Brazilian Journal of Infectious Diseases最新文献_第10页

PREVALENCE OF HEALTHCARE-ASSOCIATED INFECTION PATHOGENS IN THE PRE-, DURING-, AND POST-COVID-19 PANDEMIC PERIODS IN A LARGE PUBLIC UNIVERSITY HOSPITAL 某大型公立大学医院在covid -19大流行前、期间和之后的卫生保健相关感染病原体流行情况

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104706

Claudia Maria Dantas de Maio Carrilho, Danielle Ruiz Miyazawa, Vitor Hugo Perugini, Renata Aparecida Belei, Joseani Coelho Pascual, Herlieni de Oliveira Mota e Silva, Karollinne Boza, Adriana Cristina Galbiatti Parminondi Elias, Maria de Fátima Oliveira Hirth Ruiz, Marcos Toshiyuki Tanita, Marsileni Pelisson, Maria Cristina da Silva Paduan, Marcia Regina Eches Perugini

Introduction

Hospital Infection Control Committees (HICC) monitor pathogens responsible for healthcare-associated infections (HAIs) and issue antimicrobial susceptibility profiles to identify the institution’s pathogens, assisting in the empirical treatment of HAIs, as well as isolating or cohorting patients when indicated.

Objectives

To identify the pathogens associated with HAIs and their susceptibility profiles in a university hospital during the pre, during, and post-COVID-19 pandemic periods.

Methods

A retrospective study was conducted at a tertiary, high-complexity university hospital with 80–100 ICU beds, which fluctuated during the pandemic. Data were collected from the hospital’s electronic system (Medview, HICC module), including all positive cultures with antibiograms from patients hospitalized for more than 3 days, from all infection sites (excluding swabs and colonizations). The analyzed periods were: 2018–2019 (I – pre-pandemic), 2021–2022 (II – pandemic), and 2023–2024 (III – post-pandemic).

Results

The most prevalent Gram-negative pathogens in the three periods were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. The evolution of resistance in the three periods was: Klebsiella pneumoniae/carbapenems: 53% - 70% - 68.5%; Klebsiella pneumoniae/polymyxin: 58% - 49% - 31.5%; Acinetobacter baumannii/carbapenems: 95% - 96% - 95%; Acinetobacter/polymyxin: 4% - 21% - 8.5%; Pseudomonas aeruginosa/carbapenems: 46% - 43% - 41%. There was no resistance of P. aeruginosa to polymyxins. Regarding Gram-positive bacteria, Enterococcus faecalis maintained sensitivity to ampicillin, but resistance to vancomycin (VRE) was 9% - 31.5% - 20.5%; Enterococcus faecium/ampicillin: 82% - 94% - 93.5% and Enterococcus faecium/vancomycin: 24% - 57% - 61.5%.

Conclusion

The University Hospital presents a sensitivity profile with a high prevalence of Acinetobacter spp., Klebsiella pneumoniae and Pseudomonas aeruginosa resistant to carbapenems, worsened during the pandemic period, especially K. pneumoniae resistant to carbapenems and A. baumannii to polymyxins. Regarding Gram-positive bacteria, we observed an increase in the resistance of E. faecalis and E. faecium to vancomycin (VRE). Worsening resistance data have been addressed in several publications, especially the increase in VRE infections. Preventive measures such as hand hygiene, environmental hygiene, isolation, and precautions are fundamental in controlling multidrug-resistant pathogens

医院感染控制委员会（HICC）监测导致医疗保健相关感染（HAIs）的病原体，并发布抗菌药物敏感性档案，以确定机构的病原体，协助HAIs的经验性治疗，并在需要时隔离或合并患者。目的了解某大学医院在2019冠状病毒病（covid -19）大流行前期、中期和后期与HAIs相关的病原体及其易感特征。方法对一所拥有80-100张ICU床位的高复杂性大学三级医院进行回顾性研究，该医院在疫情期间有波动。从医院电子系统（Medview， HICC模块）收集数据，包括所有感染部位（拭子和菌落除外）住院3天以上患者的所有带抗生素图的阳性培养物。分析的时期为：2018-2019年（I -大流行前）、2021-2022年（II -大流行）和2023-2024年（III -大流行后）。结果三个时期最常见的革兰氏阴性病原菌为肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌。三个时期的耐药演变为：肺炎克雷伯菌/碳青霉烯类：53% - 70% - 68.5%；肺炎克雷伯菌/多粘菌素：58% - 49% - 31.5%；鲍曼不动杆菌/碳青霉烯类：95% - 96% - 95%；不动杆菌/多粘菌素：4% - 21% - 8.5%；铜绿假单胞菌/碳青霉烯类：46% - 43% - 41%。铜绿假单胞菌对多粘菌素无耐药性。革兰氏阳性菌中，粪肠球菌对氨苄西林保持敏感，对万古霉素（VRE）的耐药率为9% ~ 31.5% ~ 20.5%；屎肠球菌/氨苄西林：82% - 94% - 93.5%；屎肠球菌/万古霉素：24% - 57% - 61.5%。结论大学医院对碳青霉烯类耐药不动杆菌、肺炎克雷伯菌和铜绿假单胞菌的敏感性较高，且在疫情期间呈恶化趋势，以碳青霉烯类耐药肺炎克雷伯菌和鲍曼假单胞菌对多粘菌素的耐药最为突出。关于革兰氏阳性菌，我们观察到粪肠杆菌和粪肠杆菌对万古霉素（VRE）的耐药性增加。一些出版物已经讨论了日益恶化的耐药性数据，特别是VRE感染的增加。手部卫生、环境卫生、隔离和预防措施等预防措施是控制耐多药病原体的基础

