Comparison between Colistin and Polymyxin B in the Treatment of Bloodstream Infections Caused by Carbapenem-Resistant Pseudomonas aeruginosa and Acinetobacter baumannii-calcoaceticus Complex.

Polymyxins are still widely used for the treatment of carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa bloodstream infections (BSIs). This study seeks to evaluate the impact of polymyxin B versus colistin on mortality and nephrotoxicity in BSI caused by these bacteria. We conducted a retrospective cohort study from 2014 to 2021 in Porto Alegre, Brazil. We included patients aged ≥18 years and excluded patients with polymicrobial infection or treatment for ≤48 h. The 30-day mortality was the primary outcome evaluated through Cox regression. We included 259 patients with BSI episodes: 78.8% caused by A. baumannii and 21.2% caused by P. aeruginosa. Polymyxin B did not impact mortality compared to colistin (adjusted hazard ratio (aHR), 0.82; 95% confidence interval (CI), 0.52-1.30; p = 0.40 (when adjusted for COVID-19 comorbidity, p = 0.05), Pitt bacteremia score, p < 0.01; Charlson comorbidity index, p < 0.001; time to start active antimicrobial therapy, p = 0.02). Results were maintained in the subgroups of BSI caused by A. baumannii (aHR, 0.92; 95% CI, 0.55-1.54; p = 0.74), P. aeruginosa (aHR, 0.47; 95% CI, 0.17-1.32; p = 0.15) and critical care patients (aHR, 0.77; 95% CI, 0.47-1.26; p = 0.30). Treatment with polymyxin B or colistin did not impact 30-day mortality in patients with carbapenem-resistant A. baumannii or P. aeruginosa BSI.

Antimicrobial Therapy Duration for Bloodstream Infections Caused by Pseudomonas aeruginosa or Acinetobacter baumannii-calcoaceticus complex: A Retrospective Cohort Study.

BACKGROUND: Ideal therapy duration for Pseudomonas aeruginosa or Acinetobacter baumannii-calcoaceticus complex (ABC) bloodstream infections (BSI) is not defined, especially in the context of carbapenem resistance. In this study, we compared short- (≤7 days) and long-term (>7 days) antimicrobial therapy duration for these infections. METHODS: We performed a retrospective cohort study in two tertiary-care hospitals in Porto Alegre, Brazil, from 2013 to 2019. Eligible patients aged ≥18 years were included and excluded for the following criteria: polymicrobial infections, treatment with non-susceptible antibiotics, complicated infections, or early mortality (<8 days of active antimicrobial therapy). The 30-day mortality risk was evaluated using a Cox regression model. RESULTS: We included 237 BSI episodes, 51.5% caused by ABC and 48.5% by Pseudomonas aeruginosa. Short-term therapy was not associated with 30-day mortality, adjusted hazard ratio 1.01, 95% confidence interval 0.47-2.20, p = 0.98, when adjusted for Pitt score (p = 0.02), Charlson Comorbidity Index score (p < 0.01), and carbapenem resistance (p < 0.01). Among patients who survived, short-term therapy was associated with shorter hospital stay (p < 0.01). Results were maintained in the subgroups of BSI caused by carbapenem-resistant bacteria (p = 0.76), ABC (p = 0.61), and Pseudomonas aeruginosa (p = 0.39). CONCLUSIONS: Long-term therapies for non-complicated Pseudomonas aeruginosa and ABC BSI were not superior to short-term therapy for 30-day mortality.

Acidentes com animais peçonhentos mais comuns / Accidents with most common venomous animals

Os acidentes com animais peçonhentos compõem um amplo grupo de afecções atendidas nas unidades de emergência. Apresentamos neste trabalho as medidas iniciais de diagnóstico e tratamento dos agentes mais comuns no Rio Grande do Sul: ofídios (Bothrops), aranhas (Loxosceles) e lagartas (Lonomia).

Accidents with poisonous animals make up a large group of conditions met in the emergency room. We present in this work the initial steps of diagnosis and treatment of the most common agents in Rio Grande do Sul: snakes (Bothrops), spiders (Loxosceles) and caterpillars (Lonomia).

Manejo da exposição ocupacional a materiais biológicos / Management of occupational exposure to biological materials

A exposição acidental a materiais biológicos representa uma importante fonte de transmissão de doenças infecciosas, em especial HIV, hepatite B e hepatite C. Apresentamos nesse trabalho uma revisão prática para definição de condutas diante dessas situações.

Accidental exposure to biological materials is an important source of transmission of infectious diseases, specially HIV, hepatitis B ans hepatitis C. We present in this paper a practical review for management of such situations.

Meningites na infância: abordagem inicial / Meningitis in childhood: initial approach

Em pediatria, a meningite aguda é considerada uma doença grave, com grande potencial para morbidade e mortalidade. Para melhor desfecho, deve ser manejada precoce e eficazmente, em consonância com protocolos correntes. Este artigo busca apresentar, de forma prática, a abordagem inicial recomendada.

Acute meningitis in children is a dangerous disease with great potential of morbidity and mortality. It demands an effective management and the better available therapy, in agreement to the current guidelines. This paper presents the recommended initial approach in a practical way.