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Background and Aims: Non-therapeutic antibiotic use is associated with the current decrease in antibiotic therapeutic efficiency and the emergence of a wide range of resistant strains, which constitutes a public health risk. This study aimed to evaluate the use of Saccharomyces cerevisiae var. boulardii RC009 as a nutritional feed additive to substitute the prophylactic use of antibiotics and improve the productive performance and health of post-weaning piglets. Materials and Methods: Four regular nutritional phases were prepared. Post-weaning pigs (21-70 days old) received one of two dietary treatments: T1-basal diet (BD-control group) with in-feed antibiotics as a prophylactic medication (one pulse of Tiamulin in P3 and one pulse of Amoxicillin in P4); and T2-BD without in-feed antibiotics but with Saccharomyces boulardii RC009 (1 × 1012 colony forming unit/T feed). The feed conversion ratio (FCR), total weight gain (TWG-kg), and daily weight gain (DWG-kg) were determined. A post-weaning growth index (GI) was calculated and animals (160 days old) from each treatment were analyzed at the abattoir after sacrifice for carcass weight and respiratory tract lesions. Results: Pigs consuming probiotics had higher TWG and DWG than the control group. The group of animals with low body weight obtained the same results. Saccharomyces boulardii administration decreased diarrhea, and FCR reduction was related to a GI improvement. A significant increase in carcass weight and muscle thickness reduction was observed in animals received the probiotic post-weaning. Conclusion: Saccharomyces boulardii RC009, a probiotic additive, was found to improve the production parameters of pigs post-weaning and enhance their health status, indicating that it may be a promising alternative to prophylactic antibiotics.

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Resumen Introducción: Los abscesos cerebrales son una urgencia neurológica grave con alto riesgo de déficit neurológico permanente. Son patologías raras en la edad pediátrica, con una incidencia anual de 0.5 por 100,000 niños. Se han realizado pocos estudios de abscesos cerebrales de origen odontogénico y la mayoría de los pacientes son adultos con patología dental de base. Eikenella corrodens es un cocobacilo gramnegativo anaerobio facultativo de crecimiento fastidioso, que forma parte de la biota de la cavidad oral, pero es un patógeno frecuente en infecciones de cabeza y cuello, así como en infecciones dentales. Caso clínico: Paciente de sexo masculino de 16 años, previamente sano, que presentó cefalea de 2 meses de evolución acompañada de náuseas y vómitos. Antecedente de extracción del cuarto molar superior derecho 4 meses antes, sin uso de profilaxis antibiótica. La resonancia magnética de cráneo mostró una lesión compatible con absceso cerebral. Se realizó drenaje por punción guiada por estereotaxia, del que se aisló E. corrodens. El paciente completó un tratamiento con ceftriaxona y metronidazol por vía intravenosa durante 4 semanas y ampicilina-sulbactam por vía oral por 2 semanas más. Conclusiones: Los abscesos cerebrales de origen odontogénico causados por E. corrodens en la edad pediátrica son muy raros. Actualmente, el uso de antibióticos profilácticos en procedimientos dentales es controversial, ya que se ha documentado el aumento de la resistencia microbiana por su uso indiscriminado. La optimización de los estudios diagnósticos y el tratamiento multidisciplinario han mejorado el pronóstico de los pacientes con absceso cerebral.

Abstract Background: Brain abscesses are a serious neurological emergency with a high risk of permanent neurological deficit. The pathology is a rare in the pediatric age: the annual incidence is 0.5 per 100,000 children. There are a few studies of brain abscesses of oral origin mostly in adult patients with an underlying dental pathology. Eikenella corrodens, a slow-growing, Gram negative, facultatively anaerobic rod-bacillus, is part of the oral cavity biota, and common as a pathogen in head, neck, and dental infections. Case report: A previously healthy 16-year-old male presented a headache of 2 months of evolution accompanied by nausea and vomiting. Four months earlier, the fourth upper right molar was extracted, with no antibiotic prophylactic treatment. Magnetic resonance imaging of the skull showed a lesion compatible with brain abscess. Stereotaxy-guided puncture drainage was performed, isolating E. corrodens. The treatment was with ceftriaxone and metronidazole intravenously for four weeks and ampicillin sulbactam orally for two more weeks. Conclusions: Brain abscesses of odontogenic origin by E. corrodens in the pediatric age are very rare. Currently, the use of prophylactic antibiotics in dental procedures is controversial because the indiscriminate use increases antimicrobial resistance. The optimization of diagnostic studies and multidisciplinary treatment has improved the prognosis of patients with brain abscesses.

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Abstract Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.

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Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.(AU)

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Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p<0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.

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PURPOSE: We evaluated the effect of antibiotics administered via the respiratory tract to prevent the ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) patients. METHODS: We searched relevant articles for trials that evaluated the impact of prophylactic antibiotics administered through the respiratory tract on the occurrence of VAP. The end-point was the occurrence of VAP in MV patients. RESULTS: We included 6 comparative trials involving 1158 patients (632 received prophylactic antibiotic). Our meta-analysis revealed that prophylactic antibiotics administered through the respiratory tract reduced the occurrence of VAP when compared to placebo or no treatment (OR 0.53; 95% CI 0.34-0.84). This effect was seen when the antibiotics were given by nebulization (OR 0.46; 95% CI 0.22-0.97), but not when they were administered by intratracheal instillation (OR 0.57; 95% CI 0.28-1.15). We did not find a significant difference between the compared groups in the intensive care unit (ICU) mortality (OR 0.89; 95% CI 0.64-1.25). Antibiotic prophylaxis did not impact occurrence of VAP due to multidrug resistant (MDR) pathogens (OR 0.67; 95% CI 0.17-2.62). CONCLUSIONS: Prophylactic antibiotics administered through the respiratory tract by nebulization reduce the occurrence of VAP, without a significant effect on either the ICU mortality or occurrence of VAP due to MDR pathogens.