{"title":"PREVALENCE OF HEALTHCARE-ASSOCIATED INFECTION PATHOGENS IN THE PRE-, DURING-, AND POST-COVID-19 PANDEMIC PERIODS IN A LARGE PUBLIC UNIVERSITY HOSPITAL","authors":"Claudia Maria Dantas de Maio Carrilho, Danielle Ruiz Miyazawa, Vitor Hugo Perugini, Renata Aparecida Belei, Joseani Coelho Pascual, Herlieni de Oliveira Mota e Silva, Karollinne Boza, Adriana Cristina Galbiatti Parminondi Elias, Maria de Fátima Oliveira Hirth Ruiz, Marcos Toshiyuki Tanita, Marsileni Pelisson, Maria Cristina da Silva Paduan, Marcia Regina Eches Perugini","doi":"10.1016/j.bjid.2026.104706","DOIUrl":"10.1016/j.bjid.2026.104706","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospital Infection Control Committees (HICC) monitor pathogens responsible for healthcare-associated infections (HAIs) and issue antimicrobial susceptibility profiles to identify the institution’s pathogens, assisting in the empirical treatment of HAIs, as well as isolating or cohorting patients when indicated.</div></div><div><h3>Objectives</h3><div>To identify the pathogens associated with HAIs and their susceptibility profiles in a university hospital during the pre, during, and post-COVID-19 pandemic periods.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at a tertiary, high-complexity university hospital with 80–100 ICU beds, which fluctuated during the pandemic. Data were collected from the hospital’s electronic system (Medview, HICC module), including all positive cultures with antibiograms from patients hospitalized for more than 3 days, from all infection sites (excluding swabs and colonizations). The analyzed periods were: 2018–2019 (I – pre-pandemic), 2021–2022 (II – pandemic), and 2023–2024 (III – post-pandemic).</div></div><div><h3>Results</h3><div>The most prevalent Gram-negative pathogens in the three periods were <em>Klebsiella pneumoniae</em>, <em>Acinetobacter baumannii</em> and <em>Pseudomonas aeruginosa</em>. The evolution of resistance in the three periods was: <em>Klebsiella pneumoniae</em>/carbapenems: 53% - 70% - 68.5%; <em>Klebsiella pneumoniae</em>/polymyxin: 58% - 49% - 31.5%; <em>Acinetobacter baumannii</em>/carbapenems: 95% - 96% - 95%; <em>Acinetobacter</em>/polymyxin: 4% - 21% - 8.5%; <em>Pseudomonas aeruginosa</em>/carbapenems: 46% - 43% - 41%. There was no resistance of <em>P. aeruginosa</em> to polymyxins. Regarding Gram-positive bacteria, <em>Enterococcus faecalis</em> maintained sensitivity to ampicillin, but resistance to vancomycin (VRE) was 9% - 31.5% - 20.5%; <em>Enterococcus faecium</em>/ampicillin: 82% - 94% - 93.5% and <em>Enterococcus faecium</em>/vancomycin: 24% - 57% - 61.5%.</div></div><div><h3>Conclusion</h3><div>The University Hospital presents a sensitivity profile with a high prevalence of <em>Acinetobacter</em> spp<em>.</em>, <em>Klebsiella pneumoniae</em> and <em>Pseudomonas aeruginosa</em> resistant to carbapenems, worsened during the pandemic period, especially <em>K. pneumoniae</em> resistant to carbapenems and <em>A. baumannii</em> to polymyxins. Regarding Gram-positive bacteria, we observed an increase in the resistance of <em>E. faecalis</em> and <em>E. faecium</em> to vancomycin (VRE). Worsening resistance data have been addressed in several publications, especially the increase in VRE infections. Preventive measures such as hand hygiene, environmental hygiene, isolation, and precautions are fundamental in controlling multidrug-resistant pathogens</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104706"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

RATIONALIZATION OF ANTIMICROBIAL USE AS A STRATEGY FOR PATIENT SAFETY AND THE FIGHT AGAINST MICROBIAL RESISTANCE: IMPACT OF CLINICAL INTERVENTIONS EVALUATED BETWEEN 2019 AND 2024 IN A TERTIARY HOSPITAL 将抗菌药物使用合理化作为患者安全和抗击微生物耐药性的战略：2019年至2024年在一家三级医院评估的临床干预措施的影响

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104710

Natalia Reis Fraga

Introduction/Objective

Inappropriate use of antimicrobials is directly associated with increased microbial resistance, longer hospital stays, higher healthcare costs, and greater patient risk. Given this scenario, this study aimed to evaluate the impact of antimicrobial rationalization on patient safety and the reduction of microbial resistance in a tertiary hospital through a systematic prescription review program.

Methods

This was an observational and retrospective study analyzing data from January 2019 to December 2024. The actions consisted of daily evaluations of prescriptions containing antimicrobials, with direct discussions with care teams regarding escalation, de-escalation, continuation, or discontinuation of antimicrobial regimens. Compliance with recommendations was later verified. Microbiological data were also analyzed to correlate rational antimicrobial use with changes in bacterial resistance patterns.

Results

During the study period, there was a 25% increase in daily prescription evaluations. A global 26% reduction in antimicrobial use was observed. Regarding bacterial resistance, significant reductions were noted: 60% in carbapenem resistance, 18% in methicillin-resistant Staphylococcus aureus (MRSA), and 28% in ESBL-producing Enterobacteriaceae. These results indicate a positive correlation between the interventions and improved pathogen susceptibility profiles.

Conclusion

Rationalizing antimicrobial use proved to be an effective strategy for reducing microbial resistance and improving patient safety. Daily interactions with care teams contributed to more appropriate therapeutic decisions, directly reducing antimicrobial consumption and controlling multidrug-resistant strains. Strengthening stewardship programs should be a priority in healthcare institutions.

前言/目的不适当使用抗菌素与微生物耐药性增加、住院时间延长、医疗费用增加和患者风险增加直接相关。在这种情况下，本研究旨在通过系统的处方审查计划，评估抗菌药物合理化对患者安全和减少微生物耐药性的影响。方法采用观察性和回顾性研究，分析2019年1月至2024年12月的数据。这些行动包括对含有抗菌素的处方进行每日评估，并与护理团队就抗菌素方案的升级、降级、继续或停止进行直接讨论。后来核实了各项建议的遵守情况。还分析了微生物学数据，以将合理使用抗菌素与细菌耐药模式的变化联系起来。结果在研究期间，每日处方评估增加了25%。全球抗菌素使用减少了26%。关于细菌耐药性，有显著的下降：碳青霉烯耐药性下降60%，耐甲氧西林金黄色葡萄球菌（MRSA）下降18%，产esble肠杆菌科下降28%。这些结果表明，干预措施与改善的病原体敏感性之间存在正相关关系。结论合理使用抗菌药物是减少微生物耐药和提高患者安全的有效策略。与护理小组的日常互动有助于做出更适当的治疗决定，直接减少抗菌药物的使用并控制多重耐药菌株。加强管理方案应是医疗机构的优先事项。

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引用次数: 0

RELATIONSHIP BETWEEN KPC PRODUCTION AND SENSITIVITY PROFILE TO POLYMYXINS, AMINOGLYCOSIDES, AND CEFTAZIDIME-AVIBACTAM IN A PUBLIC TERTIARY HOSPITAL IN SÃO PAULO sÃo paulo某公立三级医院KPC产率与多粘菌素、氨基糖苷、头孢他啶-阿维巴坦敏感性的关系

