Introduction. The use of automated systems in identification and susceptibility tests can improve antimicrobial therapy, and positively impact clinical outcomes with a decrease in antimicrobial resistance, hospitalization time, costs, and mortality. Aim. The aim of this study was to evaluate the clinical impact of an automated method for identification and susceptibility testing of microbial isolates. Methodology. This was a retrospective cross-sectional study aimed to analyse the results before and after the implementation period of a VITEK 2 system in a Brazilian university hospital. Based on data from medical records, patients with a positive culture of clinical samples from January to July 2017 (conventional method) and from August to December 2017 (automated method) were included in this study. Demographic data, hospitalization time, time interval between culture collection and results, culture results and site, susceptibility profile, minimum inhibitory concentration, and outcome data were evaluated. Chi-square and Fischer’s tests were used in the analysis. Results. Of the total samples, 836 were considered valid by the inclusion criteria, with 219 patients before VITEK 2 system implementation group and 545 in the post-implementation group. The comparison between the two periods showed a reduction of 25 % of the time to culture reports, a decrease of 33.5 to 17.0 days of hospitalization, and a reduction in mortality from 44.3–31.0 %, respectively. Conclusion. The VITEK 2 system provided early access to appropriate antimicrobial therapy for patients and effected a positive clinical impact with a reduction in mortality and hospitalization time.
Introdução: Leiomiomas são tumores benignos que surgem no miométrio e são comuns em mulheres em idade fértil. Eles podem ser assintomáticos ou podem estar associadosa sintomas pélvicos, como sangramento e dor. Objetivo: Neste presente estudo, foram analisadas situações clínicas de 64 mulheres portadoras de leiomiomatose uterina sintomática que foram submetidas ao tratamento com a injeção de análogo de GnRH (agonista do hormônio liberador de gonadotrofina), sendo acompanhadas no período de 2009- 2019. Material e Método: Os dados foram coletados de prontuários do ambulatório de Ginecologia do Hospital Santa Casa de Curitiba. Trata-se de um método observacional,retrospectivo com variáveis quantitativas e qualitativas. Os critérios de inclusão foram mulheres portadoras de leiomiomatose uterina comprovada por ultrassonografia e quese submeteram ao tratamento com o análogo de GnRH. A quantificação da redução do volume uterino após aplicação do GnRH; avaliação na melhora dos níveis hematimétricos;mensuração e discriminação de quantas pacientes foram submetidas a cirurgia e correlação com a história clínica; a aferição de qual cirurgia foi mais realizada e a identificaçãodas queixas pré e pós aplicação da injeção correspondem aos objetivos encontrados no atual estudo. Resultados: O uso com análogo de GnRH pré-operatório contribuiu para melhora dos índices hematimétricos onde se foi observado um aumento médio de 20,1% de hemoglobina. Além disso, a pré-aplicação colaborou com uma redução de volumeuterino em 90,6% das pacientes. Mediante isso, obteve-se um cenário cirúrgico mais seguro para as 23 pacientes que necessitaram de cirurgia, seja via histerectomia abdominal,vaginal ou mesmo miomectomia. Concordante com o arsenal literário, neste estudo observou-se que as queixas principais pré aplicação do análogo foram sangramento uterinoanormal e dismenorreia; assim como a queixa pós injeção foi principalmente o fogacho, que ocorre devido ao estado de hipoestrogenismo o qual o GnRH ocasiona. Conclusão: À luz dessas evidências, o análogo de GnRH traz inúmeros benefícios, como tratamento terapêutico e pré-operatório da leiomiomatose uterina, porém seus efeitos adversos e seu alto custo contribuem para a menor acessibilidade às pacientes.Palavras-chave: Leiomiomatose, Gosserrelina, Sangramento uterino, Infertilidade, Dor pélvica, Dismenorreia ABSTRACT Introduction: Leiomyomas are benign tumors that appear in the myometrium and are common in women of childbearing age. They may be asymptomatic or may be associatedwith pelvic symptoms, such as bleeding and pain. Objective: In the present study, we analyzed clinical situations of 64 women with symptomatic uterine leiomyomatosis whounderwent treatment with GnRH analogue (gonadotropin releasing hormone agonist) injection, these patients were followed up in 2009-2019. Data were collected from medicalrecords of the Gynecology outpatient clinic of the Santa Casa Hospital in Curitiba. Material and Method: It is an observational, retrospective study, with quantitative andqualitative variables. Inclusion criteria were women with ultrasound-proven uterine leiomyomatosis who underwent GnRH analogue treatment. Quantification of uterinevolume reduction after GnRH application; assessment of improvement in hematimetric levels; measurement and discrimination of how many patients underwent surgeryand correlation with clinical history; the assessment of which surgery was mostly performed and the identification of complaints before and after injection correspond to theobjectives found in the current study. Results: The use of preoperative GnRH analogue contributed to the improvement of hematimetric indices, in which an average increaseof hemoglobin of 20.1% was observed, and pre-application contributed to a reduction of uterine volume by 90.6% of the patients. Thus, a safer surgical scenario was obtainedfor the 23 patients who required surgery, whether abdominal or vaginal hysterectomy, or even myomectomy. In accordance with the literary arsenal, this study noted thatthe main complaints – pre-application of the analogue – were abnormal uterine bleeding and dysmenorrhea; just as the complaint after injection was mainly of hot flashes, that occurs due to the state of hypoestrogenism, caused by the GnRH. Conclusion: Considering this evidence, the GnRH analogue has numerous benefits as a therapeutic and preoperative treatment for uterine leiomyomatosis; its adverse effects and high cost, however, contribute to loweraccessibility to patients. Keywords: Leiomyomatosis, Goserelin, Uterine bleeding, Infertility, Pelvic pain, Dysmenorrhea
Background: The use of the automated system for identification and susceptibility tests can improve antimicrobial stewardship. The reduction in the time of identification of the pathogen and the correct dose of antibiotic are factors that contribute significantly to institutional programs and patient outcomes. Objective: We identified and evaluated the susceptibility tests of microorganisms for common pathogens through antibiograms that accounted for the minimum inhibitory concentration (MIC), in a tertiary-care public hospital in Brazil. Methods: This retrospective, cross-sectional study was performed to identify microbiologic profiles after the implementation of a VITEK 2 system at a tertiary-care public hospital in Curitiba, Brazil. Based on data from the medical records, patients with positive cultures of clinical samples from August to December 2017 were included in this study. The analysis included culture results, susceptibility profiles, and MICs of 5 antibiotics: amikacin, cefepime, ciprofloxacin, meropenem and vancomycin. Results: In total, 545 antibiograms were evaluated using VITEK 2. The following microorganisms were isolated: 345 gram-negative bacilli (63.3%), 187 gram- positive cocci (34.3%), 9 unidentified microorganisms (1.7%), and 4 yeasts (0.7%). Among the analyzed antibiograms, amikacin was tested in 371 isolates (68.1%), with an MIC of 2 mg/L being the most prevalent value, with a frequency of 224 results (41.1%). Cefepime was tested in 319 isolates (58.5%), with an MIC of 1 mg/L being the most prevalent, with a frequency of 177 results (32.5%). Ciprofloxacin was tested in 470 isolates (86.2%), with an MIC of 0.25 mg/L being the most prevalent value, with frequency of 189 results (34.7%). Meropenem was tested in 318 isolates (58.3%), with an MIC of 0.25 mg/L being the most prevalent value, with a frequency of 223 results (40.9%). Vancomycin was tested in 157 isolates (28.8%), with an MIC of 1 mg/L being the most prevalent value, with frequency of 87 results (16%). Conclusions: When analyzing the most frequently isolated microorganisms and their predominant sensitivity profiles in our institution, amikacin proved to be a good therapeutic option, considering the epidemiological profile, as gram-negative bacilli showed greater sensitivity. Furthermore, VITEK 2 systems provided early access to appropriate antimicrobial therapy for patients, which is a known factor for reducing bacterial resistance.Funding: NoDisclosures: None
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