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Pesquisa : G06.099.225.500 [Categoria DeCS]
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Id: biblio-1283476
Autor: Lopardo, H.
Título: Sensibilidad disminuida a los antibóticos Beta-Lactamicos en estreptococos Beta-Hemolíticos / Decreased sensitivity to beta-lactam antibiotics in beta-hemolytic streptococci
Fonte: Med. infant;28(1):38-42, Marzo 2021. Tab.
Idioma: es.
Resumo: Últimamente, se están detectando mutaciones en las proteínas ligadoras de penicilina (PBP) de los estreptococos beta-hemolíticos que corresponden a sitios que en Streptococcus pneumoniae han determinado sensibilidad disminuida a los antibióticos beta-lactámicos. Primero, se describieron cepas con sensibilidad intermedia a penicilina en Streptococcus agalactiae (estreptococos del grupo B), luego en Streptococcus dysgalactiae subsp. equisimilis (mayormente grupos C y G) y, más recientemente, cepas con sensibilidad disminuida a aminopenicilinas y cefalosporinas de tercera generación en Streptococcus pyogenes (grupo A). El costo biológico de estas modificaciones nos permite pensar que los niveles de resistencia no han de ser tan elevados como para comprometer por ahora la efectividad clínica de los beta-lactámicos (AU)

Recently, mutations in penicillin-binding proteins (PBPs) of beta-hemolytic streptococci have been detected corresponding to sites that in Streptococcus pneumoniae have been determined to have decreased sensitivity to beta-lactam antibiotics. First, strains with intermediate sensitivity to penicillin were described in Streptococcus agalactiae (group B streptococci), subsequently in Streptococcus dysgalactiae subsp. equisimilis (mainly groups C and G) and, more recently, strains with decreased sensitivity to third-generation aminopenicillins and cephalosporins were found in Streptococcus pyogenes (group A). The biological cost of these modifications suggests that, for now, resistance levels are not high enough to compromise the clinical effectiveness of beta-lactams (AU)
Descritores: Streptococcus agalactiae/efeitos dos fármacos
Streptococcus pyogenes/efeitos dos fármacos
Resistência às Penicilinas
Testes de Sensibilidade Microbiana
Resistência beta-Lactâmica
beta-Lactamas/farmacologia
Antibacterianos/farmacologia
Responsável: AR305.1 - SID - Servicio de Información y Documentación


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Id: biblio-1255089
Autor: Santos, Gabriel de Oliveira; Teixeira, Renato Silva.
Título: Detection of carbapenem hydrolyzing enzyme and extendedspectrum beta-lactamase in clinical isolates of Enterobacteriaceae and Pseudomonaceae / Detecção de enzimas hidrolizantes de carbapenemas e beta-lactamases de espectro estendido em isolados clínicos de Enterobacteriaceae e Pseudomonaceae
Fonte: Rev. bras. anal. clin;52(3):235-237, 20200930. tab.
Idioma: en.
Resumo: Objective: Characterize isolates of enterobacterias and pseudomonas based on their resistance to the antibiotics. Methods: This study was conducted with 44 samples from various species from the Enterobacteriaceae and Pseudomonaceae family and they were submitted to the Modified Hodge Test and Extended Spectrum Beta-Lactamase (ESBL) test. Results: From the 44 analyzed samples nine produced ESBL and ten produced some kind of carbapenemase. Conclusion: In total, 38,6% of the samples showed an increased in the incidence of this resistance in the last few years given that before 2001 there was not a single carbapenemase described. This fact alarms patients immunosuppressed or hospitalized since they colonize our digestive tract and can cause an infection given the opportunity.

Objetivo: Caracterizar isolados de enterobactérias e pseudomonas em relação a sua resistência aos antimicrobianos. Métodos: O estudo foi realizado com 44 amostras de várias espécies das famílias Enterobacteriaceae e Pseudomonaceae, as quais foram submetidas aos testes de Hodge Modificado e Beta-Lactamase de Espectro Estendido (ESBL). Resultados: Das 44 amostras analisadas nove são produtoras de ESBL e dez são produtoras de carbapenemase. Conclusão: No total, 38,6% das amostras apresentaram algum tipo de resistência às ESBL e carbapenemases, e esse número mostra um aumento na incidência dessas resistências nos últimos anos já que, antes de 2001, não haviam sido descritas as enzimas car­­­ba­­­penemases. Esse fato é alarmante para pacientes imunossuprimidos ou hospitalizados uma vez que as enterobactérias colonizam nosso trato digestivo e podem causar uma infecção se dada a oportunidade.
Descritores: Pseudomonas
Resistência beta-Lactâmica
Enterobacteriaceae
Enterobacteriáceas Resistentes a Carbapenêmicos
Limites: Humanos
Responsável: BR408.1 - Biblioteca da Faculdade de Medicina - BFM