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104712

Ricardo Cantarim Inacio, Marcos Antonio Cyrillo

Bacterial resistance is a global problem with serious consequences: increased mortality, prolonged hospitalizations, higher surgical site infection rates, and elevated costs. Resistance monitoring allows epidemiological assessment, targeted antimicrobial therapy, and detection of new strains. Rapid immunoassay-based multiplex tests are available for phenotypic detection and differentiation of five carbapenemase families (KPC, OXA-48-like, VIM, IMP, and NDM) directly from bacterial colonies. The NG-Test Carba 5® is a rapid (≤ 15 min) in vitro multiplex immunoassay for the phenotypic detection and differentiation of these common carbapenemase families produced by Enterobacterales and Pseudomonas. Tests were performed between August 2024 and March 2025. Sixty carbapenem-resistant strains (49 Enterobacterales and 11 Pseudomonas aeruginosa) identified by Vitek MS Prime® (BioMérieux) were tested using NG-Test Carba 5® to identify the resistance mechanism. Among Enterobacterales, 42 (70%) were KPC-producing, including 40 (95.24%) Klebsiella pneumoniae: 14 (35%) were sensitive to polymyxins, 27 (67%) to amikacin, 10 (25%) to gentamicin, and 21 (52.2%) to ceftazidime-avibactam. Two (4.76%) Escherichia coli isolates were both sensitive to polymyxin and gentamicin, one sensitive to amikacin, and the single isolate tested for ceftazidime-avibactam was sensitive. Beta-lactamases of the KPC, IMP, VIM, NDM, and OXA-48 types are the main enzymes produced by Enterobacterales that confer carbapenem resistance. A 2022 study showed that 77% of K. pneumoniae isolates were carbapenem-resistant due to KPC production, with polymyxin resistance at 29.5% and amikacin resistance at 19.6%. Strains resistant to these antimicrobials often have mutations in enzyme-coding alleles, mainly due to clinical antimicrobial use. This technology enables monitoring of resistance enzyme emergence and correlation between enzyme production and cross-resistance among antimicrobial classes.

细菌耐药性是一个具有严重后果的全球性问题：死亡率增加、住院时间延长、手术部位感染率升高和费用增加。耐药性监测可用于流行病学评估、靶向抗微生物治疗和发现新菌株。基于快速免疫测定的多重检测可直接从细菌菌落中检测和分化5个碳青霉烯酶家族（KPC、oxa -48样、VIM、IMP和NDM）的表型。NG-Test Carba 5®是一种快速（≤15分钟）的体外多重免疫测定方法，用于肠杆菌和假单胞菌产生的这些常见碳青霉烯酶家族的表型检测和分化。试验在2024年8月至2025年3月之间进行。采用NG-Test Carba 5®对60株碳青霉烯耐药菌株（49株Enterobacterales和11株绿脓杆菌Pseudomonas aeruginosa）进行耐药机制鉴定。产kpc的肠杆菌42种（70%），其中肺炎克雷伯菌40种（95.24%），对多粘菌素敏感14种（35%），对阿米卡星敏感27种（67%），对庆大霉素敏感10种（25%），对头孢他啶-阿维巴坦敏感21种（52.2%）。2株（4.76%）大肠杆菌对多粘菌素和庆大霉素均敏感，1株对阿米卡星敏感，单株对头孢他啶-阿维巴坦敏感。KPC、IMP、VIM、NDM和OXA-48型的β -内酰胺酶是肠杆菌产生碳青霉烯类耐药性的主要酶。2022年的一项研究表明，77%的肺炎克雷伯菌分离株由于KPC的产生而对碳青霉烯耐药，其中多粘菌素耐药29.5%，阿米卡星耐药19.6%。对这些抗菌素耐药的菌株通常在酶编码等位基因中发生突变，主要是由于临床抗菌素的使用。该技术能够监测耐药酶的出现以及酶的产生与抗菌素类间交叉耐药性之间的相关性。

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引用次数: 0

THE PHARMACOECONOMIC IMPACT OF PHARMACEUTICAL INTERVENTION IN ANTIMICROBIAL STEWARDSHIP 药物干预对抗菌药物管理的药物经济学影响

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104695

Laura Batista Campos, Guilherme Scodelario Bettencourt, Bárbara Caterine Pegoraro, Rômulo Cardoso da Silva, Elisangela Lucia de Oliveira, Ezequiel Oliveira Felipe, Juliana Januzzi Costa, Edvânia Silva, Odeli Nicole Encinas Sejas, Rosemeire Lima Lessi, Ícaro Boszczowski

Introduction

In the Antimicrobial Stewardship Program (ASP), the pharmacist acts as a pillar in promoting the rational use of these agents through pharmacotherapeutic analysis and pharmaceutical interventions (PIs). Their role, beyond the clinical focus, contributes to the optimization of financial resources through dose, route of administration, dosage, dilution adjustments, and therapy monitoring. The objective of this study was to demonstrate that pharmaceutical evaluation transcends patient safety, directly impacting financial resource management.

Methods

We conducted a cross-sectional analytical study to evaluate the economic impact of PIs on antimicrobials between January and April 2025. The reduction of therapeutic costs was quantified based on the average value of the antimicrobial, reconstituting agent, diluent, and supply kits, multiplied by the daily frequency and duration of treatment. The savings were estimated by the difference between pre- and post-intervention costs.

Results

During the study period, 907 PIs related to antimicrobials were performed. Of these, 191 (21%) generated total savings of R$ 125,811.57, reducing the estimated cost from R$ 187,053.34 to R$ 61,241.77 — a 67% reduction. Most savings came from antibiotics (R$ 87,787.61; 185 PIs), while antifungals (6 PIs) contributed R$ 38,023.96. PIs with the greatest pharmacoeconomic impact were related to dose (29.3%), frequency (28.8%), pertinence (15.7%), and treatment duration (15.2%). Critical units (ICU and semi-intensive) accounted for 97 interventions (51%), generating R$ 73,883.26 in savings, representing a 39.5% cost reduction. In non-critical units, 94 (49%) PIs resulted in R$ 51,928.31 in savings, a 20% cost reduction. The substances that most contributed to savings were isavuconazole and ceftazidime-avibactam (48% of total savings; R$ 60,554.43), followed by teicoplanin, meropenem, micafungin, and piperacillin+tazobactam (37%; R$ 47,095.28). The remaining 26 substances accounted for 15% (R$ 18,231.86).

Conclusion

This study demonstrates that pharmacotherapeutic interventions within the context of the Antimicrobial Stewardship Program go beyond patient safety, establishing themselves as an essential strategy for optimizing financial resources. Analysis of the period from January to April 2025 revealed that only 21% of the interventions resulted in savings of R$ 125,811.57, leading to a 67% reduction in antimicrobial treatment costs.

