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Bakgrund Antibiotikaresistens är rangeras idag som ett av de största hoten mot folkhälsan. Bärare av multiresistenta bakterier är ofta dåligt införstådda i vad det innebär att vara bärare vilket leder till ett minskat välbefinnande. Sjuksköterskor har en central roll i att informera patienter om deras hälsotillstånd och ska säkerställa att informationen är förstådd. Syfte Att undersöka sjuksköterskors upplevelse av att informera patienter som bär på multiresistenta bakterier om deras bärarskap. Metod Kvalitativ intervjustudie med induktiv ansats. Semistrukturerade intervjuer genomfördes med sju sjuksköterskor på ett sjukhus i Mellansverige. Data analyserades med kvalitativ innehållsanalys. Resultat Analysen resulterade i fyra kategorier: arbetsmiljö, sjuksköterskans roll, patientens förutsättningar och okunskap. Informanterna upplevde att det var otydliga rutiner kring vilken information som skulle ges till patienterna. Informanterna antog att patienter redan var införstådda i sitt bärarskap när de ankom avdelningen. Patientens tillstånd och språk var faktorer som påverkade informationsgivandet. Det fanns en okunskap hos patienter och anhöriga som ofta ledde till en rädsla och onödig förstorning av bärarskapet. Kunskapsbrister existerade även hos vårdutbildade och kunde leda till att patienter blev felbehandlade. Slutsats Informanterna upplevde att det förekom otydliga rutiner kring vilken information som skulle ges till bärare av MRB om deras bärarskap. Förförståelse om att patienten redan var införstådd i sitt bärarskap samt patientens förutsättning att kunna motta information påverkade givandet av information. Att ge korrekt information till patienten och säkerställa sig om att informationen är förstådd är viktiga faktorer som leder till minskat lidande hos patienten samt minskad spridning av MRB i samhället. / Background Antimicrobial resistance is an increasingly serious threat to public health. Carriers of multidrug-resistant bacteria are often poorly understood in what it implies to be a carrier. This can lead to a reduced sense of wellbeing. Nurses have a central role in informing patients about their health condition and also in ensuring that the information is apprehended. Aim To investigate nurses’ experience of informing patients who carry multidrug-resistant bacteria about their colonisation. Method Qualitative interview study. Semi structured interviews were conducted with 7 nurses at a university hospital in central Sweden. The interviews were analyzed using content analysis. Result The analyze resulted in four categories: work environment, role of the nurse, patients’ conditions and lack of knowledge. The informants experienced uncertain routines concerning what information they should distribute to the patients about multidrug-resistant bacteria. The informants often assumed that the patients were well informed and understood  about colonisation of multidrug-resistant bacteria prior to the hospital stay. The patients’ condition and language could affect the distributed information. The informants recognized a lack of knowledge in patients and relatives that could lead to fear and exaggeration of the colonisation. Lack of knowledge was also seen among health care professionals and could lead to patients being mistreated at the hospital. Conclusion The informants experienced uncertain guidelines about what information to give carriers of multidrug-resistant bacteria. The patients’ condition and the preunderstanding that the patient already was well informed about being a carrier were two factors affecting the distribution of information. It is essential that nurses distribute adequate information and ensure that patients understand their condition in order to reduce the patient suffering and the spreading of multidrug-resistant bacteria in the society.

