RESUMO
Infectious keratitis is a sight-threatening condition that is usually an ocular emergency. The visual outcome depends on prompt and accurate clinical management as well as geographic and epidemiological awareness. We conducted a retrospective observational study to define the epidemiological and laboratory profile, as well as the clinical course of bacterial keratitis in a tertiary hospital in São Paulo over 21 years. Information about age, sex, predisposing factors, topical and surgical treatment, visual acuity, ulcers' classification, bacterioscopy, culture, and antibiotic sensitivity tests were collected. This study included 160 patients. The mean age was 65.1 ± 18.4 years and risk factors were identified in 83.1 % of the patients. Empirical topical fortified cephalosporin with an aminoglycoside or fourth-generation fluoroquinolone was curative for 66.2 % of the cases. The mean treatment duration was 22.5 ± 9 days. The mean variation of visual acuity was -0.25 logMAR, p < 0.001. Culture revealed 64 % of Gram-positive bacteria. All Gram-positive bacteria were sensitive to cephalothin, vancomycin, and quinolones. All Gram-negative bacteria were sensitive to gentamicin, tobramycin, amikacin, and ciprofloxacin. These findings reinforce the importance of prompt empirical treatment of severe corneal ulcers with a fortified cephalosporin and aminoglycoside or a fourth-generation fluoroquinolone as there are equally effective. Collected data was insufficient to evaluate resistance of ocular infections over time in this population.
Assuntos
Infecções Oculares Bacterianas , Ceratite , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Úlcera/tratamento farmacológico , Centros de Atenção Terciária , Brasil/epidemiologia , Ceratite/tratamento farmacológico , Ceratite/epidemiologia , Ceratite/microbiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/microbiologia , Antibacterianos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Bactérias Gram-Positivas , Cefalosporinas , Aminoglicosídeos/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Endophthalmitis is a serious infectious complication of cataract surgery, which may lead to vision loss. Aim: To evaluate the effectiveness of intracameral moxifloxacin in reducing endophthalmitis after cataract surgery in Chilean patients. MATERIAL AND METHODS: We reviewed all phacoemulsification surgeries performed between 2012 and 2020 at a public hospital. The use of intraoperative intracameral moxifloxacin and possible surgical complications were recorded. In patients with postoperative endophthalmitis, we reviewed their risk factors and clinical characteristics. RESULTS: In the study, 22,869 phacoemulsification surgeries were registered, with an annual average of 2,541. The use of prophylactic intracameral moxifloxacin started progressively in 2014. In 2018 it was used in 88% of the surgeries. Fifteen eyes evolved with postoperative endophthalmitis, but none of these surgeries used intracameral moxifloxacin. Five and seven cases occurred in 2012 and 2013, respectively. There was a trend favoring moxifloxacin use, as a preventive measure for endophthalmitis, but the difference between groups was not significant (p = 0.56). In the group with endophthalmitis, 33.3% of the eyes were from patients with type 2 diabetes mellitus, in 13.3% there was rupture of the posterior capsule and 60% of the eyes corresponded to female patients. Since 2018 there is no record of endophthalmitis after cataract surgery performed in this center. Conclusions: Intracameral moxifloxacin showed a tendency to reduce the frequency of endophthalmitis after phacoemulsification surgery, but a longer observation period is required to reach statistical significance, due to the low frequency of this complication.
Assuntos
Humanos , Catarata/tratamento farmacológico , Endoftalmite/etiologia , Endoftalmite/prevenção & controle , Endoftalmite/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Antibioticoprofilaxia , Fluoroquinolonas/uso terapêutico , Moxifloxacina , Antibacterianos/uso terapêuticoAssuntos
Catarata , Endoftalmite , Humanos , Moxifloxacina , Antibacterianos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Catarata/tratamento farmacológico , Endoftalmite/etiologia , Endoftalmite/prevenção & controle , Endoftalmite/tratamento farmacológico , Antibioticoprofilaxia , Complicações Pós-Operatórias/prevenção & controleRESUMO
The increase in bacterial resistance to available antibiotics has driven several researchers to search for new agents with therapeutic properties. Diosgenin is a naturally occurring steroidal saponin that has demonstrated several pharmacological properties. In the present study, we report the antimicrobial activity of diosgenin against the standard and multidrug-resistant bacteria of Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus, in addition to the efflux pump inhibitory activity against Staphylococcus aureus strains carrying NorA and MepA pumps. For this purpose, the broth microdilution method was used, from which the value of the Minimum Inhibitory Concentration (MIC) was obtained, and this was associated with subinhibitory concentration (MIC/8) with antibiotic of clinical use and ethidium bromide for strains carrier by efflux pump. Diosgenin showed antimicrobial activity for standard S. aureus bacteria and potentiating activity in association with gentamicin and ampicillin for P. aeruginosa multidrug-resistant bacteria, it also showed potentiation in association with norfloxacin against the E. coli strain and gentamicin against the S. aureus strain. Antimicrobial activity against efflux pump-bearing strains revealed that saponin did not interfere with the efflux pump mechanism or intervened antagonistically. Thus, saponin has shown to be very promising against bacterial resistance in association with aminoglycoside, fluoroquinolones and beta-lactam, however additional studies should be carried out to better elucidate the mechanism of action of diosgenin.