在抗菌药物管理计划（ASP）中，药剂师通过药物治疗分析和药物干预（pi）在促进这些药物的合理使用方面发挥着支柱作用。他们的作用超出了临床重点，通过剂量、给药途径、剂量、稀释调整和治疗监测，有助于优化财政资源。本研究的目的是证明药物评估超越患者安全，直接影响财务资源管理。方法采用横断面分析方法，对2025年1 - 4月间PIs对抗菌药物的经济影响进行评价。根据抗菌药物、重组剂、稀释剂和供应包的平均值乘以每日治疗次数和持续时间，量化治疗费用的减少。节省的费用是通过干预前和干预后成本的差异来估计的。结果在研究期间，共进行了907例与抗菌药物相关的pi检测。其中，191个项目（21%）总共节省了125,811.57雷亚尔，将估计成本从187,053.34雷亚尔降低到61,241.77雷亚尔，减少了67%。大部分节省来自抗生素（87,787.61雷亚尔；185个pi），而抗真菌药物（6个pi）贡献了38,023.96雷亚尔。药物经济学影响最大的pi与剂量（29.3%）、频率（28.8%）、针对性（15.7%）和治疗时间（15.2%）相关。重症病房（ICU和半重症病房）进行了97次干预（51%），节省了73,883.26雷亚尔，成本降低了39.5%。在非关键单元中，94个（49%）pi节省了51,928.31雷亚尔，降低了20%的成本。节省最多的药物是异唑康唑和头孢他啶-阿维巴坦（占总节省的48%；60554.43雷亚尔），其次是替柯普兰、美罗培南、米卡芬金和哌拉西林+他唑巴坦（37%；47095.28雷亚尔）。其余26种物质占15%（18,231.86雷亚尔）。结论：本研究表明，在抗菌药物管理计划的背景下，药物治疗干预措施超越了患者安全，成为优化财政资源的重要策略。对2025年1月至4月期间的分析显示，只有21%的干预措施节省了125,811.57雷亚尔，从而使抗菌药物治疗费用减少了67%。

{"title":"THE PHARMACOECONOMIC IMPACT OF PHARMACEUTICAL INTERVENTION IN ANTIMICROBIAL STEWARDSHIP","authors":"Laura Batista Campos, Guilherme Scodelario Bettencourt, Bárbara Caterine Pegoraro, Rômulo Cardoso da Silva, Elisangela Lucia de Oliveira, Ezequiel Oliveira Felipe, Juliana Januzzi Costa, Edvânia Silva, Odeli Nicole Encinas Sejas, Rosemeire Lima Lessi, Ícaro Boszczowski","doi":"10.1016/j.bjid.2026.104695","DOIUrl":"10.1016/j.bjid.2026.104695","url":null,"abstract":"<div><h3>Introduction</h3><div>In the Antimicrobial Stewardship Program (ASP), the pharmacist acts as a pillar in promoting the rational use of these agents through pharmacotherapeutic analysis and pharmaceutical interventions (PIs). Their role, beyond the clinical focus, contributes to the optimization of financial resources through dose, route of administration, dosage, dilution adjustments, and therapy monitoring. The objective of this study was to demonstrate that pharmaceutical evaluation transcends patient safety, directly impacting financial resource management.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analytical study to evaluate the economic impact of PIs on antimicrobials between January and April 2025. The reduction of therapeutic costs was quantified based on the average value of the antimicrobial, reconstituting agent, diluent, and supply kits, multiplied by the daily frequency and duration of treatment. The savings were estimated by the difference between pre- and post-intervention costs.</div></div><div><h3>Results</h3><div>During the study period, 907 PIs related to antimicrobials were performed. Of these, 191 (21%) generated total savings of R$ 125,811.57, reducing the estimated cost from R$ 187,053.34 to R$ 61,241.77 — a 67% reduction. Most savings came from antibiotics (R$ 87,787.61; 185 PIs), while antifungals (6 PIs) contributed R$ 38,023.96. PIs with the greatest pharmacoeconomic impact were related to dose (29.3%), frequency (28.8%), pertinence (15.7%), and treatment duration (15.2%). Critical units (ICU and semi-intensive) accounted for 97 interventions (51%), generating R$ 73,883.26 in savings, representing a 39.5% cost reduction. In non-critical units, 94 (49%) PIs resulted in R$ 51,928.31 in savings, a 20% cost reduction. The substances that most contributed to savings were isavuconazole and ceftazidime-avibactam (48% of total savings; R$ 60,554.43), followed by teicoplanin, meropenem, micafungin, and piperacillin+tazobactam (37%; R$ 47,095.28). The remaining 26 substances accounted for 15% (R$ 18,231.86).</div></div><div><h3>Conclusion</h3><div>This study demonstrates that pharmacotherapeutic interventions within the context of the Antimicrobial Stewardship Program go beyond patient safety, establishing themselves as an essential strategy for optimizing financial resources. Analysis of the period from January to April 2025 revealed that only 21% of the interventions resulted in savings of R$ 125,811.57, leading to a 67% reduction in antimicrobial treatment costs.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104695"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

LINEZOLID IN PEDIATRICS: ANALYSIS OF INDICATIONS AND HEPATOTOXICITY IN A UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL 儿科利奈唑胺：巴西南部一所大学医院的适应症和肝毒性分析

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104690

Isabelle Souza Viana, Bruno Simas da Rocha, Michele Gai Schmidt, Andressa Barros

Introduction/Objectives

Linezolid, an antimicrobial widely used for infections caused by resistant Gram-positive bacteria, has been increasingly used in pediatrics and is considered an alternative to vancomycin, especially in cases of previous nephrotoxicity and therapeutic failure, in addition to the advantage of not requiring serum level monitoring. However, it is known for its hepatotoxicity, particularly with prolonged use. In our hospital, its use increased from February 2022 due to cost reduction and the consequent easing of prescribing restrictions. This preliminary observational study aimed to characterize the use of linezolid in pediatric patients at a university hospital in southern Brazil, evaluating indications and potential hepatotoxicity in this population.

Methods

We analyzed electronic medical records of 44 pediatric patients (0 to under 18 years old) who received linezolid between July 2024 and July 2025. We collected data on clinical indications, previous use of vancomycin, and evaluated liver function through AST and ALT levels before and after treatment. Patients with missing or incomplete data were excluded.

Results

Among the 44 patients, 14 (31.81%) had not previously used vancomycin. Of these, 11 (78.57%) had no diagnosis of tuberculosis, being 10 (90.90%) oncology patients and 1 (9.09%) in the pediatric ICU. Among the 37 (84.09%) patients with AST and ALT recorded pre- and post-treatment, 15 (40.54%) and 13 (35.14%) showed AST and ALT variations, respectively, above the reference value for age.

