RESUMO
BACKGROUND: To determine adherence to the guideline for preoperative antibiotic use in Nicaragua. METHODS: An observational study in the University Hospital of León, Nicaragua. All surgical patients in the departments of general surgery, orthopaedics, gynaecology and obstetrics, and paediatrics during a four-week period were included. Patients with infections prior to surgery were excluded. Main outcome measures were the proportion of patients that received appropriate preoperative antibiotics based on wound classification, suspected pathogens, administered antibiotics (type and dose), therapy duration and timing according to the local protocol. RESULTS: In the study, 297 patients received a total of 395 antibiotics with 2595 doses for a total of 1087 days. Only 68% of patients received antibiotic prophylaxis for indications mentioned in the protocol. Antibiotics were given without indication or as treatment in 23%. In 9% of the cases no preoperative antibiotic therapy was given (no indication for 6%, but indicated for 3%). Of the 201 patients with an indication for prophylaxis, 25% received more antibiotic therapies than indicated. Antibiotic choice was discordant with the protocol in 69%, dose in 20%, and both the moment of administration and duration in 78%. Overall adherence was achieved in 7% of patients. Complete protocol violations were observed in 12%. The 243 patients in the prophylaxis group received 1707 doses, 83% of which were administered unnecessarily. CONCLUSION: Protocol violations are frequent in preoperative antibiotic prophylaxis in Nicaragua leading to considerable overprescription. Educational strategies to reinforce protocolised antibiotic use are essential for reducing costs and antibiotic resistance rates.
Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Adulto , Antibioticoprofilaxia/economia , Redução de Custos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Nicarágua/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de TempoRESUMO
We conducted a prevalence study to gain greater insight into the aetiology, bacterial resistance and risk factors for community-acquired pneumonia (CAP) in the region of León, Nicaragua. During the period from July 2002 to January 2005, all consecutive patients with signs and symptoms suggestive of CAP were included in the study. Sputum samples, paired serum samples and urinary samples were collected for the detection of respiratory pathogens. The most frequently identified pathogens were Streptococcus pneumoniae (17%), followed by Staphylococcus aureus (5%), Chlamydia pneumoniae (5%) and Mycoplasma pneumoniae (4%). Pseudomonas aeruginosa was cultured from 5% of patients. No pathogens were identified in 55%. All tested S. pneumoniae were sensitive to erythromycin and penicillin. In contrast, resistance of S. aureus to penicillin and erythromycin was high.
Assuntos
Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana , Pneumonia Bacteriana/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Chlamydophila pneumoniae/efeitos dos fármacos , Chlamydophila pneumoniae/isolamento & purificação , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Estudos Transversais , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycoplasma pneumoniae/efeitos dos fármacos , Mycoplasma pneumoniae/isolamento & purificação , Nicarágua/epidemiologia , Oxacilina/farmacologia , Oxacilina/uso terapêutico , Penicilinas/farmacologia , Penicilinas/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/epidemiologia , Prevalência , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Escarro/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.
Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infecções Urinárias/microbiologia , Adulto , Amoxicilina/farmacologia , Amoxicilina/uso terapêutico , Cefalotina/farmacologia , Cefalotina/uso terapêutico , Combinação de Medicamentos , Farmacorresistência Bacteriana , Enterobacter/efeitos dos fármacos , Enterobacter/isolamento & purificação , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Humanos , Klebsiella/efeitos dos fármacos , Klebsiella/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Nicarágua , Piúria/microbiologia , Quinolonas/farmacologia , Quinolonas/uso terapêutico , Fatores de Risco , Sulfametizol/farmacologia , Sulfametizol/uso terapêutico , Trimetoprima/farmacologia , Trimetoprima/uso terapêutico , Doenças da Bexiga Urinária , Incontinência Urinária , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Urina/microbiologiaRESUMO
We evaluated plasma sulfur amino acid concentrations in children with short gut syndrome receiving home parenteral nutrition (n = 6). Cysteine HCl addition to solutions formulated with a pediatric amino acid product will increase plasma taurine concentrations to within the normal reference range.