RESUMO
Bacteremia continues to be one of the main causes of morbidity and mortality in adult patients despite the existence of numerous antimicrobial agents and an increase in support measures. The aim of this study was to analyze the cases of community and hospital-acquired bacteremia, by evaluating the prevalence of species, risk factors, source of infection and antimicrobial susceptibility of the microorganisms involved. From January 2000 to December 2004, 129 cases of bacteremia due to enterobacteria were detected in 45 outpatients (35%) and 84 inpatients (65%). The most common risk factors were neoplasia (33.3%) and diabetes (12.4%); being urinary (29.5%) and abdominal (13.9%) the most frequently found sources of infection. E. coli was the most common enterobacteria isolated in both populations, followed by Klebsiella spp. (21.7%), and Enterobacter spp. (12.4%). Klebsiella spp. bacteremia was most common in ICU patients and, together with Enterobacter spp., constituted the most antibiotic-resistant microorganisms.
Assuntos
Bacteriemia/microbiologia , Enterobacteriaceae/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Enterobacteriaceae/efeitos dos fármacos , Feminino , Hospitais Universitários , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores de TempoRESUMO
La bacteriemia sigue siendo una de las causas más importantes de morbilidad y mortalidad en pacientes adultos, a pesar de los numerosos antimicrobianos hoy disponibles y del aumento de las medidas de soporte. El objetivo del presente estudio fue analizar los episodios de bacteriemia por enterobacterias adquiridas en la comunidad y durante la hospitalización registrados durante un período de cinco años, estableciendo la prevalencia de especies, los factores de riesgo y los focos, así como la sensibilidad a los antimicrobianos de los microorganismos involucrados. Entre enero de 2000 y diciembre de 2004 se registraron en el Hospital Nacional de Clínicas de Córdoba 129 episodios de bacteriemias por enterobacterias: 45 correspondientes a pacientes ambulatorios (35%) y 84 a hospitalizados (65%). Los factores de riesgo más frecuentes fueron neoplasia (33,3%) y diabetes (12,4%); y los focos más habituales el urinario (29,5%) y el abdominal (13,9%). La enterobacteria aislada con mayor frecuencia en ambas poblaciones fue E. coli, con una incidencia media del 53,5%, seguida de Klebsiella spp. (21,7%) y Enterobacter spp. (12,4%). Las bacteriemias por Klebsiella spp. fueron más comunes en UTI. Esta especie junto con Enterobacter spp. fueron las bacterias más resistentes a los antimicrobianos ensayados.
Bacteremia continues to be one of the main causes of morbidity and mortality in adult patients despite the existence of numerous antimicrobial agents and an increase in support measures. The aim of this study was to analyze the cases of community and hospital-acquired bacteremia, by evaluating the prevalence of species, risk factors, source of infection and antimicrobial susceptibility of the microorganisms involved. From January 2000 to December 2004, 129 cases of bacteremia due to enterobacteria were detected in 45 outpatients (35%) and 84 inpatients (65%). The most common risk factors were neoplasia (33.3%) and diabetes (12.4%); being urinary (29.5%) and abdominal (13.9%) the most frequently found sources of infection. E. coli was the most common enterobacteria isolated in both populations, followed by Klebsiella spp. (21.7%), and Enterobacter spp. (12.4%). Klebsiella spp. bacteremia was most common in ICU patients and, together with Enterobacter spp., constituted the most antibiotic-resistant microorganisms.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bacteriemia/microbiologia , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/efeitos dos fármacos , Hospitais Universitários , Testes de Sensibilidade Microbiana , Fatores de TempoRESUMO
Between April 1, 1999 and June 30, 2000, 144 isolates of enterococci (one per patient) from cultures of several anatomic sites were collected. One hundred and nineteen (82.6%) E. faecalis, 11 (7.6%) E. faecium and 14 (9.7%) of other species (5 E. raffinosus, 4 E. avium, 3 E. casseliflavus, 1 E. pseudoavium, and 1 E. dispar) were associated with clinical infections. The most common sites of isolation were: the urinary tract 54.9%, abdominal cavity 12.5%, surgical wounds 12.5%, abscesses 6.9% and diabetic foot 6.2%. High-level resistance to gentamicin or streptomycin or both was detected in 48.6% of the isolates. E. faecium and E. raffinosus were significantly more resistant than E. faecalis to ampicilin and imipenem. None of the strains exhibited beta-lactamase activity. One strain of E. faecium (0.7%) was resistant to vancomicin and teicoplanin (Van A phenotype) and two strains of E. casseliflavus (1.4%) showed low level of resistance to vancomicin (Van C phenotype). Because of these diverse antimicrobial resistance mechanisms, successful treatment and control of enterococcal infections with current antimicrobial agents are becoming increasingly difficult.
