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OBJECTIVE: To assess whether beta-lactam extended or continuous beta-lactam infusions (EI/CI) improve clinical outcomes in children with proven or suspected bacterial infections. STUDY DESIGN: We included observational and interventional studies that compared beta-lactam EI or CI with standard infusions in children less than 18 years old, and reported on mortality, hospital or intensive care unit length of stay, microbiological cure, and/or clinical cure. Data sources included PubMed, Medline, EBM Reviews, EMBASE, and CINAHL and were searched from January 1, 1980, to November 3, 2023. Thirteen studies (2945 patients) were included: 5 randomized control trials and 8 observational studies. Indications for antimicrobial therapies and clinical severity varied, ranging from cystic fibrosis exacerbation to critically ill children with bacteriemia. RESULTS: EI and CI were not associated with a reduction in mortality in randomized control trials (n = 1464; RR 0.93, 95% CI 0.71, 1.21), but were in observational studies (n = 833; RR 0.43, 95% CI 0.19, 0.96). We found no difference in hospital length of stay. Results for clinical and microbiological cures were heterogeneous and reported as narrative review. The included studies were highly heterogeneous, limiting the strength of our findings. The lack of shared definitions for clinical and microbiological cure outcomes precluded analysis. CONCLUSIONS: EI and CI were not consistently associated with reduced mortality or length of stay in children. Results were conflicting regarding clinical and microbiological cures. More well-designed studies targeting high-risk populations are necessary to determine the efficacy of these alternative dosing strategies.

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Graphene is a promising biomaterial. However, its dispersion in aqueous medium is challenging. This study aimed to modify graphene nanoparticles with L-dopa to improve the properties of experimental dental adhesives. Adhesives were formulated with 0% (control), 0.25%, 0.5%, and 0.75% of graphene, modified or not. Particle modification and dispersion were microscopically assessed. Degree of conversion was tested by Fourier-transform infrared spectroscopy. Flexural strength and modulus of elasticity were evaluated by a 3-point flexural test. Bond strength was tested by shear. To test water sorption/solubility, samples were weighed during hydration and dehydration. Antibacterial activity was tested by Streptococcus mutans colony-forming units quantification. Cytotoxicity on fibroblasts was evaluated through a dentin barrier test. The modification of graphene improved the particle dispersion. Control presented the highest degree of conversion, flexural strength, and bond strength. In degree of conversion, 0.25% of groups were similar to control. In bond strength, groups of graphene modified by L-dopa were similar to Control. The modulus of elasticity was similar between groups. Cytotoxicity and water sorption/solubility decreased as particles increased. Compared to graphene, less graphene modified by L-dopa was needed to promote antibacterial activity. By modifying graphene with L-dopa, the properties of graphene and, therefore, the adhesives incorporated by it were enhanced.

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BACKGROUND: Motor and intellectual disabilities (MIDs) represent a great challenge for maintaining general health due to physical and cognitive limitations, particularly in the maintenance and preservation of oral health. Silver nanoparticles (AgNPs) have emerged as a promising therapeutic tool for bacterial control, including oral biofilms; however, knowledge of the bactericidal effectiveness of oral biofilms from patients with MIDs is insufficient. This study aims to determine the antimicrobial effect of AgNPs on different oral biofilms taken from patients with and without MIDs. METHODS: Two sizes of AgNPs were prepared and characterized by dynamic light scattering (DLS) and transmission electron microscopy (TEM). Through consecutive sampling, biofilm samples were collected from 17 subjects with MIDs and 20 subjects without disorders. The antimicrobial effect was determined by obtaining the minimum inhibitory concentration (MIC) of AgNPs, and the identification and distribution of oral bacterial species were determined by polymerase chain reaction (PCR). Finally, correlations between sociodemographic characteristics and the antimicrobial levels of AgNPs were also explored. The values of the MIC results were analyzed with IBM-SPSS software (version25) using non-parametric tests for independent groups and correlations, with statistical significance being considered as p < 0.05. RESULTS: Both sizes of AgNPs exhibited tight particle size distributions (smaller: 10.2 ± 0.7 nm; larger: 29.3 ± 2.3 nm) with zeta potential values (-35.0 ± 3.3 and -52.6 ± 8.5 mV, respectively) confirming the stability that resulted in little to no agglomeration of nanoparticles. Although both sizes of AgNPs had good antimicrobial activity in all oral biofilms, the smallest particles had the best antimicrobial effects on the oral biofilm samples from patients with and without MIDs, even better than chlorhexidine (CHX) (p < 0.05). Likewise, the patients with disabilities showed higher levels of antimicrobial sensitivity to AgNPs compared with CHX (p < 0.05). Although the microorganisms included in the biofilms of females had a statistically higher growth level, the AgNP antimicrobial effect was statistically similar in both genders (p > 0.05). The most frequent bacteria for all oral biofilms were S. mutans (100%), P. intermedia (91.6%), T. forsythia (75.0%), T. denticola (75.0%), P. gingivalis (66.6%), F. nucleatum (66.6%), S. sobrinus (50.0%), and A. actinomycetemcomitans (8.3%). CONCLUSIONS: AgNPs exhibited considerable antimicrobial potential to be used as a complementary and alternative tool in maintaining and preserving oral health in patients with MIDs.