Assuntos
Diosgenina , Saponinas , Infecções Estafilocócicas , Aminoglicosídeos/uso terapêutico , Ampicilina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Proteínas de Bactérias , Diosgenina/farmacologia , Diosgenina/uso terapêutico , Escherichia coli/metabolismo , Etídio/farmacologia , Etídio/uso terapêutico , Fluoroquinolonas/farmacologia , Fluoroquinolonas/uso terapêutico , Gentamicinas , Humanos , Testes de Sensibilidade Microbiana , Proteínas Associadas à Resistência a Múltiplos Medicamentos , Norfloxacino/farmacologia , Norfloxacino/uso terapêutico , Saponinas/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/metabolismo , beta-Lactamas/uso terapêuticoRESUMO
OBJECTIVES: To develop a simple DNA sequencing test for simultaneous identification and antimicrobial resistance (AMR) detection of multiple sexually transmitted infections (STIs). METHODS: Real-time PCR (qPCR) was initially performed to identify Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Trichomonas vaginalis (TV) infections among a total of 200 vulvo-vaginal swab samples from female sex workers in Ecuador. qPCR positive samples plus qPCR negative controls for these STIs were subjected to single gene targeted PCR MinION-nanopore sequencing using the smartphone operated MinIT. RESULTS: Among 200 vulvo-vaginal swab samples 43 were qPCR positive for at least one of the STIs. Single gene targeted nanopore sequencing generally yielded higher pathogen specific read counts in qPCR positive samples than qPCR negative controls. Of the 26 CT, NG or MG infections identified by qPCR, 25 were clearly distinguishable from qPCR negative controls by read count. Discrimination of TV qPCR positives from qPCR negative controls was poorer as many had low pathogen loads (qPCR cycle threshold >35) which produced few specific reads. Real-time AMR profiling revealed that 3/3 NG samples identified had gyrA mutations associated with fluoroquinolone resistance, 2/10 of TV had mutations related to metronidazole resistance, while none of the MG samples possessed 23S rRNA gene mutations contributing to macrolide resistance. CONCLUSIONS: Single gene targeted nanopore sequencing for diagnosing and simultaneously identifying key antimicrobial resistance markers for four common genital STIs shows promise. Further work to optimise accuracy, reduce costs and improve speed may allow sustainable approaches for managing STIs and emerging AMR in resource poor and laboratory limited settings.
Assuntos
Farmacorresistência Bacteriana/genética , Mycoplasma genitalium/genética , Neisseria gonorrhoeae/genética , Infecções Sexualmente Transmissíveis/diagnóstico , Trichomonas vaginalis/genética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , DNA Girase/genética , Equador , Feminino , Fluoroquinolonas/farmacologia , Fluoroquinolonas/uso terapêutico , Humanos , Macrolídeos/farmacologia , Mycoplasma genitalium/efeitos dos fármacos , Mycoplasma genitalium/isolamento & purificação , Sequenciamento por Nanoporos , Neisseria gonorrhoeae/efeitos dos fármacos , Neisseria gonorrhoeae/isolamento & purificação , RNA Ribossômico 23S/química , RNA Ribossômico 23S/genética , RNA Ribossômico 23S/metabolismo , Reação em Cadeia da Polimerase em Tempo Real , Profissionais do Sexo , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Infecções Sexualmente Transmissíveis/microbiologia , Trichomonas vaginalis/efeitos dos fármacos , Trichomonas vaginalis/isolamento & purificação , Vagina/microbiologiaRESUMO
The adjunctive use of fluoroquinolone (FQ) agents in patients with periodontitis produces contradictory results. There has been no meta-analysis performed based on the evaluations of FQ use that would enable making appropriate clinical decisions. Our study aimed to evaluate, via a systematic review and metaanalysis conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, the clinical benefits, antimicrobial effects and safety profiles of the FQ agents administered to periodontitis patients under a conventional treatment regime. Relevant databases were searched for studies published up to May 2020, with the quality and risk of bias evaluations performed on the selected studies, and meta-analyses, funnel plots and heterogeneity tests carried out based on the obtained data. Any finding of p-value less than 0.05 was considered statistically significant. Quality and the risk of bias ranged from high to low. With acceptable heterogeneity and no reporting bias, the meta-analyses showed that local or systemic FQ use produced the following results: a reduced probing depth change (ΔPD) (p < 0.00001 at ≤3 months); reduced bleeding on probing (BOP) (p < 0.00001 at 3-6 months); reduced subgingival detection of Aggregatibacter actinomycetemcomitans for up to 12 months (p-values from <0.00001 to 0.001); and an insignificant number of adverse events (p ≥ 0.05) in patients subjected to a conventional therapy as compared to those subjected to an antibiotic-free therapy. Our study found evidence to show that FQ administration provides clinical benefits and ensures antibacterial effects in periodontitis patients subjected to a conventional therapy regime.
