RESUMO
The mechanisms of linezolid resistance among 86 staphylococcal isolates from two intensive care units were investigated. The most frequent was the G2576T mutation in the 23S rRNA (82%). The cfr gene was found in 17% of the isolates, seven S. aureus and eight S. epidermidis isolates. Four of the S. epidermidis isolates had the G2576T mutation and the cfr gene. In four S. haemolyticus isolates, the mechanism could not be identified.
Assuntos
Acetamidas/farmacologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Oxazolidinonas/farmacologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus haemolyticus/efeitos dos fármacos , Proteínas de Bactérias/genética , Humanos , Unidades de Terapia Intensiva , Linezolida , Mutação Puntual , RNA Ribossômico 23S/genética , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis/genética , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus haemolyticus/genética , Staphylococcus haemolyticus/isolamento & purificação , Centros de Atenção TerciáriaRESUMO
As HIV becomes a chronic infection, an increasing number of HIV-infected patients are travelling to malaria-endemic areas. Association of malaria with HIV/AIDS can be clinically severe. Severe falciparum malaria is a medical emergency that is associated with a high mortality, even when treated in an Intensive Care Unit. This article describes two cases of HIV-positive patients, who returned from malaria-endemic areas and presented a parasitaemia > 5% of erythrocytes and clinical signs of severe falciparum malaria, both with > 350 CD4 cell count/µl, absence of chemoprophylaxis and successful response. Factors like drug interactions and the possible implication of anti-malarial therapy bioavailability are all especially interesting in HIV-malaria co-infections.
Assuntos
Infecções por HIV/complicações , Malária Falciparum/diagnóstico , Plasmodium falciparum/isolamento & purificação , Adulto , Antimaláricos/administração & dosagem , Contagem de Linfócito CD4 , Humanos , Malária Falciparum/patologia , Masculino , Pessoa de Meia-Idade , Parasitemia/diagnóstico , Parasitemia/patologia , Viagem , Resultado do TratamentoRESUMO
Surveillance studies have shown the emergence of infections with linezolid-resistant bacteria. The relationship between appropriate linezolid use and the spread of linezolid resistance among Gram-positive microorganisms in a single tertiary referral centre was evaluated. In an initial observational study, a prospective prescription-indication study was conducted on intensive care areas and haematology, neurosurgery, vascular surgery and nephrology wards during 2009. An intervention through follow-up feedback on audit results from May-June 2010 was then conducted. From July-December 2010, a second drug-use study of linezolid was conducted, with the same objectives and methodology. To assess the antimicrobial pressure of linezolid, an ecological study was conducted from 2006-2010 in the same hospital wards. Indications for linezolid in the initial study were considered suitable in 38.5% of cases, whilst in the second study the rate was 51.2% (33% increase). Linezolid consumption fell by 57% in the second half of 2010. A significant correlation was found between its inadequate use (DDD/1000 patient-days) and the incidence of linezolid-resistant strains/1000 patient-days (r=0.93; P=6.9e-024); 85% of the variability in the incidence of linezolid resistance was predicted by its inadequate use. Its partial correlations were significant for Enterococcus faecium (r=0.407; P=0.049), Staphylococcus epidermidis (r=0.874; P=2.3e-008) and Staphylococcus haemolyticus (r=0.406; P=0.049) but not Staphylococcus aureus (r=0.051; P=0.704). A relationship was found between appropriate linezolid use and the incidence of linezolid-resistant strains of E. faecium, S. epidermidis and S. haemolyticus.
Assuntos
Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Prescrições de Medicamentos/normas , Farmacorresistência Bacteriana , Uso de Medicamentos/normas , Bactérias Gram-Positivas/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Oxazolidinonas/uso terapêutico , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Incidência , Linezolida , Política Organizacional , Estudos Prospectivos , Centros de Atenção TerciáriaAssuntos
Infecções por Adenovirus Humanos/virologia , Adenovírus Humanos/isolamento & purificação , Fitas Reagentes , Infecções Respiratórias/virologia , Criança , Pré-Escolar , Reações Falso-Negativas , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Cultura de VírusRESUMO
La hemorragia cerebral es la principal causa de muerte en las pacientes eclámpticas. Con la tomografía computarizada es posible realizar en forma temprana el diagnóstico de dicha hemorragia. El tratamiento de tal complcación es la evacuación del hematoma y la hemostasia de vasos sangrantes. Presentamos un caso de eclampsia y otro de preeclampsia severa complicadas con hemorragia intracerebral. Ambas pacientes tenían más de 30 años, eran secundigestas, tenían hipertensión arterial persistente, cefalea intensa y progresiva y en ambos casos se diagnósticó Síndrome de Hellp. El diagnóstico de hemorragia intracerebral se realizó con CAT simple y ambas fueron sometidas a tratamiento con excelentes resulatdos