Ceftriaxone and ciprofloxacin restriction in an intensive care unit: less incidence of Acinetobacter spp. and improved susceptibility of Pseudomonas aeruginosa / Restricción del uso de ceftriaxona y ciprofloxacino en una unidad de cuidados intensivos: menor incidencia de Acinetobacter spp. y mayor sensibilidad de Pseudomonas aeruginosa

Objective. To determine whether restricting the use of ceftriaxone and ciprofloxacin could significantly reduce colonization and infection with resistant Gram-negative bacilli (r-GNB). Methods. A two-phase prospective study (before/after design) was conducted in an intensive care unit in two time periods (2004–2006). During phase 1, there was no antibiotic restriction. During phase 2, use of ceftriaxone or ciprofloxacin was restricted. Results. A total of 200 patients were prospectively evaluated. In phase 2, the use of ceftriaxone was reduced by 93.6% (P = 0.0001) and that of ciprofloxacin by 65.1% (P = 0.041), accompanied by a 113.8% increase in use of ampicillin-sulbactam (P = 0.002). During phase 1, 48 GNB were isolated [37 r-GNB (77.1%) and 11 non-r-GNB (22.9%)], compared with a total of 64 during phase 2 [27 r-GNB (42.2%) and 37 non-r-GNB (57.8%)] (P = 0.0002). Acinetobacter spp. was isolated 13 times during phase 1 and 3 times in phase 2 (P = 0.0018). The susceptibility of Pseudomonas aeruginosa to ciprofloxacin increased from 40.0% in phase 1 to 100.0% in phase 2 (P = 0.0108). Conclusions. Restriction of ceftriaxone and ciprofloxacin reduced colonization byAcinetobacter spp. and improved the susceptibility profile of P. aeruginosa.

Objetivo. Determinar si la restricción del uso de ceftriaxona y ciprofloxacino reduce significativamente la colonización y la infección por bacilos gramnegativos resistentes. Métodos. Se efectuó un estudio prospectivo de dos fases (diseño antes/después de la intervención) en una unidad de cuidados intensivos en dos períodos sucesivos entre los años 2004 y 2006. Durante la fase 1, no hubo ninguna restricción de antibióticos. Durante la fase 2, se restringió el uso de ceftriaxona y ciprofloxacino. Resultados. Se evaluó prospectivamente a 200 pacientes en total. En la fase 2, el uso de ceftriaxona se redujo en 93,6% (P = 0,0001) y el de ciprofloxacino en 65,1% (P = 0,041), lo que se acompañó de un aumento de 113,8% en el uso de ampicilina/sulbactam (P = 0,002). Durante la fase 1, se aislaron 48 bacilos gramnegativos (37 resistentes [77,1%] y 11 no resistentes [22,9%]), en comparación con un total de 64 durante la fase 2 (27 resistentes [42,2%] y 37 no resistentes [57,8%]) (P = 0,0002). Se aisló Acinetobacter spp. 13 veces durante la fase 1 y 3 veces en la fase 2 (P = 0,0018). La sensibilidad de Pseudomonas aeruginosa al ciprofloxacino aumentó de 40,0% en la fase 1 a 100,0% en la fase 2 (P = 0,0108). Conclusiones. La restricción del uso de ceftriaxona y ciprofloxacino redujo la colonización por Acinetobacter spp. y mejoró el perfil de sensibilidad de P. aeruginosa.

Ceftriaxone and ciprofloxacin restriction in an intensive care unit: less incidence of Acinetobacter spp. and improved susceptibility of Pseudomonas aeruginosa.