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Introdução: As infecções orais e maxilofaciais de origem odontogênica representam uma área relevante do conhecimento médico, pois podem evoluir para quadros de alta morbidade e mortalidade. Objetivo: Avaliar o perfil dos pacientes atendidos com diagnostico de infecção de origem odontogênica em um hospital público de Mato Groso do Sul. Métodos: Trata-se de um estudo retrospectiva do tipo observacional e transversal que consistiu na análise de 68 prontuários de pacientes com diagnostico de infecção odontogênica, no período de março de 2019 a fevereiro de 2022. Resultados e Conclusão: Os resultados apontam para uma incidência de infecção odontogênica em 39,70% para a população jovem entre 16 a 28 anos, com sintomas como edema em 82,35% dos casos, seguidos de trismo 51,47% e disfagia 17,64%, uma média de internação de 6,1 dias e necessidade de traqueostomia em 10,29% dos casos. Deste modo, o cirurgião dentista em frente a processos agudos de infecção odontogênica exerce a função primordial do reconhecimento dos sintomas e intervenção precoce evitando seu agravamento... (AU)

Introduction: Oral and maxillofacial infections of odontogenic origin represent a relevant area of medical knowledge, as they can evolve into cases of high morbidity and mortality. Objective: To evaluate the profile of patients treated with a diagnosis of infection of odontogenic origin in a public hospital in Mato Groso do Sul. Methods: This is a retrospective observational and cross-sectional study that consisted of analyzing 68 medical records of patients diagnosed with odontogenic infection, from March 2019 to February 2022. Results and Conclusion: The results point to an incidence of odontogenic infection in 39.70% for the young population between 16 and 28 years old, with symptoms such as edema in 82.35% of cases, followed by trismus 51.47% and dysphagia 17.64%, an average hospital stay of 6 ,1 days and need for tracheostomy in 10.29% of cases. In this way, the dental surgeon, faced with acute pro[1]cesses of odontogenic infection, plays the primary role of recognizing the symptoms and early intervention, preventing their aggravation... (AU)

Introducción: Las infecciones orales y maxilofaciales de origen odontogénico representan un área relevante del conocimiento médico, ya que pueden evolucionar hacia casos de alta morbilidad y mortalidad. Objetivo: Evaluar el perfil de los pacientes atendidos con diagnóstico de infección de origen odontogénico en un hospital público de Mato Groso do Sul. Métodos: Se trata de un estudio observacional retrospectivo y transversal que consistió en analizar 68 historias clínicas de pacientes con diagnóstico de infección odontogénica, desde marzo de 2019 hasta febrero de 2022. Resultados y Conclusión: Los resultados apuntan a una incidencia de infección odontogénica del 39,70%. para la población joven entre 16 y 28 años, con síntomas como edema en el 82,35% de los casos, seguido de trismo 51,47% y disfagia 17,64%, estancia hospitalaria promedio de 6,1 días y necesidad de traqueotomía en el 10,29% de los casos . De esta forma, el cirujano dentista, ante procesos agudos de infección odontogénica, realiza la función primordial de reconocer los síntomas e intervenir precozmente, evitando su agravamiento... (AU)

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Objective: To determine the epidemiological profile of patients treated at a philanthropic hospital specialized in Orthopedics and Traumatology, located in a significant urban center, and evaluate the efficacy of initial empirical antibiotic treatment. Methods: Patients diagnosed with hand infections from September 2020 to September 2022 were included, excluding cases related to open fractures or post-surgical infections and those with incomplete medical records. The chi-square test was performed using STATISTICA ® software to correlate various variables. Results: A total of 34 patients participated, including 24 men and 10 women, with an average age of 41.9 years. Most male patients had Diabetes Mellitus, HIV, and drug addiction, and they resided in urban areas. Half of the patients did not report any apparent trauma. The most common infectious agent was Staphylococcus aureus*. Nearly 62% of patients required a change in the initial antibiotic regimen, with Penicillin being the most frequently substituted medication. Beta-lactam antibiotics and Quinolones were the most effective. Conclusion: These results suggest the importance of carefully evaluating the epidemiological profile of patients with acute hand infections and improving initial empirical treatment to ensure appropriate and effective therapy. Level of Evidence IV, Cross-Sectional Observational Study.

