Brazilian Journal of Infectious Diseases最新文献

{"title":"THE WEIGHT OF INTUITION: COGNITIVE BIASES AND SUBOPTIMAL ANTIMICROBIAL PRESCRIPTION IN INTENSIVE CARE","authors":"Natanael Sutikno Adiwardana ,&nbsp;Regia Damous Fontenele Feijo","doi":"10.1016/j.bjid.2026.104697","DOIUrl":"10.1016/j.bjid.2026.104697","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Antimicrobial prescription is a complex decision often influenced by cognitive biases that may contribute to inappropriate use and increased bacterial resistance. In the intensive care environment, where decisions are rapid and high-impact, understanding these factors is essential. The objective of this study was to assess the prevalence of cognitive biases among physicians working in intensive care units and analyze their influence on decisional accuracy in standardized clinical scenarios.</div></div><div><h3>Methods</h3><div>An observational, cross-sectional study was conducted with 150 physicians from different specialties working in intensive care units. Data were collected via an anonymous online form using a non-validated instrument developed by the authors based on cognitive biases established in the literature. The questionnaire contained statements on a five-point Likert scale to assess nine cognitive biases and accuracy in two standardized clinical cases. A descriptive analysis of the data was performed.</div></div><div><h3>Results</h3><div>The results revealed a paradox between high subjective confidence and low objective performance. Descriptive analysis of bias prevalence (“strongly agree” or “partially agree” responses) showed that the most frequent were the IKEA effect (84.7%), hyperbolic discounting (78.7%), optimism bias (76.0%), and impact bias (71.3%). Other relevant biases included diagnostic momentum (64.0%) and availability bias (54.0%). To a lesser degree, commission bias (32.7%) and negativity bias (28.0%) were observed. Notably, anchoring bias showed the lowest agreement (16.7%). Additionally, 34.0% admitted following the dogma of completing therapies in multiples of seven days. In contrast to the high prevalence of confidence-related biases, the accuracy in choosing the antimicrobial in clinical cases was only 7.3% (11/150) in the first and 19.3% (29/150) in the second.</div></div><div><h3>Conclusion</h3><div>The high prevalence of confidence-related biases (IKEA, optimism) in contrast to low objective decisional accuracy is the central finding of this study. This suggests that antibiotic therapy is strongly influenced by subjective factors, demanding strategies that transcend conventional education. Future studies should focus on prospectively and multicentrically evaluating the impact of interventions designed to mitigate the most prevalent biases on clinical and microbiological outcomes.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104697"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453882","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":"POLYMICROBIAL INFECTION AS AN INDEPENDENT RISK FACTOR FOR THE FAILURE OF CHRONIC SUPPRESSIVE ANTIBIOTIC THERAPY IN ORTHOPEDIC IMPLANT-ASSOCIATED INFECTIONS","authors":"Gustavo Dertkigil Habitante ,&nbsp;Giovanna Vicente de Freitas ,&nbsp;Catarina Lima Spina ,&nbsp;Taiana Cunha Ribeiro ,&nbsp;Ícaro Santos Oliveira ,&nbsp;Rodrigo Peixoto Vargas ,&nbsp;Giselle Burlamaqui Klautau ,&nbsp;Mauro José Costa Salles","doi":"10.1016/j.bjid.2026.104683","DOIUrl":"10.1016/j.bjid.2026.104683","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div>Orthopedic implant-associated infections (OIAI) are common and challenging complications, leading to increased healthcare costs and impaired quality of life. When implant removal or replacement is not feasible for infection control, chronic suppressive antibiotic therapy (SAT) is indicated as an alternative strategy. However, the effectiveness of SAT remains uncertain, as well as the risks of antimicrobial resistance, adverse effects, and its impact on patients’ quality of life. This study aimed to evaluate the failure rate of SAT after 12 months of follow-up and to identify independent risk factors for failure.