RESUMO
Prosthetic valve infective endocarditis represents a defined pathological entity which follows an epidemiological and nosological pattern in accordance to an arbitrary classification. Chronologically it is divided into the entities of early and late prosthetic valve endocarditis, each with its own unique characteristics. The clinical features, complications and diagnosis do not vary much from native valve endocarditis. There are clear and precise indications to aid in the diagnosis and treatment of this entity which differ from native valve endocarditis.
Assuntos
Valva Aórtica , Endocardite Bacteriana/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Ecocardiografia , Ecocardiografia Transesofagiana , Eletrocardiografia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Fatores de Risco , Fatores de TempoRESUMO
Infections in the elderly patient are a challenge, since the classical signs of infection are absent or ill defined. The present paper describes the presentation, diagnosis, clinical manifestations and treatment for a selected group of potential serious infections including influenza, bacterial pneumonia, urinary tract infections as well as infections caused by multiresistant bacteria, like vacomycin-resistant enterococcus and methicillin resistant S. aureus. We conclude with the need for prevention in the older person with the use of vaccines, specifically the influenza and pneumococcal vaccine as well as the prevention of urinary infections. Influenza is a significant cause of morbidity, whose ill effects can be prevented in many older persons with the use of a vaccine. The use in prophylaxis and treatment of antiviral agents like amantadine, rimatadine, and oseltamivir is presented. Bacterial pneumonia is one of the leading causes of death in the USA among the older persons. The emergence of drug resistant Streptococcus pneumoniae leads to the consideration as empiric therapy the newer fluoroquinolones or the use of third or fourth generation cephalosporis. Of importance is the use of pneumococcal vaccine among people age 60 or above. The frequency of urinary tract infections among the elderly is of primary although in many instances important do not require treatment. When infection of the urinary tract is diagnosed, most authors use a fluoroquinolone as empiric theraphy. The emergence of multiresistant bacteria like methicillin resistant S. aureus and or vancomycin resistant enterococci leads to the need to consider new agents like quinipristin-dalfopristin, linezolid and deptomycin in the management of such patients.
Assuntos
Influenza Humana , Pneumonia Bacteriana , Infecções Urinárias , Fatores Etários , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/diagnóstico , Influenza Humana/prevenção & controle , Influenza Humana/terapia , Pessoa de Meia-Idade , Vacinas Pneumocócicas/administração & dosagem , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/prevenção & controle , Pneumonia Bacteriana/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/prevenção & controle , Infecções Urinárias/terapiaRESUMO
Antibiotics are frequently prescribed in the older person, the dosification needs special care, since the pharmacokinetic parameters changes with aging and the side effects can be different in the older person. The creatinine clearance changes and we must modify the way we prescribe such antibiotics to the elderly, calculating. The variety of antibiotics now available led us to consider this paper in which we have presented the antimicrobial agents that can be considered in the treatment of the older person. We present several groups: the penicillins, cephalosporins, monobactams, carbapenems and betalactamase inhibitors or the great betalactam group. Other trimetroprin-sulfame-thoxazole, the newer macrolides (azithromycin and clarithromycin) as well as the aminoglycosides, vancomycin, clindamycin, metroridazole. The indications and contraindications are presented and reviewed.