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Id: biblio-899774
Autor: Galindo-Méndez, Mario.
Título: Caracterización molecular y patrón de susceptibilidad antimicrobiana de Escherichia coli productora de β -lactamasas de espectro extendido en infección del tracto urinario adquirida en la comunidad / Molecular characterization and antimicrobial susceptibility pattern of extended-spectrum β -lactamase-producing Escherichia coli as cause of community acquired urinary tract infection
Fonte: Rev. chil. infectol;35(1):29-35, 2018. tab, graf.
Idioma: es.
Resumo: Resumen Introducción Las infecciones del tracto urinario adquiridas en la comunidad (ITUac) causadas por cepas de Escherichia coli productoras de β-lactamasas de espectro extendido (BLEE), principalmente por cepas que contienen el gen blaCTX-M-15, es un fenómeno creciente a nivel mundial. Objetivo Determinar el patrón de susceptibilidad a antimicrobianos de cepas de E. coli productoras de BLEE causantes de ITUac y conocer su patrón molecular. Materiales y Métodos Se realizó un estudio descriptivo en Oaxaca, México, donde se incluyeron 288 cepas de E. coli aisladas de pacientes adultos con posible ITUac. Para obtener los patrones de susceptibilidad antimicrobiana se siguieron los criterios del CLSI y para obtener el análisis molecular se utilizó la técnica de RPC. Resultados Del total de cepas de E. coli aisladas, 31,3% fueron productoras de BLEE, presentando una menor susceptibilidad a antimicrobianos que las cepas no productoras de estas enzimas. El 95,6% de las cepas BLEE estudiadas fueron portadoras del gen blaCTX-M. Conclusiones Un tercio de las ITUac causadas por E. coli en nuestra población fueron causadas por cepas BLEE, mostrando un alto nivel de resistencia a los antimicrobianos comúnmente utilizados en su tratamiento y disminuyendo las opciones terapéuticas para tratamientos empíricos en esta población.

Background Community acquired urinary tract infections (CaUTI) caused by strains of extended-spectrum β-lactamases (ESBL) - producing Escherichia coli, mainly by strains carrying the blaCTX-M-15 gene, is a growing phenomenon worldwide. Aim To determine the antibiotic susceptibility pattern of ESBL-producing E. coli as cause of CaUTI and to identify their molecular pattern. Methods A descriptive study was performed in the city of Oaxaca, Mexico, from where 288 strains of CaUTI-producing strains of E. coli in adults with possible UTI were isolated. The CLSI criteria was followed to determine the antimicrobial susceptibility patterns, and their molecular characterization was performed by using PCR. Results 31.3% of E. coli strains isolated in our population were ESBL producers, which presented higher levels of antibiotic resistance than those of non-producers of these enzymes. 95.6% of the studied strains were carriers of the blaCTX-M gene. Conclusions One-third of the Ca-UTI caused by E. coli in our population are caused by ESBL-producing strains, which present high levels of resistance to the antibiotics widely used in our community. This situation considerably decreases the number of antibiotics available for an empiric treatment against these infections.
Descritores: Infecções Urinárias/microbiologia
beta-Lactamases/efeitos dos fármacos
beta-Lactamases/genética
Escherichia coli/efeitos dos fármacos
Escherichia coli/genética
Antibacterianos/farmacologia
-beta-Lactamases/isolamento & purificação
Testes de Sensibilidade Microbiana
Infecções Comunitárias Adquiridas/microbiologia
Resistência beta-Lactâmica
Eletroforese
Escherichia coli/isolamento & purificação
Escherichia coli/enzimologia
Infecções por Escherichia coli/microbiologia
Genótipo
México
Limites: Humanos
Masculino
Feminino
Pessoa de Meia-Idade
Responsável: CL1.1 - Biblioteca Central


