Brazilian Journal of Infectious Diseases最新文献

{"title":"RELATIONSHIP BETWEEN KPC PRODUCTION AND SENSITIVITY PROFILE TO POLYMYXINS, AMINOGLYCOSIDES, AND CEFTAZIDIME-AVIBACTAM IN A PUBLIC TERTIARY HOSPITAL IN SÃO PAULO","authors":"Ricardo Cantarim Inacio,&nbsp;Marcos Antonio Cyrillo","doi":"10.1016/j.bjid.2026.104712","DOIUrl":"10.1016/j.bjid.2026.104712","url":null,"abstract":"<div><div>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) <em>in vitro</em> multiplex immunoassay for the phenotypic detection and differentiation of these common carbapenemase families produced by Enterobacterales and <em>Pseudomonas</em>. Tests were performed between August 2024 and March 2025. Sixty carbapenem-resistant strains (49 Enterobacterales and 11 <em>Pseudomonas aeruginosa</em>) 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%) <em>Klebsiella pneumoniae</em>: 14 (35%) were sensitive to polymyxins, 27 (67%) to amikacin, 10 (25%) to gentamicin, and 21 (52.2%) to ceftazidime-avibactam. Two (4.76%) <em>Escherichia coli</em> 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 <em>K. pneumoniae</em> 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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104712"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453772","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}

{"title":"THE PHARMACOECONOMIC IMPACT OF PHARMACEUTICAL INTERVENTION IN ANTIMICROBIAL STEWARDSHIP","authors":"Laura Batista Campos,&nbsp;Guilherme Scodelario Bettencourt,&nbsp;Bárbara Caterine Pegoraro,&nbsp;Rômulo Cardoso da Silva,&nbsp;Elisangela Lucia de Oliveira,&nbsp;Ezequiel Oliveira Felipe,&nbsp;Juliana Januzzi Costa,&nbsp;Edvânia Silva,&nbsp;Odeli Nicole Encinas Sejas,&nbsp;Rosemeire Lima Lessi,&nbsp;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}

{"title":"LINEZOLID IN PEDIATRICS: ANALYSIS OF INDICATIONS AND HEPATOTOXICITY IN A UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL","authors":"Isabelle Souza Viana,&nbsp;Bruno Simas da Rocha,&nbsp;Michele Gai Schmidt,&nbsp;Andressa Barros","doi":"10.1016/j.bjid.2026.104690","DOIUrl":"10.1016/j.bjid.2026.104690","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104690"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453913","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}

{"title":"KLEBSIELLA PNEUMONIAE IN MARINE ECOSYSTEM: ESBL AND CARBAPENEMASE ON THE COAST OF RIO DE JANEIRO","authors":"Sabrina Rodrigues Rocha,&nbsp;Maria Theresa Xavier dos Santos,&nbsp;Pedro Ximenes de Oliveira,&nbsp;Aloysio de Mello Figueiredo Cerqueira,&nbsp;Carmen Baur Vieira,&nbsp;Felipe Piedade Gonçalves Neves,&nbsp;Aline Rosa Vianna de Souza,&nbsp;Júlia Peixoto de Albuquerque","doi":"10.1016/j.bjid.2026.104689","DOIUrl":"10.1016/j.bjid.2026.104689","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div><em>Klebsiella pneumoniae</em> 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 <em>K. pneumoniae</em> strains producing ESBL and/or carbapenemases isolated from marine ecosystems in the municipality of Niterói/RJ, Brazil.</div></div><div><h3>Methods</h3><div>Seawater samples were collected from three beaches in Niterói. The isolated colonies were identified through mass spectrometry (MALDI-TOF MS). After screening <em>K. pneumoniae</em> 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).</div></div><div><h3>Results</h3><div>Of the 298 <em>K. pneumoniae</em> 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.</div></div><div><h3>Conclusion</h3><div>The detection of ESBL- and carbapenemase-producing <em>K. pneumoniae</em> 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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104689"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453996","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}

{"title":"MICROBIAL ACTIVITY OF POMEGRANATE LEAF EXTRACT AGAINST RESISTANT STAPHYLOCOCCUS AUREUS","authors":"Bernardo Canêdo Martins ,&nbsp;Mariana Simões de Oliveira ,&nbsp;Luciana Cláudia Diniz Tavares ,&nbsp;Camila Pacheco Silveira Martins da Mata ,&nbsp;Taleessa Vieira Gomes ,&nbsp;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}

