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Impact of restriction of cefepime use on the antimicrobial susceptibility of Gram-negative bacilli related to healthcare-associated infections in an orthopedic hospital
Oliveira PR,Paula AP,Dal-Paz K,Felix CS
Infection and Drug Resistance , 2011,
Abstract: Priscila R Oliveira1, Adriana P Paula1, Karine Dal-Paz1, Cassia S Felix1, Flavia Rossi2, Jorge S Silva1, Ana Lucia M Lima11Orthopaedics and Traumatology Department, 2Pathology Department, University of S o Paulo, S o Paulo, BrazilIntroduction: In recent decades, antimicrobial resistance has become a public health problem, particularly in cases of healthcare-associated infections. Interaction between antibiotic consumption and resistance development is of particular interest regarding Gram-negative bacilli, whose growing resistance has represented a great challenge.Objective: Assess the impact of restriction of cefepime use on antimicrobial susceptibility among the Gram-negative bacilli (GNB) most frequently involved in healthcare-associated infections (HAI).Methods: Data relating to hospital occupancy and mortality rates, incidence of HAI, incidence of GNB as causative agents of HAI, antimicrobial consumption at the hospital and antimicrobial susceptibility of GNB related to HAI were compared between two periods: a 24-month period preceding restriction of cefepime use and a 24-month period subsequent to this restriction.Results: There was a significant drop in cefepime consumption after its restriction. Susceptibility of Acinetobacter baumanii improved relating to gentamicin, but it worsened in relation to imipenem, subsequent to this restriction. For Pseudomonas aeruginosa, there was no change in antimicrobial susceptibility. For Klebsiella pneumoniae and Enterobacter spp, there were improvements in susceptibility relating to ciprofloxacin.Conclusion: Restriction of cefepime use had a positive impact on K. pneumoniae and Enterobacter spp, given that after this restriction, their susceptibilities to ciprofloxacin improved. However, for A. baumanii, the impact was negative, given the worsening of susceptibility to imipenem.Keywords: ecological studies, cross infection, drug resistance, microbial, Gram-negative bacilli, cefepime
Impact of restriction of cefepime use on the antimicrobial susceptibility of Gram-negative bacilli related to healthcare-associated infections in an orthopedic hospital
Oliveira PR, Paula AP, Dal-Paz K, Felix CS, Rossi F, Silva JS, Lima ALM
Infection and Drug Resistance , 2011, DOI: http://dx.doi.org/10.2147/IDR.S22491
Abstract: ct of restriction of cefepime use on the antimicrobial susceptibility of Gram-negative bacilli related to healthcare-associated infections in an orthopedic hospital Original Research (2930) Total Article Views Authors: Oliveira PR, Paula AP, Dal-Paz K, Felix CS, Rossi F, Silva JS, Lima ALM Published Date August 2011 Volume 2011:4 Pages 149 - 154 DOI: http://dx.doi.org/10.2147/IDR.S22491 Priscila R Oliveira1, Adriana P Paula1, Karine Dal-Paz1, Cassia S Felix1, Flavia Rossi2, Jorge S Silva1, Ana Lucia M Lima1 1Orthopaedics and Traumatology Department, 2Pathology Department, University of S o Paulo, S o Paulo, Brazil Introduction: In recent decades, antimicrobial resistance has become a public health problem, particularly in cases of healthcare-associated infections. Interaction between antibiotic consumption and resistance development is of particular interest regarding Gram-negative bacilli, whose growing resistance has represented a great challenge. Objective: Assess the impact of restriction of cefepime use on antimicrobial susceptibility among the Gram-negative bacilli (GNB) most frequently involved in healthcare-associated infections (HAI). Methods: Data relating to hospital occupancy and mortality rates, incidence of HAI, incidence of GNB as causative agents of HAI, antimicrobial consumption at the hospital and antimicrobial susceptibility of GNB related to HAI were compared between two periods: a 24-month period preceding restriction of cefepime use and a 24-month period subsequent to this restriction. Results: There was a significant drop in cefepime consumption after its restriction. Susceptibility of Acinetobacter baumanii improved relating to gentamicin, but it worsened in relation to imipenem, subsequent to this restriction. For Pseudomonas aeruginosa, there was no change in antimicrobial susceptibility. For Klebsiella pneumoniae and Enterobacter spp, there were improvements in susceptibility relating to ciprofloxacin. Conclusion: Restriction of cefepime use had a positive impact on K. pneumoniae and Enterobacter spp, given that after this restriction, their susceptibilities to ciprofloxacin improved. However, for A. baumanii, the impact was negative, given the worsening of susceptibility to imipenem.
