RESUMO
The aims of the present study were to evaluate erythromycin, clindamycin, and streptogramin resistance rates, as well as the phenotypic and genotypic characteristics of erythromycin-resistant staphylococci in a Greek University Hospital. Macrolide, lincosamide, and streptogramin B-type resistance was investigated by double disk diffusion and the D-zone testing, while Minimal inhibitory concentration determination was performed among 656 erythromycin-resistant staphylococcal clinical consecutive isolates, too. The presence of the major genetic determinants ermA, ermB, ermC, and msrA were detected by polymerase chain reaction (PCR). The overall erythromycin resistance rate was 49·70%. One hundred and forty-six of the 322 Staphylococcus aureus were methicillin-resistant S. aureus (MRSA) (45·34%), whereas 176 were methicillin-susceptible S. aureus (54·66%). The macrolides, lincosamides, and streptogramin B-type antibiotics (MLSB)-constitutive phenotype was detected in 126 S. aureus strains (88·7%), whereas the inducible MLSB resistance phenotype was demonstrated in 16 S. aureus (11·3%). The MS phenotype was not detected. ErmC was the most frequently encountered gene responsible for macrolide resistance among S. aureus and coagulase negative staphylococci in this hospital. Pulsed-field gel electrophoresis (PFGE) analysis of SmaI DNA fragments revealed the presence of a single predominant clone among erythromycin-resistant S. aureus. The predominance of constitutive erythromycin resistance is a serious problem and limits the use of clindamycin for severe staphylococcal infections not only in this university hospital, but in many countries worldwide.
Assuntos
Antibacterianos/farmacologia , Clindamicina/farmacologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/genética , Eritromicina/farmacologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Estreptogramina B/farmacologia , Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Eletroforese em Gel de Campo Pulsado , Eritromicina/uso terapêutico , Genes Bacterianos , Genótipo , Grécia/epidemiologia , Hospitais Universitários , Humanos , Testes de Sensibilidade Microbiana , Prevalência , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Estreptogramina B/uso terapêutico , Atenção Terciária à Saúde , Virginiamicina/farmacologia , Virginiamicina/uso terapêuticoRESUMO
A total of 132 infections of Pseudomonas aeruginosa (including 112 imipenem resistant, 32 of them producing VIM-2 beta-lactamase) were identified during a one-year period (June 2002-June 2003). PFGE molecular typing revealed that P. aeruginosa clinical isolates sensitive to imipenem, P. aeruginosa isolates resistant to imipenem but VIM-negative, and P. aeruginosa-resistant and VIM-positive isolates could be allocated to three different clusters with approximately 70% similarity. A case control study of patients infected with an MBL-producing imipenem-resistant P. aeruginosa isolate and controls (patients hospitalized in the same time period with no infection), revealed that only the number of catheters present at the time of the infection was strongly associated with the development of infection due to VIM-producing P. aeruginosa (OR 4.83, 95% CI: 1.94-12.0). In conclusion, the results of the molecular typing combined with the results of the case control study indicate that in the specific hospital setting, infection control, addressed specifically to critically ill patients, is an important part of any strategy to reduce imipenem-resistant infections.
Assuntos
Infecção Hospitalar/epidemiologia , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/isolamento & purificação , Resistência beta-Lactâmica , beta-Lactamases/biossíntese , Antibacterianos/farmacologia , Técnicas de Tipagem Bacteriana , Estudos de Casos e Controles , Eletroforese em Gel de Campo Pulsado , Genoma Bacteriano , Grécia/epidemiologia , Humanos , Imipenem/farmacologia , Filogenia , Pseudomonas aeruginosa/enzimologia , Pseudomonas aeruginosa/genéticaRESUMO
Data on BacT/Alert blood cultures in a Greek hospital from 1995 to 2002 were analysed retrospectively. There was a gradual increase in the number of blood cultures (4981 in 1995 to 9054 in 2002), the true positive rate (14.4% to 16.5%) and the number of bloodstream infections/1000 hospital admissions (22.1 to 30.7). The five most common pathogens were Eschericia coli, Staphylococcus aureus, coagulase-negative staphylococci, enterococci and Klebsiella spp. The relative rates of Gram-negative and Gram-positive isolates inverted during the study period because of an increasing frequency of coagulase-negative staphylococci and enterococci.