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BACKGROUND: Nephrologists have increasingly participated in the conversion from temporary catheters (TC) to tunneled-cuffed catheters (TCCs) for hemodialysis. OBJECTIVE: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. PATIENTS AND METHODS: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008) and B (from 2013 to 2015). Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. RESULTS: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P⩽0.0001). Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092). Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan-Meier model (log-rank = 0.188). TCC removal for low blood flow occurred in 8.9% of procedures. CONCLUSION: Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic.

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Introducción: La corioamnionitis es común durante el embarazo y se asocia con diversas complicaciones perinatales; entre los problemas neonatales más frecuentes están: parto pretérmino, sepsis neonatal, enfermedad pulmonar crónica, lesión cerebral secundaria a infección y trastornos del desarrollo neurológico. Es necesario conocer el riesgo de sepsis neonatal temprana en recién nacidos hijos de madres con corioamnionitis, con la intención de plantear estrategias para su prevención y tratamiento. Objetivos: Determinar el grado de asociación entre la corioamnionitis materna y la aparición de sepsis neonatal temprana. Métodos: Se realizó un estudio de casos y controles donde se incluyeron 148 pacientes divididos en dos grupos: grupo I, los casos, hijos de madres con corioamnionitis (n = 74), y grupo II, control, neonatos sin antecedente de corioamnionitis materna (n = 74). Resultados: El grupo de madres con corioamnionitis tuvo menor control prenatal y sus recién nacidos, a pesar de haber recibido antibiótico profiláctico, tuvieron una mayor frecuencia de sepsis y problemas respiratorios. Conclusiones: Los hijos de madres con corioamnionitis tienen un incremento en el riesgo de presentar sepsis neonatal temprana.

Introduction: Chorioamnionitis is common during pregnancy and associated with several perinatal complications, including postpartum infection and sepsis. Among the most frequent neonatal complications associated to chorioamnionitis are: preterm delivery, neonatal sepsis, chronic lung disease, brain injury secondary to infection, and other neurodevelopmental disorders. It is necessary to know what the risk is of early-onset neonatal sepsis in newborns to mothers with chorioamnionitis. Objective: Determine whether maternal chorioamnionitis has an association with early-onset neonatal sepsis. Methods: We performed a case-control study, in which we included 148 patients divided in two groups: group I, cases (n = 74) and group II, controls (n = 74). The sample size was calculated through difference of proportions. Results: The group of mothers with chorioamnionitis had less prenatal care, and their newborns had a larger number of infections and respiratory problems despite the indication of prophylactic antibiotic schemes. Conclusions: Newborn infants to mother with chorioamnionitis have an increased risk of early neonatal sepsis, despite the use of prophylactic antibiotics.

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Se realizó un estudio clínico controlado en 166 pacientes a las cuales se les realizó cesárea, con el objetivo de comparar la efectividad de la profilaxis antibiótica de la dosis única con respecto a la dosis múltiple. Luego de pinzar el cordón umbilical se aplicaron 2 gramos dosis única de cefazolina a 81 pacientes, y 1 gramo cada 8 horas por tres dosis a 87 pacientes seleccionadas en forma aleatoria durante un período de 3 meses. Las variables sociodemográficas y los factores de riesgo en los dos grupos fueron homogéneos. No hubo diferencias estadísticamente significativas de la dosis única con respecto a la dosis múltiple en Endometritis (7,14por ciento vs 1,25 por ciento, p=0,0628), Infección de la herida quirúrgica (9,41 por ciento vs 18,51 por ciento , p=0,0905) e infección urinaria (23,52 por ciento vs 21,25 por ciento , p=0,7265), respectivamente. Concluimos que la profilaxis antibiótica en cesáreas con dosis única de cefazolina es tan efectiva como la dosis múltiple para prevenir la aparición de infecciones postquirúrgicas. La monodosis es una buena alternativa porque pudiera reducir costos, toxicidad, resistencia bacteriana y errores en la administración...

We performed a controlled clinical essay in 166 patients which had cesarean section, with the objective of comparing the efficacy of the prophylaxis with antibiotics with a single dose in respect to a multiple dose. After clamping the umbilical cord, we randomly gave a single dose of cefazolin to 81 patients, and 1 gram ever 8 hours for 3 doses to 87 patients during a 3 months period. The sociodemographic issues and the risk factor in both groups were homogeneous. There were no significative estadistic differences between the group with single or multiple dose in endometritis (7,14% vs 1,25%, p = 0,0628), wound infection (9,41% vs 18,51%, p = 0,0905), and urinary infection (23,52% vs 21,25%, p = 0,7265), repectively. We conclude that the prophylaxis with antibiotics in cesarean section with a single dose of cefazolin is as effective as the multiple dose to prevent postsurgical infections. The single dose is a good alternative because it could reduce costs, toxicity, bacterian resistance and administration errors.

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