Padrões de utilização de antibacterianos em unidades de terapia intensiva / Patterns of antibacterials use in intensive care units

OBJETIVO: conhecer e comparar os padrões de consumo de antibacterianos em unidades de terapia intensiva com base no sistema Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD). MÉTODOS: estudo de coorte, prospectivo, realizado em três unidades de terapia intensiva médico-cirúrgicas, duas localizadas em dois hospitais públicos e uma em hospital privado. Amostras aleatórias simples, independentes, dos pacientes internados nas unidades de terapia intensiva no período de 10/2004 a 09/2005 foram utilizadas. O consumo de antibacterianos foi avaliado com o sistema ATC/DDD. A quantidade utilizada de antibacteriano nas unidades de terapia intensiva, em gramas, foi transformada em dose diária definida (DDD). O número de DDD foi dividido pelo número de pacientes-dia e multiplicado por mil, compondo a densidade média de consumo por mil pacientes-dia (DDD1000). RESULTADOS: Hum mil setecentos e vinte e oito (1.728) pacientes-dia e 2.918,6 DDD foram analisados nas três unidades de terapia intensiva, correspondendo a densidade média de consumo de 1.689,0 DDD1000. A mediana do número de DDD referente à utilização de antibacterianos nas unidades de terapia intensiva dos hospitais públicos foi significativamente maior (p=0,002) do que na unidade de terapia intensiva do hospital privado. Ao contrário, a densidade de consumo de antibacterianos na unidade de terapia intensiva do hospital privado (2.191,7DDD1000) foi significativamente maior (p<0,001) do que nas unidades de terapia intensiva dos hospitais públicos (1.499,5DDD1000). Os grupos de antibacterianos mais utilizados nas três unidades de terapia intensiva foram cefalosporinas de 3ª geração, penicilinas/inibidores de betalactamases, carbapenêmicos e fluorquinolonas. CONCLUSÃO: os padrões de consumo de antibacterianos nas três unidades de terapia intensiva analisadas não foram uniformes. A unidade de terapia intensiva do hospital privado utilizou quantidade significativamente maior, em termos...

OBJECTIVE: To know and compare the patterns of antimicrobials use in intensive care units (ICUs) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) system. METHODS: a prospective cohort study was conducted in three medical-surgical intensive care units, two of them in public hospitals and one in a private hospital. Simple random, independent samples of patients admitted from 10/2004 to 09/2005 to the selected intensive care units were used. The antibiotics use was assessed using the ATC/DDD system. The amount of antibacterials used in each intensive care unit, in grams, was transformed in daily defined dose (DDD). The number of DDDs was divided by the number of patient-days, multiplied by one thousand, to obtain the average density of consumption (DC) per thousand patient-days (DDD1000). RESULTS: 1,728 patients-days and 2,918.6 DDDs were examined in the three intensive care units, corresponding to an average density of consumption of 1,689.0 DDD1000. The median number of DDDs of antibiotics use in the public hospitals’ intensive care units was significantly higher (p=0.002) versus the private hospital’s intensive care unit. The consumption of antibiotics in the private hospital’s intensive care unit (DC=2,191.7 DDD1000) was significantly higher (p<0.001) versus the intensive care units of public hospitals (1,499.5 DDD1000). The most used antibiotics groups in the three intensive care units were 3rd generation cephalosporins, penicillins/betalactamases inhibitors, carbapenems and fluorquinolones. CONCLUSION: The pattern of antibiotics use in the three examined intensive care units was not uniform. The private hospital’s intensive care unit used a significantly larger amount versus the public hospitals’ intensive care units. Nevertheless, the most used antibiotics groups were similar in the three intensive care units.

Patterns of antibacterials use in intensive care units. / Padrões de utilização de antibacterianos em unidades de terapia intensiva.