Conclusion

Linezolid was used as a first-line or early alternative to vancomycin in high-complexity pediatric patients (oncologic, ICU) with non-tuberculous infections. Significant changes in liver function markers indicate that hepatotoxicity is a relevant adverse reaction, reinforcing the need for continuous monitoring and critical evaluation of the risk-benefit when using linezolid in pediatrics.

利奈唑胺是一种广泛用于耐药革兰氏阳性菌引起的感染的抗菌药物，已越来越多地用于儿科，被认为是万古霉素的替代品，特别是在既往肾毒性和治疗失败的病例中，此外还具有不需要监测血清水平的优点。然而，它的肝毒性是众所周知的，特别是长期使用。在我院，由于成本降低，处方限制随之放宽，从2022年2月起，其使用量有所增加。这项初步观察性研究旨在描述巴西南部一所大学医院儿科患者使用利奈唑胺的特点，评估该人群的适应症和潜在肝毒性。方法分析2024年7月至2025年7月44例使用利奈唑胺的儿童患者（0 ~ 18岁以下）的电子病历。我们收集了临床适应症、既往使用万古霉素的数据，并通过治疗前后AST和ALT水平评估肝功能。排除资料缺失或不完整的患者。结果44例患者中有14例（31.81%）未使用过万古霉素。其中11例（78.57%）未诊断为结核，其中肿瘤科10例（90.90%），儿科ICU 1例（9.09%）。治疗前后记录的37例（84.09%）AST和ALT患者中，分别有15例（40.54%）和13例（35.14%）出现AST和ALT变化高于年龄参考值。结论利奈唑胺可作为万古霉素的一线或早期替代用药，用于高度复杂的非结核性感染儿科患者（肿瘤科，ICU）。肝功能指标的显著变化表明肝毒性是一个相关的不良反应，这加强了在儿科使用利奈唑胺时持续监测和严格评估风险收益的必要性。

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引用次数: 0

KLEBSIELLA PNEUMONIAE IN MARINE ECOSYSTEM: ESBL AND CARBAPENEMASE ON THE COAST OF RIO DE JANEIRO 海洋生态系统中的肺炎克雷伯菌：巴西海岸的esbl和碳青霉烯酶

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104689

Sabrina Rodrigues Rocha, Maria Theresa Xavier dos Santos, Pedro Ximenes de Oliveira, Aloysio de Mello Figueiredo Cerqueira, Carmen Baur Vieira, Felipe Piedade Gonçalves Neves, Aline Rosa Vianna de Souza, Júlia Peixoto de Albuquerque

Introduction/Objective

Klebsiella pneumoniae stands out as an opportunistic pathogen frequently associated with healthcare-related infections. It is classified as a critical priority by the WHO regarding antimicrobial resistance due to the production of extended-spectrum β-lactamases (ESBLs) and carbapenemases, which contribute to its dissemination and clinical impact. Considering its ubiquitous distribution and potential circulation among humans, animals, and natural environments, the objective of this study was to investigate K. pneumoniae strains producing ESBL and/or carbapenemases isolated from marine ecosystems in the municipality of Niterói/RJ, Brazil.

Methods

Seawater samples were collected from three beaches in Niterói. The isolated colonies were identified through mass spectrometry (MALDI-TOF MS). After screening K. pneumoniae strains under selective pressure, the disk diffusion test was performed to evaluate susceptibility to 12 β-lactam antibiotics. The production of ESBL and carbapenemases was confirmed through the double-disk synergy test (DDST) and the modified carbapenem inactivation method (mCIM), respectively. Subsequently, the detection of the genes blaCTX-m-1, blaCTX-m-2, blaCTX-m-8, and blaKPC was performed by Polymerase Chain Reaction (PCR).

Results

Of the 298 K. pneumoniae strains identified, 34 (11.4%) were selected through screening for susceptibility testing. Non-susceptibility to ertapenem was observed in four (11.7%) strains, and to meropenem and imipenem in three (8.8%) strains each. Ceftriaxone showed the highest resistance rate (50.0%), followed by cefazolin (47.0%), cefepime (41.2%), and cefoxitin (38.2%). Resistance to ceftazidime and cefotaxime was 35.2% and 29.4%, respectively. The DDST was positive in 55% of the tested strains, with six strains positive for the blaCTX-m-1 gene and four for blaCTX-m-8. The mCIM was positive in 13% of the evaluated strains, with detection of the blaKPC gene in two of them.

Conclusion

The detection of ESBL- and carbapenemase-producing K. pneumoniae in the coastal region of Niterói/RJ, with the presence of clinically relevant resistance genes, suggests that these areas may be acting as reservoirs and potential sources for the dissemination of these genetic determinants, representing an emerging public health risk.

简介/目的肺炎克雷伯菌是一种机会致病菌，常与医疗保健相关感染相关。由于产生广谱β-内酰胺酶（ESBLs）和碳青霉烯酶，世卫组织将其列为抗菌素耐药性的关键优先事项，这有助于其传播和临床影响。考虑到其在人类、动物和自然环境中的普遍分布和潜在传播，本研究的目的是调查从巴西Niterói/RJ市的海洋生态系统中分离出的产生ESBL和/或碳青霉烯酶的肺炎克雷伯菌菌株。方法在Niterói三个海滩采集海水样本。分离菌落通过质谱（MALDI-TOF MS）鉴定。在选择压力下筛选肺炎克雷伯菌菌株，采用纸片扩散试验评价对12种β-内酰胺类抗生素的敏感性。通过双盘协同试验（DDST）和改良碳青霉烯酶失活法（mCIM）分别确定了ESBL和碳青霉烯酶的产生。随后，采用聚合酶链式反应（Polymerase Chain Reaction， PCR）检测blaCTX-m-1、blaCTX-m-2、blaCTX-m-8和blaKPC基因。结果298株肺炎克雷伯菌经药敏试验筛选筛选出34株（11.4%）；4株（11.7%）对厄他培南不敏感，3株（8.8%）对美罗培南和亚胺培南不敏感。耐药率最高的是头孢曲松（50.0%），其次是头孢唑林（47.0%）、头孢吡肟（41.2%）和头孢西丁（38.2%）。对头孢他啶和头孢噻肟的耐药率分别为35.2%和29.4%。55%的检测菌株DDST阳性，其中blaCTX-m-1基因阳性6株，blaCTX-m-8基因阳性4株。13%的菌株mCIM阳性，其中2株检测到blaKPC基因。结论Niterói/RJ沿海地区检测到产ESBL和产碳青霉烯酶的肺炎克雷伯菌，并存在临床相关的耐药基因，提示这些地区可能是这些遗传决定因素传播的储存库和潜在来源，构成新的公共卫生风险。

