METHODS: We carried out a prospective, randomized, double blind, comparative study. Patients with isolated chest trauma requiring closed thoracostomy were divided into two groups. Group A received cefalotin, and group B received placebo. Ages ranged from 15-65 years. Results were analyzed with chi(2) and Fisher exact test. RESULTS: One hundred twenty six patients were included in this study. There were 63 patients in each group with similar demographic characteristics. The mean length of hospital stay with the tube was 6.56 days, but the average stay was 11 days for patients who developed empyema. Eight patients developed empyema, three patients with empyema belonged to group A patients and five patients with empyema belonged to group B. For empyema management, five cases were resolved by chest drainage, two cases required thoracoscopic cleaning and drainage and one patient was resolved with thoracotomy and pleural decortication. Bivariate analysis comparing antimicrobial use vs. empyema and length of drainage vs. antimicrobials did not show a statistically significant difference. CONCLUSIONS: The present study did not demonstrate that antimicrobial use was beneficial in the prevention of pleural infections in the management of chest trauma patients requiring closed thoracostomy.

Tissue accumulation of cephalothin in burns: a comparative study by microdialysis of subcutaneous interstitial fluid cephalothin concentrations in burn patients and healthy volunteers.

Burn tissue sites are a potential source of bacteremia during debridement surgery. Burn injury is likely to affect the distribution of antibiotics to tissues, but direct evidence of this is lacking. The aim of this study was to directly evaluate the influence of burn trauma on the distribution of cephalothin to peripheral tissues. We used subcutaneous microdialysis techniques to monitor interstitial fluid concentrations of cephalothin in the burnt and nonburnt tissues of adult patients with severe burns following parenteral administration of 1 g cephalothin for surgical prophylaxis. Analogous simultaneous studies conducted with healthy adult volunteers provided reference tissue concentration data. Equivalent tissue exposures were seen for burn and nonburn sites, giving overall median interstitial cephalothin concentrations (from 0 to 240 min) of 2.84 mg/liter and 3.06 mg/liter, respectively. A lower overall median interstitial cephalothin concentration of 0.54 mg/liter was observed for healthy individuals, and the patient nonburnt tissue and volunteer control tissue cephalothin concentrations exhibited significantly different data distributions (P < 0.001; Kolmogorov-Smirnov nonparametric test). The duration of tissue residence for cephalothin was longer for burn patients than for healthy volunteers. The results demonstrate the potential fallibility of using healthy population models to extrapolate tissue pharmacodynamic predictions from plasma data for burn patients.

Disco-aproximação e E-teste na pesquisa de enterobactérias produtoras de Beta-lactamase de espectro estendido (ESBL) / Double-disk synergy and E-test in the producing research of enterobacteriaceae of extended-spectrum- beta-lactamase (ESBL)

Atualmente, diferentes bactérias vêm apresentando mecanismos de resistência aos antimicrobianos, destacando-se aqueles associados à produção enzimática. Segundo vários autores, as enterobactérias produtoras de beta-lactamase de espectro estendido(ESBL) continuam proliferando-se rapidamente. Essas enzimas são plamídeo-mediadas e conferem resistência a vários antimicrobianosbeta-lactâmicos. De um total de 60 isolados de bactérias resistentes à cefalotina, obtidos em laboratório de Novo Hamburgo (RS), 23,3% foram positivos nos testes fenotípicos para pesquisa da enzima (classe A de Ambler). Foram empregados, simultaneamente, fitas de E-teste e aproximação de discos, conforme proposto por Jarlier e colaboradores (1988). A última metodologia ofereceu resultados equivalentes ao E-teste, com a vantagem de custo muito inferior. Até o momento da execução deste estudo as amostras não eram triadas nem confirmadas para tal enzima, possibilitando, em cerca de 20% dos pacientes, desfecho clínico não favorável como conseqüência de tratamento inadequado.

