Sequential Treatment Failure With Aztreonam-Ceftazidime-Avibactam Followed by Cefiderocol Due to Preexisting and Acquired Mechanisms in a New Delhi Metallo-ß-lactamase-Producing Escherichia coli Causing Fatal Bloodstream Infection.

We report a fatal case of New Delhi metallo-ß-lactamase (NDM)-producing Escherichia coli in a bacteremic patient with sequential failure of aztreonam plus ceftazidime-avibactam followed by cefiderocol. Acquired resistance was documented phenotypically and mediated through preexisting and acquired mutations. This case highlights the need to rethink optimal treatment for NDM-producing organisms.

Clinical and genomic characteristics of IMP-producing Enterobacter cloacae complex and Klebsiella pneumoniae.

Carbapenemase-producing Enterobacterales (CPEs) are one of the top priority antimicrobial-resistant pathogens. Among CPEs, those producing acquired metallo-ß-lactamases (MBLs) are considered particularly problematic as few agents are active against them. Imipenemase (IMP) is the most frequently encountered acquired MBL in Japan, but comprehensive assessment of clinical and microbiological features of IMP-producing Enterobacterales infection remains scarce. Here, we retrospectively evaluated 62 patients who were hospitalized at a university hospital in Japan and had IMP-producing Enterobacterales from a clinical culture. The isolates were either Enterobacter cloacae complex or Klebsiella pneumoniae, and most of them were isolated from sputum. The majority of K. pneumoniae, but not E. cloacae complex isolates, were susceptible to aztreonam. Sequence type (ST) 78 and ST517 were prevalent for E. cloacae complex and K. pneumoniae, respectively, and all isolates carried blaIMP-1. Twenty-four of the patients were deemed infected with IMP-producing Enterobacterales. Among the infected patients, therapy varied and largely consisted of conventional ß-lactam agents, fluoroquinolones, or combinations. Three (13%), five (21%), and nine (38%) of them died by days 14, 30, and 90, respectively. While incremental mortality over 90 days was observed in association with underlying comorbidities, active conventional treatment options were available for most patients with IMP-producing Enterobacterales infections, distinguishing them from more multidrug-resistant CPE infections associated with globally common MBLs, such as New Delhi metallo-ß-lactamase (NDM) and Verona integron-encoded metallo-ß-lactamase (VIM).

Difficult-to-treat (DTR) Pseudomonas aeruginosa harboring Verona-Integron metallo-ß-lactamase (blaVIM): infection management and molecular analysis.

Pseudomonas aeruginosa harboring Verona Integron-encoded metallo-ß-lactamase enzymes (VIM-CRPA) have been associated with infection outbreaks in several parts of the world. In the US, however, VIM-CRPA remain rare. Starting in December 2018, we identified a cluster of cases in our institution. Herein, we present our epidemiological investigation and strategies to control/manage these challenging infections. This study was conducted in a large academic healthcare system in Miami, FL, between December 2018 and January 2022. Patients were prospectively identified via rapid molecular diagnostics when cultures revealed carbapenem-resistant P. aeruginosa. Alerts were received in real time by the antimicrobial stewardship program and infection prevention teams. Upon alert recognition, a series of interventions were performed as a coordinated effort. A retrospective chart review was conducted to collect patient demographics, antimicrobial therapy, and clinical outcomes. Thirty-nine VIM-CRPA isolates led to infection in 21 patients. The majority were male (76.2%); the median age was 52 years. The majority were mechanically ventilated (n = 15/21; 71.4%); 47.6% (n = 10/21) received renal replacement therapy at the time of index culture. Respiratory (n = 20/39; 51.3%) or bloodstream (n = 13/39; 33.3%) were the most common sources. Most infections (n = 23/37; 62.2%) were treated with an aztreonam-avibactam regimen. Six patients (28.6%) expired within 30 days of index VIM-CRPA infection. Fourteen isolates were selected for whole genome sequencing. Most of them belonged to ST111 (12/14), and they all carried blaVIM-2 chromosomally. This report describes the clinical experience treating serious VIM-CRPA infections with either aztreonam-ceftazidime/avibactam or cefiderocol in combination with other agents. The importance of implementing infection prevention strategies to curb VIM-CRPA outbreaks is also demonstrated.