Assuntos
Antibacterianos/uso terapêutico , Fatores Etários , Idoso , Aminoglicosídeos/administração & dosagem , Aminoglicosídeos/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Anti-Infecciosos Urinários/administração & dosagem , Anti-Infecciosos Urinários/uso terapêutico , Carbapenêmicos/administração & dosagem , Carbapenêmicos/uso terapêutico , Cefalosporinas/administração & dosagem , Cefalosporinas/uso terapêutico , Interações Medicamentosas , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/uso terapêutico , Humanos , Macrolídeos/administração & dosagem , Macrolídeos/uso terapêutico , Monobactamas/administração & dosagem , Monobactamas/uso terapêutico , Penicilinas/administração & dosagem , Penicilinas/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Inibidores de beta-LactamasesRESUMO
Extended-spectrum Beta (beta)-lactamases (ESBLs) have emerged as an important mechanism of resistance to B-lactam antibiotics in gram-negative bacteria (GNB). They are enzymes that hydrolyze older B-lactam antibiotics as well as broad-spectrum cephalosporins and monobactams. ESBL producers have been reported in many bacteria but special attention has been paid to the ones in E.coli and Klebsiella spp. Detection of the ESBLs by the clinical laboratory is a special challenge. Surveillance to monitor resistance is important to decide when detection of ESBLs must be started. This study determined the prevalence of ESBL producers in the strains E.coli and K.pneumoniae at the San Juan VA Medical Center, and characterized their phenotypes to evaluate the importance to identify these bacteria as a standard routine procedure in the institution. All E.coli and K.pneumoniae isolated from Jan 1 to Mar 31, 2003 were evaluated according to National Committee for Clinical Laboratory Standards (NCCLS) screening criteria for suspected ESBL producers. Phenotypic confirmation of the ESBL production was performed using the Etest method. A total of 112/253 (44%) E.coli and 72/137 (53%) K.pneumoniae were identified as suspected ESBL producers. Etest was performed in 60% of the E.coli and 57% of the K.pneumoniae suspected to be ESBL producers. The overall ESBL prevalence for E.coli was 25% and in K.pneumoniae was 26%. Most E.coli ESBL-producers were from urine while the K.pneumoniae were from sputum. ESBL-producers were isolated from different sources including pleural and synovial fluids, blood, and skin besides urine and sputum. According to susceptibility results, the most reliable antibiotic in predicting a negative ESBL was cefpodoxime (CPD), and in the strains studied, the ESBL producers were consistently resistant to aztreonam (ATM). A large proportion (95%) of ESBL producing K.pneumoniae were susceptible to cefepime (CEP). Of the ESBL producing E.coli, 24% were susceptible. In the case of E.coli ESBLproducers, Cefepime can be considered as a therapeutic option if susceptibilities are available. Automated identification and sensitivity systems are valid alternatives for routine evaluation of B-lactam resistance but when increased resistance is documented in GNB and/or ESBL prevalence is high, ESBL detection should be performed. All confirmed ESBL producers should be reported resistant to all penicillins, cephalosporins, and aztreonam in spite of having susceptible ranges with routine susceptibility tests. Inappropriate antibiotic selection in infections caused by these organisms is associated with treatment failures, poor clinical outcomes, increased mortality and longer hospital stays.
Assuntos
Infecções por Escherichia coli/microbiologia , Escherichia coli/enzimologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/análise , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Hospitais de Veteranos/estatística & dados numéricos , Humanos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Fenótipo , Porto Rico , Resistência beta-Lactâmica , beta-Lactamas/uso terapêuticoRESUMO
Infections in the older person are common and a significant cause of morbidity and mortality. Infections of the urinary tract, skin and soft tissue infections including decubitus ulcers, antibiotics associated diarrhea and lower respiratory tract infections are particularly important in the elderly because of their frequency. While most initial antibiotic therapy is empiric, its important before treatment to try to document the etiology for better use of antibiotics. Infections of the urinary tract are frequently and potentially serious in the elderly, they must be separated from asymptomatic bacteriuria that requires no therapy. Upper and lower urinary tract infections are frequently caused by aerobic gram negative bacilli and or enterococci. Most authors prefer the use of fluoroquinolones to manage such infections. The elderly with decubitus ulcer presents a problem in management, since these are frequent polymicrobic infections in which anaerobes play an important role. The initial therapy usually involves the combination of a fluoroquinolone plus an antianaerobic agent like clindamycin. C. difficile diarrhea as frequent in nursing home residents as well as the older person with prior antibiotics. The treatment should be with metronidazole and avoid the use of vancomycin. Pneumonias in the elderly can be acquired in the community, the nursing home or during a hospitalization. The etiologic agents that predominate change from S. pneumoniae and atypicals in those from the community to an increase in gram negative pneumonia. The initial treatment as started by most authors as well as guidelines include the use of a new fluoroquinolone like gatifloxacin alone or in combination with a beta-lactamic agent like ceftriaxone. For those infections acquired in the hospital therapy with third or fourth generation cephalosporins, carbapenems, beta-lactams with betalactamase inhibitors alone or in combination with an aminoglucoside and or vancomycin if MRSA is suspected is accepted therapy.
