Agentes etiológicos de infecções urinárias em ambulatório

As infeções do trato urinário (ITU), depois das infeções respiratórias, são as mais comuns na comunidade, sendo a Escherichia coli o principal agente etiológico. Afeta predominantemente o sexo feminino e, anualmente, estima-se que ocorram em todo o Mundo cerca de 150 milhões de episódios de ITU, sendo responsável por 15% dos antibióticos prescritos em ambulatório. Os objetivos deste estudo foram caracterizar os agentes etiológicos das ITU e determinar o seu padrão de resistência aos antimicrobianos na região litoral norte de Portugal, de modo a contribuir para o uso racional na terapêutica empírica. Foi realizado um estudo observacional, descritivo e transversal, sendo obtidos 80 967 resultados de uroculturas de um Laboratório de Análises Clínicas de prestação de serviços à comunidade, relativos ao período entre Abril de 2007 e Março de 2015. Registaram-se 13 541 bacteriúrias positivas (16,72%). Escherichia coli foi o microrganismo mais isolado (71,62%), seguida de Klebsiella pneumoniae (12,41%), Proteus mirabilis (7,84%), Enterococcus. faecalis (3,97%) e Pseudomonas aeruginosa (1,42%), tendo-se observado diferenças estatisticamente significativas entre sexos e idades. Verificou-se uma diminuição da resistência aos antimicrobianos a partir do ano de 2012. E. coli apresentou em 2015 a menor taxa de resistência respetivamente de 4,46% e 12,37% para a fosfomicina e nitrofurantoína. A combinação de amoxicilina+ácido clavulânico registou uma taxa de resistência superior a 20% (22,03%). O baixo nível de resistência à fosfomicina permite que este antibiótico se apresente como a opção terapêutica de primeira linha no tratamento empírico de ITU não complicada na mulher em ambulatório, pelo que, estes resultados permitem corroborar as indicações de 2011 da Direção Geral de Saúde sobre a substituição de fluoroquinolonas por fosfomicina.

The Consequences of Not Looking at the Eosinophil Count: Pulmonary Infiltrates and Eosinophilia Syndrome (PIE) Probably Caused by Ciprofloxacin

Objectives: To describe a case of pulmonary infiltrates and eosinophilia (PIE syndrome) probably caused by ciprofloxacin. Materials and methods: A 64-year-old woman was admitted to our department with suspected hospital-acquired pneumonia and treated with antibiotics. She had no symptoms but had peripheral eosinophilia. She had recently been given ciprofloxacin for a urinary tract infection. Results: The patient spontaneously improved after exhaustive negative investigations. Conclusion: We concluded that this patient had PIE syndrome probably caused by ciprofloxacin.

Efficacy and safety of patisiran for familial amyloidotic polyneuropathy: a phase II multi-dose study

BACKGROUND: Transthyretin-mediated amyloidosis is an inherited, progressively debilitating disease caused by mutations in the transthyretin gene. This study evaluated the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple doses of patisiran (ALN-TTR02), a small interfering RNA encapsulated within lipid nanoparticles, in patients with transthyretin-mediated familial amyloid polyneuropathy (FAP).

A study of asymptomatic bacteriuria in Egyptian school-going children.

Background: Urinary tract infections (UTI) are a common and important clinical problem in childhood. Upper urinary tract infections (i.e., acute pyelonephritis) may lead to renal scarring, hypertension, and end-stage renal disease. Despite the presence of simple and reliable methods of preliminary screening of children's urine, urinary tract infection continues to be under diagnosed. Objectives: The aim of this study was to establish prevalence rates of significant bacteriuria in asymptomatic school children by simple urine tests in comparison to standard urine culture techniques in Giza, Egypt. Patients and methods: A total of 1000 apparently healthy school going children (6-12) years, 552 boys (55.2%) and 448 girls (44.8%), were enrolled in this cross-sectional prevalence survey. Results: Overall prevalence of significant bacteriuria was 6%. Higher prevalence occurred in girls (11.4%) than boys (1.6%). Escherichia coli was isolated in 35(58%) cases (3 boys and 32 girls), Staph. aureus in 13 (22%) cases (3 boys and 10 girls), Enterobacter in 6 girls (10%), Kelbsiella pneumoniae in 3 boys (5%) and Proteus vulgaris in 3 girls (5%) Conclusion: Asymptomatic bacteriurea could be detected by urine screening program at school age. Overall prevalence of significant bacteriuria was 6%, with predominance in girls than boys.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