In vitro and in vivo activity of ceftazidime/avibactam and aztreonam alone or in combination against mcr-9, serine- and metallo-ß-lactamases-co-producing carbapenem-resistant Enterobacter cloacae complex.

PURPOSE: Enterobacteriaceae carrying mcr-9, in particularly those also co-containing metallo-ß-lactamase (MBL) and TEM type ß-lactamase, present potential transmission risks and lack adequate clinical response methods, thereby posing a major threat to global public health. The aim of this study was to assess the antimicrobial efficacy of a combined ceftazidime/avibactam (CZA) and aztreonam (ATM) regimen against carbapenem-resistant Enterobacter cloacae complex (CRECC) co-producing mcr-9, MBL and TEM. METHODS: The in vitro antibacterial activity of CZA plus ATM was evaluated using a time-kill curve assay. Furthermore, the in vivo interaction between CZA plus ATM was confirmed using a Galleria mellonella (G. mellonella) infection model. RESULTS: All eight clinical strains of CRECC, co-carrying mcr-9, MBL and TEM, exhibited high resistance to CZA and ATM. In vitro time-kill curve analysis demonstrated that the combination therapy of CZA + ATM exerted significant bactericidal activity against mcr-9, MBL and TEM-co-producing Enterobacter cloacae complex (ECC) isolates with a 100% synergy rate observed in our study. Furthermore, in vivo survival assay using Galleria mellonella larvae infected with CRECC strains co-harboring mcr-9, MBL and TEM revealed that the CZA + ATM combination significantly improved the survival rate compared to the drug-treatment alone and untreated control groups. CONCLUSION: To our knowledge, this study represents the first report on the in vitro and in vivo antibacterial activity of CZA plus ATM against CRECC isolates co-harboring mcr-9, MBL and TEM. Our findings suggest that the combination regimen of CZA + ATM provides a valuable reference for clinicians to address the increasingly complex antibiotic resistance situation observed in clinical microorganisms.

Outcomes of 23 patients diagnosed with New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae infection treated with ceftazidime/avibactam and aztreonam at a single center in Poland.

PURPOSE: Amongst all etiologic hospital-acquired infection factors, K. pneumoniae strains producing New Delhi metallo-ß-lactamase (KP-NDM) belong to pathogens with the most effective antibiotic resistance mechanisms. Clinical guidelines recommend using ceftazidime/avibactam with aztreonam (CZA + AT) as the preferred option for NDM-producing Enterobacterales. However, the number of observations on such treatment regimen is limited. This retrospective study reports the clinical and microbiological outcomes of 23 patients with KP-NDM hospital-acquired infection treated with CZA + AT at a single center in Poland. METHODS: The isolates were derived from the urine, lungs, blood, peritoneal cavity, wounds, and peritonsillar abscess. In microbiological analysis, mass spectrometry for pathogen identification, polymerase chain reaction, or an immunochromatographic assay for detection of carbapenemase, as well as VITEK-2 system, broth microdilution, and microdilution in agar method for antimicrobial susceptibility tests were used, depending of the pathogens' nature. CZA was administered intravenously (IV) at 2.5 g every eight hours in patients with normal kidney function, and aztreonam was administered at 2 g every eight hours IV. Such dosage was modified when renal function was reduced. RESULTS: KP-NDM was eradicated in all cases. Four patients (17.4%) died: three of them had a neoplastic disease, and one - a COVID-19 infection. CONCLUSION: The combination of CZA + AT is a safe and effective therapy for infections caused by KP-NDM, both at the clinical and microbiological levels. The synergistic action of all compounds resulted in a good agreement between the clinical efficacy of CZA + AT and the results of in vitro susceptibility testing.

Rapid characterization of carbapenem-resistant Enterobacterales by multiplex lateral flow assay and detection of ceftazidime-avibactam-aztreonam synergy.

