RESUMO
We assessed the effect of a double concentration of supplemental polymyxin B, amphotericin B, nalidixic acid, trimethoprim and azlocillin (PANTA) added to the Mycobacterial Growth Indicator Tube (MGIT) on contamination and positivity rates in 216 sputum cultures. Contamination rates were respectively 12.9% and 5.5% for samples processed using standard and double PANTA concentrations (P = 0.0001, McNemar's test). Thirty-five per cent of cultures performed using standard PANTA and 36.5% of those performed using two-fold PANTA concentrations were positive for Mycobacterium tuberculosis, compared to 25.9% of cultures inoculated on Ogawa medium. These results suggest that the use of MGIT with 2× PANTA may be useful in reducing culture contamination without reducing the diagnostic yield.
Assuntos
Antibacterianos/farmacologia , Técnicas Bacteriológicas/instrumentação , Equipamentos Descartáveis/microbiologia , Contaminação de Equipamentos/prevenção & controle , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Anfotericina B/farmacologia , Azlocilina/farmacologia , Meios de Cultura , Relação Dose-Resposta a Droga , Humanos , Mycobacterium tuberculosis/crescimento & desenvolvimento , Ácido Nalidíxico/farmacologia , Polimixina B/farmacologia , Valor Preditivo dos Testes , Estudos Prospectivos , Trimetoprima/farmacologia , Tuberculose Pulmonar/microbiologiaRESUMO
A case of meningoencephalitis of bacterial etiology caused by Pseudomonas cepacia was described. The strain was received at the Reference Laboratory of Bacterial Acute Respiratory Infections of "Pedro Kouri" Institute of Tropical Medicine, where its microbiological identification was confirmed. This isolation was a finding in an adult immunocompetent patient. The evolution was favourable with no sequelae for his future life. Pseudomona cepacia has been associated with respiratory infections in patients with cystic fibrosis. Patients with Pseudomonas cepacia may be asymptomatic or present fatal acute and fulminant infection.
Assuntos
Infecções por Burkholderia/microbiologia , Burkholderia cepacia/isolamento & purificação , Infecções Comunitárias Adquiridas/microbiologia , Meningoencefalite/microbiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Azlocilina/farmacologia , Aztreonam/uso terapêutico , Burkholderia cepacia/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Ticarcilina/farmacologiaRESUMO
Meningitis caused by gram-negative bacilli increased since the 1970, with a higher incidence in small children. Within this group of infections, the meningitis caused by Pseudomonas sp is rare. The case of a 54-year-old patient with a clinical picture of meningitis is reported. Pseudomonas aeruginosa was isolated from the cerebrospinal fluid. The meningitis caused by Pseudomonas aeruginosa should be taken into consideration because of the severity of the clinical picture and the high mortality and increasing strain resistance.
Assuntos
Meningites Bacterianas , Infecções por Pseudomonas , Pseudomonas aeruginosa/efeitos dos fármacos , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Azlocilina/farmacologia , Carbenicilina/farmacologia , Ceftriaxona/administração & dosagem , Ceftriaxona/farmacologia , Ceftriaxona/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Infecções Comunitárias Adquiridas , Farmacorresistência Bacteriana Múltipla , Gentamicinas/farmacologia , Humanos , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Ticarcilina/farmacologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the effectiveness of combined therapy with azlocillin and amikacin in a group of neonates with sepsis caused by multiresistant staphylococci who were hospitalized in the neonatal intensive care unit of Hospital Ginecobstétrico "America Arias" in Havana, Cuba, from 1998 to 2000. METHODS: A retrospective study was carried out of the clinical and laboratory results obtained in 15 patients with sepsis caused by multiresistant staphylococci who received combined therapy with azlocillin and amikacin, according to hospital guidelines on the use of antibiotics. We used a broth microdilution method to study the patterns of resistance shown by isolated strains to 10 of the antibiotics in use. In vitro synergy tests, specifically the checkerboard technique with microtitration plates, were used to observe the effects of treatment in 8 patients. RESULTS: Twelve coagulase-negative staphylococci and three Staphylococcus aureus isolates showed five different patterns of resistance on the basis of their sensitivity to oxacillin, three aminoglycosides, and vancomycin. Six of the synergy tests showed a considerable synergistic effect, with an average three-fold reduction in the minimum inhibitory concentrations (MIC) of the two antibiotics used to treat the patients. No antagonistic effects were noted, and the combined antibiotics showed an overall clinical effectiveness of 91.7%. CONCLUSIONS: The test showed that the therapeutic combination used was effective, but further studies are needed before conclusive results are obtained.
Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Azlocilina/uso terapêutico , Sepse/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus/efeitos dos fármacos , Amicacina/administração & dosagem , Amicacina/farmacologia , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Azlocilina/administração & dosagem , Azlocilina/farmacologia , Farmacorresistência Bacteriana Múltipla , Sinergismo Farmacológico , Quimioterapia Combinada/uso terapêutico , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Testes de Sensibilidade Microbiana , Modelos Teóricos , Estudos Retrospectivos , Staphylococcus aureus/efeitos dos fármacosRESUMO
Compared with previously available penicillins, piperacillin, azlocillin, and mezlocillin have increased activity in vitro against gram-negative bacilli. After intravenous administration of conventional doses (50 to 100 mg/kg) in children, peak concentrations of these drugs are approximately 70 to 350 micrograms/ml. For piperacillin, azlocillin, and mezlocillin, the half-lives during the beta elimination phase (t 1/2 beta) are approximately 0.5 to 0.75, 0.8 to 1.7, and 0.8 to 1.0 hours, respectively. In patients receiving the higher dosage, particularly of azlocillin, the t 1/2 beta may be prolonged by approximately 20%. A total daily dosage of 300 mg/kg or 9 gm/m2 given in four to six divided dosages should produce peak concentrations of approximately 150 micrograms/ml, and concentrations greater than 16 micrograms/ml for at least 2 hours after each administration. Lower daily dosages are needed in neonates, but precise dosage recommendations cannot be made at this time. Only approximately 60% of piperacillin and approximately 45% of azlocillin are eliminated unchanged in the urine; thus only modest dosage reductions are needed in patients with decreased renal function. In children, adverse effects have been infrequent.