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Id: lil-792800
Autor: Kobs, Vanessa Cristine; Ferreira, Jéssica Augustini; Bobrowicz, Thaís Alexandra; Ferreira, Leslie Ecker; Deglmann, Roseneide Campos; Westphal, Glauco Adrieno; França, Paulo Henrique Condeixa de.
Título: The role of the genetic elements bla oxa and IS Aba 1 in the Acinetobacter calcoaceticus-Acinetobacter baumannii complex in carbapenem resistance in the hospital setting
Fonte: Rev. Soc. Bras. Med. Trop;49(4):433-440, July-Aug. 2016. tab, graf.
Idioma: en.
Resumo: Abstract: INTRODUCTION: Members of the Acinetobacter genus are key pathogens that cause healthcare-associated infections, and they tend to spread and develop new antibiotic resistance mechanisms. Oxacillinases are primarily responsible for resistance to carbapenem antibiotics. Higher rates of carbapenem hydrolysis might be ascribed to insertion sequences, such as the ISAba1 sequence, near bla OXA genes. The present study examined the occurrence of the genetic elements bla OXA and ISAba1 and their relationship with susceptibility to carbapenems in clinical isolates of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex. METHODS: Isolates identified over 6 consecutive years in a general hospital in Joinville, Southern Brazil, were evaluated. The investigation of 5 families of genes encoding oxacillinases and the ISAba1 sequence location relative to bla OXA genes was conducted using polymerase chain reaction. RESULTS: All isolates presented the bla OXA-51-like gene (n = 78), and 91% tested positive for the bla OXA-23-like gene (n = 71). The presence of ISAba1 was exclusively detected in isolates carrying the bla OXA-23-like gene. All isolates in which ISAba1 was found upstream of the bla OXA-23-like gene (n = 69) showed resistance to carbapenems, whereas the only isolate in which ISAba1 was not located near the bla OXA-23-like gene was susceptible to carbapenems. The ISAba1 sequence position of another bla OXA-23-like-positive isolate was inconclusive. The isolates exclusively carrying the bla OXA-51-like gene (n = 7) showed susceptibility to carbapenems. CONCLUSIONS: The presence of the ISAba1 sequence upstream of the bla OXA-23-like gene was strongly associated with carbapenem resistance in isolates of the A. calcoaceticus-A. baumannii complex in the hospital center studied.
Descritores: Proteínas de Bactérias/genética
DNA Bacteriano/genética
Carbapenêmicos/farmacologia
Acinetobacter calcoaceticus/efeitos dos fármacos
Resistência beta-Lactâmica/genética
Acinetobacter baumannii/efeitos dos fármacos
Antibacterianos/farmacologia
-Fenótipo
Proteínas de Bactérias/metabolismo
Brasil
Infecções por Acinetobacter/microbiologia
Reação em Cadeia da Polimerase
Eletroforese em Gel de Campo Pulsado
Acinetobacter calcoaceticus/isolamento & purificação
Acinetobacter calcoaceticus/genética
Acinetobacter baumannii/isolamento & purificação
Acinetobacter baumannii/genética
Genótipo
Limites: Humanos
Responsável: BR1.1 - BIREME


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Id: biblio-959424
Autor: García, José; Martínez, Dianny; Caña, Luisa; González, Diorelis; Rodríguez, Lucy; Rodulfo, Hectorina; Donato, Marcos De; Guzmán, Militza.
Título: Genes qnr en Enterobacteriaceae aisladas en un hospital de Venezuela / qnr genes in Enterobacteriaceae isolated from at a hospital in Venezuela
Fonte: Rev. chil. infectol;35(2):147-154, abr. 2018. tab, graf.
Idioma: es.
Projeto: Misión Ciencia.
Resumo: Resumen Introducción: La resistencia de enterobacterias a quinolonas se ha difundido por el mundo, fenómeno presente también en Venezuela. El mecanismo de esta resistencia pudiera estar mediado por genes incluidos en el cromosoma bacteriano o transmitirse en el interior de plásmidos. Objetivo: Evaluar la resistencia a quino-lonas, codificada por genes qnr, presentes en cepas de enterobacterias, aisladas en el Hospital Universitario de Cumaná, Venezuela. Métodos: A las cepas obtenidas se les realizaron pruebas de susceptibilidad antimicrobiana a quinolonas, β-lactámicos y aminoglucósidos. La presencia del gen qnr se determinó por RPC. Las enterobacterias portadoras del gen qnr fueron sometidas al proceso de conjugación bacteriana para comprobar su capacidad de transferencia. A las transconjugantes obtenidas se les realizó pruebas de susceptibilidad antimicrobiana y RPC para comprobar la transferencia de los genes. Resultados: Se encontraron elevados porcentajes de resistencia antimicrobiana a quinolonas y betalactámicos. El 33,6% de las cepas eran portadoras del gen qnrB, y 0,9% del gen qnrA. Se obtuvieron 23 cepas transconjugantes; de éstas, 20 portaban el gen qnrB, no se observó la presencia de qnrA. Discusión: En conclusión, el elevado porcentaje de genes qnr encontrado en las enterobacterias aisladas, y comprobada la presencia de éstos en plásmidos transferibles, complica la aplicación de tratamientos basados en quinolonas y fluoroquinolonas, por lo que es recomendable el uso racional de estos antimicrobianos, y proponer la rotación de la terapia antimicrobiana, a fin de evitar la selección de cepas resistentes.