{"title":"OUTBREAK OF POLYMYXIN-RESISTANT ACINETOBACTER BAUMANNII CARRYING BLAOXA-23 CARBAPENEMASE IN A HOSPITAL IN RIO DE JANEIRO","authors":"Bruna Ribeiro Sued-Karam ,&nbsp;Daiana Cristina Silva Rodrigues ,&nbsp;Gabriela Alves da Silva ,&nbsp;Maria Eduarda Conde ,&nbsp;Letícia da Silva Nascimento ,&nbsp;Bruno Rocha Pribul ,&nbsp;Diana Galvão Ventura ,&nbsp;Bibiana Nogueira Siqueira ,&nbsp;Melise Chaves Silveira ,&nbsp;Cláudio Marcos Rocha-de-Souza ,&nbsp;Ana Paula D’Alincourt Carvalho-Assef","doi":"10.1016/j.bjid.2026.104720","DOIUrl":"10.1016/j.bjid.2026.104720","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div><em>Acinetobacter baumannii</em> 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 <em>A. baumannii</em> clinical isolates from a state hospital in Rio de Janeiro.</div></div><div><h3>Methods</h3><div>Between September and December 2024, nine <em>A. baumannii</em> 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.</div></div><div><h3>Results</h3><div>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 <em>pmrB</em> and <em>lpxC</em> associated with polymyxin resistance.</div></div><div><h3>Conclusion</h3><div>The results suggest persistence and circulation of a clonal <em>A. baumannii</em> 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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104720"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454201","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}

{"title":"EVALUATION OF THE POTENTIAL OF VISMIA BRASILIENSIS FOR THE TREATMENT OF SKIN INFECTIONS CAUSED BY STAPHYLOCOCCUS AUREUS","authors":"Pietra Piotto Marcellini,&nbsp;Cláudia Gontijo Silva,&nbsp;Vera Lúcia de Almeida,&nbsp;Denise de Oliveira Scoaris","doi":"10.1016/j.bjid.2026.104645","DOIUrl":"10.1016/j.bjid.2026.104645","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div><em>Staphylococcus aureus</em> 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 <em>Vismia brasiliensis</em> 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 <em>Vismia brasiliensis</em>, to be used in a topical formulation aimed at the treatment of skin infections caused by <em>Staphylococcus aureus</em>.</div></div><div><h3>Methods</h3><div>Crude extracts from the stem (AM-151C), leaves (AM-151F), and inflorescences (AM-151INF) were evaluated to determine the minimum inhibitory concentration (MIC) against <em>S. aureus</em> (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.</div></div><div><h3>Results</h3><div>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 <em>S. aureus</em>.</div></div><div><h3>Conclusion</h3><div>The results show a strong antimicrobial potential of <em>Vismia brasiliensis</em> as an alternative to be employed in the development of topical formulations for the treatment of skin infections caused by <em>Staphylococcus aureus</em>.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104645"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454331","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}

{"title":"COMPARATIVE IN VITRO PERFORMANCE OF COMBINED ANTIBIOTIC ELUTION IN DIFFERENT CERAMIC BONE SUBSTITUTES AND CEMENT USING SENSITIVE AND MULTIDRUG-RESISTANT PATHOGENS","authors":"Isabelle Caroline Frois Brasil Tannus,&nbsp;Mariana Neri Lucas Kurihara,&nbsp;Ingrid Marcelino Santos,&nbsp;Stefânia Bazanelli Prebianchi,&nbsp;Laura Batista Campos,&nbsp;Mayara Muniz de Andrade Silva,&nbsp;Rafael Brull Tuma,&nbsp;Thomas Stranvinskas Durigon,&nbsp;Carlos Augusto Finelli,&nbsp;Fernando Baldy Dos Reis,&nbsp;Danielle Borges Germano,&nbsp;Steffany Bernardo Oliveira,&nbsp;Mauro José Costa Salles","doi":"10.1016/j.bjid.2026.104660","DOIUrl":"10.1016/j.bjid.2026.104660","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the efficacy of biomaterials with antibacterial properties in inhibiting the growth of microorganisms commonly associated with infections in orthopedic implants.</div></div><div><h3>Methods</h3><div>Antibiotics released from nanocrystalline hydroxyapatite with calcium sulfate (HCS), calcium sulfate (CaSO₄), and polymethylmethacrylate (PMMA) beads were tested against ATCC strains (ATCC29213, ATCC12228, ATCC6919, ATCC47085) and clinical isolates of <em>Staphylococcus aureus</em> (SA), <em>Staphylococcus epidermidis</em> (SE), <em>Pseudomonas aeruginosa</em> (PSA), and <em>Cutibacterium acnes</em> (CA), including multidrug-resistant and susceptible strains. Carriers were loaded with gentamicin (G), vancomycin (V), or gentamicin plus vancomycin (G+V). Inhibition zone (ZOI) assays determined antibiotic release and potency over 1 to 15 days (D1–D15). The Biofilm-Oriented Antiseptic Test (BOAT) was used to assess biofilm suppression after 24-hour exposure to antibiotic-loaded beads.</div></div><div><h3>Results</h3><div>Bioceramics (CaSO₄ and HCS) showed greater potency during early phases (D1–D3) (p &lt; 0.05) against <em>Staphylococcus</em> spp., especially for G+V combinations. Between D1–D5, the ZOI differences between bioceramics and PMMA were no longer statistically significant, suggesting initial efficacy differences diminish over time. At later stages (D5–D15), PMMA exhibited larger ZOIs compared to bioceramics (p &lt; 0.05) for most strains. CaSO₄ loaded with V maintained a larger ZOI up to D7 versus PMMA for MRSA (p &lt; 0.05). No statistical differences were found between CaSO₄ and HCS for SA. G+V elution in both bioceramics and PMMA significantly improved ZOIs for SE and CA strains (p &lt; 0.05). There were no significant ZOI differences between carriers for PSA strains; by D5, no inhibition was observed for PSA with any material. For CA, bioceramics tended to yield larger ZOIs. BOAT demonstrated optical density inhibition for all strains except MRSA exposed to G alone and CA strains.</div></div><div><h3>Conclusion</h3><div>Both bioceramics and PMMA beads acted as effective carriers; however, greater antimicrobial elution and biofilm eradication during early phases (D1–D5) were observed with bioceramics, while PMMA showed superior activity at later stages (D5–D15).</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104660"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454314","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}

