Meropenem versus piperacillin-tazobactam for definitive treatment of bloodstream infections due to ceftriaxone non-susceptible Escherichia coli and Klebsiella spp (the MERINO trial): study protocol for a randomised controlled trial

BACKGROUND: Gram-negative bacteria such as Escherichia coli or Klebsiella spp. frequently cause bloodstream infections. There has been a worldwide increase in resistance in these species to antibiotics such as third generation cephalosporins, largely driven by the acquisition of extended-spectrum beta-lactamase or plasmid-mediated AmpC enzymes. Carbapenems have been considered the most effective therapy for serious infections caused by such resistant bacteria; however, increased use creates selection pressure for carbapenem resistance, an emerging threat arising predominantly from the dissemination of genes encoding carbapenemases. Recent retrospective data suggest that beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin-tazobactam, may be non-inferior to carbapenems for the treatment of bloodstream infection caused by extended-spectrum beta-lactamase-producers, if susceptible in vitro. This study aims to test this hypothesis in an effort to define carbapenem-sparing alternatives for these infections.

METHODS/DESIGN: The study will use a multicentre randomised controlled open-label non-inferiority trial design comparing two treatments, meropenem (standard arm) and piperacillin-tazobactam (carbapenem-sparing arm) in adult patients with bacteraemia caused by E. coli or Klebsiella spp. demonstrating non-susceptibility to third generation cephalosporins. Recruitment is planned to occur in sites across three countries (Australia, New Zealand and Singapore). A total sample size of 454 patients will be required to achieve 80% power to determine non-inferiority with a margin of 5%. Once randomised, definitive treatment will be for a minimum of 4 days, but up to 14 days with total duration determined by treating clinicians. Data describing demographic information, antibiotic use, co-morbid conditions, illness severity, source of infection and other risk factors will be collected. Vital signs, white cell count, use of vasopressors and days to bacteraemia clearance will be recorded up to day 7. The primary outcome measure will be mortality at 30 days, with secondary outcomes including days to clinical and microbiological resolution, microbiological failure or relapse, isolation of a multi-resistant organism or Clostridium difficile infection.

Genetic similarity between staphylococcus sp isolated from human and hospital settings, and susceptibility to different antimicrobials

Foram coletadas 143 amostras de mãos de humanos e camas hospitalares, através de swabs no caldo BHI, em um hospital escola da cidade de Ribeirão Preto/SP. As amostras coletadas foram incubadas a 37ºC por 24 horas e após este período as culturas foram semeadas em placas de Petri contendo agar Staphylococcus Médium 110. As colônias típicas do gênero Staphylococcus foram colhidas e estocados a 4ºC até o momento de elaboração das provas de catalase, manitol, hemólise, DNAse e coagulase. As cepas isoladas foram analisadas através da técnica de RAPD-PCR para verificar o grau de similaridade. A sensibilidade das cepas isoladas foi testada frente a 10 diferentes antibióticos. Das 92 cepas de Staphylococcus sp isoladas, 67 (72,8%) foram identificados como Staphylococcus coagulase-negativas e 25 (27,2%) como Staphylococcus coagulase-positivas. A análise de similaridade mostrou uma grande heterogeneidade entre as cepas, entretanto foram isoladas algumas cepas com 100% de similaridade. Resistência a oxacilina foi encontrada em 39 (42%) cepas. Duas cepas de estafilococos coagulase-negativos mostraram-se resistentes a vancomicina. Onze cepas (12%) de estafilococos foram consideradas multirresistentes. Medidas de desinfecção das mãos de pessoal e dos leitos hospitalares e a racionalização do uso indiscriminado de antibióticos podem contribuir para a queda da transmissão de patógenos e diminuição da pressão de seleção, e conseqüentemente diminuindo a freqüência e letalidade das infecções nosocomiais.

Chromosome polymorphism in the Brazilian dwarf brocket deer, Mazama nana (Mammalia, Cervidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Relation of pretreatment sequence diversity in NS5A region of HCV genotype 1 with immune response between pegylated-INF/ribavirin therapy outcomes

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Diversity and Adaptation of Human Respiratory Syncytial Virus Genotypes Circulating in Two Distinct Communities: Public Hospital and Day Care Center

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Formando lotes uniformes de reprodutores múltiplos e usando-os em acasalamentos dirigidos, em populações Nelore

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sequence, evolution and ligand binding properties of mammalian Duffy antigen/receptor for chemokines