</div></div><div><h3>Methods</h3><div>This was a single-center prospective cohort study including patients with OIAI who received SAT and were followed in the musculoskeletal infection outpatient clinic of a specialized university hospital between August 2019 and May 2025. Patients were divided into two groups according to SAT success or failure and matched based on demographic, clinical, microbiological, and surgical variables. Outpatient follow-up was conducted at 3, 6, and 12 months after SAT initiation. Independent risk factors for SAT failure were identified using logistic regression with the stepwise forward method. A significance level of 5% was adopted for all analyses.</div></div><div><h3>Results</h3><div>Twenty-three out of 59 patients experienced SAT failure, with a mean age of 53.2 years (SD ± 18.5) in the failure group. Prosthetic joint infections showed the highest failure rate (56.3%), followed by spinal arthrodesis-associated infections (50%) and fracture-related infections (28.2%). The mean SAT duration was 38.2 weeks (SD ± 30.1). The most frequently isolated microorganisms in OIAI were <em>S. aureus</em> (n = 24) and coagulase-negative <em>Staphylococcus</em> (n = 9). Gram-negative bacteria were found in 43.7% of failures (RR 1.1; 95% CI 0.5–2.45; p = 0.81), and multidrug-resistant bacteria in 13.6% (RR 1.0; 95% CI 0.38–2.64; p = 1.0). The most commonly used antibiotic regimen was ciprofloxacin plus sulfamethoxazole-trimethoprim (39% in the failure group and 58% in the success group, p = 0.15). Polymicrobial infection was the only independent risk factor for SAT failure (57% vs. 43% in the success group; RR 2.29; 95% CI 1.08–4.85; p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>A high rate of SAT failure was identified, and polymicrobial OIAI was independently associated with this unfavorable outcome.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104683"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453962","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":"PHARMACEUTICAL INTERVENTION IN AMIKACIN: DOSE OPTIMIZATION AND REDUCTION OF ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS","authors":"Julia Toledo Fature ,&nbsp;Andressa Barros ,&nbsp;Maria Helena Pitombeira Rigatto ,&nbsp;Tatiane da Silva Dal Pizzol","doi":"10.1016/j.bjid.2026.104687","DOIUrl":"10.1016/j.bjid.2026.104687","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Amikacin, an aminoglycoside with renal excretion, is used for infections caused by resistant pathogens, but its use is related to the risk of nephrotoxicity. The hospital pharmacist can optimize its use, minimizing this adverse event. The present study evaluated the impact of pharmaceutical intervention in the prevention of nephrotoxicity associated with amikacin, comparing outcomes before and after daily pharmaceutical follow-up in a tertiary hospital in southern Brazil.</div></div><div><h3>Methods</h3><div>A “before and after” study was conducted through an institutional database, with an anonymized query request. Data from patients over 18 years old who used amikacin for ≥ 5 days during hospitalization were analyzed for the periods January/2019 to July/2021 (Period 1) and September/2021 to February/2024 (Period 2). The daily pharmaceutical intervention, implemented in August/2021, consisted of signaling to the prescriber dosage adjustments of amikacin when these were necessary. Descriptive statistical analysis of dose and acute kidney injury (RIFLE) data was performed with SPSS 18.0, considering p ≤ 0.05.</div></div><div><h3>Results</h3><div>A total of 698 patients were analyzed (349 per period), with similar demographic characteristics. There were no significant differences between periods for sex (p = 0.759), race (p = 0.703), length of stay (P1: 24.5 days; P2: 22.0 days), duration of treatment with amikacin (P1: 8.5 days; P2: 7.0 days), or clinical outcomes (discharge: P1: 78.3% vs P2: 82.5%; death: P1: 21.7% vs P2: 17.5%; p = 0.171). However, Period 2 showed greater dose adjustment adequacy for amikacin (p &lt; 0.001) over 14 days (e.g., D0: 58 P2 vs 38 P1; D13: 7 P2 vs 2 P1). This optimization correlated with superior renal protection in Period 2 (p = 0.001), with more patients without AKI (296 P2 vs 138 P1) and lower incidence of RIFLE categories of risk (45 P2 vs 183 P1), injury (0 P2 vs 13 P1), and failure (0 P2 vs 6 P1).</div></div><div><h3>Conclusion</h3><div>The work of the clinical pharmacist, as part of a multidisciplinary strategy, may contribute to more appropriate therapy with the antimicrobial amikacin and to a considerable reduction in patients at risk of acute kidney injury, injury, and renal failure.