Assuntos
Anti-Infecciosos/uso terapêutico , Pneumonia/tratamento farmacológico , Úlcera por Pressão/tratamento farmacológico , Dermatopatias Infecciosas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Idoso , Humanos , Pneumonia/diagnóstico , Pneumonia/microbiologia , Úlcera por Pressão/diagnóstico , Úlcera por Pressão/microbiologia , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/microbiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/microbiologiaRESUMO
After almost forty years of its introduction, erythromycin will not be the exclusive member of the macrolide group of antibiotic agents, but a new generation of its derivatives which surpass it in pharmacological properties and clinical efficacy will also be available. Clarithromycin, a 14-membered derivative, has shown acid stability, longer half-life, lower protein binding and higher lung tissue penetration. Its exceedingly high activity against erythromycin-susceptible gram-positive cocci, Mycoplasma pneumoniae, and Legionella pneumophila makes it and important alternative choice in the therapy of respiratory tract infections. Also, it has shown high activity against Chlamydia trachomatis, and high urinary clearance of this unmetabolized molecule, important properties which would render it a special role in the treatment of genitourinary tract infections. Azithromycin, a 15-membered derivative has shown enhanced basicity (due to the nitrogen atom in its lactone ring), longer half-life and lower protein bindings. Its exceptional activity against Hemophilus influenzae, Branhamella catarrhalis, Neisseria gonorrhoeae, Ureaplasma urealyticum and gram-negative bacteria, and its high concentration in tonsillar, pulmonary, prostatic and female reproductive tract tissues, assigns it an honorific place among the macrolides in the therapy against respiratory tract and genitourinary tract infections. Its role against T. gondii deserves further study, but points out this agent as a promise against this parasite
Assuntos
Humanos , Antibacterianos/uso terapêutico , Antibacterianos/efeitos adversos , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Interações Medicamentosas , Testes de Sensibilidade Microbiana , Resistência Microbiana a MedicamentosRESUMO
We have presented the microbiology, pathogenesis, clinical presentation, diagnosis and treatment of disseminated histoplasmosis. Emphasis is presented on the manifestations in the HIV infected patient
Assuntos
Humanos , Histoplasmose , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Histoplasmose/epidemiologia , Histoplasmose/etiologiaRESUMO
Las personas infectadas por el virus immunodeficiencia humana frecuentemente tienen manifestaciones clínicas de disfunción del sistema nervioso central. Esto puede ser envolvimiento primario o procesos secundários como infecciones o tumores. El trabajo que presentamos es un resumen corto de las manifestaciones radiológicas de afectación del sistema nervioso central en pacientes con SIDA según se ve en CT o MRI. Incluimos los hallazgos radiológicos de encefalitis por HIV-1, toxoplasmosis, linfoma primario del SNC, cryptococcosis, histoplasmosis, encefalitis por CMV, virus de herpes y varicella. Esperamos que este trabajo ayude en el manejo del paciente con SIDA
Assuntos
Humanos , Sistema Nervoso Central , Doenças do Sistema Nervoso Central/diagnóstico , Imageamento por Ressonância Magnética , Síndrome da Imunodeficiência Adquirida/diagnóstico , Tomógrafos Computadorizados , Sistema Nervoso Central/patologia , Doenças do Sistema Nervoso Central/complicações , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Síndrome da Imunodeficiência Adquirida/complicaçõesRESUMO
El absceso piogénico del hígado es una condición asociada con complicaciones serias en un 10 a 20% de los casos. Endoftalmitis bacteriana por embolización sépticas es una de las complicaciones raras asociadas a abscesos hepáticos. A pesar del tratamiento apropiado, las consecuencias de esta condición son devastadoras en la mayor parte de los casos. En este informe presentamos la etiología de endoftalmitis, su diagnóstico y su tratamiento
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Hepático/complicações , Bacteriemia/etiologia , Endoftalmite/etiologia , Infecções por Klebsiella/complicações , Klebsiella pneumoniae , Abscesso Hepático/microbiologia , Abscesso Hepático/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Quimioterapia Combinada , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/isolamento & purificaçãoRESUMO
Se presenta la escrofulosis desde una perspectiva histórica recalcando su importancia en la era de infección por el VIH. Se repasa la epidemiología de esta enfermedad micobacteriana y el rol de las micobacterias no tuberculosas y M. tuberculosis. Se discuten las alternativas diagnósticas y terapéuticas