Economic impact of treatment for surgical site infections in cases of total knee arthroplasty in a tertiary public hospital in Brazil
Dal-Paz, Karine;Oliveira, Priscila RD;Paula, Adriana P de;Emerick, Maria Cristina da S;Pécora, José Ricardo;Lima, Ana Lucia LM;
Brazilian Journal of Infectious Diseases , 2010, DOI: 10.1590/S1413-86702010000400008
Abstract: the aim of this study was to estimate the additional cost of treatment of a group of nosocomial infections in a tertiary public hospital. a retrospective observational cohort study was conducted by means of analyzing the medical records of 34 patients with infection after total knee arthroplasty, diagnosed in 2006 and 2007, who met the criteria for nosocomial infection according to the centers for disease control and prevention. to estimate the direct costs of treatment for these patients, the following data were gathered: length of hospital stay, laboratory tests, imaging examinations, and surgical procedures performed. their costs were estimated from the minimum values according to the brazilian medical association. the estimated cost of the antibiotics used was also obtained. the total length of stay in the ward was 976 days, at a cost of us$ 18,994.63, and, in the intensive care unit, it was 34 days at a cost of us$ 5,031.37. forty-two debridement procedures were performed, at a cost of us$ 5,798.06, and 1965 tests (laboratory and imaging) were also performed, at a cost of us$ 15,359.25. us$ 20,845.01 was spent on antibiotics and us$ 1,735.16 on vacuum assisted closure therapy, microsurgical flaps, implant removal, spacer use, and surgical revision. the total additional cost of these cases of hospital infection in 2006 and 2007 was of us$ 91,843.75. based on that, we demonstrate that the high cost of treatment for hospital infections emphasizes the importance of taking measures to prevent and control hospital infection.
Gram-negative osteomyelitis: clinical and microbiological profile
Carvalho, Vladimir Cordeiro de;Oliveira, Priscila Rosalba Domingos de;Dal-Paz, Karine;Paula, Adriana Pereira de;Félix, Cássia da Silva;Lima, Ana Lúcia Lei Munhoz;
Brazilian Journal of Infectious Diseases , 2012, DOI: 10.1590/S1413-86702012000100011
Abstract: introduction: despite the growing interest in the study of gram-negative bacilli (gnb) infections, very little information on osteomyelitis caused by gnb is available in the medical literature. objectives and methods: to assess clinical and microbiological features of 101 cases of osteomyelitis caused by gnb alone, between january 2007 and january 2009, in a reference center for the treatment of high complexity traumas in the city of s?o paulo. results: most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). the patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. after 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. nine percent of cases were lost to follow-up. a total of 121 gnb was isolated from 101 clinical samples. the most frequently isolated pathogens were enterobacter sp. (25%), acinetobacter baumannii (21%) e pseudomonas aeruginosa (20%). susceptibility to carbapenems was about 100% for enterobacter sp., 75% for pseudomonas aeruginosa and 60% for acinetobacter baumannii. conclusion: osteomyelitis caused by gnb remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. we emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.
Carbapenem stewardship: positive impact on hospital ecology
Lima, Ana Lucia Lei Munhoz;Oliveira, Priscila Rosalba Domingos de;Paula, Adriana Pereira de;Dal-Paz, Karine;Almeida Jr, Jo?o Nóbrega de;Félix, Cássia da Silva;Rossi, Flávia;
Brazilian Journal of Infectious Diseases , 2011, DOI: 10.1590/S1413-86702011000100001
Abstract: introduction: excessive group 2 carbapenem use may result in decreased bacterial susceptibility. objective: we evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. methods: ertapenem was mandated for esbl-producing enterobacteriaceae infections in the absence of non-fermenting gram-negative bacilli (gnb) from april 2006 to march 2008. group 2 carbapenems were restricted for use against gnb infections susceptible only to carbapenems and suspected gnb infections in unstable patients. cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using clinical and laboratory standards institute (clsi) guide-lines.vitek system or conventional identification methods were performed and susceptibility testing done by disk diffusion according to clsi.antibiotic consumption (t-test) and susceptibilities (mcnemar's test) were determined. results: the defined daily doses (ddd) of group 2 carbapenems declined from 61.1 to 48.7 ddd/1,000 patient-days two years after ertapenem introduction (p = 0.027). mean ertapenem consumption after restriction was 31.5 ddd/1,000 patient-days. following ertapenem introduction no significant susceptibility changes were noticed among gram-positive cocci. the most prevalent gnb were p. aeruginosa, klebsiella pneumoniae, and acinetobacter spp. there was no change in p. aeruginosa susceptibility to carbapenems. significantly improved p. aeruginosa and k. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. k. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. conclusion: preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on p. aeruginosa and k. pneumoniae susceptibility.
