Analysis of vancomycin use and associated risk factors in a university teaching hospital: a prospective cohort study

Background: Vancomycin use is considered inappropriate in most hospitals. A particular concern is the recent emergence of S. aureus with decreased susceptibility to vancomycin, making it important to reduce overall exposure to vancomycin to minimize the incidence of VRE ( vancomycin- resistant enterococci). the aim of this work was to analyze the use of vancomycin and the risk factors associated with inappropriate treatment.Methods: A prospective survey was conducted on all patients receiving vancomycin between 1(st) March 2002 and 30(th) September 2002 in a university- school hospital. Appropriateness of vancomycin use was assessed, according to the criteria established by the Centers for Disease Control and Prevention ( CDC), at two time points: first, at the beginning of therapy, and second, continuing after 72 hours.Results: A total of 557 patients received vancomycin. Three hundred seventy- four ( 67.1%) were under 60 years old, 374 ( 67.1%) had prolonged stays (> two weeks) in hospital, and 455 ( 81.7%) were in the intensive care unit ( ICU). Two hundred sixty- three patients ( 47.2%) had some invasive device. in 324 ( 58.2%) patients the duration of vancomycin treatment was up to two weeks. Vancomycin was inappropriately used in 65.7% during the first 24 hours and in 67% at the 72 hours point according to CDC criteria [ 4]. the inappropriateness of vancomycin use during the first 24 hours was related to: patients aged less than 60 ( OR 1.7; CI 95% 1.1 - 2.5), non- ICU patients ( OR 1.5; CI 95% 1.0 - 2.4) and patients without neutropenia ( OR 7.5; CI 95% 2.4 - 22.7). At 72 hours, the inappropriateness of vancomycin use was related to: patients aged less than 60 ( OR 1.5; CI 95% 1.0 - 2.3), non- ICU patients ( OR 1.7; CI 95% 1.1 - 2.7) and patients without neutropenia ( OR 8.0; CI 95% 2.6 - 24.3).Conclusion: Vancomycin was abused. Patients aged less than 60, non- ICU patients and those who did not present neutropenia were the principal groups at risk of inappropriate use.Universidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Infect Dis, São Paulo, BrazilWeb of Scienc

Mutagenicity and antimutagenicity of (−)-hinokinin a trypanosomicidal compound measured by <it>Salmonella</it> microsome and comet assays

<p>Abstract</p> <p>Background</p> <p>The dibenzylbutyrolactone lignan (−)-hinokinin (HK) was derived by partial synthesis from (−)-cubebin, isolated from the dry seeds of the pepper, <it>Piper cubeba</it>. Considering the good trypanosomicidal activity of HK and recalling that natural products are promising starting points for the discovery of novel potentially therapeutic agents, the aim of the present study was to investigate the (anti) mutagenic∕ genotoxic activities of HK.</p> <p>Methods</p> <p>The mutagenic∕ genotoxic activities were evaluated by the Ames test on <it>Salmonella typhimurium</it> strains TA98, TA97a, TA100 and TA102, and the comet assay, so as to assess the safe use of HK in the treatment of Chagas’ disease. The antimutagenic ∕antigenotoxic potential of HK were also tested against the mutagenicity of a variety of direct and indirect acting mutagens, such as 4- nitro-<it>o</it>-phenylenediamine (NOPD), sodium azide (SA), mitomycin C (MMC), benzo[<it>a</it>]pyrene (B[<it>a</it>]P), aflatoxin B₁ (AFB₁), 2-aminoanthracene (2-AA) and 2-aminofluorene (2-AF), by the Ames test, and doxorubicin (DXR) by the comet assay.</p> <p>Results</p> <p>The mutagenicity∕genotoxicity tests showed that HK did not induce any increase in the number of revertants or extent of DNA damage, demonstrating the absence of mutagenic and genotoxic activities. On the other hand, the results on the antimutagenic potential of HK showed a strong inhibitory effect against some direct and indirect-acting mutagens.</p> <p>Conclusions</p> <p>Regarding the use of HK as an antichagasic drug, the absence of mutagenic effects in animal cell and bacterial systems is encouraging. In addition, HK may be a new potential antigenotoxic ∕ antimutagenic agent from natural sources. However, the protective activity of HK is not general and varies with the type of DNA damage-inducing agent used.</p