Currently different bacteria are showing resistance mechanisms to antimicrobial, especially those associated with enzymeproduction. According to several authors, the species of Enterobacteriaceae family producers of extended-spectrum-beta-lactamase(ESBL) remain proliferating quickly. These enzymes are plasmid mediated and confer resistance to various beta-lactams antimicrobial agents. Within a total of 60 isolates of bacteria resistant to cefalotin, obtained in a hospital of the city of Novo Hamburgo (RS), 23,3% were positive in tests for phenotypic search of the enzyme (class A of Ambler). They had been employees, simultaneously, E-test and double-disk synergy, as considered for Jarlier and collaborators (1988). The last methodology offers resulted equivalents to the E-test with the advantage of very inferior cost. So far the execution of this study, the samples were not screened or confirmed for this enzyme, leading in about 20% of patients, not favorable clinical outcome as a result of inadequate treatment.

Inadequate antimicrobial prophylaxis during surgery: a study of beta-lactam levels during burn debridement.

OBJECTIVES: To determine how long single-dose prophylactic antibiotic regimens for burns surgery maintained plasma concentrations above the MICs for target organisms during surgery. PATIENTS AND METHODS: We monitored antibiotic plasma concentrations in 12 patients (mean +/- SD 43 +/- 12% total burn surface area) throughout debridement surgery after administration of the standard prophylactic antibiotic dosing regimens of either 1 g of intravenous cefalotin or 4.5 g of intravenous piperacillin/tazobactam. RESULTS: The eschar debridement and grafting procedures ranged in duration from 2.25 to over 8.5 h. The duration of total plasma cefalotin concentration above an MIC of 0.2 mg/L for Staphylococcus aureus was 6.49 +/- 2.85 h, whereas the mean duration of total plasma piperacillin concentration above an MIC of 64 mg/L for Pseudomonas aeruginosa was only 1.15 +/- 0.59 h. None of the patients dosed with piperacillin/tazobactam was adequately protected for the duration of their surgery and adequate prophylaxis was only evident in four of the nine patients administered cefalotin. CONCLUSIONS: These results suggest a need to review antibiotic prophylaxis dosage regimens for burns surgery and the adoption of regimens that will minimize the risk of infection in this high-risk patient group. It is suggested that the antibiotic prophylaxis guideline for burn debridement surgery be modified to include re-dosing or a continuous infusion of beta-lactam antibiotics.

Endocarditis infecciosa por nocardia en valvulas nativas aortica y tricuspide / Nocardia endocarditis in aortic and tricuspid native valves

La endocarditis infecciosa por Nocardia en válvula nativa es una infección excepcional, que afecta a pacientes inmunodeprimidos. Presentamos el caso de un varón de 51 años con diagnóstico de endocarditis infecciosa por Nocardia en válvulas nativas aórtica y tricúspide, que recibió terapia antimicrobiana específica y que requirió reemplazo valvular aórtico, con buena evolución clínica en el seguimiento a 6 meses.

Nocardia endocarditis in native valve is an uncommon infection that usually arises in immunodepressed patients. We report a 51-yearold man diagnosed as having Nocardia endocarditis in aortic and tricuspid native valves, which received antimicrobial therapy and required aortic valve replacement. In 6 month follow up the patient remained asymptomatic with good clinical evolution.

Short course of prophylactic antibiotics in laparoscopically assisted vaginal hysterectomy.

OBJECTIVE: To evaluate whether a short course of prophylactic antibiotics is as efficacious as a longer course in laparoscopically assisted vaginal hysterectomy (LAVH). STUDY DESIGN: A total of 156 patients who underwent LAVH were included in the study; 82 received a long course of combined prophylactic antibiotics, and 74 received a short course, administered for < 24 hours during the perioperative period. The subjects were randomly assigned using a computer-generated schedule. Data regarding resource consumption were collected from the hospital's electronic database. Patient characteristics and medical care process data were collected from the patient charts. Student's t test was used to determine the statistical significance of the differences between continuous variables in the 2 groups of patients. The chi2 test was used to measure the statistical significance of differences between nominal variables in the 2 groups. RESULTS: The short course significantly influenced the number of injected vials of antibiotics, the antibiotic fee and the total admission fee. The average total admission fee decreased by 2.3% (p = 0.034), and the average antibiotic-fee dropped by 68.4% (p < 0.01). The average injected vials of cephalothin decreased by 4.3, and the vials of gentamycin decreased by 3.3 (p < 0.01). As for the rate of operative site infection and urinary tract infection during hospitalization and within 7 days of discharge, no statistical differences were found between the 2 groups (p = 0.735; p = 0.917). CONCLUSION: This pilot study revealed that a short course of prophylactic antibiotics was as efficacious as a longer course in preventing postoperative infection. It was also cost-effective.