Objetivo: Determinar o perfil epidemiológico de pacientes atendidos em um hospital filantrópico referência em Ortopedia e Traumatologia localizado em um centro urbano importante, e avaliar a eficácia do tratamento antibiótico empírico inicial. Métodos: Foram incluídos pacientes com diagnóstico de infecção na mão, atendidos no período de setembro de 2020 a setembro de 2022, excluindo-se casos relacionados a fraturas expostas ou pós-cirúrgicas e aqueles com prontuários incompletos. Realizou-se o teste do qui-quadrado, utilizando o software STATISTICA ® para correlacionar diversas variáveis. Resultados: Participaram do estudo 34 pacientes, sendo 24 homens e 10 mulheres, com média de idade de 41,9 anos. A maioria era de homens, com alta incidência de diabetes mellitus, HIV e drogadição, que residiam em áreas livres. Metade não relatou trauma evidente. O agente infeccioso mais comum foi o Staphylococcus aureus. Aproximadamente 62% dos pacientes precisaram de troca do esquema inicial de antibióticos, sendo a penicilina o medicamento mais frequentemente substituído. Os antibióticos beta-lactâmicos e quinolonas foram os mais eficientes. Conclusão: Esses resultados sugerem a importância de avaliar cuidadosamente o perfil epidemiológico dos pacientes com infecções agudas na mão e aprimorar o tratamento empírico inicial para garantir uma terapia adequada e eficaz. Nível de Evidência IV, Estudo Observacional Transversal.

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BACKGROUND: Antimicrobial resistance has become one of the world's most important public health problems. Accordingly, nursing strategies to manage antimicrobials in hospital environments are fundamental to promoting patient health. The aim of this study was to summarise the best evidence available on nursing strategies for the safe management of antimicrobials in hospital environments. METHODS: This qualitative systematic review used meta-aggregation in accordance with the recommendations of the Joanna Briggs Institute. The protocol was registered in the data base of the Prospective Register of Systematic Reviews under No. CRD42021224804. The literature search was conducted, in April and May 2021, in the following data bases and journal repositories: Latin American and Caribbean Health Sciences Literature (LILACS) via the Virtual Health Library (VHL), Medical Literature Analysis and Retrieval System on-line (Medline) via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scientific Electronic Library Online (SciELO) and Excerpta Medica Database (EMBASE). The findings of each study were summarized and the results were meta-aggregated in JBI SUMARI software. RESULTS: The search resulted in a total of 447 studies and, after selection, the review included 26 studies, in which 42 nursing strategies were identified. The strategies were first categorised as care- or stewardship-related and then into the subcategories: Screening, Administration, Monitoring and Discharge, Nursing Team, Multi-professional Teams, Patients and Institutional Leadership. The 42 strategies were meta-aggregated and represented in flow diagrams. The best evidence was synthesized related to nursing strategies in the safe management of antimicrobials in the hospital environment. CONCLUSIONS: Nurses play an indispensable function in antimicrobial stewardship in the hospital environment, because they work directly at the core of safe patient care. Significant contributions by nursing towards reducing antimicrobial resistance were found in care-related practice, education activities, research and policy.

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This scoping review focused on exploring the efficacy of flavonoids against bacteria associated with dental caries and periodontal diseases. Inclusion criteria comprise studies investigating the antibacterial effects of flavonoids against bacteria linked to caries or periodontal diseases, both pure or diluted in vehicle forms. The search, conducted in August 2023, in databases including PubMed/MEDLINE, Scopus, Web of Science, Embase, LILACS, and Gray Literature. Out of the initial 1125 studies, 79 met the inclusion criteria, majority in vitro studies. Prominent flavonoids tested included epigallocatechin-gallate, apigenin, quercetin, and myricetin. Predominant findings consistently pointed to bacteriostatic, bactericidal, and antibiofilm activities. The study primarily investigated bacteria associated with dental caries, followed by periodontopathogens. A higher number of publications presented positive antibacterial results against Streptococcus mutans in comparison to Porphyromonas gingivalis. These encouraging findings underline the potential applicability of commercially available flavonoids in materials or therapies, underscoring the need for further exploration in this field.

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Urinary tract infections (UTI) affect between 3% to 7.5% of the febrile pediatric population each year, being one of the most common bacterial infections in pediatrics. Nevertheless, there is no consensus in the medical literature regarding the duration of per oral (p.o.) antibiotic therapy for UTI among these patients. Therefore, our meta-analysis aims to assess the most effective therapy length in this scenario. PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing short (≤ 5 days) with long-course (≥ 7 days) per os (p.o.) antibiotic therapy for children with UTI. Statistical analysis was performed using R Studio version 4.2.1, heterogeneity was assessed with I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered statistically significant. Seventeen studies involving 1666 pediatric patients were included. Of these, 890 patients (53.4%) were randomized to receive short-course therapy. Patients undergoing short-course therapy showed higher treatment failure rates (RR 1.61; 95% CI 1.15-2.27; p = 0.006). Furthermore, there were no statistically significant differences between groups regarding reinfection (RR 0.73; 95% CI 0.47-1.13; p = 0156) and relapse rates (RR 1.47; 95% CI 0.8-2.71; p = 0.270).  Conclusion: In summary, our results suggest that long-course p.o. antibiotic therapy is associated with a lower rate of treatment failure when compared to short-course p.o. antibiotic therapy. There was no statistical difference between both courses regarding reinfection and relapse rates within 15 months.    PROSPERO identifier: CRD42023456745. What is Known: • Urinary tract infections (UTIs) are common in children, affecting around 7.5% of those under 18. • The optimal duration of antibiotic treatment for pediatric UTIs has been a subject of debate. What is New: • Short-course therapy (5 or fewer days) was associated with a significantly higher failure rate when compared to long-course therapy. • There was no significant difference in reinfection and relapse rates within 15 months between short and long-course therapy.