Identificación de infección de vías urinarias mediante examen elemental y microscópico de orina en habitantes de la comunidad de Romerillo Tambo-Cañar 2015

Antecedentes: Las infecciones de vías urinarias (IVU) constituyen un padecimiento común a nivel mundial afectando a millones de personas cada año. Representan la segunda causa de infección más frecuente, únicamente superada por las infecciones del tracto respiratorio. Objetivo: Determinar la infección de vías urinarias mediante exámen elemental y microscópico de orina en los habitantes de la comunidad de Romerillo Tambo-Cañar 2015. Metodología: Se realizó un estudio de tipo descriptivo, de corte transversal, en un universo finito de 238 habitantes de la comunidad de Romerillo del cantón Tambo, del cual se obtuvo una muestra de 150 personas. Los participantes firmaron un consentimiento/asentimiento informado y llenaron una encuesta. Se analizaron las muestras de orina mediante un exámen elemental y microscópico de orina en el laboratorio del Centro de Diagnóstico y de Investigaciones Biomédicas de la Facultad de Ciencias Médicas de la Universidad de Cuenca, aplicando normas de bioseguridad y control de calidad. Los datos obtenidos fueron analizados para la estadística descriptiva y gráfica en los programas SPSS v22 y Microsoft Excel. Resultados: De 150 muestras analizadas, 9,3% fueron positivas para IVU, de éstas el 100% corresponde a mujeres y el 85,7% pertenece al grupo de edades entre 19 y 45 años. El 78,6 % mantienen una vida sexual activa; el 28,6% retiene el deseo de orinar de 30 a 60 minutos; el 85,7% realiza su higiene íntima cada 2-4 días y el 78,6% usa ropa interior o pantalón apretados

Identificación del agente etiológico y sensibilidad a antimicrobianos en muestras de orina de los habitantes con infección urinaria de la comunidad de Chuichún-Tambo -Cañar agosto - enero 2015-2016.

ANTECEDENTES: Las infecciones urinarias (ITU) son una de las principales causas de morbimortalidad en el país. Las enterobacterias son los principales uropatógenos que por vía ascendente colonizan el tracto urinario. (1) OBJETIVO: Fue identificar el agente etiológico y sensibilidad a antimicrobianos en muestras de orina de los habitantes con infección urinaria de la comunidad de Chuichún-Tambo-Cañar. Agosto-Enero 2015-2016. METODOLOGÍA: Se realizó un estudio descriptivo de corte transversal compuesto por 1037 habitantes, cuya muestra representativa fue de 281 personas. Se realizó urocultivo y antibiograma previa detección de ITU mediante el Examen Elemental y Microscópico de Orina (EMO). Los participantes con su firma/huella en el consentimiento informado aceptaron colaborar en el proyecto, llenaron una encuesta con datos de filiación y variables de estudio, luego entregaron la muestra de orina para su respectivo análisis. Para procesar y tabular la información obtenida, se utilizaron los programas SPSS v22 y Microsoft Excel 2010 para la estadística descriptiva y gráfica. RESULTADOS: De 281 habitantes el 16,0% presentó infección urinaria según el EMO, de los cuales el 66,7% resultó urocultivo positivo. De los pacientes con ITU el 64,4% son mujeres entre 15–64 años. Escherichia coli resultó ser el microorganismo más frecuente (63,3%), seguido de Proteus spp, (16,7%), Enterococo (10,0%), Klebsiella spp (6,7%) y Estafilococo aureus (3,3%). CONCLUSIÓN: Las ITU afectan principalmente a mujeres, relacionándose con infecciones recurrentes, actividad sexual y mala práctica de hábitos de higiene.