Diagnostic value of routine drain tip culture in primary joint arthroplasty.

BACKGROUND: Closed suction drainage after joint arthroplasty is common practice in many institutions. The purpose of this study was to determine the correlation between routine drain tip culture and the diagnosis of superficial or deep postoperative wound infection after primary knee and hip replacement. METHODS: Over a 12-month period, drain tips were retrieved and cultured in all patients who underwent unilateral primary total knee or hip replacement with the use of closed suction drainage. A total of 393 cultures was performed in 387 patients (145 hip replacements, 242 knee replacements). Patients were followed for an average of 8.9 months after surgery to assess for postoperative wound infection. RESULTS: Three patients had a positive drain tip culture, none of which were diagnosed with superficial or deep infection. Four patients (1%) were diagnosed with deep infection, 16 (4.1%) with superficial infection. No patient with either superficial or deep infection had a positive drain tip culture after their index procedure. The sensitivity of routine drain tip culture for the diagnosis of postoperative infection in primary joint replacement was 0% and specificity was 99.2%. CONCLUSIONS: These data do not support the practice of routine drain tip culture after primary hip or knee replacement for the diagnosis of postoperative infection.

Características laboratoriais das ceratites e conjuntivites causadas por Streptococcus sp / Laboratorial findings of Streptococcus keratitis and conjunctivitis

OBJETIVOS: Analisar os resultados laboratoriais de conjuntivites e ceratites com cultura positiva para Streptococcus sp, avaliando a incidência das diferentes espécies e os dados dos antibiogramas. MÉTODOS: Estudo retrospectivo de revisão de prontuários de pacientes encaminhados ao laboratório de Doenças Externas do Departamento de Oftalmologia da UNIFESP com resultado de cultivo bacteriano positivo de córnea ou conjuntiva e com identificação de alguma cepa do gênero Streptococcus sp, no período de janeiro de 1995 a dezembro de 2001. Analisou-se idade do paciente, espécie de Streptococcus e os testes de sensibilidade aos seguintes antibióticos: cefalotina, amicacina, gentamicina, tobramicina, ciprofloxacina, lomefloxacina, ofloxacina, norfloxacina e vancomicina. RESULTADOS: As espécies mais encontradas foram Streptococcus pneumoniae e Streptococcus viridans. Com relação aos antibióticos, a sensibilidade foi maior à cefalotina, às quinolonas e à vancomicina. CONCLUSÕES: Considerando-se os antibióticos tópicos comercialmente disponíveis, as quinolonas apresentam melhor espectro de ação quando comparadas aos aminoglicosídios.

A importância da antibioticoprofilaxia nas herniorrafias inguinais / The importance of antibiotic prophylaxis in inguinal herniorraphies

de antibióticos profiláticos a fim de reduzir os índices de infecção da ferida operatória permanece como motivo de análise. O objetivo do presente estudo é analisar o benefício da antibioticoprofilaxia no reparo das hérnias, refletindo na redução da morbidade do paciente e dos custos hospitalares. Material e método: Foram analisados, prospectivamente, 120 pacientes submetidos a herniorrafias inguinais no Complexo Hospitalar Santa Casa de Porto Alegre, com um acompanhamento pós-operatório de 3 meses. Desses, 19 pacientes foram excluídos do estudo por não comparecerem às consultas de acompanhamento. Os pacientes foram divididos em 2 grupos, com e sem o uso de cefalotina endovenosa 1h antes da herniorrafia. Os grupos foram semelhantes quanto às variáveis analisadas. Resultados: Um total de 12 pacientes (12,1%) apresentou infecção na ferida operató- ria. Verificou-se maior índice de infecção no grupo sem antibioticoprofilaxia (14,6% contra 9,4%); no entanto, esta diferença não foi significativa (p>0,05). Conclusões: Nosso estudo, bem como a literatura, não permite concluir quanto à eficácia da antibioticoprofilaxia no reparo das hérnias inguinais (AU)