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104687"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453966","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":"GENOMIC ANALYSIS OF PSEUDOMONAS AERUGINOSA CARRYING BLAGES-1 AND BLAKPC-2 ISOLATED FROM BLOODSTREAM INFECTION IN RONDÔNIA","authors":"Emanuelle Leite Galdino ,&nbsp;Ana Carolina Gonçalves ,&nbsp;Maria Clara Franco Schincaglia ,&nbsp;Fernanda Fernandes dos Santos ,&nbsp;Maycon Rosa Bonfim ,&nbsp;Heloísa Magnoler Alencar da Silva ,&nbsp;Rosineide Vieira Góis ,&nbsp;Mariana Pinheiro Alves Vasconcelos ,&nbsp;Antonieta Ferreira Machado de Oliveira ,&nbsp;Wellington Pine Omorif ,&nbsp;Allan Silva ,&nbsp;Ana Cristina Gales ,&nbsp;Tiago Barcelos Valiatti","doi":"10.1016/j.bjid.2026.104634","DOIUrl":"10.1016/j.bjid.2026.104634","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div><em>Pseudomonas aeruginosa</em> (PSA) is an opportunistic bacterium widely associated with hospital infections, especially in immunocompromised patients. The emergence of PSA strains producing carbapenemase has worsened the clinical scenario, limiting the therapeutic options available an important public health problem on a global scale. In this context, the present study aims to perform the genomic characterization of a PSA isolate co-producing GES-1 and KPC-2.</div></div><div><h3>Methods</h3><div>Thirteen PSA strains resistant to carbapenems were included, isolated from blood culture (n = 5) and tracheal secretion (n = 8) from patients in two hospitals in Porto Velho, Rondônia. The BlueCarba test was used to detect carbapenemase production. The strain with a positive result was selected for whole-genome sequencing using the Illumina HiSeq 2500 platform. De novo genome assembly and annotation were performed using SPAdes and Prokka, respectively. Sequence Type (ST) determination and identification of plasmid replicons were conducted using tools from the CGE Platform. Phage elements were identified using PHASTER, and the resistome was identified using CARD.</div></div><div><h3>Results</h3><div>Among the strains, only PSA-8697 (blood culture) was positive in the BlueCarba test and was selected for genomic sequencing. The assembled genome of PSA-8697 presented 107 contigs, with a total length of 6,831,535 base pairs and an average G+C content of 66.04 percent. Resistome analysis revealed the presence of genes encoding resistance to beta-lactams (blaGES-1 and blaKPC-2) and aminoglycosides (APH(3’)-IIb). MLST typing identified PSA-8697 as belonging to ST3079. Analysis of phage elements identified 12 sequences, of which five were classified as intact. No plasmid replicons were detected. It is noteworthy that previous studies conducted in Brazil reported the presence of an ST3079 clone co-producing GES-1 and KPC-2 in the Northeast, thus suggesting that this clone may be spreading in the country.</div></div><div><h3>Conclusion</h3><div>We describe here for the first time in the northern region of Brazil the genomic characterization of a PSA ST3079 lineage co-producing GES-1 and KPC-2. The findings of this study, from a region with scarce data on the epidemiology of antimicrobial resistance, reinforce the importance of continuous monitoring of this genetic profile.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104634"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454079","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":"CIRCULATING GENOTYPES OF SALMONELLA TYPHI AND THEIR RELATIONSHIP WITH QUINOLONE RESISTANCE IN NORTHERN BRAZIL","authors":"Ana Judith Pires Garcia,&nbsp;Mayza Miranda Bezerra,&nbsp;Alex Brito Souza,&nbsp;Davi Josue Marcon,&nbsp;Yan Corrêa Rodrigues,&nbsp;Karla Valéria Batista Lima","doi":"10.1016/j.bjid.2026.104672","DOIUrl":"10.1016/j.bjid.2026.104672","url":null,"abstract":"<div><div>Quinolone resistance in <em>Salmonella Typhi</em>, the causative agent of typhoid fever, represents a significant and growing global public health concern, severely limiting treatment options, especially in regions with a high disease burden. The recurrent emergence of resistant isolates underscores the need for studies investigating genetic characteristics and mechanisms that allow the characterization of circulating lineages and their association with