Assuntos
Bacteriemia/microbiologia , Sangue/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais , Bacteriemia/epidemiologia , Técnicas Bacteriológicas , Coleta de Amostras Sanguíneas/estatística & dados numéricos , Meios de Cultura , Infecções por Enterobacteriaceae/epidemiologia , Escherichia coli/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Cocos Gram-Positivos/isolamento & purificação , Grécia/epidemiologia , Humanos , Klebsiella/isolamento & purificaçãoRESUMO
Susceptibility data for 10 049 Escherichia coli isolates derived from community-acquired urinary tract infections in Greece during the period January 2000 to June 2002 indicated 8.1% resistance to nalidixic acid and 36% resistance to ciprofloxacin. In a sample of 170 E. coli isolates, mutations in gyrA (25 isolates) and parC (15 isolates) were consistent with the levels of resistance to quinolones. Previous exposure to quinolones and underlying chronic disease were independent risk factors for infection by quinolone-resistant E. coli strains.
Assuntos
Anti-Infecciosos/farmacologia , Ciprofloxacina/farmacologia , Farmacorresistência Bacteriana , Infecções por Escherichia coli/microbiologia , Escherichia coli/efeitos dos fármacos , Infecções Urinárias/microbiologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , DNA Girase/genética , DNA Topoisomerase IV/genética , Escherichia coli/genética , Infecções por Escherichia coli/epidemiologia , Grécia , Humanos , Testes de Sensibilidade Microbiana , Ácido Nalidíxico/farmacologia , Infecções Urinárias/epidemiologiaRESUMO
The environmental fungal load (FL) of three hospitals was studied in representative regions in Greece (Thessalonika, Northern Greece, Athens, Central Greece and Heraklion, Southern Greece). Air, surfaces and tap water from high-risk departments were sampled monthly during one year. Air FL was [median (range)] 10.6 (1.2-37), 5.5 (3-28.8) and 7.7 (3.1-12.1) cfu/m(3) at Thessalonika, Athens and Heraklion, respectively. Air FL was lower in winter and higher in summer and autumn but seldom above acceptable levels. Aspergillus spp. constituted 70.5% of the filamentous fungi isolated. Aspergillus niger was the most prevalent species in the air of all the hospitals followed by Aspergillus flavus and Aspergillus fumigatus. The least contaminated departments were the intensive care units, whilst most contaminated were the solid organ transplantation in Athens and haematology departments in Thessalonika. No correlation between fungal species, season, hospital or departments was observed. Sixty per cent of all surfaces examined yielded filamentous fungi and/or blastomycetes. While no fungi were recovered from water in Thessalonika and Athens, one-third of the samples in Heraklion (apart from those of ICU) yielded multiple fungal species. The higher air FL in Thessalonika and Athens was recorded in departments located close to renovation works. These findings suggest that the air and surface FL fluctuates over the year, is due to varying fungal species, but does not differ greatly among hospitals. The variation among hospitals, as well as the role of hospital water fungal contamination and appropriate measures to eliminate it, need further study.
Assuntos
Microbiologia do Ar , Monitoramento Ambiental/métodos , Fungos/isolamento & purificação , Hospitais Gerais , Hospitais Universitários , Controle de Infecções/métodos , Microbiologia da Água , Aspergillus/isolamento & purificação , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Monitoramento Epidemiológico , Grécia/epidemiologia , Arquitetura Hospitalar , Humanos , Hospedeiro Imunocomprometido , Micoses/etiologia , Micoses/prevenção & controle , Vigilância da População , Fatores de Risco , Estações do AnoRESUMO
We report the first case of endocarditis caused by Lactobacillus after an uneventful colonoscopy. The initial empiric treatment with the standard regimen of penicillin-aminoglycoside failed; subsequent treatment with a combination of antibiotics, selected according to the in vitro studies, was successful.