A surgimento de bactérias multirresistentes é uma ameaça global. Essas bactérias têm sido associadas com infecções hospitalares, no entanto, diversos casos de infecções multirresistentes adquiridas na comunidade vêm sendo relatadas, o que acendo um alerta quanto a propagação destes micro-organismos para além do ambiente hospitalar. Em todo o mundo o consumo indiscriminado de antibióticos tem aumentado significativamente, sendo este o principal fator para o surgimento e propagação de novas formas de resistência. Outro fator preocupante é a velocidade com que estas novas formas de resistência cruzam fronteiras internacionais se disseminando facilmente em todo o mundo. Este fato tem preocupado líderes mundiais, os quais consideram o aparecimento de \"superbactérias\" um pesadelo, o que pode vir a ser em um futuro próximo uma catástrofe mundial. Diante desse quadro preocupante, a necessidade de desenvolvimento de novos agentes antimicrobianos para combater essas infecções se torna iminente. Neste contexto, os compostos nitrofurânicos tem se destacado por sua atividade contra bactérias com caráter de multirresistência. Por isto, este trabalho teve como objetivo o desenvolvimento de novos compostos nitrofurânicos, tendo como composto-protótipo a nifuroxazida. O processo de desenvolvimento das estruturas análogas a nifuroxazida foi realizado a partir do planejamento da série de compostos 5-nitro-2-furfurilidênicos, com base nos parâmetros estabelecidos por Lipinski para obtenção de compostos com características farmacocinéticas e farmacodinâmicas que favorecem a biodisponibilidade, com vistas a administração por via oral. Os ensaios de avaliação da atividade antimicrobiana dos compostos foram realizados com base no método de teste de sensibilidade a agentes antimicrobianos por diluição para bactérias de crescimento aeróbio, norma M07-A9, e como base no método de padrões de crescimento para teste de suscetibilidade a antimicrobianos, vigésimo terceiro suplemento informativo, M100-S23, aprovados pelo Clinical and Laboratory Standards Institute. Os resultados de avaliação da atividade antimicrobiana indicam que o composto mais ativo c24, 6-amino-N\'-((5-nitrofurano-2-il)metileno)-2-naftohidrazida, teve atividade significativa frente a todas cepas, sendo superior a nifuroxazida, NF; nitrofurantoína, NTF; oxacilina, OXA; e vancomicina, VAN; [ (Staphylococcus aureus ATCC 29213, c24 - IC90 = 0.31 µM ± 0.06; NF - IC90 = 2.39 µM ± 0.08; NTF - IC90 = 5.26 µM ± 0.39; OXA - IC90 = 1.14 µM ± 0.18; VAN - IC90 = 0.31 µM ± 0.06); (Staphylococcus aureus resistente à oxacilina, c24 - IC90 = 0.52 µM ± 0.26; NF - IC90 = 5.37 µM ± 0.67; NTF - IC90 = 8.20 µM ± 1.66; OXA - IC90 = s. a.; VAN - IC90 = 0.50 µM ± 0.20); (Staphylococcus aureus cepa heterogênea com resistência intermediária à vancomicina, hVISA-FCFHV36, c24 - IC90 = 0.82 µM ± 0.07; NF - IC90 = 7.22 µM ± 0.29; NTF - IC90 = 13.14 µM ± 0.94; OXA - IC90 = s. a.; VAN - IC90 = 0.88 µM ± 0.05); (Staphylococcus epidermidis com perfil de resistência a linezolida, c24 - IC90 = 0.74 µM ± 0.02; NF - IC90 = 4.36 µM ± 0.54; NTF - IC90 = 8.46 µM ± 0.60; OXA - IC90 = 12.66 µM ± 0.36; VAN - IC90 = 1.40 µM ± 0.28); e (Enterococcus faecalis resistente à vancomicina fenótipo vanA, c24 - IC90 = 0.72 µM ± 0.02; NF - IC90 = 5.09 µM ± 0.08; NTF - IC90 = 9.28 µM ± 0.32; OXA - IC90 = 12.26 µM ± 0.72, VAN - IC90 = s. a.) ]. Entre as propriedades de maior influência na atividade do composto c24 estão ClogP e PSA. / The emergence of multidrug-resistant bacteria is a global threat. These bacteria have been associated with nosocomial infections, however, many cases of community-acquired multidrug resistant infections have been reported which light a warning about the spread of these microorganisms