specific antimicrobial resistance mechanisms. This study aimed to identify circulating <em>S. Typhi</em> genotypes and their relationship with quinolone susceptibility in Northern Brazil. Six <em>S. Typhi</em> isolates from sporadic cases in Pará State, Northern Brazil, collected between 2010 and 2022 and presenting different antimicrobial susceptibility profiles, were analyzed from the bacterial collection of the Bacteriology Section, Instituto Evandro Chagas (SABAC-IEC). The isolates were subjected to disk diffusion assays to assess susceptibility to nalidixic acid, pefloxacin, and ciprofloxacin, and to broth microdilution testing for ciprofloxacin evaluation. Genomic DNA was extracted, and whole-genome sequencing (WGS) was performed to determine genotypes and detect antimicrobial resistance determinants. Genotyping followed the GenoTyphi scheme on the PathogenWatch platform. MLST profiles were determined using MLST v2.0, and resistance genes were identified with ResFinder v4.4.3.Genotype 2.0.2 (sequence type ST2) predominated in the region, corresponding to 5 of the 6 isolates, while 1 isolate was identified as genotype 3 (ST1). Isolates belonging to genotype 2.0.2 were susceptible to quinolones, whereas the genotype 3 isolate harbored the <em>gyrA_D87G</em> mutation and exhibited resistance to nalidixic acid, ciprofloxacin (MIC 16 µg/mL), and pefloxacin. No mutations were detected in <em>gyrB</em>, <em>parC</em>, or <em>parE</em>. These preliminary findings revealed the circulation of two distinct <em>S. Typhi</em> lineages in Pará State. Genotype 3 appears to represent a high-risk lineage in the region, as it was associated with quinolone resistance and potential therapeutic failure, posing a significant public health challenge.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104672"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454084","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":"FACTORS ASSOCIATED WITH ANTIMICROBIAL RESISTANCE IN ENCAPSULATED BACTERIA IN BRAZIL: A TEMPORAL TREND ANALYSIS FROM 2013 TO 2023","authors":"Matheus Negri Boschiero ,&nbsp;Nathalia Sansone ,&nbsp;Laura Ribeiro de Matos ,&nbsp;Lucas Silva Mello ,&nbsp;Luiz Felipe Azevedo Marques ,&nbsp;Fernando Augusto Lima Marson","doi":"10.1016/j.bjid.2026.104668","DOIUrl":"10.1016/j.bjid.2026.104668","url":null,"abstract":"<div><h3>Introduction</h3><div>Excessive antimicrobial use, environmental factors, and bacterial evolutionary dynamics contribute to antimicrobial resistance. This study aimed to describe and analyze factors related to resistance in <em>Neisseria meningitidis</em>, <em>Haemophilus influenzae</em>, and <em>Streptococcus pneumoniae</em>.</div></div><div><h3>Methods</h3><div>Resistance profile data were provided by the Adolfo Lutz Institute. Minimum inhibitory concentration cutoffs followed CLSI guidelines until 2021 and the Brazilian Committee on Antimicrobial Susceptibility Testing from 2022 onward. Isolates were classified as “susceptible” or “susceptible, increased exposure” versus “resistant.” Binary logistic regression was performed to assess factors associated with resistance. Results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and α &lt; 0.05.</div></div><div><h3>Results</h3><div>For <em>N. meningitidis</em>, 2,008 isolates were included, with 3/1,984 resistant to ciprofloxacin and penicillin, and 6/1,981 to rifampicin. For <em>H. influenzae</em> (n = 1,274), male sex was associated with ampicillin resistance (OR: 1.46; 95%CI: 1.08–2.00). Resistance to sulfamethoxazole-trimethoprim (SMX-TMP) was higher in bronchoalveolar lavage samples (OR: 1.65; 95%CI: 1.02–2.64) and lower in cerebrospinal fluid samples (OR: 0.65; 95%CI: 0.45–0.92). For <em>S. pneumoniae</em> (n = 9,706), progressive resistance increases were observed for all antimicrobials, peaking in 2022–2023. The highest resistance rates were seen for ceftriaxone (OR: 8.47; 95%CI: 4.60–17.2), clindamycin (OR: 4.63; 95%CI: 3.65–5.91), erythromycin (OR: 5.16; 95%CI: 4.17–6.43), oxacillin (OR: 2.28; 95%CI: 1.89–2.75), SMX-TMP (OR: 1.64; 95%CI: 1.37–1.97), and tetracycline (OR: 2.57; 95%CI: 2.12–3.11). Children under 12 years had higher odds of resistance to all antimicrobials. Female sex was associated with resistance to clindamycin (OR: 1.19; 95%CI: 1.08–1.32), oxacillin (OR: 1.15; 95%CI: 1.05–1.26), and SMX-TMP (OR: 1.11; 95%CI: 1.01–1.21).