Navegando por Palavras-chave "Imipenem"

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    Caracterização molecular e perfil de sensibilidade de amostras clínicas de Pseudomonas aeruginosa resistentes ao imipenem
    (Universidade Federal de São Paulo (UNIFESP), 2000) Cerbara, Eleuza F. Vicentini [UNIFESP]; Sader, Hélio Silva [UNIFESP]
    As taxas de resistencia ao imipenem em nossa instituicao sofreram um aumento importante nos ultimos anos, especialmente em amostras de Pseudomonas aeruginosa. Atualmente, 30 por cento a 40 por cento das amostras de P. aeruginosa isoladas de especimes clinicos sao resistentes ao imipenem. O objetivo do presente estudo foi avaliar outras opcoes terapeuticas, dentro da classe dos ß-lactamicos, para o tratamento de infeccoes causadas por cepas de P. aeruginosa resistentes ao imipenem (IRPA) e avaliar a disseminacao entre pacientes do mesmo hospital e inter-hospitalar. Foram avaliadas 160 amostras de IRPA coletadas consecutivamente de pacientes internados no Hospital São Paulo-UNIFESP. As amostras foram testadas para cefepima, cefpiroma e caftazidima utilizando a metodologia do Etest©. A resistencia ao imipenem tambem foi confirmada por Etest©. Quarenta e uma destas 160 amostras do Hospital São Paulo foram estudadas epidemiologicamente pela tecnica de eletroforese em campo eletrico pulsado (PFGE) com intuito de avaliar o modo de disseminacao desse tipo de resistencia em nossa instituicao. Foram incluidas tambem 26 amostras de P. aeruginosa resistentes ao imipenem de 14 outros hospitais brasileiros, para avaliar a disseminacao inter-hospitalar. A cefepima foi o antibiotico mais ativo (MiC5O, 24 mg/mL; MIC9O.64mg/mL) e somente 57 (35,6 por cento) amostras apresentaram resistencia cruzada com essa cefalosporina de quarta geracao. Resistencia cruzada com ceftazidima foi detectada em 77(48,1 por cento) amostras, enquanto que a maioria das amostras (86,9 por cento) foi resistente tambem a cefpiroma. O numero de amostras que apresentou alto grau de resistencia (MIC, > 256mg/mL) a cefepima, ceftazidima e cefpiroma foi,: 8(5.0 por cento), 22(13,8 por cento) e 38 (23,8 por cento) respectivamente. Os resultados de tipagem molecular mostraram a presenca de 31 clones entre as 67 amostras de IRPA avaliadas, sugerindo a selecao de mutantes resistentes em cada paciente. Porem, casos de transmissao paciente-paciente foram detectados assim como a disseminacao inter-hospitalar. Os resultados do presente estudo indicam que a cefepima e a cefalosporina mais potente contra amostras de IRPA isoladas no Hospital São Paulo. Porem, estudos clinicos sao necessarios para esclarecer o papel das cefalosporinas no tratamento de infeccoes causadas por amostras de IRPA. Alem disso, concluimos que amostras de P. aeruginosa resistentes ao imipenem podem ser...(au)
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    Comparação das atividades antimicrobianas de meropenem e imipenem/cilastatina: o laboratório necessita testar rotineiramente os dois antimicrobianos?