other than the hospital environment. Worldwide the indiscriminate use of antibiotics has increased significantly, which is the main factor for the emergence and spread of new forms of resistance. Another factor of concern is the speed with which these new forms of resistance cross international boundaries easily spreading worldwide. This has worried world leaders, who consider the emergence of \"superbugs\" a nightmare, which might be in the near future a global catastrophe. Faced with this alarming situation, the need for development of new antimicrobial agents to combat such infections becomes imminent. In this context, nitrofuran compounds has been noted for its activity against bacteria with multidrug resistance character. Therefore, this study aimed to develop new nitrofuran compounds, with the composite prototype to nifuroxazida. The process of developing similar structures nifuroxazida was performed using the designed series of substituted 5-nitro-2-furfurilidênicos, based on parameters set by Lipinski to obtain compounds with pharmacokinetic and pharmacodynamic properties that promote the bioavailability in order administration orally. The evaluation of the antimicrobial activity tests of the compounds were carried out based on the method of the antimicrobial susceptibility testing by dilution for bacterial aerobic growth, M07-A9 standard, and based on the method of growth standards for antimicrobial susceptibility testing , twenty-third informational supplement M100-S23, approved by the Clinical and Laboratory Standards Institute. The results of evaluation of the antimicrobial activity indicate that the compound more active c24, 6-amino-N\'-((5-nitrofuran-2-yl) methylene)-2-naftohidrazida had significant activity against all strains, exceeding nifuroxazida, NF; nitrofurantoin, NTF; oxacillin, OXA; and vancomycin, VAN; [(Staphylococcus aureus ATCC 29213, c24 - IC90 = 0:31 uM ± 12:06; NF - IC90 = 2.39 uM ± 12:08; NTF - IC90 = 5.26 uM ± 12:39; OXA - IC90 = 1.14 uM ± 00:18; VAN - IC90 = 0:31 uM ± 12:06); (Staphylococcus aureus resistant to methicillin, c24 - IC90 = 0:52 uM ± 00:26; NF - IC90 = 5:37 uM ± 0.67; NTF - IC90 = 8.20 uM ± 1.66; OXA - IC90 = s to .; VAN - IC90 = 0:50 uM ± 00:20.); (Staphylococcus aureus heterogeneous strain with intermediate resistance to vancomycin, hVISA-FCFHV36, c24 - IC90 = 0.82 uM ± 00:07; NF - IC90 = 7.22 uM ± 00:29; NTF - IC90 = 13:14 uM ± 0.94; OXA - IC90 = sa; VAN - IC90 = 0.88 ± 0.05 uM); (Staphylococcus epidermidis with linezolid resistance profile, c24 - IC90 = 0.74 uM ± 12:02; NF - IC90 = 4:36 uM ± 00:54; NTF - IC90 = 8:46 uM ± 0.60; OXA - IC90 = 12.66 uM ± 12:36; VAN - IC90 = uM 1:40 ± 0:28); and (Enterococcus faecalis Vancomycin-resistant vanA phenotype, c24 - IC90 = 0.72 uM ± 00:02; NF - IC90 = 9.5 uM ± 12:08; NTF - IC90 = 9.28 uM ± 00:32; OXA - IC90 = 12.26 uM ± 0.72, VAN - IC90 = sa)]. Among the most influential properties in the activity of the compound c24 are ClogP and PSA

A surgimento de bactérias multirresistentes é uma ameaça global. Essas bactérias têm sido associadas com infecções hospitalares, no entanto, diversos casos de infecções multirresistentes adquiridas na comunidade vêm sendo relatadas, o que acendo um alerta quanto a propagação destes micro-organismos para além do ambiente hospitalar. Em todo o mundo o consumo indiscriminado de antibióticos tem aumentado significativamente, sendo este o principal fator para o surgimento e propagação de novas formas de resistência. Outro fator preocupante é a velocidade com que estas novas formas de resistência cruzam fronteiras internacionais se disseminando facilmente em todo o mundo. Este fato tem preocupado líderes mundiais, os quais consideram o aparecimento de \"superbactérias\" um pesadelo, o que