PURPOSE: The choice of antibiotics for treatment of Carbapenem-Resistant Enterobacterales (CRE) is increasing becoming limited due to co-expression of Metallo-beta-lactamases (MBL) along with other carbapenemases in these isolates. The study aimed to investigate the occurrence of CRE and to determine the in-vitro synergy and clinical outcomes of Ceftazidime-Avibactam and Aztreonam combination in CRE infections in adult Intensive Care Units (ICUs). METHODS: 79 CRE isolates recovered from adult ICUs during January to March 2023 were tested by O.K.N.V.I. RESIST-5, a lateral flow multiplex assay for rapid detection of OXA-48-like, NDM, IMP, VIM, and KPC carbapenemases. Ceftazidime-Avibactam MIC was determined by microbroth dilution method and in vitro synergy between Ceftazidime-Avibactam and Aztreonam was assessed by Modified E-test/disc diffusion method for these isolates. RESULTS: The study revealed 7.5 % occurrence of CRE in our hospital, with high occurrence of NDM (n = 42, 53.1 %) and OXA-48-like (n = 63, 79.7 %) carbapenemase. Production of more than one type of carbapenemases was found in 44 isolates. A total of 57 isolates (72 %) had Ceftazidime-Avibactam resistance and 44 of them displayed Ceftazidime-Avibactam and Aztreonam in-vitro synergy. Successful clinical outcome was observed in two patients who received Ceftazidime-Avibactam and Aztreonam combination therapy for 7 days or more. CONCLUSIONS: Despite the preponderance of Ceftazidime-Avibactam resistant CRE expressing NDM and OXA-48-like carbapenemase in our hospital, 77.2 % of them displayed in-vitro synergy of Ceftazidime-Avibactam with Aztreonam. It emphasizes the potential therapeutic utility of this combination in CRE strains showing coproduction of MBL and serine carbapenemases. Greater therapeutic potential of Ceftazidime-Avibactam and Aztreonam combination was observed with extended duration of therapy. However, further clinical evidence is needed to establish the efficacy of this combination and consider other factors that influence treatment outcomes.

Confronting multidrug-resistant Klebsiella meningitis after mid-clival Cerebrospinal Fluid leak repair: a therapeutic odyssey.

A man in his 40s with type 2 diabetes mellitus had persistent right-sided watery nasal discharge for 6 months following cerebrospinal fluid (CSF) leak repair at another hospital, prompting his visit to us due to recurring symptoms. Imaging revealed a CSF leak from the mid-clivus for which revision endoscopic CSF leak repair was done. Regrettably, he developed postoperative meningitis caused by multidrug-resistant (MDR) Klebsiella pneumoniaeManaging this complex case was a challenging task due to the pathogen's resistance to conventional drugs and the scarcity of scientific evidence. We initiated a culture-guided combination regimen with ceftazidime, avibactam, aztreonam and tigecycline. This decision stemmed from meticulous literature review and observed antibiotic synergy while testing for this organism.After 4 weeks of vigilant treatment, the patient's symptoms improved significantly, and CSF cultures were sterile. We present our approach to effectively confront and manage a challenging instance of postoperative MDR bacterial meningitis.

Investigación traslacional en microbioma (InTraMic): un área de interés común y creciente en el IMTIB, Hospital Italiano e Instituto Universitario / Translational research in microbiome (InTraMic): an area of common and growing interest at IMTIB, Hospital Italiano and Instituto Universitario