</div></div><div><h3>Conclusion</h3><div>Factors associated with antimicrobial resistance varied by microorganism and drug tested. Sex, age, and year of isolation were significant determinants of the increasing bacterial resistance observed in Brazil from 2013 to 2023.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104668"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454088","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 ANTIMICROBIAL ACTIVITY OF CORDIA VERBENACEA ESSENTIAL OIL AGAINST DIFFERENT CLINICALLY RELEVANT PATHOGENS","authors":"Vitória Batista Clemente,&nbsp;Luciana Cláudia Diniz Tavares,&nbsp;Cássia Pereira da Silva,&nbsp;Marília Ulhoa Soares,&nbsp;Amanda Marota de Oliveira,&nbsp;Ana Carolina Morais Apolônio","doi":"10.1016/j.bjid.2026.104641","DOIUrl":"10.1016/j.bjid.2026.104641","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>The growing resistance to conventional antimicrobials represents a global public health challenge, encouraging the search for effective and safe therapies. In this context, essential oils have stood out due to their antimicrobial activity, with reduced microbial resistance during their use against pathogens. This study aimed to evaluate the antimicrobial activity of <em>Cordia verbenacea</em> essential oil (EO) against clinically relevant pathogens.</div></div><div><h3>Methods</h3><div>The antimicrobial activity was assessed through Minimum Inhibitory Concentration (MIC) and Minimum Microbicidal Concentration (MMC) assays of the EO. The microbial strains included <em>Acinetobacter baumannii</em> (ATCC 19606); <em>Candida albicans</em> (INCQS 40175); <em>Candida tropicalis</em> (ATCC 750); <em>Enterococcus faecalis</em> (ATCC 51299); <em>Enterococcus faecium</em> (ATCC 6569); <em>Klebsiella pneumoniae</em> (ATCC 700603 and BAA 2814); <em>Pseudomonas aeruginosa</em>(INCQS 2742); <em>Staphylococcus aureus</em> (ATCC 29213 and ATCC 33591); <em>Streptococcus mutans</em> (ATCC 25175); <em>Streptococcus oralis</em> (ATCC 10557). MIC and MMC values were determined by the broth microdilution method in Mueller-Hinton broth (MH), following CLSI (2022) guidelines, with visual evaluation of microbial growth and confirmation of microbicidal activity on Brain Heart Infusion (BHI) agar. Tested concentrations ranged from 30 to 0.23 mg/mL, and bacterial and fungal inocula were standardized by McFarland scale at 0.5 × 10⁵ CFU/well and 0.5 × 10³ CFU/well, respectively, with incubation under conditions specific for each microorganism.</div></div><div><h3>Results</h3><div>After MIC testing, it was observed that the EO showed inhibitory activity at 30 mg/mL for <em>S. aureus</em> (ATCC 33591), 25 ± 8.66 mg/mL for <em>E. faecium</em>, 20 ± 8.66 mg/mL for <em>A. baumannii</em> and <em>C. tropicalis</em>, 15 mg/mL for <em>C. albicans</em>and <em>S. aureus</em> (ATCC 29213), 15 ± 7.5 mg/mL for <em>E. faecalis</em>, 0.5 ± 0.42 mg/mL for <em>S. mutans</em>, and greater than 30 mg/mL for the remaining strains. The MMC assay showed that its activity was microbiostatic.</div></div><div><h3>Conclusion</h3><div>The EO demonstrated inhibitory activity at concentrations ranging from 30 to 0.5 mg/mL against the tested microorganisms, but no activity against <em>K. pneumoniae</em> and <em>P. aeruginosa</em> at the tested concentrations. Thus, EO represents a promising natural alternative for the control of clinically relevant pathogens, especially in light of the advance of microbial resistance.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104641"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454128","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":"CEFTAROLINE AS THERAPY OF CHOICE IN SEVERE PEDIATRIC PNEUMONIA: EVALUATION OF USE IN A LARGE TERTIARY HOSPITAL IN RECIFE-PE","authors":"Moacir Batista Jucá,&nbsp;Bárbara Barros de Figueiredo,&nbsp;Tomaz Christiano de Albuquerque Gomes,&nbsp;Thaysa Maria Gama Albuquerque Leão de Menezes,&nbsp;Dóris Pires Gomes,&nbsp;Ronyllton Brito Costa,&nbsp;Priscila Keila Silvestre da Silva","doi":"10.1016/j.bjid.2026.104651","DOIUrl":"10.1016/j.bjid.2026.104651","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Community-acquired pneumonia remains among the main causes of hospitalization and infant morbidity and mortality. The increase in resistance of <em>Streptococcus pneumoniae</em> and <em>Staphylococcus aureus</em>, including methicillin-resistant strains (MRSA), to conventional antimicrobials represents a growing clinical challenge. Ceftaroline fosamil, a fifth-generation cephalosporin with effective action against resistant Gram-positive pathogens, has been considered a promising alternative in the management of severe respiratory infections in pediatrics. This study aimed to evaluate the clinical efficacy and safety profile of ceftaroline in pediatric patients hospitalized with pneumonia.