pode vir a ser em um futuro próximo uma catástrofe mundial. Diante desse quadro preocupante, a necessidade de desenvolvimento de novos agentes antimicrobianos para combater essas infecções se torna iminente. Neste contexto, os compostos nitrofurânicos tem se destacado por sua atividade contra bactérias com caráter de multirresistência. Por isto, este trabalho teve como objetivo o desenvolvimento de novos compostos nitrofurânicos, tendo como composto-protótipo a nifuroxazida. O processo de desenvolvimento das estruturas análogas a nifuroxazida foi realizado a partir do planejamento da série de compostos 5-nitro-2-furfurilidênicos, com base nos parâmetros estabelecidos por Lipinski para obtenção de compostos com características farmacocinéticas e farmacodinâmicas que favorecem a biodisponibilidade, com vistas a administração por via oral. Os ensaios de avaliação da atividade antimicrobiana dos compostos foram realizados com base no método de teste de sensibilidade a agentes antimicrobianos por diluição para bactérias de crescimento aeróbio, norma M07-A9, e como base no método de padrões de crescimento para teste de suscetibilidade a antimicrobianos, vigésimo terceiro suplemento informativo, M100-S23, aprovados pelo Clinical and Laboratory Standards Institute. Os resultados de avaliação da atividade antimicrobiana indicam que o composto mais ativo c24, 6-amino-N\'-((5-nitrofurano-2-il)metileno)-2-naftohidrazida, teve atividade significativa frente a todas cepas, sendo superior a nifuroxazida, NF; nitrofurantoína, NTF; oxacilina, OXA; e vancomicina, VAN; [ (Staphylococcus aureus ATCC 29213, c24 - IC90 = 0.31 µM ± 0.06; NF - IC90 = 2.39 µM ± 0.08; NTF - IC90 = 5.26 µM ± 0.39; OXA - IC90 = 1.14 µM ± 0.18; VAN - IC90 = 0.31 µM ± 0.06); (Staphylococcus aureus resistente à oxacilina, c24 - IC90 = 0.52 µM ± 0.26; NF - IC90 = 5.37 µM ± 0.67; NTF - IC90 = 8.20 µM ± 1.66; OXA - IC90 = s. a.; VAN - IC90 = 0.50 µM ± 0.20); (Staphylococcus aureus cepa heterogênea com resistência intermediária à vancomicina, hVISA-FCFHV36, c24 - IC90 = 0.82 µM ± 0.07; NF - IC90 = 7.22 µM ± 0.29; NTF - IC90 = 13.14 µM ± 0.94; OXA - IC90 = s. a.; VAN - IC90 = 0.88 µM ± 0.05); (Staphylococcus epidermidis com perfil de resistência a linezolida, c24 - IC90 = 0.74 µM ± 0.02; NF - IC90 = 4.36 µM ± 0.54; NTF - IC90 = 8.46 µM ± 0.60; OXA - IC90 = 12.66 µM ± 0.36; VAN - IC90 = 1.40 µM ± 0.28); e (Enterococcus faecalis resistente à vancomicina fenótipo vanA, c24 - IC90 = 0.72 µM ± 0.02; NF - IC90 = 5.09 µM ± 0.08; NTF - IC90 = 9.28 µM ± 0.32; OXA - IC90 = 12.26 µM ± 0.72, VAN - IC90 = s. a.) ]. Entre as propriedades de maior influência na atividade do composto c24 estão ClogP e PSA. / The emergence of multidrug-resistant bacteria is a global threat. These bacteria have been associated with nosocomial infections, however, many cases of community-acquired multidrug resistant infections have been reported which light a warning about the spread of these microorganisms other than the hospital environment. Worldwide the indiscriminate use of antibiotics has increased significantly, which is the main factor for the emergence and spread of new forms of resistance. Another factor of concern is the speed with which these new forms of resistance cross international boundaries easily spreading worldwide. This has worried world leaders, who consider the emergence of \"superbugs\" a nightmare, which might be in the near future a global catastrophe. Faced with this alarming situation, the need for development of new antimicrobial agents to combat such infections becomes imminent. In this context, nitrofuran compounds has been noted for its activity against bacteria with multidrug resistance character. Therefore, this study aimed to develop new nitrofuran