Se estima que aproximadamente 100 trillones de microorganismos (incluidos bacterias, virus y hongos) residen en el intestino humano adulto y que el total del material genético del microbioma es 100 veces superior al del genoma humano. Esta comunidad, conocida como microbioma se adquiere al momento del nacimiento a través de la flora comensal de la piel, vagina y heces de la madre y se mantiene relativamente estable a partir de los dos años desempeñando un papel crítico tanto en el estado de salud como en la enfermedad. El desarrollo de nuevas tecnologías, como los secuenciadores de próxima generación (NGS), permiten actualmente realizar un estudio mucho más preciso de ella que en décadas pasadas cuando se limitaba a su cultivo. Si bien esto ha llevado a un crecimiento exponencial en las publicaciones, los datos sobre las poblaciones Latinoamérica son casi inexistentes. La investigación traslacional en microbioma (InTraMic) es una de las líneas que se desarrollan en el Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB). Esta se inició en 2018 con la línea de cáncer colorrectal (CCR) en una colaboración con el Colorectal Cancer Research Group del Leeds Institute of Medical Research en el proyecto Large bowel microbiome disease network: Creation of a proof of principle exemplar in colorectal cancer across three continents. A fines de 2019 se cumplió el objetivo de comprobar la factibilidad de la recolección, envío y análisis de muestras de MBF en 5 continentes, incluyendo muestras provenientes de la Argentina, Chile, India y Vietnam. Luego de haber participado de capacitaciones en Inglaterra, se ha cumplido con el objetivo de la etapa piloto, logrando efectivizar la recolección, envío y análisis metagenómico a partir de la secuenciación de la región V4 del ARNr 16S. En 2019, la línea de enfermedad de hígado graso no alcohólico se sumó a la InTraMic iniciando una caracterización piloto en el marco de una colaboración con el laboratorio Novartis. Los resultados de ese estudio, así como el de cáncer colorrectal, están siendo enviados a publicación. En 2020, con la incorporación de la línea de trasplante alogénico de células progenitoras hematopoyéticas, fue presentado un proyecto para un subsidio del CONICET que ha superado la primera etapa de evaluación. En el presente artículo se brinda una actualización sobre la caracterización taxonómica de microbioma y se describen las líneas de investigación en curso. (AU)

It is estimated that approximately 100 trillion microorganisms (including bacteria, viruses, and fungi) reside in the adult human intestine, and that the total genetic material of the microbiome is 100 times greater than that of the human genome. This community, known as the microbiome, is acquired at birth through the commensal flora of the mother's skin, vagina, and feces and remains relatively stable after two years, playing a critical role in both the state of health and in disease. The development of new technologies, such as next-generation sequencers (NGS), currently allow for a much more precise study of it than in past decades when it was limited to cultivation. Although this has led to exponential growth in publications, data on Latin American populations is almost non-existent. Translational research in microbiome (InTraMic) is one of the lines developed at the Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB). This started in 2018 with the Colorectal Cancer Line (CRC) in a collaboration with the Colorectal Cancer Research Group of the Leeds Institute of Medical Research in the project "Large bowel microbiome disease network: Creation of a proof of principle exemplar in colorectal cancer across three continents". At the end of 2019, the objective of verifying the feasibility of collecting, sending and analyzing MBF samples on 5 continents, including samples from Argentina, Chile, India and Vietnam, was met. After having participated in training in England, the objective of the pilot stage has been met, achieving the collection, delivery and metagenomic analysis from the sequencing of the V4 region of the 16S rRNA. In 2019, the non-alcoholic fatty liver disease line joined InTraMic, initiating a pilot characterization in the framework of a collaboration with the Novartis laboratory. The results of that study, as well as that of colorectal cancer, are being published. In 2020, with the incorporation of the allogeneic hematopoietic stem cell transplantation line, a project was presented for a grant from the CONICET that has passed the first stage of evaluation. This article provides an update on the taxonomic characterization of the microbiome and describes the lines of ongoing research. (AU)

Causas de cambio de tratamiento en un grupo de pacientes VIH/SIDA cubanos / Causes of change in treatment in a group of HIV/AIDS Cuban patients