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BACKGROUND: Hospital acquired infections (HAI) and liberal use of broad-spectrum antibiotics are common in intensive care unit(ICU)s of low-middle income countries. We investigated the long-term association of a stepwise multifaceted educational program with the incidence of HAIs and antibiotics use in a Brazilian ICU. We also evaluated the program's cost impact. METHODS: We retrieved data from a prospective daily collected database of a twelve bedrooms ICU, all admitted patients within a period of eleven years were enrolled. FINDINGS: From 03/15/2007 to 09/11/2019, we admitted 3059 patients where 2406 (79%) survived the ICU stay. Median age was 51 years-old, and median SAPS3 was 53. The initial density of catheter related blood infection (4.3 events / 1000 patients-day), urinary tract infection (9.2 event / 1000 patients-day) and ventilator associated pneumonia (54.9 events / 1000 patients-day) felt during the observed period to (0.35 events / 1000 patients-day), (0 events / 1000 patients-day), and (1.5 events / 1000 patients-day) respectively. The days of antibiotic therapy also decreased from 797.9 days of therapy / 1000 patients day to 292.3 days of therapy / 1000 patients day. The total cost per patient also decreased. The adjusted mortality rate was steady during the studied period from 23.2% to 22.9%. INTERPRETATION: A stepwise multifaceted educational program is an effective way to reduce hospital-associated infections, improve the rational use of antibiotics, and reduce costs. This impact occurred in a long term, and is probably consistent.

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The main causes of maternal mortality are comorbidities, hypertensive pregnancy syndrome, obstetric haemorrhage, and maternal sepsis. For this reason, uterotonics, magnesium sulphate, and antibiotics are essential tools in the management of obstetric patients during labour and in the peripartum period. These drugs are widely used by anaesthesiologists in all departments, and play a crucial role in treatment and patient safety. For the purpose of this narrative review, we performed a detailed search of medical databases and selected studies describing the use of these drugs in patients during pregnancy, delivery and the pospartum period. Uterotonics, above all oxytocin, play an important role in the prevention and treatment of pospartum haemorrhage, and various studies have shown that in obstetric procedures, such as scheduled and emergency caesarean section, they are effective at lower doses than those hitherto accepted. We also discuss the use of carbetocin as an effective alternative that has a therapeutic advantage in certain clinical circumstances. Magnesium sulphate is the gold standard in the prevention and treatment of eclampsia, and also plays a neuroprotective role in preterm infants. We describe the precautions to be taken during magnesium administration. Finally, we discuss the importance of understanding microbiology and the pharmacology of antibiotics in the management of obstetric infection and endometritis, and draw attention to the latest trends in antibiotic regimens in labour and caesarean section.

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RESUMEN Introducción. El uso inapropiado de antimicrobianos en las unidades de cuidados intensivos (UCI) contribuye a la resistencia bacteriana. Objetivo. El propósito del presente estudio fue medir el uso y tipo de antimicrobianos en los pacientes hospitalizados en la Unidad de Cuidados Intensivos del Hospital Regional de Loreto (HRL). Métodos. Estudio de tipo descriptivo. Revisamos 120 historias clínicas en pacientes de UCI-HRL desde enero a junio 2023. Resultados. La mayoría de los pacientes usaron antimicrobianos (74,2%), indicados por shock séptico (42,7%), de 1 a 3 antimicrobianos (93,2%), con terapia de 1 a 3 días (45%). Del total de antimicrobianos usados, la mayor proporción fueron bactericidas 89 (90,4%), de la familia de cefalosporinas (33,1%) y carbapenémicos (23,5%); los fármacos más empleados fueron ceftriaxona (26,5%) y meropenem (21,1%) por vía intravenosa (90,4%). Conclusión. La mayor proporción de pacientes hospitalizados usan antimicrobianos de la familia de cefalosporinas y carbapenémicos.

ABSTRACT Introduction. Inappropriate use of antimicrobials in the Intensive Care Unit (ICU) contributes to bacterial resistance. Objective. The purpose of the present study was to measure the use and type of antimicrobials in patients hospitalized in the Intensive Care Unit of the Loreto Regional Hospital (HRL). Methods. Descriptive study. We reviewed 120 medical records in ICU-HRL patients from January to June 2023. Results. Most patients used antimicrobials (74.2%), indicated for septic shock (42.7%), 1 to 3 antimicrobials (93.2%), with therapy of 1 to 3 days (45%). Of the total number of antimicrobials used, the greatest proportion were bactericides 89 (90.4%), from the cephalosporin family (33.1%) and carbapenemics (23.5%); the most commonly used drugs were ceftriaxone (26.5%) and meropenem (21.1%) by the intravenous route (90.4%). Conclusion. The highest proportion of hospitalized patients use antimicrobials of the cephalosporin and carbapenemics family.