Assuntos
Colonoscopia/efeitos adversos , Endocardite Bacteriana/microbiologia , Lactobacillus/isolamento & purificação , Idoso , Antibacterianos , Quimioterapia Combinada/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Humanos , MasculinoRESUMO
BACKGROUND AND AIMS: The validity of the rapid urease (CLO) test to diagnose Helicobacter pylori infection in patients with bleeding ulcers has been questioned. The aim of this paper is to evaluate the validity of the CLO test in comparison with histology in diagnosing H. pylori infection in patients with acute upper gastrointestinal bleeding (UGB), irrespective of non-steroidal anti-inflammatory drug (NSAID) use. METHODS: Upper gastrointestinal endoscopy was performed within 24 h of admission for all patients with UGB admitted to the Department of Pathophysiology, Medical School, Athens, for a period of 12 months. Patients with variceal bleeding, previous gastric operation, recent treatment with proton pump inhibitors (< 2 months) and those with a history of H. pylori eradication therapy were excluded from the study. At least four biopsies (two from the antrum and two from the body) were obtained for the CLO test and histology (modified Giemsa). RESULTS: Seventy-two consecutive patients (aged 18-90 years, 51 men, 21 women) were included. Forty-six patients (64%) used NSAID. Thirty-two patients (44%) were found to be positive for H. pylori infection by the CLO test, while 44 patients (61%) were found to be positive on histology (P<0.045, 95% CI, 0.004-0.331). The sensitivity and specificity of the CLO test were 68 and 93% respectively; positive and negative predictive values were 94 and 65%, respectively. The age of the patient and visible blood in the stomach did not influence results of either the CLO or histology. CONCLUSIONS: The CLO test, performed within 24 h of hospital admission in patients with UGB, irrespective of NSAID use, is unreliable for the detection of H. pylori infection. The age of the patient and the presence of blood in the stomach do not seem to influence these results.
Assuntos
Biópsia , Mucosa Gástrica/patologia , Hemorragia Gastrointestinal/diagnóstico , Infecções por Helicobacter/diagnóstico , Helicobacter pylori/enzimologia , Urease/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Diagnóstico Diferencial , Úlcera Duodenal/complicações , Úlcera Duodenal/diagnóstico , Endoscopia do Sistema Digestório , Feminino , Mucosa Gástrica/microbiologia , Hemorragia Gastrointestinal/etiologia , Infecções por Helicobacter/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/etiologia , Estudos Prospectivos , Recidiva , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Úlcera Gástrica/complicações , Úlcera Gástrica/diagnósticoRESUMO
A case of bacterial endocarditis caused by Moraxella catarrhalis in an apparently immunocompetent Greek male is presented, which was diagnosed after a 2-month history of low-grade fever of unknown origin. The agent seems to be a rare pathogen, but due to the high mortality rate, it should always be considered in the differential diagnosis of relevant cases. Beta-lactamase production by many strains complicates the choice of antibiotic.