OBJECTIVE: To determine whether restricting the use of ceftriaxone and ciprofloxacin could significantly reduce colonization and infection with resistant Gram-negative bacilli (r-GNB). METHODS: A two-phase prospective study (before/after design) was conducted in an intensive care unit in two time periods (2004-2006). During phase 1, there was no antibiotic restriction. During phase 2, use of ceftriaxone or ciprofloxacin was restricted. RESULTS: Atotal of 200 patients were prospectively evaluated. In phase 2, the use of ceftriaxone was reduced by 93.6% (P = 0.0001) and that of ciprofloxacin by 65.1% (P = 0.041), accompanied by a 113.8% increase in use of ampicillin-sulbactam (P = 0.002).During phase 1, 48 GNB were isolated [37 r-GNB (77.1%) and 11 non-r-GNB (22.9%)], compared with a total of 64 during phase 2 [27 r-GNB (42.2%) and 37 non-r-GNB (57.8%)](P = 0.0002). Acinetobacter spp. was isolated 13 times during phase 1 and 3 times in phase 2 (P = 0.0018). The susceptibility of Pseudomonas aeruginosa to ciprofloxacin increased from 40.0% in phase 1 to 100.0% in phase 2 (P = 0.0108). CONCLUSIONS: Restriction of ceftriaxone and ciprofloxacin reduced colonization by Acinetobacter spp. and improved the susceptibility profile of P. aeruginosa.

Estudio epidemiológico de la psoriasis inducida por fármacos / An epidemiological study of psoriasis induced by drugs

Objetivo. La hipótesis de trabajo es la de demostrar una asociación genética de la psoriasis inducida por fármacos. Material y métodos. 114 casos con psoriasis vulgar (61 hombres y 53 mujeres). Se registró: (1) antecedentes familiares de psoriasis; (2) otras enfermedades; (3) fármacos referidas en la bibliografía como inductoras de psoriasis y que se demuestran como tales en la población estudiada; y (4) que exacerbaron la psoriasis. Análisis de la distribución por edad de inicio de la psoriasis, antecedente familiar y psoriasis inducida por fármacos. Resultados. 28/114 casos (24,56 %) iniciaron su psoriasis luego de la administración de fármacos. 6/35 casos (17,14 %) con antecedentes familiares y 22/79 casos (27,84 %) sin antecedentes familiares (X2 = 0,98 p > 0,05). La aparición de psoriasis inducida por fármacos ocurrió en: (1) 1/56 30 años (X2 = 17,56 p 30 años sin antecedentes familiares (X2 = 12,64 p 30 años con antecedentes familiares (X2 = 3,18 p > 0,05). La edad de inicio es mayor en los casos de psoriasis inducida por fármacos (51,42±13,06 años) comparado a la que no se vincula a fármacos (26,55±12,77 años), p < 0,001. Conclusiones. La psoriasis inducida por fármacos no depende de una condición genética o heredable, sugiriendo que es debida a una alteración bioquímica

Objective. The hypothesis is the demonstration of a genetic association for the psoriasis induced by drugs. Material and methods. One hundred and fourteen cases with psoriasis vulgaris (61 men and 53 women). The data for analysis was: (1) family background of psoriasis; (2) others illnes; (3) drugs referred in the bibliography to induce psoriasis and that they are demonstrated as such in the studied population; and (4) drugs that exacerbated the psoriasis. Analysis of the distribution by age of beginning the psoriasis, sex, family background and psoriasis induced by drugs. Results. Twenty eight out of 114 cases (24,56%) began their psoriasis after the administration of drugs. Six out of 35 cases (17,14%) with family background and 22 out of 79 cases (27,84%) without family background(X2 = 0,98 p > 0,05). The beginning of psoriasis induced by drugs was: (1) 1/56 30 years-old (X2 = 17,56 p 30 years-old without family background (X2 = 12,64 p 30 years-old with family background (X2 = 3,18 p > 0,05). The beginning age is over in the cases with psoriasis induced by drugs (51,42±13,06 years-old) compared with the one that is not linked to drugs (26,55±12,77 years-old), p < 0,001. Conclusions. The psoriasis induced by drugs does not depend on a genetic or inheritable condition, suggesting that it is due to a biochemical alteration