compounds, with the composite prototype to nifuroxazida. The process of developing similar structures nifuroxazida was performed using the designed series of substituted 5-nitro-2-furfurilidênicos, based on parameters set by Lipinski to obtain compounds with pharmacokinetic and pharmacodynamic properties that promote the bioavailability in order administration orally. The evaluation of the antimicrobial activity tests of the compounds were carried out based on the method of the antimicrobial susceptibility testing by dilution for bacterial aerobic growth, M07-A9 standard, and based on the method of growth standards for antimicrobial susceptibility testing , twenty-third informational supplement M100-S23, approved by the Clinical and Laboratory Standards Institute. The results of evaluation of the antimicrobial activity indicate that the compound more active c24, 6-amino-N\'-((5-nitrofuran-2-yl) methylene)-2-naftohidrazida had significant activity against all strains, exceeding nifuroxazida, NF; nitrofurantoin, NTF; oxacillin, OXA; and vancomycin, VAN; [(Staphylococcus aureus ATCC 29213, c24 - IC90 = 0:31 uM ± 12:06; NF - IC90 = 2.39 uM ± 12:08; NTF - IC90 = 5.26 uM ± 12:39; OXA - IC90 = 1.14 uM ± 00:18; VAN - IC90 = 0:31 uM ± 12:06); (Staphylococcus aureus resistant to methicillin, c24 - IC90 = 0:52 uM ± 00:26; NF - IC90 = 5:37 uM ± 0.67; NTF - IC90 = 8.20 uM ± 1.66; OXA - IC90 = s to .; VAN - IC90 = 0:50 uM ± 00:20.); (Staphylococcus aureus heterogeneous strain with intermediate resistance to vancomycin, hVISA-FCFHV36, c24 - IC90 = 0.82 uM ± 00:07; NF - IC90 = 7.22 uM ± 00:29; NTF - IC90 = 13:14 uM ± 0.94; OXA - IC90 = sa; VAN - IC90 = 0.88 ± 0.05 uM); (Staphylococcus epidermidis with linezolid resistance profile, c24 - IC90 = 0.74 uM ± 12:02; NF - IC90 = 4:36 uM ± 00:54; NTF - IC90 = 8:46 uM ± 0.60; OXA - IC90 = 12.66 uM ± 12:36; VAN - IC90 = uM 1:40 ± 0:28); and (Enterococcus faecalis Vancomycin-resistant vanA phenotype, c24 - IC90 = 0.72 uM ± 00:02; NF - IC90 = 9.5 uM ± 12:08; NTF - IC90 = 9.28 uM ± 00:32; OXA - IC90 = 12.26 uM ± 0.72, VAN - IC90 = sa)]. Among the most influential properties in the activity of the compound c24 are ClogP and PSA

Les infections nosocomiales à bactéries multi-résistantes sont en constante augmentation en réanimation. Elles ont des conséquences individuelles et collectives majeures. La mortalité en réanimation et les prolongations des durées de séjour sont les deux principales conséquences individuelles connues à ce jour. Plusieurs facteurs confondants rendent l'interprétation des études difficiles, dont l'état sous jacent du patient, la virulence de la bactérie et l'adéquation thérapeutique. Mesurer la part de chacun de ces facteurs et préciser leur responsabilité respective est indispensable pour mobiliser les différents acteurs et améliorer le pronostic des patients en réanimation. Dans cette thèse nous avons souhaité approcher la réponse quant aux conséquences individuelles. A partir d'une base de données incluant des patients de réanimation, nous avons utilisé les méthodes statistiques les plus récentes et avons tenté de prendre en compte les différents facteurs confondants , pour répondre à trois questions précises que sont : la mortalité liée à une espèce bactérienne donnée, les facteurs associés à la mortalité des patients présentant un sepsis sévère ou choc septique en réanimation et les conséquences liées à l'isolement des patients infectés ou colonisés avec une bactérie multi-résistante. Nous montrons que (1) par l'intermédiaire d'une prolongation de la durée de séjour en réanimation, l'infection à Clostridium difficile augmente la pression de colonisation, sans pour autant avoir d'impact direct sur le décès. (2) que le pronostic des sepsis sévères et des chocs