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Background and Objectives: antimicrobial resistance is one of the main public health concerns worldwide. Intensive Care Units have a high prevalence of resistant microorganisms and infections, and the rational use of antibiotics is one of the main strategies for tackling this problem. This work aimed to describe patterns associated with antimicrobial drugs as well as the resistance profile of microorganisms. Methods: an observational study was carried out using data from patients hospitalized in the Intensive Care Unit who used antimicrobial agents. Results: respiratory and cardiological causes were the most frequent reasons for admission, with cephalosporins (29.02%), with penicillin (25.84%) and macrolides (16.10%) being the most used classes of antibiotics. The predominant microorganisms were Klebsiella pneumoniae (13.98%), Staphylococcus aureus (13.44%) and Acinetobacter baumannii (11.83%). Urine cultures and tracheal aspirate were the culture tests with the highest growth of gram-negative microorganisms. Patients with bacteria isolated in tracheal aspirate had longer hospital stays; 20 patients had positive surveillance cultures; and the mortality rate found was 55.45%. Conclusion: the study combined the institution's epidemiological profile with patient characteristics, isolated microorganisms and outcomes.(AU)

Justificativa e Objetivos: a resistência antimicrobiana é uma das principais preocupações de saúde pública em todo o mundo. As Unidades de Terapia Intensiva têm uma alta prevalência de microorganismos resistentes e infecções, e o uso racional de antibióticos é uma das principais estratégias para lidar com esse problema. Este trabalho teve como objetivo descrever padrões associados a medicamentos antimicrobianos, bem como o perfil de resistência dos microorganismos. Métodos: foi realizado um estudo observacional utilizando dados de pacientes hospitalizados na Unidade de Terapia Intensiva que utilizaram agentes antimicrobianos. Resultados: causas respiratórias e cardiológicas foram os motivos mais frequentes de admissão, com cefalosporinas (29,02%), penicilina (25,84%) e macrolídeos (16,10%) sendo as classes de antibióticos mais utilizadas. Os microorganismos predominantes foram Klebsiella pneumoniae (13,98%), Staphylococcus aureus (13,44%) e Acinetobacter baumannii (11,83%). Culturas de urina e aspirado traqueal foram os testes de cultura com maior crescimento de microorganismos gram-negativos. Pacientes com bactérias isoladas no aspirado traqueal tiveram internações mais longas; 20 pacientes tiveram culturas de vigilância positivas; e a taxa de mortalidade encontrada foi de 55,45%. Conclusão: o estudo combinou o perfil epidemiológico da instituição com características dos pacientes, microorganismos isolados e resultados.(AU)

Antecedentes y Objetivos: la resistencia antimicrobiana es una de las principales preocupaciones de salud pública en todo el mundo. Las Unidades de Cuidados Intensivos tienen una alta prevalencia de microorganismos resistentes e infecciones, y el uso racional de antibióticos es una de las principales estrategias para abordar este problema. Este trabajo tuvo como objetivo describir patrones asociados con medicamentos antimicrobianos, así como el perfil de resistencia de los microorganismos. Métodos: se llevó a cabo un estudio observacional utilizando datos de pacientes hospitalizados en la Unidad de Cuidados Intensivos que utilizaron agentes antimicrobianos. Resultados: las causas respiratorias y cardiológicas fueron las razones más frecuentes de admisión, con cefalosporinas (29,02%), penicilina (25,84%) y macrólidos (16,10%) siendo las clases de antibióticos más utilizadas. Los microorganismos predominantes fueron Klebsiella pneumoniae (13,98%), Staphylococcus aureus (13,44%) y Acinetobacter baumannii (11,83%). Los cultivos de orina y el aspirado traqueal fueron las pruebas de cultivo con mayor crecimiento de microorganismos gramnegativos. Los pacientes con bacterias aisladas en el aspirado traqueal tuvieron estancias hospitalarias más largas; 20 pacientes tuvieron cultivos de vigilancia positivos; y la tasa de mortalidad encontrada fue del 55,45%. Conclusión: el estudio combinó el perfil epidemiológico de la institución con las características de los pacientes, los microorganismos aislados y los resultados.(AU)

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BACKGROUND: Antimicrobial resistance is a global health problem, due to morbidity, mortality, and healthcare costs. The misuse of antimicrobials is the main cause of antimicrobial resistance. The aim of this study was to report antimicrobial resistance and antibiotic consumption in a secondary care hospital in Mexico. METHODS: Within a cross-sectional study, antimicrobial resistance data on ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) and antibiotic consumption from 2020 to 2022 were collected. Antimicrobial resistance was reported based on percentages of resistance and consumption was analyzed using the defined daily dose (DDD)/100 bed days and the AWaRe (Access, Surveillance, Reservation) antibiotic group. RESULTS: Antibiotic consumption in 2020, 2021 and 2022 was 330, 175 and 175 DDD/100 beds day, respectively. The rate of ceftriaxone resistance in E. coli (n = 526) and K. pneumoniae (n = 80) was 76% and 69%, respectively, the rate of carbapenem resistance in A. baumannii (n = 168) and P. aeruginosa (n = 108) was 92% and 52%, respectively; the rate of oxacillin resistance in S. aureus (n = 208) was 27%; and the rate of vancomycin resistance in E. faecium (n = 68) was 47%. CONCLUSION: The reported results are congruent with global estimates of antibiotic resistance and consumption, providing an overview that could generate actions for antimicrobial optimization at the local and regional levels.