Assuntos
Endocardite/microbiologia , Moraxella catarrhalis/isolamento & purificação , Infecções por Neisseriaceae/microbiologia , Adulto , Amoxicilina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Ácido Clavulânico/uso terapêutico , Endocardite/tratamento farmacológico , Humanos , Imunocompetência , Masculino , Testes de Sensibilidade Microbiana , Moraxella catarrhalis/efeitos dos fármacos , Infecções por Neisseriaceae/tratamento farmacológico , Penicilinas/uso terapêutico , Literatura de Revisão como Assunto , Resultado do TratamentoRESUMO
A total of 55 Enterococcus faecalis and 21 Enterococcus faecium non-replicate isolates were obtained from routine clinical specimens, during a 1 year period, in a tertiary care hospital in Athens, Greece. The most common isolation site was the urinary tract (44% of E. faecalis and 33% of E. faecium isolates). No vancomycin resistance was detected. Ampicillin-resistant isolates did not produce beta-lactamase. High-level gentamicin resistance was detected in 22% and 0% of E. faecalis and E. faecium isolates, respectively. The corresponding figures for high-level streptomycin resistance were 40% and 33%. The aminoglycoside-modifying enzyme gene aac(6')+aph(2") was detected by PCR in 10 of 12 high-level gentamicin-resistant E. faecalis isolates, and the ant(6)-I gene in all high-level streptomycin-resistant isolates of both species. DNA fingerprinting by PFGE grouped 31 of 55 E. faecalis isolates into 10 clusters, and 10 of 21 E. faecium isolates into two clusters, containing two to seven isolates each. Two E. faecalis PFGE types, comprising isolates expressing high-level aminoglycoside resistance, and not observed among non-high-level aminoglycoside-resistant strains, were disseminated in building A of the hospital. In contrast, high-level aminoglycoside resistance seemed to have been acquired nosocomially by a number of genotypically different E. faecium types. Molecular typing was therefore instrumental in understanding the differences in the mode of spread and acquisition of high-level aminoglycoside resistance among these two different enterococcal species.
Assuntos
Antibacterianos/farmacologia , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Aminoglicosídeos , Resistência a Ampicilina , Impressões Digitais de DNA , DNA Bacteriano/análise , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Resistência Microbiana a Medicamentos , Eletroforese em Gel de Campo Pulsado , Enterococcus faecalis/genética , Enterococcus faecium/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Hemólise/efeitos dos fármacos , Hospitais Universitários , Humanos , Testes de Sensibilidade Microbiana , Fenótipo , Reação em Cadeia da PolimeraseRESUMO
We report the first case of Cryptococcus laurentii meningitis and a rare case of Cryptococcus albidus cryptococcaemia in AIDS patients. Both infections were treated with amphotericin B and flucytosine. The C. laurentii meningitis was controlled after 2 weeks of treatment with no evidence of infection 20 months later. The patient with C. albidus cryptococcaemia, despite the amphotericin B/flucytosine combination therapy, died on the 14th day of treatment. The minimum inhibitory concentrations (MICs) for C. laurentii, as determined by Etest on RPMI 1640 agar, were 0.25 microg ml(-1) of amphotericin B, 1.25 microg ml(-1) flucytosine, 4 microg ml(-1) fluconazole, 0.50 microg ml(-1) itraconazole and 1.0 microg ml(-1) of ketoconazole. The MIC of amphotericin B for C. albidus was 0.5 microg ml(-1), flucytosine 1.25 microg ml(-1), fluzonazole 4 microg ml(-1), itraconazole 0.5 microg ml(-1) and ketonazole 0.25 microg ml(-1). The agreement of the amphotericin B MIC values obtained in antibiotic medium 3 by the broth microdilution method, with those obtained on casitone medium by Etest, was within a two-dilution range for both isolates. C. laurentii may cause meningitis and may also involve the lungs in AIDS patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Criptococose/diagnóstico , Cryptococcus/classificação , Flucitosina/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Antifúngicos/farmacologia , Criptococose/tratamento farmacológico , Cryptococcus/efeitos dos fármacos , Cryptococcus/isolamento & purificação , Quimioterapia Combinada , Evolução Fatal , Feminino , Humanos , Masculino , Meningite/diagnóstico , Meningite/tratamento farmacológico , Meningite/microbiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-IdadeRESUMO
A postanginal Sepsis Syndrome with metastatic lung abscess caused by Fusobacterium necrophorumin a 25-year-old previously healthy man is described. The incomplete and ineffective antibiotic treatment at onset of angina ended progressively in septicaemia and metastatic infections in a 3-week time period. The early parenteral use of Metronidazole based only on the clinical picture, the Gram stain findings and the strict anaerobic feature of the blood isolate in parallel with the long-term antibiotic treatment were possibly the main reasons for the good outcome of this serious infection.