Beers versus STOPP criteria in polyharmacy community-dwelling older patients

Objective: To assess potentially inappropriate prescribing (PIP) using Beers (2012 version) and STOPP (2008 version) criteria in polypharmacy, community-dwelling, older patients. Methods: From the information collected in the invoicing data of the prescriptions and the electronic medical records, a sample was selected of 223 ≥ 65-year-old patients who were taking simultaneously 10 or more drugs per day. Beers and STOPP criteria were separately applied, and the results obtained with the two methods were compared. Results: A total of 141 (63.2%) patients presented at least one Beers criterion. The two most frequently observed Beers criteria independent of diagnosis were the use of benzodiazepines and the use of non-COX-2-selective non-steroidal anti-inflammatory drugs. With regard to Beers criteria considering diagnosis, the most frequent were the use of anticholinergic drugs in patients with lower urinary tract symptoms or benign prostatic hyperplasia, and the use of benzodiazepines, antipsychotics, Zolpidem or H2-antihistamines, in patients with dementia or cognitive impairment. A total of 165 (73.9%) patients had at least one PIP according to the STOPP criteria. Duplicate drug classes and long-term use of long-acting benzodiazepines were the two most frequent STOPP criteria. Discussion: Our study identified a high frequency of PIP in poly-medicated community-dwelling older patients. Simultaneous application of Beers and STOPP criteria represents a useful tool to improve prescribing in this population group.

Identificación de infección de vías urinarias según el examen elemental y microscópico de orina de los habitantes de Absul-Tambo. 2015

ANTECEDENTES: El análisis elemental y microscópico de orina (EMO) es un examen básico de gran significación clínica, útil en el diagnóstico de infección de vías urinarias. (1) OBJETIVO: Identificar la infección de vías urinarias según el examen elemental y microscópico de orina en los habitantes de la comunidad de Absul – Tambo, 2015. METODOLOGÍA: El estudio fue de tipo descriptivo, de corte transversal, en la comunidad de Absul - Tambo. El universo estuvo constituido por 250 habitantes, por cuestiones de calidad y servicio a la comunidad se trabajó con 200 personas equivalente al 80 %. Las personas a participar recibieron capacitación para la correcta recolección de la muestra de orina. Para el levantamiento de la información se aplicó un formulario encuesta, las muestras fueron procesadas por las autoras del proyecto de investigación en el laboratorio de la Facultad de Ciencias Médicas, bajo estrictas normas de calidad y bioseguridad; los resultados obtenidos fueron ingresados en el programa estadístico SPSSV-22 y Microsoft Excel para la estadística descriptiva. RESULTADOS: El 12 % de los habitantes presentaron infección de vías urinarias, el 95,8% corresponden al género femenino, el 66,6 % se encuentran en edades entre 5 a 34 años, el 55,5% mantienen una vida sexual activa y el 20,8 % tuvieron recurrencia de infección de vías urinarias. CONCLUSIÓN: La investigación contribuyó a la identificación de infección de vías urinarias en los habitantes de Absul, aportando datos estadísticos de IVU en la comunidad.