Background: Enterobacteria resistant to quinolones is increasing worldwide, including Venezuela. The mechanism for this resistance could be due to genes included in the chromosome or in transmissible plasmids. Aim: To evaluate the resistance to quinolones, coded by qnr genes present in enterobacteria species, isolated in the University Hospital of Cumana, Venezuela. Methods: Antimicrobial susceptibility tests to quinolones, beta-lactams and aminoglycosides were carried out to all the isolates. The presence of qnr genes were determined by PCR. The isolates carrying the qnr genes were used for bacterial conjugation tests to determine the presence of transferable plasmids. Antimicrobial susceptibility tests and PCR were carried out in the transconjugants to verify the transfer of the genes. Results: High levels of antimicrobial resistance to quinolones and beta-lactams were found among the isolates. We found that 33.6% of the isolates carry the qnrB gene and 0.9% qnr A gene. Of the 23 transconjugants, 20 showed to have qnrB gene, but none qnrA. Discussion: We concluded that the high frequency of qnr genes found in the enterobacteria isolates and their presence on transferable plasmids, complicate the use of quinolones for the treatment of bacterial infections, thus, a treatment plan should be designed with the rational use and the rotation of different types of antimicrobials, in order to avoid the selection of increasingly resistant strains.
Descritores: Plasmídeos
Quinolonas/farmacologia
Resistência beta-Lactâmica/genética
Farmacorresistência Bacteriana/genética
Enterobacteriaceae/genética
Infecções por Enterobacteriaceae/genética
Bactérias Gram-Negativas/genética
Antibacterianos/farmacologia
-Venezuela
beta-Lactamases/genética
DNA Bacteriano/genética
Testes de Sensibilidade Microbiana
Reação em Cadeia da Polimerase
Análise de Sequência de DNA
Proteínas de Escherichia coli
Enterobacteriaceae/isolamento & purificação
Infecções por Enterobacteriaceae/microbiologia
Genes Bacterianos
Bactérias Gram-Negativas/classificação
Hospitais Universitários
Responsável: CL1.1 - Biblioteca Central