OBJECTIVE: To know and compare the patterns of antimicrobials use in intensive care units (ICUs) based on the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) system. METHODS: a prospective cohort study was conducted in three medical-surgical intensive care units, two of them in public hospitals and one in a private hospital. Simple random, independent samples of patients admitted from 10/2004 to 09/2005 to the selected intensive care units were used. The antibiotics use was assessed using the ATC/DDD system. The amount of antibacterials used in each intensive care unit, in grams, was transformed in daily defined dose (DDD). The number of DDDs was divided by the number of patient-days, multiplied by one thousand, to obtain the average density of consumption (DC) per thousand patient-days (DDD1000). RESULTS: 1,728 patients-days and 2,918.6 DDDs were examined in the three intensive care units, corresponding to an average density of consumption of 1,689.0 DDD1000. The median number of DDDs of antibiotics use in the public hospitals’ intensive care units was significantly higher (p=0.002) versus the private hospital’s intensive care unit. The consumption of antibiotics in the private hospital’s intensive care unit (DC=2,191.7 DDD1000) was significantly higher (p<0.001) versus the intensive care units of public hospitals (1,499.5 DDD1000). The most used antibiotics groups in the three intensive care units were 3rd generation cephalosporins, penicillins/betalactamases inhibitors, carbapenems and fluorquinolones. CONCLUSION: The pattern of antibiotics use in the three examined intensive care units was not uniform. The private hospital’s intensive care unit used a significantly larger amount versus the public hospitals’ intensive care units. Nevertheless, the most used antibiotics groups were similar in the three intensive care units.

Exposure to mixed asymptomatic infections with Trypanosoma cruzi, Leishmania braziliensis and Leishmania chagasi in the human population of the greater Amazon.

Lack of conservation of the Amazon tropical rainforest has imposed severe threats to its human population living in newly settled villages, resulting in outbreaks of some infectious diseases. We conducted a seroepidemiological survey of 1100 inhabitants of 15 villages of Paço do Lumiar County, Brazil. Thirty-five (3%) individuals had been exposed to Trypanosoma cruzi (Tc), 41 (4%) to Leishmania braziliensis (Lb) and 50 (4.5%) to Leishmania chagasi (Lc) infections. Also, 35 cases had antibodies that were cross-reactive against the heterologous kinetoplastid antigens. Amongst these, the Western blot assays revealed that 11 (1%) had Tc and Lb, that seven (0.6%) had Lc and Tc, and that 17 (1.6%) had Lb and Lc infections. All of these cases of exposures to mixed infections with Leishmania sp, and eight of 11 cases of Tc and Lb were confirmed by specific PCR assays and Southern hybridizations. Two cases had triple infections. We consider these asymptomatic cases showing phenotype and genotype markers consistent with mixed infections by two or more kinetoplastid flagellates a high risk factor for association with Psychodidae and Triatominae vectors blood feeding and transmitting these protozoa infections. This is the first publication showing human exposure to mixed asymptomatic kinetoplastid infections in the Amazon.

Specific human antibodies do not inhibit Trypanosoma cruzi oligopeptidase B and cathepsin B, and immunoglobulin G enhances the activity of trypomastigote-secreted oligopeptidase B.

Trypanosoma cruzi expresses oligopeptidase B and cathepsin B that have important functions in the interaction with mammalian host cells. In this study, we demonstrated that sera from both chagasic rabbits and humans have specific antibodies to highly purified native oligopeptidase B and cathepsin B. Levels of antibodies to cathepsin B were higher than those observed to oligopeptidase B by absorbance values recorded upon ELISA. We next showed that 90% and 30% of sera from individuals with mucocutaneous leishmaniasis have antibodies that recognize oligopeptidase B and cathepsin B as antigens, respectively. In addition, 55% and 40% of sera from kala-azar patients have antibodies to oligopeptidase B and cathepsin B, respectively. Sera from malaria patients did not recognize the proteases as antigens. Despite high levels of specific antibodies, sera from T. cruzi-infected patients did not inhibit the activities of either oligopeptidase B or cathepsin B. Furthermore, sera or IgG purified from either infected or non-infected individuals enhanced the enzymatic activity of the secreted oligopeptidase B. Oligopeptidase B secreted by trypomastigotes and cathepsin B released upon parasite lysis retain their enzymatic activities and may be associated with Chagas' disease pathogenesis by hydrolyzing host proteins and inducing host immune responses.

Heritable integration of kDNA minicircle sequences from Trypanosoma cruzi into the avian genome: insights into human Chagas disease.