Identificación de infección de vías urinarias según el examen elemental y microscópico de orina de los habitantes de la Comunidad de Sarapamba Yutuloma Tambo-Cañar 2015

ANTECEDENTES.- Las infecciones de vías urinarias son causadas por bacterias, hongos y parásitos a nivel mundial.1Esta investigación se realizó en los habitantes de la comunidad de Sarapamba Yutuloma. OBJETIVO.- Determinar la prevalencia de infección de vías urinarias y sus factores asociados en los habitantes de la comunidad de Sarapamba Yutuloma Tambo. METODOLOGÍA.- La investigación fue de tipo descriptivo transversal, se trabajó con un universo de 280 habitantes de la comunidad. El tamaño de la muestra fue calculada con la fórmula finita con un nivel de confiabilidad del 95%.el resultado de la población a estudiar fue de 180 habitantes. Los participantes de esta investigación firmaron o colocaron su huella digital en el consentimiento informado en mayores o asentimiento para menores de edad, personas analfabetas o discapacitadas, llenaron una encuesta que han sido elaborados en base al modelo de Vigilancia STEPS de los factores de riesgo de enfermedades crónicas no transmisibles de la OMS 2010 aplicado en Suiza. Las muestras fueron recolectadas bajo normas de Bioseguridad, estas fueron procesadas en el Laboratorio del Centro de Diagnóstico de la Facultad de Ciencias Médicas de la Universidad de Cuenca. La información obtenida se registró en los programas, SPSS V 22 y Excel para hacer el análisis y las estadísticas. RESULTADOS.- El 16,1% de los habitantes de Sarapamba Yutuloma tiene infección del tracto urinario, el 86,2% son mujeres, el 13,8 son varones, 72,4% en edades comprendidas entre 22 y 53 años y el 89,9% al mantener actividad sexual.

Identificación de infección del tracto urinario mediante el examen elemental microscópico de orina en los habitantes de la Comuna Sunicorral Tambo-Cañar 2015

Antecedentes: La infección del tracto urinario es una de las patologías más comunes y forma parte de las principales causas de consulta médica y hospitalización. (1, 2) Es frecuente en mujeres, personas con vida sexual activa, mujeres embarazadas y diabéticos. El 10 al 20 % de mujeres entre los 18 y 40 años experimentan infección del tracto urinario, en hombres mayores a 50 años se asocia a problemas por hiperplasia prostática y en personas de la tercera edad la frecuencia es similar tanto en hombres como en mujeres. (1) Objetivo: Identificar infección de vías urinarias mediante el examen elemental y microscópico de orina en los habitantes de la comuna Sunicorral Tambo- Cañar 2015. Metodología: Estudio de tipo descriptivo transversal en habitantes la comuna Sunicorral, la muestra fue de 202 personas. Luego firmar del consentimiento y asentimiento informado, se llenó las encuesta con información relacionada a las variables de estudio, se recolectaron las muestras de orina y el análisis se realizó en el laboratorio del Centro de Diagnóstico de la Universidad de Cuenca, los datos obtenidos fueron analizado en el programa SPSS y Microsoft Excel y presentados en tablas y gráficos estadísticos. Resultados: De 202 muestras el 15% reportó infección del tracto urinario, el 87,1% fue mujer, el 25,8% correspondió a la edad de 10 a 19 años, el 64,6% realizó su higiene intima pasando uno o más días, el 62,0% tiene actividad sexual siendo un factor importante.

Sistemas de vigilância das resistências aos antibióticos

Dissertação de Mestrado, Ciências Farmacêuticas, Faculdade de Ciências e Tecnologia, Universidade do Algarve, 2015

Factores relacionados a sépsis neonatal. Unidad de Neonatología Clínica Humanitaria-Fundación Pablo Jaramillo

Se realizó un estudio observacional en recién nacidos sépticos ocurridos en la Unidad de Neonatología de la Fundación Humanitaria Pablo Jaramillo, durante el período de enero de 2009 a diciembre de 2011, con el objetivo de analizar la incidencia de antecedentes maternos y parámetros propios del recién nacido como posibles factores de riesgo para la sepsis, los parámetros de laboratorio que contribuyen a diagnosticar procesos infecciosos en el recién nacido y el desenlace que tuvieron los mismos. Durante este tiempo ingresaron 164 casos con riesgo de sepsis, sospecha de sepsis y sepsis bacteriana (42.62 /1000 nacidos vivos) y la mortalidad fue del 3.04%. Predominó la sepsis de inicio precoz sobre la tardía. Los principales antecedentes maternos fueron la ruptura prematura de membranas seguido de la infección de vías urinarias. En cuanto a los factores del recién nacido prevaleció el sexo masculino, prematurez y de bajo peso al nacer