La infección por virus de inmunodeficiencia humana (VIH) es uno de los mayores problemas de salud actuales, se estima que más de 40 millones de personas están infectadas en el mundo. Se realizó un estudio descriptivo de corte transversal en 40 pacientes VIH/SIDA pertenecientes al servicio de Medicina del IPK con el propósito de caracterizar las causas del cambio de tratamiento antirretroviral y los tipos de reacciones adversas presentadas con este tratamiento en un grupo de pacientes VIH/SIDA..Los pacientes recibieron diferentes esquemas de antirretrovirales entre los que predominaron los siguientes: 3TC, d4T e Indinavir (57,5 por ciento), seguido de 3TC, AZT e Indinavir (22,5 por ciento). Las causas más frecuentes de cambio de tratamiento fueron las reacciones adversas y la mala adherencia al tratamiento. Entre las personas que están recibiendo terapia contra el VIH, existe una tendencia cada vez más frecuente de abandonar o cambiar la terapia. Las causas de estos cambios y del abandono de las terapias suelen estar relacionadas con los efectos secundarios, la fatiga del tratamiento, la fase de la infección por VIH en que se encuentra el paciente, y factores relativos a su estilo de vida. Las causas más frecuentes de cambio de tratamiento fueron las reacciones adversas, seguidas de la mala adherencia al tratamiento antirretroviral. Las reacciones adversas más frecuentes en el grupo de estudio fueron los vómitos y los trastornos digestivos respectivamente

The HIV virus infection is one of the major current problems of health estimating that more than 40 millions of persons are infected at world level. A cross-sectional and descriptive study was conducted in 40 HIV/AIDS patients from the Tropical Medicine Institute service to characterize the causes of the change in antiretroviruses treatment and the types of adverse reactions related to this treatment in a group of HIV/AIDS patients. Patients received different antiretroviruses schemes with predominance of 3TC, d4T and Indinarir (57,5 percent), followed by 3TC, AZT and Indinavir (22,5 percent). The more frequent causes of change of this treatment were the adverse reactions and a poor adherence to it. Among the persons with therapy HIV there is a more and more frequent trend to give up or to change of therapy. The causes of these changes and the leaving the therapy are related to side effects, treatment fatigue, and the HIV infection phase in patient and relative factors related to the lifestyle. The more frequent causes of the change of treatment were the adverse reactions followed by a poor adherence to antiretroviruses treatment. The more frequent adverse reactions were vomiting and digestive disorders, respectively

Tigeciclina versus vancomycin más aztreonam en el tratamiento de infecciones complicadas de piel y tejidos blandos: Experiencia en Latinoamérica / Tigecycline as effective as vancomycin plus aztreonam in the treatment of complicated skin and skin structure infections: Experience in Latin America

BACKGROUND: Treating complicated skin and skin structure infections (cSSSIs) can be challenging. Tigecycline was compared to vancomycin/aztreonam in patients with cSSSIs in a multinational trial; this article reports on the Latin American (LA) population. METHODS: Patients were randomly assigned to receive tigecycline or vancomycin/ aztreonam. Primary endpoint was clinical cure rate at test-of-cure (TOC). Several secondary endpoints and safety were also assessed. RESULTS: A subtotal of 167 LA patients from the multinational trial (N = 573) received ≥ 1 dose of study drug. At TOC, cure rates were similar between tigecycline and vancomycin/aztreonam in the clinically evaluable population.) Noninferiority of tigecycline could not be demonstrated (insufficient sample sizes). Tigecycline-treated patients had higher incidences of nausea, vomiting, anorexia; vancomycin/aztreonam-treated patients had higher incidences of pruritus and rash. CONCLUSIONS: Efficacy results in the LA population were consistent with the multinational study suggesting that tigecycline is noninferior to vancomycin/aztreonam in treating patients with cSSSI.