septiques dépend de l'adéquation de l'antibiothérapie et que les bactéries résistantes sont plus souvent traitées de manière inadéquate. (3) que l'isolement contact est associé non seulement à une augmentation attendue du risque de pneumonie nosocomiale a germe multi-résistants mais aussi à une augmentation du risque d'erreurs thérapeutiques et d'événements indésirables non infectieux. Cet impact délétère suggéré par des études en dehors de la réanimation doit être pris en compte lors de la mise en place des précautions contact en réanimation. / Nosocomial infections with multidrug-resistant bacteria are increasing in ICU. They have major individual and collective consequences. Mortality in the ICU and prolongation of length of stay are the two main individual consequences known to date. Several confounding factors make it difficult to interpret studies, including the patient's underlying condition, the virulence of bacteria and the adequacy of therapy. It is essential to measure the share of each of these factors and to clarify their respective responsibilities to mobilize the different actors and improve the prognosis of patients in intensive care. In this thesis, and drawing upon a database including ICU patients, we used the latest statistical methods and tried to take into account the various confounding factors to evaluate the individual consequences of multidrug-resistant bacteria in ICU. We sought to address three specific questions: mortality linked to specific bacterial species, factors associated with mortality in patients with severe sepsis or septic shock in intensive care unit, and the consequences of the isolation of patients infected or colonized with multidrug-resistant bacteria. We demonstrated that (1) because they are associated with a longer stay in intensive care unit, Clostridium difficile infections increase the pressure of colonization although they have no direct consequence on mortality; (2) the prognosis of sever sepsis or septic shock depends on the adequacy of the antibiotic therapy and that resistant bacteria are often inadequately treated; and (3) that isolation is not only associated with an expected increase in the risk of nosocomial pneumonia with multi-drug resistant pathogens strains but also with an increase in non-infectious adverse events.

On the verge of entering the post-antibiotic era, numerous efforts are in place to regain the waning charm of antibiotics which are proving ineffective against most “Superbugs”. Engineered nanomaterials, especially gold nanoparticles (GNPs) capped with antibacterial agents, are proving to be an effective and novel strategy against multidrug resistant (MDR) bacteria. In this study, we report a one-step synthesis of antibioticcapped GNPs (25 ± 5 nm) utilizing the combined reducing and capping ability of a cephalosporin antibiotic, ceftazidime. No signs of aggregation or leaching of ceftazidime from GNP surface was observed upon its storage. Antibacterial testing showed dosedependent broad spectrum activity of Cef-GNPs against both Gram-positive (S. bovis and E. durans) and Gram-negative (P. aeruginosa and E. aerogenes) bacteria. A significant reduction in the minimum inhibition concentration (MIC) of Cef-GNPs was observed as compared to the ceftazidime by itself against Gram-negative bacteria. The MIC of Cef- GNPs were 0.1 mg mL-1 (P. aeruginosa and E. aerogenes) and 1.2 mg mL-1 (E. durans and S. bovis). Cef-GNPs exerted bactericidal action on both P. aeruginosa and E. durans by disrupting the cellular membrane resulting in leakage of cytoplasmic content and death of bacterial cell. Our investigation and results provides an additional step in the development of antibiotic capped GNP as potent next generation antibacterial agents.