RESUMO
A patient with rheumatoid arthritis is described who presented with low-grade fever for 3 months, in whom Actinobacillus ureae was cultured from bone marrow aspirate. Fever responded favourably to penicillin therapy. It is the first reported isolation of A. ureae from bone marrow.
Assuntos
Infecções por Actinobacillus/tratamento farmacológico , Actinobacillus/isolamento & purificação , Artrite Reumatoide/complicações , Medula Óssea/microbiologia , Actinobacillus/efeitos dos fármacos , Infecções por Actinobacillus/etiologia , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Biópsia por Agulha , Diclofenaco/uso terapêutico , Quimioterapia Combinada , Febre , Humanos , Indometacina/uso terapêutico , Masculino , Exame Neurológico , Penicilina G/uso terapêutico , Penicilinas/uso terapêutico , Exame FísicoRESUMO
Anaerobic arthritis due to Bacteroides fragilis was diagnosed in a 33-year-old patient with prolonged fever suffering from sickle cell/thalassaemia. The causative agent was isolated from blood and purulent synovial fluid from both knee joints. A combination of chloramphenicol plus metronidazole treatment proved effective. Anaerobic arthritis has not previously been described in patients with sickle cell disease, and may reflect the well-known susceptibility of these patients to pathogens.
Assuntos
Anemia Falciforme/complicações , Artrite Infecciosa/microbiologia , Infecções por Bacteroides/complicações , Bacteroides fragilis , Talassemia/complicações , Adulto , Artrite Infecciosa/tratamento farmacológico , Infecções por Bacteroides/tratamento farmacológico , Cloranfenicol/uso terapêutico , Quimioterapia Combinada , Humanos , Articulação do Joelho/microbiologia , Masculino , Metronidazol/uso terapêutico , Líquido Sinovial/microbiologiaRESUMO
Neutropenic patients with underlying hematologic (usually malignant) diseases were randomized to receive either 2 g ceftriaxone once daily +0.5 g amikacin or 2 g ceftazidime twice daily +0.5 g amikacin b.i.d. when fever was higher than 38 degrees C and granulocyte counts less than 0.5 x 10(9)/l. 25 patients were included in each treatment group. Successful outcome of treatment was observed in 28 (13/15) and in an additional 5 (2/3) patients after modification of the therapy. Tolerability was excellent in both groups.
Assuntos
Amicacina/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Ceftazidima/uso terapêutico , Ceftriaxona/uso terapêutico , Febre/complicações , Neutropenia/complicações , Adolescente , Adulto , Idoso , Amicacina/administração & dosagem , Infecções Bacterianas/etiologia , Ceftazidima/administração & dosagem , Ceftriaxona/administração & dosagem , Esquema de Medicação , Quimioterapia Combinada/uso terapêutico , Feminino , Febre/induzido quimicamente , Humanos , Leucemia/complicações , Masculino , Pessoa de Meia-Idade , Neutropenia/induzido quimicamenteAssuntos
Bacteriemia/diagnóstico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Coleta de Amostras Sanguíneas/métodos , Testes de Sensibilidade Microbiana/métodos , Bacteriemia/sangue , Bacteriemia/epidemiologia , Bacteriemia/mortalidade , Feminino , Humanos , Incidência , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologiaAssuntos
Falência Renal Crônica/complicações , Falência Renal Crônica/microbiologia , Sepse/tratamento farmacológico , Sepse/etiologia , Adulto , Idoso , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções por Pseudomonas/tratamento farmacológicoRESUMO