INTRODUCCIÓN: El tratamiento de infecciones complicadas de piel y tejidos blandos (ICPTB) puede representar un desafío. Se comparó la eficacia de tigeciclina versus vancomicina/aztreonam en pacientes con ICPTB en un estudio multicéntrico; este artículo se refiere a la experiencia en Latinoamérica (LA). MÉTODO: Se asignaron, en forma randomizada, los pacientes a dos grupos de tratamiento: tigeciclina o vancomicina/aztreonam. La meta a evaluar (outcome) primaria fue la curación clínica, denominada test de curación (TC). Se establecieron, además, metas secundarias y la evaluación de seguridad del fármaco. RESULTADOS: Un subtotal de 167 pacientes procedentes de LA, de un estudio multinacional que incluyó 573 pacientes, recibieron ≥ 1 dosis del fármaco en estudio. Al TC, los porcentajes de curación fueron similares entre tigeciclina y vanco-micina/aztreonam en los pacientes clínicamente evaluables). La no inferioridad de tigeciclina no pudo ser demostrada (tamaño de muestra insuficiente). Los pacientes tratados con tigeciclina tuvieron mayor incidencia de náuseas, vómitos y anorexia; los pacientes que recibieron vancomicina/aztreonam tuvieron mayor incidencia de prurito y rash. CONCLUSIONES: Los resultados de eficacia en LA fueron consistentes con el estudio multinacional sugiriendo que tigeciclina no es inferior a vancomicina/aztreonam en el tratamiento de pacientes con ICPTB.

Informe de evaluación científica basada en la evidencia disponible: fibrosis quística / Scientific evaluation report based on available evidence: cystic fibrosis

INTRODUCCIÓN: La fibrosis quística (FQ) es la enfermedad autosómica recesiva más frecuente entre las poblaciones caucásicas, con una frecuencia de 1 en 2000 a 3000 nacidos vivos. Esta patología es producida por la mutación del gen que codifica la proteína reguladora de la conductancia transmembrana de la FQ (CFTR), existiendo en la actualidad más de 1.400 mutaciones que pueden determinarla. El defecto de la proteína provoca un trastorno del transporte de cloro y sodio por las células de los epitelios, generándose un gran espesamiento de las secreciones, que daña los epitelios secretores, siendo los principales órganos afectados el pulmón, páncreas, hígado, la piel, el aparato reproductor masculino y otros. Los síntomas y signos habituales de presentación incluyen infección pulmonar persistente, insuficiencia pancreática y niveles elevados de cloruro de sudor. Sin embargo, muchos pacientes presentan síntomas leves o atípicos y los clínicos deben permanecer alertas. No se realiza evaluación de los fármacos descritos, en conformidad con los artículos 6º y 9º del Reglamento que establece el proceso destinado a determinar los diagnósticos y tratamientos de alto costo con Sistema de Protección Financiera, según lo establecido en los artículos 7°y 8° de la ley N°20.850, aprobado por el decreto N°13 de 2017 del Ministerio de Salud. TECNOLOGÍAS SANITARIAS ANALIZADAS: Ivacaftor; combinación Lumacaftor/Ivacaftor, Aztreonam nebulizador. ALTERNATIVAS DISPONIBLES: No existe una cura para la fibrosis quística, pero existen muchos tratamientos que pueden aliviar los síntomas y reducir las complicaciones. Terapia farmacológica: - Antibióticos para tratar y prevenir las infecciones pulmonares. -Medicamentos antiinflamatorios para reducir la hinchazón de las vías respiratorias de los pulmones. -Medicamentos que aflojen la mucosidad para ayudar a expulsarla con la tos, lo cual puede mejorar la función pulmonar. -Medicamentos inhalados llamados broncodilatadores que pueden ayudar a mantener abiertas las vías respiratorias mediante la relajación de los músculos que rodean los bronquios. -Enzimas pancreáticas por vía oral para ayudar a que el tubo digestivo absorba nutrientes. -Para las personas con fibrosis quística que tienen determinadas mutaciones genéticas, los médicos podrían recomendar un nuevo medicamento llamado ivacaftor. Fisioterapia y rehabilitación pulmonar: La fisioterapia y la rehabilitación pulmonar ayudan a ablandar la mucosidad espesa de los pulmones facilitando su expulsión mediante la tos y a mejorar la función pulmonar. Cirugía: Por último, se recomienda en algunos casos tratamiento quirúrgico que pueden variar desde la extracción de pólipos nasales, cirugía intestinal para eliminar la obstrucción hasta el trasplante de pulmón en casos graves. CONCLUSIÓNES: El siguiente informe no continúa en evaluación y, por lo tanto, no conforma parte del informe de evaluación entregado a la comisión de recomendación priorizada, debido a que los tratamientos a evaluar no se encuentran registrados en el país ni tampoco han sido presentados a registro, faltando menos de 1 año para la dictación del próximo decreto.

