RESUMO
OBJECTIVES: The aim of this study was to describe antibiotic prescribing patterns and antimicrobial resistance rates in hospitalised children with febrile and afebrile urinary tract infections (UTIs). METHODS: Antibiotic prescriptions and antibiograms for neonates, infants and older children with UTI admitted to a general district hospital in Central Greece were evaluated. Data covering a 5-year period were collected retrospectively from the Paediatric Department's Electronic Clinical Archive. Patients were included based on clinical and microbiological criteria. Antimicrobial susceptibility was determined by the Kirby-Bauer disk diffusion method. RESULTS: A total of 230 patients were included in the study. Among 459 prescriptions identified, amikacin (31.2%) was the most common antibiotic prescribed in this population, followed by amoxicillin/clavulanic acid (17.4%) and ampicillin (13.5%). Children received prolonged intravenous (i.v.) treatments for febrile (mean ± S.D., 5.4 ± 1.45 days) and afebrile UTIs (mean ± S.D., 4.4 ± 1.64 days). A total of 236 pathogens were isolated. The main causative organism was Escherichia coli (79.2%) with high reported resistance rates to ampicillin (42.0%), trimethoprim/sulfamethoxazole (26.5%) and amoxicillin/clavulanic acid (12.2%); lower resistance rates were identified for third-generation cephalosporins (1.7%), nitrofurantoin (2.3%), ciprofloxacin (1.4%) and amikacin (0.9%). Klebsiella spp. isolates were highly resistant to cefaclor (27.3%). CONCLUSION: High prescribing rates for amikacin and penicillins (± ß-lactamase inhibitors) and prolonged i.v. treatments were observed. Escherichia coli was highly resistant to ampicillin, whilst third-generation cephalosporins exhibited greater in vitro efficacy. Establishment of antimicrobial stewardship programmes and regular monitoring of antimicrobial resistance could help to minimise inappropriate prescribing for UTIs.
Assuntos
Amicacina/administração & dosagem , Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Ampicilina/administração & dosagem , Antibacterianos/administração & dosagem , Febre/microbiologia , Infecções Urinárias/tratamento farmacológico , Administração Intravenosa , Adolescente , Amicacina/farmacologia , Combinação Amoxicilina e Clavulanato de Potássio/farmacologia , Ampicilina/farmacologia , Antibacterianos/farmacologia , Gestão de Antimicrobianos , Criança , Pré-Escolar , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Bacteriana Múltipla , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Febre/tratamento farmacológico , Grécia , Humanos , Lactente , Recém-Nascido , Klebsiella/efeitos dos fármacos , Klebsiella/isolamento & purificação , Masculino , Estudos Retrospectivos , Infecções Urinárias/microbiologiaRESUMO
PURPOSE: To evaluate the therapeutic outcome of radical cystectomy and radical radiotherapy in patients with T2N0M0 clinical stage bladder cancer in relation to their age. PATIENTS AND METHODS: Between 1995-2006, 119 patients with clinical stage T2N0M0 bladder cancer were treated with radical radiotherapy (group A) and were divided in 2 subgroups: >70 years old (A1) and Assuntos
Cistectomia
, Neoplasias Musculares/terapia
, Neoplasias da Bexiga Urinária/terapia
, Fatores Etários
, Idoso
, Terapia Combinada
, Intervalo Livre de Doença
, Seguimentos
, Humanos
, Neoplasias Musculares/radioterapia
, Neoplasias Musculares/cirurgia
, Recidiva Local de Neoplasia/diagnóstico
, Estadiamento de Neoplasias
, Estudos Retrospectivos
, Resultado do Tratamento
, Neoplasias da Bexiga Urinária/radioterapia
, Neoplasias da Bexiga Urinária/cirurgia