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Esta tese englobou a realização de três estudos, reportados em cinco artigos científicos, que abordaram a temática da utilização de medicamentos na Odontologia. O primeiro estudo consistiu em uma revisão sistemática, o segundo em um estudo transversal e o terceiro em análises de série temporal. A revisão sistemática (PROSPERO: CRD42020211226), teve como objetivo investigar a relação entre fatores sociodemográficos e a prescrição de opioides. As buscas foram conduzidas em oito bases eletrônicas: MEDLINE (PubMed), Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar e Open Grey. Dois pesquisadores, de forma independente, realizaram a seleção dos estudos (Cohen Kappa=0,80), extração dos dados e avaliação do risco de viés. A síntese dos resultados foi apresentada de forma narrativa. O segundo estudo, um estudo transversal, a partir de dados secundários analisou as interações medicamentosas potenciais envolvendo psicofármacos prescritos por cirurgiões-dentistas em Minas Gerais (MG) em 2017. Foram utilizados dados do Sistema Integrado de Gerenciamento da Assistência Farmacêutica (Sigaf), que forneceu informações sobre todos os medicamentos dispensados pelos serviços públicos de saúde, o que possibilitou identificar os indivíduos em uso concomitante de dois ou mais fármacos. Os fármacos foram agrupados, de acordo com Anatomical Therapeutic Chemical Classification System, e o número de Doses Diárias Definidas (DDD) contabilizadas. Indivíduos, independentemente da idade, em uso simultâneo de psicofármacos e outros medicamentos foram incluídos. Na sequência, as interações medicamentosas potenciais foram pesquisadas utilizando-se o IBM Micromedex® Drug Interactions. O terceiro estudo, uma análise de série temporal, objetivou descrever as tendências de prescrição de antibacterianos, anti-inflamatórios não esteroidais (AINE) e analgésicos no período de 2011 a 2021 em MG, buscando compreender possíveis associações com os indicadores dos serviços de saúde bucal. Foram estimados o número de DDD e DDD/1.000 habitantes/ano (desfecho) para cada município em MG. As covariáveis referiam-se a indicadores dos serviços, tais como cobertura da saúde bucal, estimativas de procedimentos odontológicos e frequência de dor de dente. Para a variável desfecho, foi aplicada uma transformação logarítmica, e modelos de regressão linear de séries temporais simples e múltipla foram empregados nas análises. Os resultados da revisão sistemática apontaram, com muito baixa certeza da evidência, que indivíduos mais jovens apresentavam maior probabilidade de receber prescrição de opioides do que os mais velhos. O estudo transversal revelou que a prevalência de interações medicamentosas potenciais foi de 24,8%, totalizando 648 casos, dos quais a maioria (n=438; 67,6%) era considerada de gravidade alta. A análise de série temporal evidenciou um aumento geral nas prescrições odontológicas durante o período estudado. O log do número de DDD/1.000 habitantes cresceu em média 0,35 (p<0,001) ao ano para os antibacterianos, 0,38 (p<0,001) para os AINE e 0,28 para os analgésicos entre os anos de 2011 e 2021.Os modelos de regressão indicaram que apenas a frequência de dor de dente se mostrou associada ao uso de AINE. Os resultados desses estudos apontaram aspectos importantes sobre o uso de medicamentos prescritos por cirurgiões-dentistas, ressaltando a necessidade de algumas estratégias para garantir a segurança dos pacientes.