{"title":"EFFICACY OF ORAL ANTIBIOTIC PROPHYLAXIS WITH CEPHALEXIN AND METRONIDAZOLE AFTER CESAREAN DELIVERY IN OBESE PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"Júlia Cremonini Bernardi,&nbsp;Nicoly Fiorese Andrade,&nbsp;Maria Eduarda Molinari,&nbsp;Gabriel Olivo Leandro","doi":"10.1016/j.bjid.2026.104663","DOIUrl":"10.1016/j.bjid.2026.104663","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical site infections are a significant cause of morbidity following cesarean deliveries. Preoperative prophylaxis with cephalosporins is the standard of care; however, obesity remains an independent risk factor. Effective preventive measures are essential to improve maternal health and reduce costs. This study aimed to evaluate the efficacy of oral cephalexin and metronidazole prophylaxis in the postoperative period of cesarean sections.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Embase, and Cochrane databases for randomized clinical trials evaluating the efficacy of oral cephalexin and metronidazole for preventing surgical site infection, incision dehiscence, fever, endometritis, and cellulitis after cesarean section. Statistical analyses were performed using R software (version 4.5.0), with risk ratio as the effect measure. Results were expressed as geometric means and geometric mean ratios, applying a random-effects model and a 5% significance level. Heterogeneity was assessed using the I² statistic. Sensitivity analyses were performed when data were available.</div></div><div><h3>Results</h3><div>Three randomized controlled trials were included, totaling 1,144 patients—572 in the oral antibiotic prophylaxis group (cephalexin plus metronidazole) and 572 in the control group. The mean age of participants was 27 years, and the mean BMI was 37 kg/m². A significant reduction was observed in the incidence of cellulitis (RR = 0.41; 95% CI 0.25–0.67; p &lt; 0.001; I² = 0%) and surgical site infection (RR = 0.39; 95% CI 0.27–0.58; p &lt; 0.001; I² = 0%) in the intervention group. No statistically significant differences were found between groups for endometritis (RR = 0.37; 95% CI 0.11–1.21; p = 0.102; I² = 0%), fever (RR = 0.68; 95% CI 0.36–1.30; p = 0.247; I² = 46.4%), or wound separation (RR = 0.47; 95% CI 0.18–1.20; p = 0.113; I² = 55.3%).</div></div><div><h3>Conclusion</h3><div>This meta-analysis confirms that postoperative oral antibiotic prophylaxis with cephalexin and metronidazole is effective in reducing surgical site infections and cellulitis after cesarean delivery. These findings support its use as an adjuvant strategy for preventing infectious complications in obstetric settings, particularly among high-risk populations such as obese patients.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104663"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454317","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}

{"title":"CHALLENGES FOR SWITCHING INTRAVENOUS TO ORAL ANTIMICROBIALS: PHYSICIAN INERTIA AS A BARRIER IN A BRAZILIAN HOSPITAL","authors":"Manuela Jacques ,&nbsp;Marcelo Carneiro ,&nbsp;André Piccolo Pereira ,&nbsp;Rochele Mosmann Menezes ,&nbsp;Paula Trevisan ,&nbsp;Ingrid Pilz ,&nbsp;Felipe Provensi Rangel ,&nbsp;Anna Júlia Castoldi Ravazio ,&nbsp;Bruna Bombel da Luz ,&nbsp;André Luiz Silva Alvim ,&nbsp;Caroline Alegransi ,&nbsp;Adalia Pinheiro Loureiro ,&nbsp;Alana Pinheiro Alves","doi":"10.1016/j.bjid.2026.104659","DOIUrl":"10.1016/j.bjid.2026.104659","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104659"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454313","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}