Assuntos
Fluoroquinolonas , Periodontite , Antibacterianos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Humanos , Periodontite/tratamento farmacológicoRESUMO
To evaluate the prognostic factors in adult cancer patients with pneumococcal bacteremia, describe episode features and the phenotypic characteristics of the isolated strains. We evaluated the episodes in patients admitted to a cancer hospital between 2009 and 2015. The outcomes were defined as 48 h mortality and mortality within 10 days after the episode. The variables evaluated were: age, sex, ethnicity, ECOG, Karnofsky score, SOFA, cancer type, metastasis, chemotherapy, radiotherapy, neutropenia, previous antibiotic therapy, community or healthcare-acquired infection, comorbidities, smoking, pneumococcal vaccination, infection site, presence of fever, polymicrobial infection, antimicrobial susceptibility, serotype and treatment. 165 episodes were detected in 161 patients. The mean age was 61.3 years; solid tumors were the most prevalent (75%). 48 h and 10-day mortality were 21% (34/161) and 43% (70/161) respectively. The 48 h mortality- associated risk factors were SOFA and polymicrobial bacteremia; 10-day mortality-associated risk factors were fever, neutropenia, ECOG 3/4, SOFA and fluoroquinolones as a protective factor. Pneumococcal bacteremia presented high mortality in cancer patients, with prognosis related to intrinsic host factors and infection episodes features. Fluoroquinolone treatment, a protective factor in 10-day mortality, has potential use for IPDs and severe community-acquired pneumonia in cancer patients.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/mortalidade , Fluoroquinolonas/uso terapêutico , Neoplasias/complicações , Infecções Pneumocócicas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/microbiologia , Estudos Retrospectivos , Streptococcus pneumoniaeRESUMO
BACKGROUND: The spread of ß-lactam-resistant Gram-negative bacilli (GNB) is a topic of worldwide concern; however, knowledge about colonization by these bacteria in haemodialysis patients is limited. AIM: To analyse the dynamics and factors associated with colonization by ß-lactam-resistant GNB in a dialysis centre. METHODS: A longitudinal study was conducted. Stool samples were collected for each patient to evaluate extended-spectrum ß-lactamase (ESBL)- and carbapenemase-producing Gram-negative bacilli. Colonization screens were performed at three time-points and then classified as absent, intermittent, or persistent. Molecular typing included enterobacterial repetitive intergenic consensus (ERIC)-polymerase chain reaction, pulsed-field gel electrophoresis (PFGE), and multi-locus sequence typing (MLST). Clinical information was obtained from medical records and personal interview. A generalized estimating equations model was performed to determinate factors associated with the colonization. FINDINGS: A total of 210 patients were included. ESBL-producing and carbapenem-resistant GNB colonization reached 41.2% and 11.5%, respectively. Most patients were intermittent carriers with frequencies of 73.9% and 92.95% for each bacteria group. The most frequent ESBL was CTX-M-G1, while the most common carbapenemase was KPC. ERIC-PCR and PFGE revealed high genetic diversity among strains and the Escherichia coli clone ST131 was the most important by MLST. Fluoroquinolone use (odds ratio: 3.13; 95% confidence interval: 1.03-9.44; P [cap] = 0.043) and chronic obstructive lung disease (odds ratio: 3.53; 1.42-8.74; P = 0.006) were associated with ESBL-producing GNB colonization. CONCLUSION: Our findings indicate a high intermittent colonization by diverse clones of ß-lactam-resistant GNB in haemodialysis patients. It suggests excessive antibiotic pressure that favours the acquisition of bacteria with diverse genetic profiles and different transmission sources.