    (Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2002-01-01) Gales, Ana Cristina [UNIFESP]; Mendes, Rodrigo Elisandro [UNIFESP]; Rodrigues, José [UNIFESP]; Sader, Helio Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Meropenem and imipenem are the most active and potent ß-lactams against gram-negative bacteria and the only carbapenems commercially available in Brazil, USA, and Europe. Meropenem has higher in vitro activity against gram-negative bacteria, while imipenem has slightly higher in vitro activity against gram-positive. The objectives of this study are to compare the in vitro activities of these carbapenems and to evaluate the necessity of susceptibility testing both compounds at the routine of the microbiology laboratory. The broth microdilution results of 2,144 gram-negative bacilli were analyzed. Against Enterobacteriaceae meropenem was at least eight-fold more potent than imipenem. Against Pseudomonas aeruginosa meropenem (MIC50, 1mug/ml) was also more potent than imipenem (MIC50, 2mug/ml), and against Acinetobacter baumannii both carbapenems presented similar in vitro activities (MIC50, 1mug/ml for both). Only 2.7% of the isolates presented discrepant category results between the carbapenems; i.e. susceptible to one and resistant to the other. Forty-six isolates (2.14%) were susceptible to meropenem and resistant to imipenem; while only 12 isolates (0.55%) were susceptible to imipenem and resistant to meropenem. The vast majority of discordant results (91.4%) occur among non-fermentative bacilli (NF-BGN). Five discordant results were detected among 1,350 Enterobacteriaceae evaluated (0.37%); while 53 discrepant results were detected among 794 NF-BGN (6.64%). Isolates showing susceptibility to meropenem and resistance to imipenem account for 80% of the discrepant results. The results of this study indicate that the microbiology laboratory may susceptibility test only one of the carbapenems for Enterobacteriaceae and use the same category result for the other one. It is important that the results for both carbapenems are sent to the physicians in order for them to be able to choose the most appropriated for the case. On the other hand, for NF-BGN the laboratory should susceptibility test both carbapenems.
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    Infecção da corrente sanguínea causada por Pseudomonas aeruginosa resistente aos carbapenêmicos: fatores associados a mortalidade e influência da terapia combinada com polimixina B e imipenem
    (Universidade Federal de São Paulo (UNIFESP), 2011-07-27) Teixeira, Jane de Oliveira Gonzaga [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Pseudomonas aeruginosa is an important pathogen causing nosocomial bloodstream infections. The treatment of carbapenem-resistant P. aeruginosa is a challenge as the drugs used for this purpose, the polymyxins, have lower activity compared with carbapenems. However, it has been suggested that polymyxins have the ability to make gram-negative bacteria more susceptible to other antibiotics. As carbapenems are considered the main drugs against P. aeruginosa, it would be interesting to demonstrate the efficacy of this combination in vivo, targeting a more effective therapy. Objectives: To evaluate the response of the treatment with polymyxin B versus polymyxin B and carbapenem in patients with nosocomial bloodstream infection caused by carbapenenresistant Pseudomonas aeruginosa and identify factors associated with mortality among those patients Methods: A retrospective cohort study was performed at Hospital São Paulo - UNIFESP, from January 1st, 2000 to December 31, 2009. The identification of patients was done through data collection from the blood cultures report. Patients were initially divided into deaths and survivors, and assessed for exposure to various factors potentially associated with in-hospital mortality and infection-related mortality. Presence of metalobetalactamase was tested trough PCR technique. Results: We studied 69 bloodstream infections caused by carbapenems-resistant P. aeruginosa. Thirthy-five were treated with polymyxin B monotherapy and 34 with combined therapy. In- hospital mortality was 77.1% and 79.4% in the monotherapy group and combined therapy group, respectively (p = 0.819). The infection-related mortality was 42.8% among patients who received monotherapy, and 44.1% in those receiving combined therapy (p = 0.917). Factors associated with mortality were previous use of glycopeptides (OR 10.71, CI95% 1.20 to 95.34, p = 0.033) and Charlson score (OR 1.9, CI95% 1, 22 to 2.94, p = 0.004). Infection-related mortality was associated with the presence of septic shock (OR 9.99, CI95% 1.81 to 55.22, p = 0.006) and parenteral nutrition (OR 7.45, CI95% 1.23 - 45.24, p = 0.029). No statistically significant difference was found between patients with MBLharboring and non-MBL-harboring strains treated with combined therapy. Conclusions: No difference was found between the monotherapy and combined therapy group regarding mortality. Independent factors related to in- hospital mortality were prior use of glycopeptides and the Charlson score. Presence of septic shock and use of parenteral nutrition were independently associated with infection-related mortality.