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引用次数: 0

MICROBIAL ACTIVITY OF POMEGRANATE LEAF EXTRACT AGAINST RESISTANT STAPHYLOCOCCUS AUREUS 石榴叶提取物对耐药金黄色葡萄球菌的微生物活性研究

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104640

Bernardo Canêdo Martins , Mariana Simões de Oliveira , Luciana Cláudia Diniz Tavares , Camila Pacheco Silveira Martins da Mata , Taleessa Vieira Gomes , Ana Carolina Morais Apolônio

Introduction

Bacterial resistance is a considerable public health risk, with projections of up to 10 million deaths per year by 2050. Resistant Staphylococcus aureus is one of the main multidrug-resistant hospital pathogens. Due to the low efficacy of many antimicrobials, there is growing interest in natural alternatives, such as pomegranate leaf extract (Punica granatum), which is rich in antimicrobial compounds such as punicalagin, ellagic acid, and tannins.

Objective

To evaluate the antimicrobial activity of the hydroalcoholic extract of pomegranate leaf (HPE) against one sensitive strain (S. aureus ATCC 33591) and nine resistant strains (ATCC 25904 and eight clinical strains – Ethics approval: CAAE 32572820.6.0000.5133).

Methods

Leaves of P. granatum were collected, macerated in hydroalcoholic solution (50%), filtered, evaporated, and lyophilized. The eight clinical strains were tested for susceptibility with 18 antimicrobials. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays were performed using broth microdilution in Mueller-Hinton broth, with HPE concentrations ranging from 1000 to 7.8 μg/mL. Azithromycin (40 μg/mL) was used as a control. Inocula (5 × 10⁴ CFU/well) were prepared according to the 0.5 McFarland standard. Plates were incubated at 37°C for 24 h, and the MIC was defined as the lowest concentration visually inhibiting growth. For the MBC, 10 μL from wells without growth were plated on BHI agar.

Results

All tested strains were resistant (R) to benzylpenicillin and oxacillin, and most were resistant to clindamycin and erythromycin. Some showed intermediate susceptibility or resistance to rifampicin. Half of the strains were resistant to levofloxacin. Only one strain was resistant to trimethoprim/sulfamethoxazole, nitrofurantoin, and ciprofloxacin. HPE showed a mean MIC of 500 μg/mL with activity against four strains, including three resistant to at least one antimicrobial. It demonstrated microbiostatic action for four strains at the tested concentrations.

Conclusion

The data indicate the promising potential of HPE as a microbiostatic agent against S. aureus, reinforcing the importance of investigating higher concentrations and the development of natural therapeutic formulations against resistant strains.

细菌耐药性是相当大的公共卫生风险，预计到2050年每年将有多达1000万人死亡。耐药金黄色葡萄球菌是医院主要的多重耐药病原菌之一。由于许多抗菌剂的功效较低，人们对天然替代品的兴趣越来越大，例如石榴叶提取物（石榴叶提取物），它富含抗菌化合物，如石榴苷、鞣花酸和单宁。目的评价石榴叶水醇提取物（HPE）对1株敏感菌株（金黄色葡萄球菌ATCC 33591）、9株耐药菌株（ATCC 25904）和8株临床耐药菌株（CAAE 32572820.6.0000.5133）的抑菌活性。方法采集石榴叶，在50%的水酒精溶液中浸泡，过滤，蒸发，冻干。对8株临床菌株进行18种抗菌素的药敏试验。最小抑菌浓度（MIC）和最小杀菌浓度（MBC）采用微稀释法测定，HPE浓度范围为1000 ~ 7.8 μg/mL。以阿奇霉素40 μg/mL作为对照。接种剂（5 × 10⁴CFU/孔）按0.5 McFarland标准配制。37℃孵育24 h， MIC定义为视觉抑制生长的最低浓度。从未生长的孔中提取10 μL的MBC，涂在BHI琼脂上。结果所有菌株均对青霉素和oxacillin耐药(R)，对克林霉素和红霉素耐药(R)最多。有些对利福平表现出中等敏感性或耐药性。一半的菌株对左氧氟沙星耐药。只有1株对甲氧苄啶/磺胺甲恶唑、呋喃妥因和环丙沙星耐药。HPE显示平均MIC为500 μg/mL，对4株菌株有活性，其中3株对至少一种抗菌素耐药。在测试浓度下对四种菌株表现出抑菌作用。结论HPE作为抗金黄色葡萄球菌的抑菌剂具有广阔的应用前景，进一步加强了研究HPE的浓度和开发抗耐药菌株天然治疗制剂的重要性。

{"title":"MICROBIAL ACTIVITY OF POMEGRANATE LEAF EXTRACT AGAINST RESISTANT STAPHYLOCOCCUS AUREUS","authors":"Bernardo Canêdo Martins , Mariana Simões de Oliveira , Luciana Cláudia Diniz Tavares , Camila Pacheco Silveira Martins da Mata , Taleessa Vieira Gomes , Ana Carolina Morais Apolônio","doi":"10.1016/j.bjid.2026.104640","DOIUrl":"10.1016/j.bjid.2026.104640","url":null,"abstract":"<div><h3>Introduction</h3><div>Bacterial resistance is a considerable public health risk, with projections of up to 10 million deaths per year by 2050. Resistant <em>Staphylococcus aureus</em> is one of the main multidrug-resistant hospital pathogens. Due to the low efficacy of many antimicrobials, there is growing interest in natural alternatives, such as pomegranate leaf extract (<em>Punica granatum</em>), which is rich in antimicrobial compounds such as punicalagin, ellagic acid, and tannins.</div></div><div><h3>Objective</h3><div>To evaluate the antimicrobial activity of the hydroalcoholic extract of pomegranate leaf (HPE) against one sensitive strain (<em>S. aureus</em> ATCC 33591) and nine resistant strains (ATCC 25904 and eight clinical strains – Ethics approval: CAAE 32572820.6.0000.5133).</div></div><div><h3>Methods</h3><div>Leaves of <em>P. granatum</em> were collected, macerated in hydroalcoholic solution (50%), filtered, evaporated, and lyophilized. The eight clinical strains were tested for susceptibility with 18 antimicrobials. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays were performed using broth microdilution in Mueller-Hinton broth, with HPE concentrations ranging from 1000 to 7.8 μg/mL. Azithromycin (40 μg/mL) was used as a control. Inocula (5 × 10⁴ CFU/well) were prepared according to the 0.5 McFarland standard. Plates were incubated at 37°C for 24 h, and the MIC was defined as the lowest concentration visually inhibiting growth. For the MBC, 10 μL from wells without growth were plated on BHI agar.</div></div><div><h3>Results</h3><div>All tested strains were resistant (R) to benzylpenicillin and oxacillin, and most were resistant to clindamycin and erythromycin. Some showed intermediate susceptibility or resistance to rifampicin. Half of the strains were resistant to levofloxacin. Only one strain was resistant to trimethoprim/sulfamethoxazole, nitrofurantoin, and ciprofloxacin. HPE showed a mean MIC of 500 μg/mL with activity against four strains, including three resistant to at least one antimicrobial. It demonstrated microbiostatic action for four strains at the tested concentrations.</div></div><div><h3>Conclusion</h3><div>The data indicate the promising potential of HPE as a microbiostatic agent against <em>S. aureus</em>, reinforcing the importance of investigating higher concentrations and the development of natural therapeutic formulations against resistant strains.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104640"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