This dissertation encompassed three studies, reported in five scientific manuscripts, that addressed the subject of medication use in Dentistry. The first study consisted of a systematic review, the second a cross-sectional study, and the third involved time-series analyses. The systematic review (PROSPERO: CRD42020211226), aimed to investigate the relationship between sociodemographic factors and opioid prescriptions. Searches were conducted in eight electronic databases: MEDLINE (PubMed), Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar, and Open Grey. Two researchers independently selected the studies (Cohen Kappa=0.80), extracted the data, and assessed the risk of bias. The results were presented in a narrative synthesis. The second study, a cross-sectional secondary data study, analyzed the potential drug-drug interactions involving psychotropic drugs prescribed by dental practitioners in Minas Gerais (MG) in 2017. Data from the Integrated Pharmaceutical Care Management System (Sigaf) were used; this system provided information about all medication dispensed by public health services, which enabled the identification of individuals on concomitant use of at least two drugs. Drugs were grouped according to the Anatomical Therapeutic Chemical Classification System, and the number of Defined Daily Doses (DDD) was calculated. Individuals, regardless of age, on concomitant use of psychotropics and other drugs were included. Afterwards, potential drug-drug interactions were screened using the IBM Micromedex® Drug Interactions database. The third study, a time-series analysis, aimed to describe trends of dentist-prescribed antibacterials, nonsteroidal anti-inflammatory drugs (NSAID), and analgesics from 2011 to 2021 in MG, as well as to examine possible associations with characteristics of oral health services. The number of DDD and DDD/1,000 inhabitants/year (outcome) was estimated for each municipality in MG. Covariates referred to characteristics of the health services, such as coverage of oral health care, estimates of dental procedures, and frequency of toothache. For the outcome variable, a logarithmic transformation was performed, and simple and multiple linear time-series regression models were used in the analysis. The findings of the systematic review showed, with very low certainty of evidence, that younger individuals were more likely to receive a prescription of opioids than older individuals. In the cross-sectional study, the prevalence of potential drug-drug interactions was 24.8%, accounting for 648 cases, with the majority (n=438; 67.6%) being of major severity. The time-series analysis showed an overall increase in dental prescriptions during the period under investigation. The log of the number of DDD/1,000 inhabitants increased by an average of 0.35 (p<0.001) per year for antibacterials, 0.38 (p<0.001) for NSAID, and 0.28 for analgesics between 2011 and 2021.Regression models indicated that only the frequency of toothache was associated with NSAID use. These results emphasized important aspects of medications prescribed by dental practitioners, underlining the need for strategies to ensure patient safety.

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Soaps play an important role in our hygiene and health, as they not only have a bactericidal effect but also remove dirt from the human body. To evaluate the effectiveness of soaps with antimicrobial activity from different commercial brands sold in Brazil. Tests of the antimicrobial activity of different soaps were carried out through diffusion in agar against the microorganisms Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, Acinetobacter baumannii, Proteus mirabilis, and Candida albicans. All commercial soaps tested transfer antimicrobial inhibition halo formation against S. aureus and P. aeruginosa bacteria. Only two commercial soaps inhibit the species A. baumannii and C. albicans. None of the seven products studied showed inhibition of E. cloacae, P. mirabilis, and E. coli bacteria. When comparing the information contained in the packaging of the products with the results obtained during a survey, divergences were observed. The soaps that provide greater efficiency against the tested microorganisms were presented in presentations 1 and 2, which become useful against the bacteria species S. aureus, P. aeruginosa, and A. baumannii and a fungus species C. albicans. Marks 3, 4, 5, 6, and 7 parallel the same sensitivity result opposite as bacteria of the species S. aureus and P. aeruginosa, with quantitative variation only of the inhibition halo. There was a divergence between the information contained in the packaging of the seven products under study and the results of the experimental tests.

Os sabonetes têm um papel importante para a nossa higiene e saúde, pois eles além de ter efeito bactericida, também removem as sujeiras presentes no corpo humano. Avaliar a eficácia de sabonetes com atividade antimicrobiana de diferentes marcas comerciais vendidas no Brasil. Foram realizados ensaios da atividade antimicrobiana dos diferentes sabonetes através do método difusão em ágar frente aos microrganismos Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloacae, Acinetobacter baumannii, Proteus mirabilis e Candida albicans. Todos os sabonetes comerciais testados apresentaram formação de halo de inibição antimicrobiana frente às bactérias S. aureus e P. aeruginosa. Apenas dois sabonetes comerciais apresentaram inibição das espécies A. baumannii e C. albicans. Nenhum dos sete produtos estudados apresentou inibição das bactérias E. cloacae, P. mirabilis e E. coli. Na comparação das informações contidas nas embalagens dos produtos com os resultados obtidos durante a pesquisa realizada foram observadas divergências. Os sabonetes que apresentaram maior eficiência contra os microrganismos testados foram aqueles das apresentações 1 e 2, que se mostraram eficazes contra as espécies de bactérias S. aureus, P. aeruginosa e A. baumannii e contra a espécie de fungo C. albicans. As marcas 3, 4, 5, 6 e 7 apresentaram o mesmo resultado de sensibilidade frente as bactérias das espécies S. aureus e P. aeruginosa, com variação quantitativa apenas do halo de inibição. Houve divergência entre as informações contidas nas embalagens dos sete produtos em estudo e os resultados dos testes experimentais.

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Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy

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Aims: This study aimed to examine the biological response of synthetic nanocomposite material on canine mandibular bone. Methods: Nine healthy adult male local breed dogs aged 12 to 18 months and weighing 10.2 to 15.2 kg were used in the study. Based on healing intervals of 1 and 2 months, the dogs were divided into 2 groups. Each group had 3 subgroups with 3 dogs each. The division was based on the grafting material used to fill the created defect: an empty defect (Control-ve), Beta-Tricalcium Phosphate, and nanocomposite (Beta-Tricalcium Phosphate and nanosilver 1%) . Surgery started after the dogs were anaesthetized. The surgical procedure began with a 5 cm parallel incision along the mandible's lower posterior border. After exposing the periosteum, a three 5mm-diameter, 5-mmdeep critical-size holes were made, 5mm between each one. Each group's grafting material had independent 3 holes. The defects were covered with resorbable collagen membranes followed by suturing of the mucoperiosteal flap. Results: Total densitometric analysis showed no significant differences between groups at 1-month intervals, with the nanocomposite group having a higher mean rank (165.66± 31.21) in comparison to other groups while at 2 months intervals that there was a highly significant difference between three groups as the P-value was (0.000) with the nanocomposite group having a higher mean rank (460.66± 26.40). Conclusions: In the current study, the use of nanocomposites improved osteoconductivity by accelerating new bone formation. Moreover, the encorporation of nanosilver enhanced growth factor activity. These attributes make nanocomposites a promising material for enhancing the bone healing process

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Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.

