RESUMO
Several studies from developed countries have documented the association between trimethoprim-sulfamethoxazole prophylaxis failure and mutations in the Pneumocystis jirovecii gene coding for dihydropteroate synthase (DHPS). DNA was extracted from Giemsa-stained smears of 70 patients with P. jirovecii pneumonia seen in Porto Alegre, Brazil, from 1997 to 2004. Successful PCR amplification of the DHPS locus was obtained in 57 of 70 cases (81.4%), including five cases (8.7%) that had used sulfa prophylaxis. No DHPS gene mutations were seen. These results suggest that DHPS mutations are currently as rare in Brazil as in other developing countries.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Síndrome da Imunodeficiência Adquirida/complicações , Di-Hidropteroato Sintase/genética , Pneumocystis carinii/efeitos dos fármacos , Pneumocystis carinii/enzimologia , Pneumonia por Pneumocystis/microbiologia , Sulfametizol/farmacologia , Trimetoprima/farmacologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Adulto , Idoso , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Brasil , Líquido da Lavagem Broncoalveolar/microbiologia , Combinação de Medicamentos , Farmacorresistência Fúngica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Pneumocystis carinii/genética , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/prevenção & controle , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Sulfametizol/uso terapêutico , Trimetoprima/uso terapêutico , Resistência a TrimetoprimaRESUMO
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/microbiologiaAssuntos
Países em Desenvolvimento , Resistência Microbiana a Medicamentos , Enterobacteriaceae/efeitos dos fármacos , África , Ásia , América Central , Cloranfenicol/farmacologia , Surtos de Doenças/epidemiologia , Combinação de Medicamentos/farmacologia , Disenteria Bacilar/tratamento farmacológico , Disenteria Bacilar/epidemiologia , Enterobacteriaceae/genética , Humanos , Fatores R/efeitos dos fármacos , Estreptomicina/farmacologia , Sulfametizol/farmacologia , Sulfonamidas/farmacologia , Tetraciclina/farmacologia , Trimetoprima/farmacologiaRESUMO
Resistance of Escherichia coli to trimethoprim (TMP)-sulfamethoxazole remains at 3%-8% at many medical centers within the United States. In this study a 44% resistance rate was observed among E. coli isolated at a pediatric hospital in Santiago, Chile, and a 40% resistance rate at a general teaching hospital in Bangkok, Thailand. Most isolates were from urinary tract infections and showed high-level resistance (minimal inhibitory concentration of TMP greater than 1,000 micrograms/ml). Nineteen of 35 isolates tested transferred resistance to TMP; most cotransferred resistance to streptomycin and sulfonamides. Dihydrofolate reductase type I was detected by gene probing in 14 of 35 strains. Subsequent investigations in Brazil, Honduras, and Costa Rica revealed that this high rate of resistance was not an isolated phenomenon.