OUTBREAK OF POLYMYXIN-RESISTANT ACINETOBACTER BAUMANNII CARRYING BLAOXA-23 CARBAPENEMASE IN A HOSPITAL IN RIO DE JANEIRO 携带blaoxa-23碳青霉烯酶的耐多粘菌鲍曼不动杆菌在里约热内卢一家医院暴发

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104720

Bruna Ribeiro Sued-Karam , Daiana Cristina Silva Rodrigues , Gabriela Alves da Silva , Maria Eduarda Conde , Letícia da Silva Nascimento , Bruno Rocha Pribul , Diana Galvão Ventura , Bibiana Nogueira Siqueira , Melise Chaves Silveira , Cláudio Marcos Rocha-de-Souza , Ana Paula D’Alincourt Carvalho-Assef

Introduction/Objectives

Acinetobacter baumannii is a challenging pathogen and a major epidemiological threat responsible for healthcare-associated infections and increasing multidrug resistance, including to last-resort agents such as polymyxins. This study aimed to characterize carbapenem- and polymyxin-resistant A. baumannii clinical isolates from a state hospital in Rio de Janeiro.

Methods

Between September and December 2024, nine A. baumannii isolates resistant to carbapenems and polymyxin B were received at LabSUR from ICU patients of a state hospital. Carbapenemase genes were screened by multiplex PCR. Clonal relatedness was assessed by pulsed-field gel electrophoresis (PFGE). A representative isolate of the predominant clone underwent whole-genome sequencing (WGS), analyzed through the CABGen pipeline.

Results

All isolates were positive for blaOXA-23 and blaOXA-51 genes. The nine polymyxin-resistant isolates belonged to the same clonal group, six from tracheal secretions and three from surveillance swabs, originating from seven ICU patients (two patients with duplicate samples). Five patients occupied the same ICU beds at different times; two patients died. The sequenced representative strain belonged to sequence type 1 (ST1), a high-risk clone linked to outbreaks and global dissemination of resistance genes. The isolate also harbored aminoglycoside- and sulfonamide-resistance genes and mutations in pmrB and lpxC associated with polymyxin resistance.

Conclusion

The results suggest persistence and circulation of a clonal A. baumannii lineage resistant to carbapenems and polymyxin B within a hospital unit, belonging to a high-risk clone. These findings reinforce the importance of continuous monitoring, control of clonal dissemination, and targeted interventions to mitigate its impact on public health.

鲍曼不动杆菌是一种具有挑战性的病原体，也是一种主要的流行病学威胁，导致卫生保健相关感染和增加多药耐药性，包括对多粘菌素等最后手段的耐药性。本研究的目的是表征巴西里约热内卢一家州立医院的耐碳青霉烯类和耐多粘菌素鲍曼不动杆菌临床分离株。方法对2024年9 - 12月从某州立医院ICU收治的9株鲍曼不动杆菌耐碳青霉烯类和多粘菌素B耐药菌株进行LabSUR检测。采用多重PCR筛选碳青霉烯酶基因。克隆亲缘性通过脉冲场凝胶电泳（PFGE）进行鉴定。对优势克隆的代表性分离物进行全基因组测序（WGS），通过CABGen管道进行分析。结果所有分离株blaOXA-23和blaOXA-51基因均阳性。9株多粘菌素耐药菌株属于同一克隆群，6株来自气管分泌物，3株来自监测拭子，来自7例ICU患者（2例患者有重复样本）。5例患者在不同时间占用同一ICU床位；两名患者死亡。测序的代表性菌株属于序列1型（ST1），这是一种与抗性基因的暴发和全球传播有关的高风险克隆。该分离物还含有氨基糖苷和磺胺耐药基因，以及与多粘菌素耐药相关的pmrB和lpxC突变。结论一株耐碳青霉烯类和多粘菌素B的鲍曼不动杆菌克隆系在某医院单位内存在并循环，属于高危克隆。这些发现强调了持续监测、控制克隆传播和有针对性干预以减轻其对公共卫生影响的重要性。

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引用次数: 0

EVALUATION OF THE POTENTIAL OF VISMIA BRASILIENSIS FOR THE TREATMENT OF SKIN INFECTIONS CAUSED BY STAPHYLOCOCCUS AUREUS 巴西利亚粘菌治疗金黄色葡萄球菌引起的皮肤感染的潜力评价

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104645

Pietra Piotto Marcellini, Cláudia Gontijo Silva, Vera Lúcia de Almeida, Denise de Oliveira Scoaris

Introduction/Objective

Staphylococcus aureus is a Gram-positive bacterium present in the human microbiota, responsible for causing various skin infections, ranging from folliculitis to complex and painful abscesses. With the growing increase in bacterial resistance to previously developed drugs, the development of new agents capable of inhibiting these microorganisms has become a global public health priority. In this context, the use of plants with medicinal properties in the formulation of antimicrobials is considered a promising alternative. Many plants have perfected natural defense mechanisms, producing a variety of bioactive secondary metabolites. The species Vismia brasiliensis is native to Brazil, found mainly in the Atlantic Forest and Cerrado regions. Its medicinal properties stand out for their antioxidant, antimicrobial, and healing activities, which are attributed to the presence of bioactive compounds such as flavonoids and naphthoquinones. The objective of this study was to evaluate the antimicrobial activity of the crude extract of Vismia brasiliensis, to be used in a topical formulation aimed at the treatment of skin infections caused by Staphylococcus aureus.

Methods

Crude extracts from the stem (AM-151C), leaves (AM-151F), and inflorescences (AM-151INF) were evaluated to determine the minimum inhibitory concentration (MIC) against S. aureus (ATCC 25923), in triplicate, by the broth microdilution method. The samples were concentrated and solubilized in DMSO at 50 mg/mL and then tested at concentrations from 7.8125 to 500 µg/mL. The MIC was defined as the lowest concentration of the samples capable of inhibiting at least 70% of microbial growth.