Assuntos
Antibacterianos , Infecções por Bactérias Gram-Negativas , Diálise Renal , Resistência beta-Lactâmica , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , Células Clonais , Fluoroquinolonas/uso terapêutico , Infecções por Bactérias Gram-Negativas/classificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Estudos Longitudinais , Tipagem de Sequências Multilocus , beta-Lactamases , beta-LactamasRESUMO
Introduction: There is evidence of the indiscriminate use of antibiotics for different pathologies. Objective: To determine the prescription patterns and indications for the use of fluoroquinolones in a group of outpatients in Colombia. Materials and methods: We conducted a descriptive pharmaco-epidemiological study on prescription-indication using a population database where patients with outpatient fluoroquinolone prescriptions were included from May to October, 2018. We obtained the information on sociodemographic, pharmacological, and clinical variables, as well as on the diagnosis according to the International Classification of Diseases, version 10, and we established if the use was approved by the regulatory agencies or if it was off-label. Results: A total of 23,373 patients were identified who were using fluoroquinolones; their mean age was 47.9 ± 18.1 years and women predominated (n=15,767, 67.5%). Ciprofloxacin was the medication most commonly prescribed (n=19,328, 82.7%), followed by norfloxacin (n=3076, 13.2%), levofloxacin (n=573, 2.5%), and moxifloxacin (n=394; 1.7%). The main indications were urinary tract infection in unspecified site (n=10,777, 46.1%), diarrhea and gastroenteritis of presumed infectious origin (n=3077, 13.2%), and acute cystitis (n=956; 4.2%). The prescriptions followed approved indications in 76% (n=17,759) of cases while the rest were used off-label or without indication for nasopharyngitis or soft-tissue infections, for example. Being male (OR=1.26, 95%CI:1.18-1.34) and under 35 years of age (OR=1.92, 95%CI:1.48-1.50) were associated with a greater probability of using fluoroquinolones in unapproved indications. Conclusions: Fluoroquinolones, particularly ciprofloxacin, are being prescribed especially to women with urinary tract infections, but up to a quarter of the patients received them for unapproved indications by regulatory agencies.
Introducción. Existen evidencias sobre el uso indiscriminado de antibióticos en el tratamiento de diversas enfermedades. Objetivo. Determinar los patrones de prescripción y de indicaciones de uso de las fluoroquinolonas en un grupo de pacientes ambulatorios en Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo farmacoepidemiológico del tipo de prescripción e indicaciones de uso a partir de una base de datos poblacionales que incluía pacientes con prescripciones ambulatorias de fluoroquinolonas entre mayo y octubre de 2018. Se recabó la información sobre las variables sociodemográficas, farmacológicas y clínicas (diagnóstico según la Clasificación Internacional de Enfermedades, versión 10) y se estableció la proporción del uso de fluoroquinolonas en indicaciones aprobadas y no aprobadas por las agencias reguladoras. Resultados. Se identificaron 23.373 pacientes que habían recibido fluoroquinolonas; su edad media era de 47,9 ± 18,1 años y 15.767 eran mujeres (67,5 %). La ciprofloxacina fue el medicamento más prescrito (n=19.328; 82,7 %), seguida de la norfloxacina (n=3.076; 13,2 %), la levofloxacina (n=573; 2,5 %) y la moxifloxacina (n=394; 1,7 %). Las principales indicaciones fueron la infección de las vías urinarias en sitio no especificado (n=10.777; 46,1 %), la diarrea y la gastroenteritis de presunto origen infeccioso (n=3.077, 13,2 %) y la cistitis aguda (n=956; 4,2 %). El 76 % (n=17.759) de las prescripciones correspondía a indicaciones aprobadas y el resto a usos no aprobados, como la rinofaringits o las infecciones de tejidos blandos. El ser hombre (odds ratio, OR=1,26; IC95%: 1,18-1,34) y tener menos de 35 años (OR=1,92; IC95%:1,48-1,50) se asociaron con una mayor probabilidad de uso de fluoroquinolonas en indicaciones no aprobadas. Conclusión. Las fluoroquinolonas, en particular la ciprofloxacina, se están prescribiendo especialmente a mujeres con infecciones de las vías urinarias, pero hasta la cuarta parte de los pacientes las recibieron para usos no aprobados por las agencias reguladoras.