We demonstrate the genetic transfer of DNA between eukaryotes from different kingdoms. The mitochondrial kinetoplast DNA (kDNA) of the intracellular parasite Trypanosoma cruzi is transferred to human patients with Chagas disease. This transfer was reproduced experimentally in rabbits and chickens. The kDNA is integrated into the host genome. In the human chromosomes, five loci were identified as integration sites, and the beta-globin locus and LINE-1 retrotransposons were frequently targeted. Short repeated sequences in the parasite and the target host DNAs favor kDNA integration by homologous recombination. Introduced kDNA was present in offspring of chronically infected rabbits and in chickens hatched from T. cruzi-inoculated eggs. kDNA incorporated into the chicken germline was inherited through the F2 generation in the absence of persistent infection. kDNA integration represents a potential cause for the autoimmune response that develops in a percentage of chronic Chagas patients, which can now be approached experimentally.

Persistent infections in chronic Chagas'disease patients treated with anti-Trypanosoma cruzi nitroderivatives

We used a molecular method and demonstrated that treatment of the chronic human Trypanosoma cruzi infections with nitroderivatives did not lead to parasitological cure. Seventeen treated and 17 untreated chronic Chagas' disease patients, with at least two out of three positive serologic assays for the infection, and 17 control subjects formed the study groups. PCR assays with nested sets of T. cruzi DNA primers monitored the efficacy of treatment. The amplification products were hybridized to their complementary internal sequences. Untreated and treated Chagas' disease patients yielded PCR amplification products with T. cruzi nuclear DNA primers. Competitive PCR was conducted to determine the quantity of parasites in the blood and revealed < 1 to 75 T. cruzi/ml in untreated (means 25.83 +/- 26.32) and < 1 to 36 T. cruzi/ml in treated (means 6.45 +/- 9.28) Chagas' disease patients. The difference between the means was not statistically significant. These findings reveal a need for precise definition of the role of treatment of chronic Chagas'disease patients with nitrofuran and nitroimidazole compounds.

Emprego de quatro exames imunológicos na determinaçäo da prevalência da doença de Chagas nos garis do Serviço de Limpeza Urbana do Distrito Federal / The use of four immunological tests to determine the prevalence of Chagas' disease in street cleaners of the Urban Cleaning Service of the Federal District

Seropositivity for Trypanosoma cruzi infection was studied in 368 street-sweepers of the SLU, Federal District, Brazil, with the aid of haemaglutination, immunofluorescence and, also, a delayed-type skin test to the parasite T12E antigen. It showed 32.1 per cent, 42.1 per cent and 38.6 per cent positive results, respectively for each assay. Among these, however, only 47 per cent were positive with each of three exams performed. In addition, 19.7 per cent were positive with two out of three exams performed. The remaining 33.3 per cent sera yielded one positive result out of three exams employed and were submitted to the immunoblot assay. This analysis confirmed 3 cases (37.5 per cent) positive by hemmaglutination, 3 (11.5 per cent) positive by skin test, and 1 (3.7 per cent) positive by immunofluorescence. At the end of the analysis, it was shown that 129 (35 per cent) individuals yielded at least two positive assays and, therefore, they should be considered as T. cruzi-infected individuals.

Parasitoses intestinais / Intestinal parasitosis

A autora descreve as condutas terapêuticas nas helmintíases e protozooses intestinais analisando as indicaçSes do tratamento, os medicamentos de valor, seus paraefeitos e contra-indicaçöes. A escolha das drogas e a citaçäo de mais de um composto na terapêutica de cada infecçäo em particular, embora concedendo alguma preferência, decorreram da observaçäo de certas propriedades, em especial os aspectos ligados à tolerância, facilidade de administraçäo e disponibilidade. Menciona alguns cuidados e métodos específicos que devem ser observados na realizaçäo do exame parasitológico de fezes para um correto diagnóstico e controle de cura. Näo há dúvidas que o tratamento diminue a prevalência, reduz rapidamente a carga parasitária e consequentemente a morbidade, dificultando portanto a transmissäo, mas deve vir ao lado das medidas de assistência sanitária no controle das parasitoses intestinais