Investigating the Effect of Aspirin on Mercury Toxicity
Fatih Polat,Tar?k Dal
Journal of Ecosystems , 2013, DOI: 10.1155/2013/737059
Abstract: The effect of aspirin on the toxicology of mercury was investigated by using fish. The variations between blood parameters of the fish, which were made exposed directly to mercury solutions prepared at certain concentrations (500?μg/L, 250?μg/L, 125?μg/L, 62.5?μg/L, and 31.25?μg/L), and blood parameters of the fish, which were made exposed to mercury at the same concentrations after they had been interacting with aspirin, were investigated. At the end of the study, increases in blood parameters were observed depending on the increases in mercury concentration. Statistically significant variations were observed in blood parameters of the fish, which were made exposed to mercury at the same concentrations after they had been interacting with aspirin, compared to blood parameters of the fish, which were made exposed directly to mercury ( ). It was found that aspirin has caused significant increases in especially the levels of serum aspartate aminotransferase and alanine aminotranspherase and significant decreases in cortisol and glucose levels among to blood parameters. It was concluded that aspirin alters the toxic effect of mercury. 1. Introduction Aspirin is the popular name of a salicylate ester of acetic acid. Aspirin (acetyl salicylic acid) is an anti-inflammatory medicine, which has been in the use prevalently since 1899 for rheumatic diseases because it is very effective and inexpensive. Aspirin affects antioxidant system by shifting the equilibrium between oxidants and antioxidants in favor of oxidants causing hepatic and renal damages [1]. Although many nonsteroidal anti-inflammatory drugs (NSAID) have been added to the treatment in the recent 30 years, aspirin indisputably keeps its position during treatment of rheumatic diseases like RA and Kawasaki and new areas in which it can be used like antiphospholipid antibody syndrome and Alzheimer have emerged. Aspirin is absorbed rapidly after it is dissolved and hydrolyzed in the liver, and it can be seen in plasma after 10–20 minutes. Serum reaches the peak value in two hours. Aspirin is hydrolyzed into salicylic acid by nonspecific esterases in liver and bound to salicylate serum proteins, especially albumin. Cytoplasmic enzyme (LDH) released due to salicylates without depending on dose has an effect on hepatotoxicity [2]. Many plant and animal species act as a bioindicator to observe many pollutants in the ecosystem surrounding us [3–8]. It is becoming more important day by day to predict and describe the hidden and harmful effects, which come into sight when that fish is exposed to low toxic
An Important Method in the Investigation of Vascular Pathologies: Endothelial Cell Culture
Yusufhan Yaz?r,Hakk? Dal??k
Ko?uyolu Kalp Dergisi , 2012,
Abstract: Endothelial cells line the interior surface of blood vessels and form an interface between circulating blood in the lumen and the rest of the vessel wall. Endothelial cells are involved in many aspects of vascular biology, including barrier function, vasoconstriction, coagulation and inflamation. The endothelial cells in different organs have different functions and surface phenotype. These cells express prostoglandin-I2, platelet activating factor, collagen, endothelin-1, laminin, fibronectin and growth factors including platelet derived growth factor, fibroblast growth factor. n the cell culture, cells can be isolated, maintened and proliferate in the laboratory conditions. The techniques of the cell culture have allowed scientists to use the cells in vitro for experimental studies, such as the production of vaccine, antibody and enzime, drug research, cell-cell interactions. Human umbilical vein endothelial cell is a good source for endothelial cell, because it is cheaper, easy to find and has the basic features of the normal endothelial cells.
Hepatotoxicity due to tocilizumab and anakinra in rheumatoid arthritis: two case reports
Mahamid M,Paz K,Safadi R
International Journal of General Medicine , 2011,
Abstract: Mahmud Mahamid1,3, Kalman Paz3, Rifaat Safadi1,21Liver Unit, Holy Family Hospital, Nazareth, Israel; 2Hadassah Medical Center, 3Shaare Zedek Medical Center, Jerusalem, IsraelAbstract: Elevation of liver enzymes in patients with rheumatoid arthritis treated with the biological agents, tocilizumab and anakinra, is now well documented. However, histological characterization of these effects and outcomes has not been defined. Here we report toxic liver effects in two women with rheumatoid arthritis, refractory to all nonbiological therapies, following treatment with anakinra and tocilizumab. Liver biopsy in both cases showed focal necrosis of hepatocytes as a hallmark of drug toxicity, along with steatosis and early fibrosis. In addition, the patient treated with anakinra demonstrated inflammatory changes. Tocilizumab was continued with no further deterioration in liver function. Withdrawal of anakinra led to rapid normalization of liver function. The biological agents, tocilizumab and anakinra, may result in significant histological hepatic changes, including necrosis, but despite this, the outcome appears to be good.Keywords: tocilizumab, anakinra, interleukin receptors, lymphocytes, liver injury, rheumatoid arthritis
Parallel-in-time method for calculation of long-range electrostatic interactions
Jana Pazúriková,Luděk Matyska
Physics , 2013,
Abstract: Large molecular dynamics simulations (millions of atoms, tens of microseconds, thousands of processors) hit the strong scalability wall: simulation on twice as many processors does not take half the time. Inspired by large N-body space simulations, we suggest to calculate the bottleneck---the long-range interactions---parallel in time. This technical report aims to present the combination of parareal method and multilevel summation method. We thoroughly describe both methods and reasons for their particular combination. We also propose several optimizations that should provide the acceleration by an order of magnitude.
Complete ccc Boolean algebras, the order sequential topology, and a problem of von Neumann
B. Balcar,T. Jech,T. Pazák
Mathematics , 2003,
Abstract: It is consistent that every weakly distributive complete ccc Boolean algebra carries a strictly positive Maharam submeasure.
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