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Id: biblio-842833
Autor: Silva, Danielly da Costa; Rampelotto, Roberta Filipini; Lorenzoni, Vinícius Victor; Santos, Silvana Oliveira dos; Damer, Juliana; Hörner, Manfredo; Hörner, Rosmari.
Título: Phenotypic methods for screening carbapenem-resistant Enterobacteriaceae and assessment of their antimicrobial susceptibility profile
Fonte: Rev. Soc. Bras. Med. Trop;50(2):173-178, Mar.-Apr. 2017. tab.
Idioma: en.
Resumo: Abstract INTRODUCTION: In this study, we used phenotypic methods to screen carbapenem-resistant Enterobacteriaceae (CREs) and evaluated their antimicrobial sensitivity profile. METHODS: One hundred and seventy-eight CREs were isolated at a university hospital in south Brazil in a one-year period. Samples were assessed using disk diffusion tests with inhibitors of β-lactamases such as phenylboronic acid (AFB), cloxacillin (CLOXA), and ethylenediaminetetraacetic acid (EDTA). Strains with differences in zone diameters ≥ 5mm for disks supplemented or not were considered producers of carbapenemases. RESULTS: Klebsiella pneumoniae was the most prevalent CRE, which appeared in 80.3% cases (n = 143). Among clinical materials, the rectal swab was responsible for 43.4% of the isolations (n = 62), followed by urine (18.9%; n = 27). Among the CREs identified in this study, the growth of 56.7% (n = 101) isolates, which were putative producers of Klebsiella pneumoniae carbapenemase (KPC), were inhibited by AFB, whereas 7.3% (n = 13) isolates were inhibited by both AFB and CLOXA and were considered as putative producers of plasmid-mediated AmpC; approximately 3.4% (n = 6) were inhibited by EDTA, which possibly produced metallo-β-lactamase. Lastly, 32.6% (n = 58) cases showed negative results for AFB, CLOXA, and EDTA sensitivity, and represented another class of β-lactamases and/or mechanism of resistance. CONCLUSIONS: Phenotypic screening of CREs is important for clinical laboratories that monitor outbreaks of resistant microbes. Phenotypic tests that use carbapenemase inhibitors and enhancers such as AFB, CLOXA, and EDTA are necessary since they are good screening methods for the detection of carbapenemases.
Descritores: Carbapenêmicos/farmacologia
Resistência beta-Lactâmica/genética
Enterobacteriaceae/efeitos dos fármacos
Antibacterianos/farmacologia
-Fenótipo
Testes de Sensibilidade Microbiana
Enterobacteriaceae/classificação
Enterobacteriaceae/enzimologia
Enterobacteriaceae/genética
Hospitais Universitários
Limites: Humanos
Responsável: BR1.1 - BIREME


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Id: biblio-842816
Autor: Maciel, Wirlaine Glauce; Silva, Kesia Esther da; Bampi, José Victor Bortolotto; Bet, Graciela Mendonça dos Santos; Ramos, Ana Carolina; Gales, Ana Cristina; Simionatto, Simone.
Título: Identification of São Paulo metallo-beta-lactamase-1-producing Pseudomonas aeruginosa in the Central-West region of Brazil: a case study
Fonte: Rev. Soc. Bras. Med. Trop;50(1):135-137, Jan.-Feb. 2017.
Idioma: en.
Projeto: Conselho Nacional de Desenvolvimento Científico e Tecnológico; . Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado do Mato Grosso do Sul.
Resumo: Abstract: Metallo-beta-lactamase production is an important mechanism for carbapenem resistance of Pseudomonas aeruginosa , which represents an emerging public health challenge. We report the case of a patient admitted to an intensive care unit, with sepsis caused by multidrug-resistant São Paulo Metallo-beta-lactamase-1-producing P. aeruginosa . This is the first case of infection by this pathogenic strain in the State of Mato Grosso do Sul, Brazil. Thus, infection control measures are required for preventing future spread and outbreaks.
Descritores: Pseudomonas aeruginosa/enzimologia
Infecções por Pseudomonas/microbiologia
beta-Lactamases/biossíntese
Infecção Hospitalar/microbiologia
Resistência beta-Lactâmica
-Pseudomonas aeruginosa/isolamento & purificação
Brasil
Evolução Fatal
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Tipo de Publ: Relatos de Casos
Responsável: BR1.1 - BIREME