Carbapenémicos y monobactámicos / Carbapenemics and monobactemics

Se hace una revisión y actualización de los antibióticos del grupo de los carbapenémicos y monobactámicos, se hace énfasis en algunos aspectos como espectro antibacteriano, utilidad clínica, estructura química y otros. Se señalan las diferencias entre los diversos fármacos que conforman estos grupos

Aztreonam no tratamento de infecçöes causadas por bacilos Gram-negativos de múltiplas resistências / Astreonam in the treatment of infections caused by Gram-negative bacilli of multiple resistance

Aztreonam é um composto de uma nova classe de agentes Beta-lactâmicos monocíclicos sintéticos com atividade contra a grande maioria das bactérias Gram-negativas, mas nao contra as bactérias Gram-positivas ou anaeróbias. Aztreonam foi usado para tratar 23 pacientes com importantes infeccçoes por germes Gram-negativos. Neste estudo dos 17 homens e seis mulheres, haviam 11 casos de infecçoes urinárias, três de pneumonia, três de meningite e seis com outros locais de infecçao. Noventa por cento das infecçoes foram curadas tanto por critérios clínicos como microbiológicos sem significantes reaçoes adversas ou toxicidade pela droga.

Estudios de Aztreonam en infecciones producidas por bacilos gram negativos aerobicos

Se estudió la eficacia y la tolerancia al Aztreonam en veinte pacientes adultos, de ambos sexos, que sufrían de una infección debida a bacterias gram negativas y aeróbicas, como son la Escherichia coli, Pseudomonas aeruginosa, Edwarsiella tarda, Klebsiella pneumoniae, Proteus mirabilis y P. vulgaris. Fue efectivo en combinación con Clindamicina, en sepsis intra-abdominal producida por Bacteroides fragilis; y con Penicilina, en un paciente en cuyo cultivo creció Peptostreptoccoco. Observamos mejoría en las primeras 72 horas, en el 80% de los pacientes; y restablecimiento total en los primeros siete días, en el 65% de los casos

Aztreonam, atividade in vitro frente a bactérias gram-negativas / Aztreonam in vitro activity front a Gram-negative bacteria

Os autores estudaram a atividade in vitro de Aztreonam frente a 560 cepas de Enterobactérias e 83 cepas de bacilos Gram-negativos näo fundamentadores de glicose, 95,89% das Enterobactérias e 77,11% dos näo fermentadores foram sensíveis a Aztreonam

Tratamento de peritonites por bactérias Gram-negativas com aztreonam em pacientes submetidos a diálise peritoneal / Treatment of peritonitis by Gram-negative bacteria with aztreonam in patients submitted to peritoneal dialysis

As peritonites em pacientes submetidos a diálise peritoneal apresentam pior prognóstico quando säo causadas por bactérias Gram-negativas, o que exige um tratamento rápido e com antibióticos de amplo espectro sobre estas bactérias. Analisamos a eficácia de um novo antibiótico monobactâmico, ativo contra a maioria das bactérias aeróbicas Gram-negativas, o aztreonam, no tratamento de peritonites causadas por estas bactérias em 10 pacientes submetidos a diálise peritoneal intermitente e seis pacientes submetidos a diálise peritoneal ambulatorial contínua, todos fazendo diálise com cateter permanente (Tenckhoff). Os microorganismos isolados mais comumente foram Pseudomonas sp. em oito casos (50,0 por cento e Enterobacter sp. em tres casos (18,8 por cento). Após monoterapia com aztreonam, obtivemos cura em 13(81,2 por cento) episódios. Em três destes pacientes, entretanto, a cura só foi obtida após retirada do cateter de Tenckhoff. Nos três casos em que houve falência do tratamento com aztreonam, só se obteve cura após mudança do esquema terapêutico, tendo sido necessária a retirada do cateter em dois casos. Näo foram observados efeitos colaterais significativos devido a administraçäo do aztreonam. Os resultados do presente estudo demonstram a eficácia desta droga para tratamento das peritonites por agentes Gram-negativos em pacientes submetidos a diálise peritoneal