Background: Nowadays herniorraphies are surgical procedures widely performed. The use of prophylatic antibiotics with the goal to reduce infection rates at the wound remains as a matter of discussion. This study analises the benefits of antibioticprophylaxis on hernia repair, concerning reduction in both morbidity and hospital expenses. Method: One hundred and twenty patients who have undergone inguinal herniorraphies at the Santa Casa Hospital Complex of Porto Alegre were analised prospectively, with a 3-month postoperative follow-up period. Nineteen pacients were excluded from the study because of lack of follow-up. Patients were divided in 2 groups: with and without the use of intravenous Cefalotine 1g, one hour before the procedure. Groups were similar as for the variables analised. Results: A total of 12 (12,1%) patients presented with wound infections. A higher infection rate was verified in the group without antibioticprophylaxis (14,6% against 9,4%), however this diference wasn't significative (p>0.05). Conclusions: Our study, just as the literature, does not allow one to conclude about the antibioticprophylaxis efficacy in inguinal hernia repairs (AU)

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua.

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.

Piomiositis no tropical y síndrome de superposición: lupus / Sjõgren / Nontropical pyomyositis and overlap syndrome: systemic lupus erythematosus and Sjõgren syndrome

La Piomiositis (PMS) es una infección primaria del músculo estriado, con progresión insidiosa de una colección purulenta, que se presenta generalmente en áreas tropicales denominándose por esa razón PMS tropical. La incidencia de PMS se ha incrementado últimamente en zonas templadas, denominándose a esta entidad como PMS no tropical, ya que existen algunas características que la diferencian de la PMS clásica. Presentamos el caso de una mujer de 39 años de edad con Síndrome de Superposición, Lupus Erimatoso Sistémico (LES) / Síndrome de Sjõgren (SS), que presentó durante la evolución de su enfermedad una PMS no tropical como ampliación atípica.

Trauma torácico: importância da antibioticoterapia sobre o tempo de internaçäo / Thoracic trauma: the importance of antibiotic therapy about the lenght of stay

No que tange a comprovada eficácia da drenagem pleural fechada, grande controvérsia ainda persiste em relaçäo ao uso associado da antibioticoterapia. Os autores estudaram 167 pacientes, com trauma isolado do tórax, com objetivo de avaliar a importância do uso do antibiótico sobre o tempo de internaçäo pós-drenagem pleural fechada. Dois grupos de pacientes foram incluídos num estudo longitudinal e prospectivo de acompanhamento de coortes. O grupo controle incluiu 104 pacientes sem uso da antibioticoterapia; no grupo experimental, 63 pacientes receberam a cefalotina sódica no pós-operatório (500 mg IV - 6/6 h). Entre os pacientes estudados, 12 (7.2 por cento) apresentavam trauma fechado; 98 (58.6 por cento), ferimento por arma branca; 41 (24.6 por cento) ferida por projétil de arma de fogo e, 16 (9.6 por cento) lesöes por outros agentes vulnerantes. Entre os pacientes do grupo controle o tempo médio de permanência hospitalar foi de 5.7 +/- 3.2 dias e, no grupo com antibiótico, 5.7 +/- 2.9 dias. Os resultados mostraram que nos pacientes que näo receberam antibiótico e evoluíram com algum tipo de complicaçäo pleuropulmonar, o tempo de internaçäo foi, em média, 3.2 dias maior que nos demais.

Bacillus circulans endophthalmitis.

An 80-year-old woman presented with right endophthalmitis, characterized by chalky white deposits covering her posterior capsule. This occurred 17 months after uncomplicated right cataract surgery. A three-port pars plana vitrectomy and partial posterior capsulectomy isolated Bacillus circulans, and the patient made a rapid and full recovery on topical cephalothin and prednisolone acetate 1%. The case demonstrates that, unlike endophthalmitis due to other Bacillus spp., B. circulans endophthalmitis does not necessarily follow a fulminant course. It is the first report describing a subacute presentation, and response to posterior capsulectomy and simple antibiotic therapy It is also the first description of B. circulans causing white plaques in the posterior capsule, a finding characteristic of chronic endophthalmitis and previously considered pathognomonic of Proprionibacterium acnes endophthalmitis.