RESUMO
BACKGROUND: Antibiotic resistance in Gram-negative bacilli poses a serious problem for public health. In hospitals, in addition to high mortality rates, the emergence and spread of resistance to practically all antibiotics restricts therapeutic options against serious and frequent infections. OBJECTIVE: The aim of this work is to present the views of a group of experts on the following aspects regarding resistance to antimicrobial agents in Gram-negative bacilli: 1) the current epidemiology in Spain, 2) how it is related to local clinical practice and 3) new therapies in this area, based on currently available evidence. METHODS: After reviewing the most noteworthy evidence, the most relevant data on these three aspects were presented at a national meeting to 99 experts in infectious diseases, clinical microbiology, internal medicine, intensive care medicine, anaesthesiology and hospital pharmacy. RESULTS AND CONCLUSIONS: Subsequent local debates among these experts led to conclusions in this matter, including the opinion that the approval of new antibiotics makes it necessary to train the specialists involved in order to optimise how they use them and improve health outcomes; microbiology laboratories in hospitals must be available throughout a continuous timetable; all antibiotics must be available when needed and it is necessary to learn to use them correctly; and the Antimicrobial Stewardship Programs (ASP) play a key role in quickly allocating the new antibiotics within the guidelines and ensure appropriate use of them.
Assuntos
Antibacterianos , Anti-Infecciosos , Humanos , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Espanha/epidemiologia , Bactérias Gram-Negativas , Anti-Infecciosos/uso terapêuticoRESUMO
No disponible
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Humanos , Infecções por Coronavirus/tratamento farmacológico , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/patogenicidade , Lopinavir/farmacocinética , Ritonavir/farmacocinética , Síndrome Torácica Aguda/tratamento farmacológico , Darunavir/farmacocinética , Cobicistat/farmacocinética , Tomada de Decisões , Formulação de Políticas , Pandemias/prevenção & controleRESUMO
INTRODUCTION: Incidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital. METHODS: Retrospective, observational study that includes any patient diagnosed of R. equi infection during the 1999-2007 period. Clinical and epidemiological characteristics were recorded. RESULTS: Four patients were diagnosed of R. equi infection, with a mean age of 37.75+/-9.94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83+/-55.2 cells/microl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions. CONCLUSIONS: R. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia.
Assuntos
Infecções por Actinomycetales/etiologia , Infecções por HIV/complicações , Rhodococcus equi , Adulto , Humanos , Masculino , Estudos RetrospectivosRESUMO
IntroducciónLa incidencia de la infección por Rhodococcus equi está incrementándose en paralelo con la mayor prevalencia de pacientes inmunodeprimidos. Este estudio se propone conocer las características clínico-epidemiológicas de las infecciones por R. equi en un único centro.MétodosEstudio retrospectivo, de observación, que incluye a todos los pacientes diagnosticados de infección por R. equi en el período 19992007. Se registraron características clínicas y epidemiológicas generales.ResultadosSe diagnosticó a cuatro pacientes de infección por R. equi, de 37,75±9,94 años de edad, todos ellos varones infectados por el virus de la inmunodeficiencia humana (VIH), con inmunosupresión importante (contaje medio de linfocitos CD4+: 83±55,2 células/μl). Todos los pacientes tenían sintomatología respiratoria y mostraban lesiones pulmonares radiológicas cavitadas. Se aisló R. equi tanto en sangre como en muestras respiratorias.ConclusionesLa infección por R. equi es poco frecuente, incide sobre todo en pacientes con infección por VIH muy inmunodeprimidos y cursa casi siempre como neumonía cavitada(AU)
IntroductionIncidence of Rhodococcus equi (R. equi) infection is increasing parallel to a greater prevalence of immunosupressed patients. This study aims to describe clinico-epidemiological characteristics of R. equi infections in a single hospital.MethodsRetrospective, observational study that includes any patient diagnosed of R. equi infection during the 19992007 period. Clinical and epidemiological characteristics were recorded.ResultsFour patients were diagnosed of R. equi infection, with a mean age of 37,75±9,94 years old. All of them were male, infected with human immunodeficiency virus, and showed severe immunosuppression (mean CD4+ lymphocyte count of 83±55,2 cells/μl). Respiratory symptoms and cavitary pulmonary lesions were constantly present. R. equi was always cultured in blood and respiratory secretions.ConclusionsR. equi infection is a rare disease that occurs predominantly in HIV infected patients, severely immunosuppressed patients and almost always causes cavitary pneumonia(AU)
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Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Rhodococcus equi/isolamento & purificação , Rhodococcus equi/patogenicidade , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/diagnóstico , Pneumonia/complicações , Pneumonia/diagnóstico , Macrolídeos/uso terapêutico , Quinolonas/uso terapêutico , Estudos Retrospectivos , Sinais e Sintomas , Hepatopatias/complicações , Radiografia Torácica , Antirretrovirais/uso terapêuticoRESUMO
No disponible
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Humanos , Masculino , Pessoa de Meia-Idade , Glândulas Perianais/lesões , Glândulas Perianais , Fístula/diagnóstico , Biópsia/métodos , Fibrose/complicações , Tomografia Computadorizada de Emissão/métodos , Mycobacterium tuberculosis/isolamento & purificação , Isoniazida/uso terapêutico , Rifampina/uso terapêuticoAssuntos
Ascite/etiologia , Infecções por Corynebacterium , Corynebacterium/isolamento & purificação , Antibacterianos/uso terapêutico , Líquido Ascítico/microbiologia , Infecções por Corynebacterium/tratamento farmacológico , Infecções por Corynebacterium/microbiologia , Humanos , Neutrófilos , Peritonite/etiologia , Peritonite/microbiologiaAssuntos
Tularemia/epidemiologia , Adulto , Surtos de Doenças , Humanos , Masculino , Espanha/epidemiologia , Tularemia/diagnósticoRESUMO
Rickettsia spp. infections produce hepatic damage with transaminases elevation and biological signs of cholostasis. Classical biochemical tests of hepatic function were analyzed and compared in 8 patients with Q Fever (QF) and 7 with Boutonneuse Mediterranean Fever (BMF). Liver enlargement was detected in 75% of the QF group of patients as compared with the 57% of the BMF group. Transaminases were raised in 75% of the patients of the QF group and in 85, 7% of the BMF patients. Only one patient in the QF group showed manifest clinical jaundice. Statistically significant differences were found between the values of AST, ALT, alkaline phosphatase and GGT, which were higher in the QF group. Liver involvement is more important in patients with QF than in FBM. There is a large percentage of clinically silent involvement in both diseases. Liver function tests should be carried out in infections by Rickettsia spp.