Assuntos
Resistência a Medicamentos , Enterococcus/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Abscesso/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Líquidos Corporais/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Pé Diabético/microbiologia , Farmacorresistência Bacteriana Múltipla , Enterococcus/efeitos dos fármacos , Feminino , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Imipenem/farmacologia , Masculino , Pessoa de Meia-Idade , Especificidade da Espécie , Infecção da Ferida Cirúrgica/microbiologia , Teicoplanina/farmacologia , Infecções Urinárias/microbiologia , Vancomicina/farmacologiaRESUMO
Between April 1, 1999 and June 30, 2000, 144 isolates of enterococci (one per patient) from cultures of several anatomic sites were collected. One hundred and nineteen (82.6
) E. faecium and 14 (9.7
) of other species (5 E. raffinosus, 4 E. avium, 3 E. casseliflavus, 1 E. pseudoavium, and 1 E. dispar) were associated with clinical infections. The most common sites of isolation were: the urinary tract 54.9
. High-level resistance to gentamicin or streptomycin or both was detected in 48.6
of the isolates. E. faecium and E. raffinosus were significantly more resistant than E. faecalis to ampicilin and imipenem. None of the strains exhibited beta-lactamase activity. One strain of E. faecium (0.7
) was resistant to vancomicin and teicoplanin (Van A phenotype) and two strains of E. casseliflavus (1.4
) showed low level of resistance to vancomicin (Van C phenotype). Because of these diverse antimicrobial resistance mechanisms, successful treatment and control of enterococcal infections with current antimicrobial agents are becoming increasingly difficult.
RESUMO
Between April 1, 1999 and June 30, 2000, 144 isolates of enterococci (one per patient) from cultures of several anatomic sites were collected. One hundred and nineteen (82.6
) E. faecalis, 11 (7.6
) E. faecium and 14 (9.7
) of other species (5 E. raffinosus, 4 E. avium, 3 E. casseliflavus, 1 E. pseudoavium, and 1 E. dispar) were associated with clinical infections. The most common sites of isolation were: the urinary tract 54.9
, abdominal cavity 12.5
, surgical wounds 12.5
, abscesses 6.9
and diabetic foot 6.2
. High-level resistance to gentamicin or streptomycin or both was detected in 48.6
of the isolates. E. faecium and E. raffinosus were significantly more resistant than E. faecalis to ampicilin and imipenem. None of the strains exhibited beta-lactamase activity. One strain of E. faecium (0.7
) was resistant to vancomicin and teicoplanin (Van A phenotype) and two strains of E. casseliflavus (1.4
) showed low level of resistance to vancomicin (Van C phenotype). Because of these diverse antimicrobial resistance mechanisms, successful treatment and control of enterococcal infections with current antimicrobial agents are becoming increasingly difficult.
RESUMO
The purpose of this work was to evaluate the efficacy and safety of a single dose of 400 mg of fleroxacin for the empiric antibiotic treatment of acute diarrhea in adult patients. A prospective, double-blind, placebo-controlled, randomized trial was designed. All the adult patients who consulted in our hospital for acute diarrhea from December 1994 to April 1995 were included. 72 patients were randomized to receive a single dose of fleroxacin 400 mg and 73 were placebo. Thirty-eight patients in each group were evaluable for efficacy. Between both groups there were not statistically significant differences in age, sex, number of loose stools per day at inclusion, days since the onset of symptoms up to inclusion, other symptoms than diarrhea at inclusion, percentages of bacterial pathogens and parasites isolated and symptomatic treatment indicated. At the third day since inclusion, clinical cure occurred in 72.2% of the patients receiving fleroxacin, compared with 36.4% of those receiving placebo; p = 0.002. The mean +/- SD time to cure was 2.2 +/- 1.2 days in the fleroxacin group and 3.2 +/- 2.0 days in the placebo group; p = 0.01. Twenty-eight and 16.7% of patients reported adverse effects in the fleroxacin and placebo groups respectively; p = 0.3. It is concluded that a single dose of fleroxacin 400 mg is an effective and safe alternative for the empiric antibiotic treatment of acute diarrhea in adults.