Estudo comparativo entre as associaçöes aztreonam/clindamicina e tobramicina/clindamicina no tratamento de infecçöes intra-abdominais / Comparison of aztreonam plus clindamycin with tobramycin plus clindamycin in the treatment of intra-abdominal infections

Este estudo avaliou a atividade do aztreonam (um antibiótico ß-lactâmico com atividade específica contra bactérias Gram-negativas), comparando-a com a da tobramicina, em pacientes hospitalizados com infecçöes intra-abdominais severas causadas por patógenos Gram-negativos isoladamente ou associados a outras bactérias. O estudo incluiu no total 156 pacientes, dos quais 76 receberam aztreonam + clindamicina e 80 foram tratados com tobramicina + clindamicina. Os pacientes foram submetidos a diversos procedimentos cirúrgicos envolvendo a cavidade peritoneal. A avaliaçäo clínica final revelou percentagens semelhantes de resultados satisfatórios: 86,5% nos pacientes tratados com aztreonam e 86.2% no grupo tratado com tobramicina. Entre os pacientes que tiveram maus resultados observou-se que em 50% dos casos as infecçöes eram causadas por Gram-negativos isoladamente ou associados a miciroorganismos Gram-positivos, no grupo tratado com aztreonam; esta percentagem subiu para 82% quando se avaliou o mesmo subgrupo entre os pacientes tratados com tobramicina. A incidência de efeitos adversos e de alteraçöes dos parâmetros laboratoriais näo foi significante e semelhante nos dois grupos. Os resultados deste estudo sugerem que o aztreonam pode ser uma droga eficaz e segura para o tratamento de infecçöes causadas por bactérias Gram-negativas

Aztreonam-ceftriaxone em infecçöes severas / Aztreonam-ceftriaxone in severe infection

Foram tratados 20 pacientes com infecçöes bacterianas clínica e bacteriologicamente documentadas por germes sensíveis ao aztreonam, num estudo aberto e realizado num único centro, com a combinaçäo ceftriaxone/aztreonam. Foram excluídos pacientes neutropênicos, com insuficiência hepática e em uso de diálise peritoneal ou hemodiálise. Foram tratados 1 septicemia, 1 abscesso intra-abdominal, 1 infecçäo severa do seio maxilar e celulite facial, 11 infecçöes urinárias definidas pelo critério de Kass (mais de 10**5 CFU/ml de lavado broncoalveolar. Ocorreram 17 curas e 3 superinfecçöes por staphylococcus aureus (as 3), todas no grupo de infecçäo pulmonar baixa. Näo foram experimentados efeitos adversos clínicos nem manifestaçöes laboratoriais de toxicidade. O uso da combinaçäo cefriaxone/aztreonam mostrou-se eficicente e, ao contrário de outros estudos, näo foram vistas superinfecçöes por germes gram-negativos

Uso de Aztreonam en infección de prótesis vascular / Aztreonam use in infection of vascular prosthesis

El 27 de noviembre de 1992; se intervino un paciente masculino de 24 años, por herida de arma de fuego a nivel de la región inguinal derecha, con lesión de los vasos ileofemorales. Se le realizó interposición de vena safena. Evolucionando torpidamente, presentando deshicencia de anastomosis por infección, debido a Pseudomona aeruginosa y Enterobacter aglomerans. Fue reintervenido en cuatro oportunidades colocándose prótesis de dacron 8mm. Siendo la última reintervención un bypass extra-anatómico ileofemoral derecho. La infección fué tratada con aztreonam y ceftazidima durante 15 días; con evolución satisfactoria. Egresa del hospital el día 15-02-93; presentando pulsos distales en miembro afecto