Results

The samples that showed the most relevant inhibition results were those from inflorescences (AM-151INF) with an MIC of 250 µg/mL (97.6 ± 0.1%) and from the stem (AM-151C) with an MIC of 500 µg/mL (92.9 ± 1.0%). The sample from the leaves (AM-151F) was not considered active against S. aureus.

Conclusion

The results show a strong antimicrobial potential of Vismia brasiliensis as an alternative to be employed in the development of topical formulations for the treatment of skin infections caused by Staphylococcus aureus.

简介/目的金黄色葡萄球菌是一种存在于人类微生物群中的革兰氏阳性细菌，可引起各种皮肤感染，从毛囊炎到复杂和疼痛的脓肿。随着细菌对以前开发的药物的耐药性日益增加，开发能够抑制这些微生物的新药已成为全球公共卫生的优先事项。在这种情况下，在抗菌剂配方中使用具有药用特性的植物被认为是一种有希望的替代方法。许多植物具有完善的天然防御机制，产生多种具有生物活性的次生代谢产物。Vismia brasiliensis原产于巴西，主要分布在大西洋森林和塞拉多地区。其药用特性因其抗氧化、抗菌和愈合活性而突出，这归功于其生物活性化合物如类黄酮和萘醌的存在。本研究的目的是评估巴西粘菌粗提取物的抗菌活性，用于局部配方，旨在治疗金黄色葡萄球菌引起的皮肤感染。方法采用微量肉汤稀释法测定茎（AM-151C）、叶（AM-151F）和花序（AM-151INF）粗提物对金黄色葡萄球菌（ATCC 25923）的最低抑菌浓度（MIC）。将样品在50 mg/mL的DMSO中浓缩和溶解，然后在7.8125至500µg/mL的浓度范围内进行测试。MIC定义为能够抑制至少70%微生物生长的样品的最低浓度。结果抑菌效果最好的样品为花序（AM-151INF）和茎（AM-151C），其MIC值分别为250µg/mL（97.6±0.1%）和500µg/mL（92.9±1.0%）。从叶子中提取的样品（AM-151F）对金黄色葡萄球菌没有活性。结论巴西螺具有较强的抗菌潜力，可用于开发治疗金黄色葡萄球菌感染的外用制剂。

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引用次数: 0

CHALLENGES FOR SWITCHING INTRAVENOUS TO ORAL ANTIMICROBIALS: PHYSICIAN INERTIA AS A BARRIER IN A BRAZILIAN HOSPITAL 将静脉注射抗菌素转为口服抗菌素的挑战：巴西一家医院的医生惰性是一个障碍

IF 2.8 4区医学 Q2 INFECTIOUS DISEASES

Brazilian Journal of Infectious Diseases

Pub Date : 2026-03-01 Epub Date: 2026-03-14 DOI: 10.1016/j.bjid.2026.104659

Manuela Jacques , Marcelo Carneiro , André Piccolo Pereira , Rochele Mosmann Menezes , Paula Trevisan , Ingrid Pilz , Felipe Provensi Rangel , Anna Júlia Castoldi Ravazio , Bruna Bombel da Luz , André Luiz Silva Alvim , Caroline Alegransi , Adalia Pinheiro Loureiro , Alana Pinheiro Alves

Introduction/Objective

The timely switch from intravenous to oral administration is one of the key actions recommended by Antimicrobial Stewardship Programs. This practice offers several benefits, such as minimizing catheter-related adverse events, reducing treatment costs, and shortening hospital stays, without compromising treatment safety or efficacy. Despite this, up to two-thirds of eligible patients remain on intravenous therapy. Recognizing this scenario may help identify opportunities for improvement in clinical practice and support the implementation of standardized protocols. The objective of the study was to evaluate the frequency of prescriptions in which the route of administration was transitioned for ≥ 72 hours and that met the eligibility criteria.

Methods

This was a cross-sectional study conducted from January 1 to May 31, 2025, in a teaching hospital located in the southern region of Brazil. Inclusion criteria were adult patients (≥ 18 years) hospitalized in critical and non-critical care units who received intravenous antimicrobials and were clinically eligible for conversion to oral therapy, that is, those with a clinical indication for sequential oral therapy according to institutional protocol. All patients receiving prophylactic antibiotic therapy were excluded.

Results

During the study period, six cases of antimicrobial route conversion were identified, five of which occurred in non-critical care units. The antimicrobial classes involved were quinolones, penicillins combined with beta-lactamase inhibitors, and macrolides.

Conclusion

The findings reveal a low adherence to intravenous-to-oral antimicrobial conversion practices, even among patients hospitalized in non-critical units and receiving antimicrobials with good oral bioavailability. This scenario highlights the urgent need to implement structured strategies within the antimicrobial stewardship program, including tailored clinical protocols, staff training, and audit and feedback processes, to promote safe and effective adoption of conversion practices. Such measures may contribute to the improvement of key hospital indicators, including optimization of institutional resources and patient safety.

前言/目的及时将静脉给药改为口服给药是抗菌药物管理规划建议的关键措施之一。这种做法有几个好处，如最大限度地减少导管相关不良事件，降低治疗费用，缩短住院时间，而不影响治疗的安全性或有效性。尽管如此，仍有多达三分之二的符合条件的患者继续接受静脉注射治疗。认识到这种情况可能有助于确定改善临床实践的机会，并支持标准化方案的实施。该研究的目的是评估给药途径转换≥72小时且符合资格标准的处方频率。方法采用横断面研究，于2025年1月1日至5月31日在巴西南部地区的一家教学医院进行。纳入标准为在重症和非重症监护病房接受静脉注射抗菌素且临床符合转口服治疗条件的成年患者（≥18岁），即根据机构方案具有序贯口服治疗临床指征的患者。所有接受预防性抗生素治疗的患者均被排除在外。结果在研究期间，共发现6例抗菌药物途径转换病例，其中5例发生在非重症监护病房。所涉及的抗菌药物类别是喹诺酮类，青霉素与β -内酰胺酶抑制剂联合使用，以及大环内酯类。结论研究结果显示，即使在非危重病房住院并接受具有良好口服生物利用度的抗菌素的患者中，静脉注射到口服的抗菌素转换做法的依从性也很低。这种情况突出表明，迫切需要在抗菌药物管理规划中实施结构化战略，包括量身定制的临床方案、工作人员培训以及审计和反馈流程，以促进安全有效地采用转化做法。这些措施可能有助于改善医院的关键指标，包括优化机构资源和患者安全。

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