The efficacy of sulbactam plus ampicillin in the treatment of various gynecologic infections was evaluated in 24 women (median age, 35 years). Ten women had pelvic cellulitis plus vaginal cuff abscess; six, pyeloperitonitis; three, vaginal cuff abscess; three, surgical wound sepsis; one, tubo-ovarian abscess; and one, endometritis. Surgical procedures preceding infection included abdominal hysterectomy, ovarian cyst removal, ectopic pregnancy, correction of cystocele, and uterine dilatation and curettage. Twenty patients received 1 g of sulbactam plus 1 g of ampicillin per dose; four received 0.5 g of sulbactam plus 1 g of ampicillin per dose. The combination was given iv every 6 hr for three to four days and then im every 8 hr for three to five days (mean treatment duration, seven days). Pus cultures yielded Enterobacteriaceae (21 cases), enterococci (two), Bacteroides fragilis (12), other Bacteroides species (five), Peptococcus species (nine), Peptostreptococcus species (seven), and other anaerobes (five). Six infections were purely anaerobic; 18 were mixed. All but two infections were cured by both clinical and bacteriologic criteria, with no adverse reactions. Parenteral sulbactam/ampicillin seems safe and effective in the treatment of gynecologic infections of moderate severity.
Assuntos
Ampicilina/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Doenças dos Genitais Femininos/tratamento farmacológico , Ácido Penicilânico/uso terapêutico , Adulto , Idoso , Bactérias Aeróbias/efeitos dos fármacos , Bactérias Anaeróbias/efeitos dos fármacos , Combinação de Medicamentos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , SulbactamRESUMO
A randomised prospective clinico-laboratory evaluation of the efficacy of ornidazole versus clindamycin in anaerobic infections was performed in 140 patients; 67 were given ornidazole and 73 received clindamycin. Patients were mainly suffering from peritonitis, pelvic cellulitis, endometritis, soft tissue infections and abdominal abscesses, which were distributed rather equally in both groups. Ornidazole was administered at a dose of 500 mg every 12 h i.v. or/and orally, and clindamycin 600 mg every 8 h i.v. for 7-60 days. In pus cultures, Escherichia coli and Bacteroides fragilis were the main isolates. The coexistence of aerobes necessitated the addition of an aminoglycoside in 111 patients, while six times chloramphenicol had proved ineffective against anaerobes. Between the two groups no statistically significant difference was found in the excellent response rate, although the overall cure rate was superior in the ornidazole group (80.6 vs. 68.5%), with a prompt response within less than 48 h in the case of ornidazole. Side effects necessitating discontinuation of chemotherapy included severe nausea in 1 patient treated with ornidazole and diarrhea in 8 patients given clindamycin.
Assuntos
Infecções Bacterianas/tratamento farmacológico , Clindamicina/uso terapêutico , Nitroimidazóis/uso terapêutico , Ornidazol/uso terapêutico , Adolescente , Adulto , Idoso , Aminoglicosídeos/uso terapêutico , Anaerobiose , Antibacterianos/uso terapêutico , Infecções por Bacteroides/tratamento farmacológico , Bacteroides fragilis , Criança , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos , Distribuição AleatóriaRESUMO
MIC determinations for 275 multiply-resistant nosocomial isolates of enterobacteria showed that ceftazidime was more effective than cefotaxime, cefoxitin or cephalothin. Enterobacter species were the most resistant with 12% isolates resistant to more than 8 mg/l of ceftazidime, but this was still the most active agent. Of 150 isolates of Pseudomonas aeruginosa (55% of which were resistant to gentamicin), only 9% were resistant to 8 mg/l of ceftazidime and 2% to cefsulodin, both of which were more active than cefotaxime, ceftriaxone, cefoperazone or moxalactam. Ceftazidime was less active than cefoxitin against Bacteroides fragilis, with 30% of strains resistant to 8 mg/l of ceftazidime, but it was more active than cefotaxime or cephalothin.