Bioelectric Impedance Analysis in the Diagnosis of Vesicoureteral Reflux

Background: Vesicoureteral reflux (VUR) is a common abnormality of the urinary tract in childhood. Objectives: As urine enters the ureters and renal pelvis during voiding in vesicoureteral reflux (VUR), we hypothesized that change in body water composition before and after voiding may be less different in children with VUR. Patients and Methods: Patients were grouped as those with VUR (Group 1) and without VUR (Group 2). Bioelectric impedance analysis was performed before and after voiding, and third space fluid (TSF) (L), percent of total body fluid (TBF%), extracellular fluid (ECF%), and intracellular fluid (ICF%) were recorded. After change of TSF, TBF, ECF, ICF (ΔTSF, ΔTBF%, ΔECF%, ΔICF%), urine volume (mL), and urine volume/body weight (mL/kg) were calculated. Groups 1 and 2 were compared for these parameters. In addition, pre- and post-voiding body fluid values were compared in each group. Results: TBF%, ECF%, ICF%, and TSF in both pre- and post-voiding states and ΔTBF%, ΔECF%, ΔICF%, and ΔTSF after voiding were not different between groups. However, while post-voiding TBF%, ECF% was significantly decreased in Group 1 (64.5 ± 8.1 vs 63.7 ± 7.2, P = 0.013 for TBF%), there was not post-voiding change in TSF in the same group. On the other hand, there was also a significant TSF decrease in Group 2. Conclusions: Bladder and ureter can be considered as the third space. Thus, we think that BIA has been useful in discriminating children with VUR as there was no decreased in patients with VUR, although there was decreased TSF in patients without VUR. However, further studies are needed to increase the accuracy of this hypothesis.

Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children

Background: Ureteropelvic junction obstruction (UPJO) is one of the most common causes of urinary tract obstruction in children. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography (US), intravenous pyelogram (IVP), diuretic renography (DR), magnetic resonance urography (MRU) and antegrade or retrograde pyelography. Nowadays it is suggested to use diuretic renography as the best method for diagnosing of UPJO. There is no comparative study between IVP and DR scan for diagnosis of UPJO in children. Objectives: The aim of the present study was to compare IVP with furosemide injection and diuretic renography in diagnosis of clinically significant UPJO. Patients and Methods: This was a cross sectional study performed in 153 UPJO suspected children (121 boys, 32 girls) based on US findings in cases presented with urinary tract infection (UTI), prenatal hydronephrosis, abdominal/flank pain, abdominal mass and hematuria. Renal ultrasound was used as an initial screening tool for detection of urinary tract abnormality. Vesicoureteral reflux (VUR) was ruled out by voiding cystourethrography (VCUG). Serum creatinin, blood urea nitrogen, urinalysis and urine culture was screened in all cases. IVP with furosemide and DR were performed as soon as possible after the mentioned workup. Results: During a five year period, 46 out of 153 patients were diagnosed as UPJO based on diuretic renography: the age ranged from 4 months to 13 years (mean: 3.1 ± 0.78 years). There was a significant higher (76%) proportion of UPJO in the boys and in the left side (78%). The sensitivity of IVP with furosemide injection in diagnosis of UPJO was 91.3% whereas DR was accepted as standard for diagnostic procedure in diagnosis of UPJO. Conclusions: Although DR is accepted as the best method for diagnosis of UPJO, we found a small sensitivity difference between IVP and DR in kidneys with normal or near normal function. In many settings such as small cities lacking facilities for advanced isotope imaging technology, use of IVP with diuretic maybe an acceptable procedure for diagnosis of UPJO.