</div></div><div><h3>Methods</h3><div>Retrospective observational study conducted in a private tertiary hospital in Recife-PE, between January 2023 and December 2024. Patients between 2 months and 17 years with a diagnosis of community-acquired pneumonia (CAP) or complicated pneumonia who received ceftaroline as part of antibiotic treatment were included. Clinical data were obtained from electronic medical records, and outcomes assessed included: clinical response at the end of treatment, need to change the antibiotic regimen, and related adverse events. Statistical analysis was descriptive, with assessment of associations between clinical variables and therapeutic success.</div></div><div><h3>Results</h3><div>34 children were included, with a mean age of 5.3 years, 67% over 4 years old. Ceftaroline was used in 100% of cases due to failure of initial empirical therapy. About 11% of patients had comorbidities or an admission diagnosis other than pneumonia. Clinical response was observed in 83% of cases, with resolution of fever and respiratory symptoms on average after 3.9 days of treatment. Switch to oral therapy was possible in 22.2% of patients, and 77.7% did not require antibiotic escalation. No serious adverse events were recorded. One death was reported in a patient admitted in septic shock, with unfavorable evolution in less than 72 hours.</div></div><div><h3>Conclusion</h3><div>Ceftaroline showed a favorable efficacy and safety profile in the treatment of severe pneumonia in children, especially in the failure of conventional empirical regimens and in suspected resistant pathogens. The findings support its use as a relevant therapeutic option in the pediatric hospital setting, highlighting the need for prospective studies for incorporation into clinical protocols.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104651"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454321","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 ANTIMICROBIAL USE IN AN ADULT ICU OF A PRIVATE HOSPITAL WITH AN ESTABLISHED STEWARDSHIP PROGRAM: DESCRIPTIVE AND COMPARATIVE ANALYSIS OF MONTHLY DDD","authors":"Giovanna Marssola Nascimento,&nbsp;Angela Figueiredo Sola,&nbsp;Nayara Larissa de Almeida Moura,&nbsp;Amanda Migliorini do Nascimento,&nbsp;Luisa Dias Gonçalves,&nbsp;Juliana Luciano Pinto,&nbsp;Amanda Sanches Martini,&nbsp;Thiago Vitoriano Barbosa","doi":"10.1016/j.bjid.2026.104643","DOIUrl":"10.1016/j.bjid.2026.104643","url":null,"abstract":"<div><h3>Introduction</h3><div>Antimicrobial resistance is a major public health problem, and the rational use of antimicrobials is a fundamental strategy to address it. Antimicrobial stewardship programs have proven effective in optimizing antimicrobial therapy, especially in intensive care units (ICUs), where consumption is high (1-3).</div></div><div><h3>Objectives</h3><div>To evaluate the trend in antimicrobial consumption in an adult ICU of a private tertiary hospital in Brazil with an active stewardship program.</div></div><div><h3>Methods</h3><div>This was a retrospective descriptive study that assessed monthly antimicrobial consumption data, measured by defined daily dose (DDD), in a 22-bed adult ICU over one year (April 2024 to March 2025) (4). Data were extracted from an automated electronic health record system and organized in spreadsheets. Eight antimicrobials (ceftriaxone, meropenem, piperacillin-tazobactam, polymyxin B sulfate, and ceftazidime-avibactam) were selected based on total DDD during the period, as well as cost and spectrum. A descriptive analysis of monthly trends was performed, along with statistical comparison between the first semester (April to September 2024) and the second semester (October 2024 to March 2025), using the Mann-Whitney test.