CIPROFLOXACIN RESISTANCE PATTERN AMONG BACTERIA ISOLATED FROM PATIENTS WITH COMMUNITY-ACQUIRED URINARY TRACT INFECTION

SUMMARY Objective: To identify the main bacterial species associated with community-acquired urinary tract infection (UTI) and to assess the pattern of ciprofloxacin susceptibility among bacteria isolated from urine cultures. Methods: We conducted a retrospective study in all the patients with community-acquired UTI seen in Santa Helena Laboratory, Camaçari, Bahia, Brazil during five years (2010-2014). All individuals who had a positive urine culture result were included in this study. Results: A total of 1,641 individuals met the inclusion criteria. Despite the fact that participants were female, we observed a higher rate of resistance to ciprofloxacin in males. The most frequent pathogens identified in urine samples were Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus. Antimicrobial resistance has been observed mainly for ampicillin, sulfamethoxazole + trimethoprim and ciprofloxacin. Moreover, E. coli has shown the highest rate of ciprofloxacin resistance, reaching 36% of ciprofloxacin resistant strains in 2014. Conclusion: The rate of bacterial resistance to ciprofloxacin observed in the studied population is much higher than expected, prompting the need for rational use of this antibiotic, especially in infections caused by E. coli. Prevention of bacterial resistance can be performed through control measures to limit the spread of resistant microorganisms and a rational use of antimicrobial policy

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barré syndrome) following dengue fever

This paper reports a case of dengue in a six-year-old female child who suddenly developed excruciating headaches, fever, myalgia and paresis. Laboratory examinations included blood count, platelet count, biochemical tests (BUN, creatinine, aminotransferases, and total bilirubin and bilirubin fractions) and specific IgM titers (enzyme-immunoassay with recombinant tetravalent dengue). After ten days of hospitalization and having already been in a home environment, a new clinical image emerged, characterized by dysphagia, dysphonia, weakness, peripheral facial palsy and paresthesia. The diagnosis of Guillain-Barré Syndrome was based on clinical findings, cerebrospinal fluid examination, electrophysiological findings and the exclusion of other pathologies. Our case, as some shown in previous reports, calls attention to the possibility that Guillain-Barré Syndrome may occur in association with dengue

Enfermagem perioperatória: identificação do diagnóstico de enfermagem risco para infecção fundamentada no modelo conceitual de levine Enfermería perioperatória: identificación del diagnóstico de enfermería riesgo para infección fundamentada en el modelo conceptual de levine Perioperative nursing: identification of the nursing diagnosis infection risk based on levine's conceptual model

A visita pré-operatória consiste na primeira etapa da sistematização da assistência de enfermagem perioperatória. O presente estudo teve como objetivo identificar o diagnóstico de enfermagem com maior freqüência na visita pré-operatória de pacientes submetidos a cirurgia geral. O referencial teórico selecionado foi o modelo conceitual de Levine, tendo como eixo norteador os quatros princípios de conservação, a saber: conservação de energia, conservação da integridade estrutural, conservação da integridade pessoal e conservação da integridade social. Para o alcance do objetivo proposto foi previamente elaborado e validado um instrumento para a coleta de dados. A amostra consistiu de 30 (trinta) pacientes, de ambos os sexos que foram submetidos a cirurgia geral. O diagnóstico de enfermagem Risco para Infecção obteve 100% de freqüência nas visitas pré-operatórias com os pacientes cirúrgicos. Em relação aos fatores relacionados identificados destacamos: o local de invasão dos organismos secundário à cirurgia e procedimentos invasivos. Assim, a identificação deste diagnóstico poderá auxiliar o enfermeiro no planejamento e implementação de cuidados de prevenção e controle de infecção, principalmente se os fatores de risco forem identificados no período pré-operatório.<br>La visita preoperatoria consiste en la primera etapa de la sistematización de la asistencia de enfermería perioperatoria. El presente estudio tuvo como objetivo identificar el diagnóstico de enfermería con mayor frecuencia, en la visita preoperatoria, de pacientes sometidos a cirugía general. El referencial teórico seleccionado fue el modelo conceptual de Levine, teniendo como eje orientador los cuatros principios de conservación: conservación de energía, conservación de integridad estructural, conservación de integridad personal y conservación de integridad social. Para el alcance del objetivo propuesto fue previamente elaborado y validado un instrumento para la recolección de datos. La muestra estuvo constituida por 30 (treinta) pacientes, de ambos sexos que fueron sometidos a cirugía general. El diagnóstico de enfermería Riesgo para Infección obtuvo 100% de frecuencia, en las visitas preoperatorias con los pacientes quirúrgicos. En relación con los factores relacionados identificados destacamos: el lugar de invasión de los organismos secundario a cirugía y procedimientos invasivos. Así, la identificación de este diagnóstico podrá ayudar al enfermero en la planeación e implementación de cuidados de prevención y control de infección, sobretodo si los factores de riesgo son identificados en el periodo preoperatorio.<br>The pre-operative visit consists in the first phase in the systematization of perioperative nursing care. This study aimed at identifying, during the pre-operative visit and more frequently, a nursing diagnosis of clients submitted to general surgery. The selected theoretical framework was Levine's conceptual model based on the four conservation principles, which are: energy conservation, structural integrity conservation, personal integrity conservation and social integrity conservation. In order to reach the proposed objective, an instrument was previously elaborated and validated for data collection. The sample consisted of 30 patients, males and females, who had been submitted to general surgery. The nursing diagnosis Infection Risk obtained 100% of frequency during the pre-operative visits to surgery patients. As to related factors that were identified, we point out: the site of invasion by organisms after the surgery and invasive procedures. Thus, the identification of this diagnosis can help nurses with the planning and implementation of preventive and infection control care, especially if risk factors are identified in the pre-operative period