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Id: biblio-957426
Autor: Jabalameli, Fereshteh; Taki, Elahe; Emaneini, Mohammad; Beigverdi, Reza.
Título: Prevalence of metallo-ß-lactamase-encoding genes among carbapenem-resistant pseudomonas aeruginosa strains isolated from burn patients in Iran
Fonte: Rev. Soc. Bras. Med. Trop;51(3):270-276, Apr.-June 2018. tab, graf.
Idioma: en.
Projeto: Tehran University of Medical Sciences and Health Services.
Resumo: Abstract Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has been considered a major cause of infection and mortality in burn patients, especially in developing countries such as Iran. One of the most common mechanisms of carbapenem resistance is production of metallo-β-lactamases [(MBLs), including Verona Integron-encoded Metallo-beta-lactamase (VIM), imipenemase (IMP), São Paulo metalo-beta-lactamase (SPM), German imipenemase (GIM), New Delhi metallo-beta-lactamase (NDM), Dutch imipenemase (DIM), Adelaide imipenemase (AIM), Seoul imipenemase (SIM), KHM, Serratia metallo-β-lactamase (SMB), Tripoli metallo-β-lactamase (TMB), and Florence imipenemase (FIM)]. Limited information is available on the prevalence of CRPA and MBLs in Iranian burn units. We performed a systematic search by using different electronic databases, including Medline (via PubMed), Embase, Web of Science, and Iranian Database. Of 586 articles published from January 2000 to December 2016, 14 studies reporting the incidence of CRPA and MBLs as detected by molecular methods in burn patients were included in this review. The meta-analyses showed that the prevalence of CRPA, IMP, and VIM was 76.8% (95% CI 67.5-84.1), 13.1% (95% CI 4.7-31.5), and 21.4% (95% CI 14.6-30.1), respectively, in Iranian burn centers and remaining MBLs types have not yet been detected. There was a high prevalence of MBLs and CRPA in Iranian burn centers. Therefore, these measurements should be applied nationally and rigorous infection control measures and antimicrobial stewardship will be the major pillars to control multidrug resistant microorganisms, such as CRPA.
Descritores: Pseudomonas aeruginosa/genética
Infecções por Pseudomonas/microbiologia
Carbapenêmicos
Resistência beta-Lactâmica/genética
-Pseudomonas aeruginosa/efeitos dos fármacos
Pseudomonas aeruginosa/enzimologia
Infecções por Pseudomonas/epidemiologia
DNA Bacteriano/genética
Testes de Sensibilidade Microbiana
Prevalência
Irã (Geográfico)
Limites: Humanos
Tipo de Publ: Revisão
Metanálise
Responsável: BR1.1 - BIREME


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Id: biblio-1039210
Autor: Abboud, Cely Saad; Rao, Gauri G; Souza, Ercilia E; Zavascki, Alexandre P; Kiffer, Carlos.
Título: Effect of polymyxin B-containing regimens on renal function for the treatment of carbapenem-resistant Enterobacteriacea mediastinitis
Fonte: Braz. j. infect. dis;22(1):51-54, Jan.-feb. 2018. tab, graf.
Idioma: en.
Projeto: FAPESP.
Resumo: ABSTRACT A retrospective cohort study, were evaluated: polymyxin B plus aminoglycosides or polymyxin B plus other antibiotics. Any degree of acute kidney injury occurred in 26 (86.6%) patients. The median time to acute kidney injury was 6.0 (95% CI 3-14) days in the polymyxin-aminoglycoside containing regimen group, against 27.0 (95% CI 6-42) days in the polymyxin with other antimicrobial combinations group (p = 0.03). Polymyxin B with aminoglycosides group progressed faster to any degree of renal dysfunction.
Descritores: Polimixina B/uso terapêutico
Infecções por Enterobacteriaceae/tratamento farmacológico
Rim/efeitos dos fármacos
Mediastinite/microbiologia
Mediastinite/tratamento farmacológico
Antibacterianos/uso terapêutico
-Testes de Sensibilidade Microbiana
Carbapenêmicos/farmacologia
Estudos Retrospectivos
Resultado do Tratamento
Estatísticas não Paramétricas
Medição de Risco
Resistência beta-Lactâmica/efeitos dos fármacos
Infecções por Enterobacteriaceae/mortalidade
Estimativa de Kaplan-Meier
Injúria Renal Aguda/induzido quimicamente
Aminoglicosídeos/uso terapêutico
Mediastinite/mortalidade
Limites: Humanos
Masculino
Feminino
Responsável: BR1.1 - BIREME