</div></div><div><h3>Results</h3><div>A general downward trend was observed in mean monthly DDD from the first to the second semester for all antimicrobials analyzed (ceftriaxone: 187.5–134.4; meropenem: 220.9–159.6; piperacillin-tazobactam: 121.7–102.5; ceftazidime-avibactam: 36.0–13.1; polymyxin B: 15.2–9.5). Despite consistent reductions in means, statistical comparison between semesters did not demonstrate significant differences for any of the antimicrobials (p &gt; 0.05). STATA v17 software was used.</div></div><div><h3>Conclusion</h3><div>There was a trend of reduced antimicrobial consumption over time, reinforcing the positive impact of an active stewardship program. The lack of statistical significance may be related to monthly variability and the limited number of sampling points. These findings highlight the importance of continuous monitoring of antimicrobial use in intensive care settings.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104643"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454329","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":"PHENOTYPIC AND GENOTYPIC CHARACTERIZATION OF CARBAPENEM-RESISTANT KLEBSIELLA PNEUMONIAE ISOLATED IN A STATE OF THE BRAZILIAN AMAZON","authors":"Ana Carolina Gonçalves ,&nbsp;Emanuelle Leite Galdino ,&nbsp;Pamela Suyane Pessoa Baia de Oliveira ,&nbsp;Fernanda Fernandes dos Santos ,&nbsp;Heloísa Magnoler Alencar da Silva ,&nbsp;Maycon Rosa Bonfim ,&nbsp;Myrna Lícia Gelle de Oliv ,&nbsp;eira ,&nbsp;Rosineide Vieira Góis ,&nbsp;Mariana Pinheiro Alves Vasconcelos ,&nbsp;Antonieta Ferreira Machado de Oliveira ,&nbsp;Tatiane Silva Carvalho ,&nbsp;Ana Cristina Gales ,&nbsp;Tiago Barcelos Valiatti","doi":"10.1016/j.bjid.2026.104649","DOIUrl":"10.1016/j.bjid.2026.104649","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Carbapenem-resistant <em>Klebsiella pneumoniae</em> (CRKP) are currently among the main bacterial pathogens associated with high mortality rates worldwide. Monitoring these isolates allows a better understanding of their dissemination; however, studies on this topic remain scarce in the Brazilian Amazon region. Therefore, we present here the molecular characterization of CRKP strains isolated in Rondônia.</div></div><div><h3>Methods</h3><div>This study included 21 CRKP isolates recovered from blood cultures (n =13), tracheal aspirates (n = 6), and urine (n = 2) from two hospitals located in Porto Velho, Rondônia. The search for genes encoding carbapenemases and extended-spectrum β-lactamases (ESBLs) was performed by polymerase chain reaction (PCR), followed by sequencing of the amplicon. Antimicrobial susceptibility testing was carried out for 13 antimicrobials by disk diffusion and broth microdilution (for polymyxin and colistin), according to BrCAST/EUCAST guidelines.</div></div><div><h3>Results</h3><div>All isolates showed resistance to aztreonam, ceftriaxone, ceftazidime, cefepime, ertapenem, imipenem, and meropenem. Resistance to aminoglycosides was observed in 17 isolates based on gentamicin and amikacin testing. A total of 19 isolates were resistant to ciprofloxacin and levofloxacin. Additionally, five isolates showed resistance to colistin and polymyxin B. Molecular analysis revealed that all isolates were positive for the <em>blaKPC-2</em> gene. Among the ESBL genes, 17 isolates were positive, with <em>blaCTX-M-15</em> being the most frequent (n = 14), followed by <em>blaCTX-M-14</em> (n = 3). One isolate was positive for both <em>blaCTX-M-15</em> and <em>blaCTX-M-14</em>. Moreover, one isolate carried <em>blaGES-1</em>, and 14 strains harbored the <em>blaTEM-like</em> gene. The identification of these various genes reinforces the complexity of the resistome of <em>K. pneumoniae</em> strains circulating in Rondônia.</div></div><div><h3>Conclusion</h3><div>The findings of this study reveal a concerning scenario of dissemination of <em>K. pneumoniae</em> producing KPC-2 in hospitals in Rondônia, with high levels of resistance to multiple antimicrobial classes, including polymyxins. Considering that Rondônia is a region with limited data on resistance epidemiology, this study provides unprecedented regional insight and highlights the urgent need for genomic monitoring and continuous microbiological surveillance in the Brazilian Amazon.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104649"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454335","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}