The Duffy antigen/receptor for chemokine, DARC, acts as a widely expressed promiscuous chemokine receptor and as the erythrocyte receptor for Plasmodium vivax. To gain insight into the evolution and structure/function relations of DARC, we analyzed the binding of anti-human Fy monoclonal antibodies (mAbs) and human chemokines to red blood cells (RBCs) from 11 nonhuman primates and two nonprimate mammals, and we elucidated the structures of the DARC genes from gorilla, gibbon, baboon, marmoset, tamarin, night monkey and cattle. CXCL-8 and CCL-5 chemokine binding analysis indicated that the promiscuous binding profile characteristic of DARC is conserved across species. Among three mAbs that detected the Fy6 epitope by flow cytometric analysis of human and chimpanzee RBCs, only one reacted with night monkey and squirrel monkey. Only chimpanzee RBCs bound a significant amount of the anti-Fy3 mAb. Fy3 was also poorly detected on RBCs from gorilla, baboon and rhesus monkey, but not from new world monkeys. Alignment of DARC homologous sequences allowed us to construct a phylogenetic tree in which all branchings were in accordance with current knowledge of primate phylogeny. Although DARC was expected to be under strong internal and external selection pressure, in order to maintain chemokine binding and avoid Plasmodium vivax binding, respectively, our present study did not provide arguments in favor of a selection pressure on the extracellular domains involved in ligand specificity. The amino acid variability of DARC-like polypeptides was found to be well correlated with the hydrophylicity indexes, with the highest divergence on the amino-terminal extracellular domain. Analysis of the deduced amino acid sequences highlighted the conservation of some amino acid residues, which should prove to be critical for the structural and functional properties of DARC.

Performance de Trichogramma pretiosum Riley, 1879 e T. exiguum Pinto & Platner, 1978 (Hymenoptera: trichogrammatidae) em ovos de populações de Plutella xylostella (LINNAEUS, 1758) (Lepidoptera: Plutellidae) sob ação de Bacillus thuringiensis Berliner, 1915 (Bacillales: Bacillaceae)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Biologia reprodutiva de Bokermannohyla ibitiguara (Anura, Hylidae) em riachos no sudoeste de Minas Gerais

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Influência de gerações de Plutella xylostella (L.) (Lepidoptera: Plutellidae) e de radiação no desempenho de isolados de Bacillus thuringiensis Berliner

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Métodos para identificação de moléculas com atividade herbicida com ênfase na rota de síntese de carotenóides

Pós-graduação em Agronomia (Proteção de Plantas) - FCA

Estrutura genética de populações de Rhizoctonia oryzae-sativae do arroz em São Paulo, Brasil, e em meta, Colômbia, e potencial adaptativo do patógeno à Urochloa spp

Pós-graduação em Agronomia - FEIS

Ocorrência de Escherichia coli resistente a antimicrobianos em diferentes sítios corporais em uma população diversa de gatos saudáveis

Pós-graduação em Microbiologia Agropecuária - FCAV

Susceptibility of Rhipicephalus (Boophilus) microplus to ivermectin (200, 500 and 630 mu g/kg) in field studies in Brazil

The present study aimed to determine the susceptibility of 17 Rhipicephalus (Boophilus) microplus populations, originating in the Southeast and Southern regions of Brazil, to different ivermectin concentrations (200, 500 and 630 mu g/kg), administered through subcutaneous or topical (pour-on) routes. R. (B.) microplus populations from the states of Minas Gerais (seven populations), Sao Paulo (seven populations) and Parana (three populations) were chosen for the tests. The selected cattle were allocated to treatment groups on day 0, and block formation was based on the arithmetic mean of female ticks (4.5-8.0 mm long) counted on three consecutive days (-3, -2 and -1). To evaluate the therapeutic and residual efficacies of these formulations, tick counts (females ranging from 4.5 to 8.0 mm long) were performed on days 3,7 and 14 post-treatment, and continued on a weekly basis thereafter until the end of each experiment. The results obtained throughout this study, utilizing field efficacy studies, allowed us to conclude that the resistance of R. (B.) microplus against 200 and 500 mu g/kg ivermectin is widely disseminated because all tick populations that had contact with these specific concentrations were diagnosed as resistant. However, it is possible to infer that R. (B.) microplus resistance against 630 mu g/kg ivermectin was also widespread, diagnosed at six of ten analyzed properties. Resistance of these ectoparasites to 630 mu g/kg ivermectin is most likely emerging in three other populations of R. (B.) microplus. Strategies of resistance management need to be quickly determined to keep the selection pressure at a minimum level in Brazil. (C) 2014 Elsevier B.V. All rights reserved.

Estudo genético de populações de soja com fonte de resistência à Heterodera glycines (raça 3) oriundas de topocruzamentos tipo alimento x tipo grão

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)