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Id: biblio-1140775
Autor: García Cruz, Carlos Enrique; Zambrano Meza, Janeth Alexandra; Fajardo Herrera, José Mauricio; Bowen Flores, Aquiles Eduardo.
Título: Estudio Observacional: Uso de Antimicrobianos en la Unidad de Cuidados Intensivos del Hospital SOLCA Guayaquil-Ecuador Publicaciones del Proyecto de Optimización de Uso de Antibióticos en Latinoamérica (PROA) / Observational Study: Use of Antimicrobials in the Intensive Care Unit of the SOLCA-Guayaquil Hospital
Fonte: Oncol. (Guayaquil) = Oncol. (Guayaquil);29(3):165-178, 31 de diciembre del 2019.
Idioma: es.
Resumo: Introducción: Los programas de optimización del uso de antimicrobianos (PROA) surgen ante la necesidad de disminuir el porcentaje de infecciones por microorganismos resistentes a los antimicrobianos, lo cual beneficiaria con mejores resultados clínicos, disminuyendo efectos adversos y reduciendo el gasto que involucra el uso de los mismos. Este programa se implementó en la unidad de cuidados intensivos del hospital oncológico SOLCA Guayaquil, durante un año. Es objetivo del presente estudiofueestablecer la tasa de uso de antimicrobianos en una Unidad de Cuidados Intensivos(UCI) el porcentaje de descalamiento y la epidemiología de las infecciones en UCI. Métodos: En este estudio observacional prospectivo, con muestra no probabilística se incluyeron todos los casos ingresados en la UCIdel Instituto Oncológico Nacional Dr. Juan Tanca Marengo de la ciudad de Guayaquil, en el período julio 2018 a junio 2019. Las variablesfueron prevalencia del uso de antibióticos, tipo de antibiótico usado, descalamiento de antibioterapia, adherencia del personal a las guías clínicas y dosis diarias definidas (DDD) y el índice días-paciente mes por área de internación. Resultados: Se incluyeron 246 pacientes; el 81% se encontraba recibiendo antibióticos, con un máximo de dos antibióticos por paciente; la profilaxis quirúrgica se mantuvo dentro de las primeras 24 horas en el 50% de la veces y el 25.66% la recibió por un periodo mayor a 24 horas; 57.25% tuvo un decalamiento mantenido, en el 20.75% de tipo escalado y el13.66% de tipo descalado. Entre los patógenos aislados están las enterobacterias productoras de beta lactamasas de espectro extendido positivas (BLEE+) con un 57% y las enterobacterias resistentes a los carbapenémicos con un 32%. El mayor consumo fue de carbapenémicos con 625.24g. seguidos de los inhibidores de betalactamasas con 402.94 g. La tasa de tratamientos empíricos del 49.58% vs el 26.41% de tratamientos dirigidos; y mortalidad bruta del 22.76%. Conclusión:La tasa de uso de antibióticos en UCI es alta, el porcentaje de descalamiento fue aceptable comparada con las tasas reportadas regionalmente, la epidemiología de gérmenes reportados más frecuentes son las enterobacterias productoras de beta lactamasa espectro extendido.

Introduction: Antimicrobial use optimization programs (PROA) arise due to the need to decrease the percentage of infections by antimicrobial resistant microorganisms, which would benefit from better clinical results, reducing adverse effects and reducing the expense involved in the use of the same. This program was implemented in the intensive care unit of the SOLCA Guayaquil cancer hospital for one year. The objective of the present study was to establish the rate of use of antimicrobials in an Intensive Care Unit (ICU), the percentage of descaling and the epidemiology of infections in the ICU. Methods:In this prospective observational study, with a non-probability sample, all the cases admitted to the ICU of the Dr. Juan Tanca Marengo National Oncological Institute in the city of Guayaquil, in the period July 2018 to June 2019 were included. The variables were prevalence of the antibiotic use, type of antibiotic used, antibiotics displacement, staff adherence to clinical guidelines and defined daily doses (DDD) and the patient-day-month index by hospitalization area. Results:246 patients were included; 81% were receiving antibiotics, with a maximum of two antibiotics per patient; Surgical prophylaxis was maintained within the first 24 hours 50% of the time and 25.66% received it for a period greater than 24 hours; 57.25% had a sustained offset, in 20.75% the scaled type and 13.66% the bare type. Isolated pathogens include 57% positive extended spectrum beta lactamase-producing enterobacteriaceae (ESBL +) and 32% carbapenem-resistant enterobacteriaceae. The highest consumption was of carbapenems with 625.24 g. followed by beta-lactamase inhibitors with 402.94 g. The empirical treatment rate of 49.58% vs. 26.41% of targeted treatments; and gross mortality of 22.76%. Conclusion:The rate of use of antibiotics in the ICU is high, the percentage of descaling was acceptable compared to the rates reported regionally, the epidemiology of the most frequent reported germs are the extended spectrum beta lactamase-producing enterobacteriaceae.
Descritores: Infecção Hospitalar
Resistência beta-Lactâmica
Unidades de Terapia Intensiva
-Pneumonia Pneumocócica
Gestão de Antimicrobianos
Limites: Humanos
Tipo de Publ: Estudo Observacional
Responsável: EC104.1 - Biblioteca



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