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Abstract The aim of this study was to evaluate the influence of adding quaternary ammonium methacrylates (QAMs) to experimental adhesives by assessing the degree of conversion (DC), cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. Two QAMs were added to an experimental adhesive: dimethylaminododecyl methacrylate bromododecane (DMADDM) or dimethylaminododecyl methacrylate bromohexadecane (DMAHDM) at three concentrations each: 1, 2.5, and 5 wt.%. Experimental adhesive without QAMs (control group) and commercially available Transbond XT Primer (3M Unitek, Monrovia, California, USA) were used for comparisons. The adhesives were tested for DC, cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. DC, cytotoxicity against fibroblasts, and antibacterial activity were analyzed using one-way ANOVA and Tukey's multiple comparisons. Cytotoxicity against keratinocytes was evaluated using the Kruskal Wallis and Dunn's post-hoc (α = 5%) tests. Transbond showed lower DC as compared to 5% DMAHDM, 1% DMADDM, and 5% DMADDM (p < 0.05). However, all groups presented proper DC when compared to commercial adhesives in the literature. In the evaluation of cytotoxicity against keratinocytes, Transbond induced higher viability than 2.5 wt.% groups (p < 0.05). Against fibroblasts, Transbond induced higher viability as compared to 5 wt.% groups (p < 0.05). DMAHDM at 5 wt.% reduced biofilm formation when compared to all the other groups (p < 0.05). Despite their cytotoxic effect against keratinocytes, gingival fibroblasts showed higher viability. DMAHDM at 5 wt.% decreased Streptococcus mutans viability. The incorporation of DMAHDM at 5 wt.% may be a strategy for reducing the development of white spot lesions.

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ABSTRACT Objective: To determine the epidemiological profile of patients treated at a philanthropic hospital specialized in Orthopedics and Traumatology, located in a significant urban center, and evaluate the efficacy of initial empirical antibiotic treatment. Methods: Patients diagnosed with hand infections from September 2020 to September 2022 were included, excluding cases related to open fractures or post-surgical infections and those with incomplete medical records. The chi-square test was performed using STATISTICA ® software to correlate various variables. Results: A total of 34 patients participated, including 24 men and 10 women, with an average age of 41.9 years. Most male patients had Diabetes Mellitus, HIV, and drug addiction, and they resided in urban areas. Half of the patients did not report any apparent trauma. The most common infectious agent was Staphylococcus aureus*. Nearly 62% of patients required a change in the initial antibiotic regimen, with Penicillin being the most frequently substituted medication. Beta-lactam antibiotics and Quinolones were the most effective. Conclusion: These results suggest the importance of carefully evaluating the epidemiological profile of patients with acute hand infections and improving initial empirical treatment to ensure appropriate and effective therapy. Level of Evidence IV, Cross-Sectional Observational Study.

RESUMO Objetivo: Determinar o perfil epidemiológico de pacientes atendidos em um hospital filantrópico referência em Ortopedia e Traumatologia localizado em um centro urbano importante, e avaliar a eficácia do tratamento antibiótico empírico inicial. Métodos: Foram incluídos pacientes com diagnóstico de infecção na mão, atendidos no período de setembro de 2020 a setembro de 2022, excluindo-se casos relacionados a fraturas expostas ou pós-cirúrgicas e aqueles com prontuários incompletos. Realizou-se o teste do qui-quadrado, utilizando o software STATISTICA ® para correlacionar diversas variáveis. Resultados: Participaram do estudo 34 pacientes, sendo 24 homens e 10 mulheres, com média de idade de 41,9 anos. A maioria era de homens, com alta incidência de diabetes mellitus, HIV e drogadição, que residiam em áreas livres. Metade não relatou trauma evidente. O agente infeccioso mais comum foi o Staphylococcus aureus. Aproximadamente 62% dos pacientes precisaram de troca do esquema inicial de antibióticos, sendo a penicilina o medicamento mais frequentemente substituído. Os antibióticos beta-lactâmicos e quinolonas foram os mais eficientes. Conclusão: Esses resultados sugerem a importância de avaliar cuidadosamente o perfil epidemiológico dos pacientes com infecções agudas na mão e aprimorar o tratamento empírico inicial para garantir uma terapia adequada e eficaz. Nível de Evidência IV, Estudo Observacional Transversal.