Thesis (M. Phil.)--Hong Kong University of Science and Technology, 2002. / Includes bibliographical references (leaves 71-76). Also available in electronic version. Access restricted to campus users.

Thesis (Ph. D.)--Illinois State University, 2002. / Title from title page screen, viewed January 31, 2006. Dissertation Committee: Brian J. Wilkinson (chair), Radheshyam K. Jayaswal, Alan J. Katz, Wade A. Nichols, Anthony J. Otsuka. Includes bibliographical references (leaves 144-149) and abstract. Also available in print.

Thesis (Ph. D.)--Illinois State University, 1999. / Title from title page screen, viewed July 20, 2006. Dissertation Committee: Brian J. Wilkinson (chair), Radheshyam K. Jayaswal, Alan J. Katz, Anthony J. Otsuka, David L. Williams. Includes bibliographical references and abstract. Also available in print.

Summary Objectives and hypothesis: This thesis concerns the study of plasmids of vancomycin- resistant enterococci isolated from feces of American crows in the years 2012 - 2013 period. The hypothesis is that, in various environments, there is one or more types of epidemiologically significant vanA gene-carrying plasmids that are capable of horizontally spread. Methods: Based on PFGE method the number and size of plasmids were detected in selected isolates of vancomycin-resistant E. faecium. Using PCR method the isolates were subjected to detection of genes of replicases, relaxases and toxin-antitoxin system of plasmid-bound resistance genes. Using 19 primers were characterized types of Tn1546. Results: Of the 12 tested vancomycin-resistant isolates of E. faecium the following number and size of plasmids was proven using PFGE method: 2 isolates contained two plasmids (17%), 3 isolates contained three plasmids (25 %), 5 isolates contained four plasmids (42 %) and 2 isolates contained five plasmids (17 %). All isolates (n = 12) were then subjected to the detection of genes of replicases, relaxases and toxin-antitoxin system for typing of plasmids from each plasmid families. RepA_N family of plasmids: genes characterizing plasmids related to pRUM: rep17 in 11 isolates (92 %), gene Axe-Txe was detected in 5 isolates (42 %) genes characterizing plasmids related to pLG1: rep20 in 7 isolates (58 %) genes characterizing plasmids related to pAD1: relpAD1 gene was detected in one isolate (8 %) Inc18 family of plasmids: genes characterizing plasmids related to pIL501: rep1 gene detected in one case (8 %) genes characterizing plasmids related to pRES25: rep2 gene in 2 isolates (17 %) genes characterizing plasmids related to pEF1: relpEF1 detected in 11 isolates (92 %) pHTB family of plasmids: genes characterizing plasmids related to pHTB: rep22 gene was detected in 4 isolates (33%) and in 2 isolates gene relpHTB was detected (17%) RCR family of plasmids: genes characterizing plasmids related to pRI: positive detection of Rep14 gene in 8 isolates (67%) and in 4 isolates relpRI gene was detected Small theta-replicating plasmids: genes characterizing plasmids related to pEF418 plasmids: rep18a gene in 2 isolates (17%) genes characterizing plasmids related to pB82: rep18b gene was detected in one isolate (8%) genes characterizing plasmids related to pCIZ2: relpCIZ2 gene was detected in 9 isolates tested (75%) Types of transposon Tn1546 Using the PCR method types of Tn1546 were characterized. In 4 isolates (n = 12; 33 %) Tn1546 was characterized as a F3 type. In one isolate (8 %) Tn1546 was characterized as a type F5, in one isolate (8 %) as a type PP-16. In 6 isolates Tn1546 was untypeable. Most likely these are new, yet unknown types. Conclusion: This is the first study of plasmids of vancomycin-resistant isolates E. faecium isolated from feces of American crows. These results emphasize not only a high proportion of plasmids in individual isolates, but also a high proportion of genes with horizontal transfer.

A vancomicina é um antimicrobiano de escolha para o tratamento de microrganismos gram-positivos multirresistentes, como Staphylococcus aureus resistente à meticilina (MRSA). Apesar da importância ouso indiscriminado gera preocupação em relação à resistências bacteriana, além de ser considerado nefrotóxico e haver carência de dados em pediatria.Objetivo:Avaliar o perfil de utilização de vancomicina, a presença de eventos adversos, nefrotoxicidade e o desfecho clínico pacientes de uma Unidade de Terapia Intensiva. Método: Estudo transversal, retrospectivo, conduzido entre pacientes pediátricos internados em unidade de terapia intensiva que receberam vancomicina durante o período de abril de 2013 a junho de 2014. Os dados foram coletados de fontes secundárias como prontuário, prescrições e exames laboratoriais. Resultados: De 94 pacientes selecionados, 53,2% eram lactentes e o CID mais prevalente foi bronquiolite aguda devido a outros microrganismos especificados. A duração do tratamento com vancomicina teve uma média de 13±6,7 dias e uma dose média inicial de 51,2±14,7 mg/kg/dia. Entre os eventos adversos observados, edema foi o mais prevalente, seguido de toxicidade renal. Dos doze pacientes que tiveram MRSA identificado em hemocultura ou cultura de secreções, três tiveram infecção persistente e um foi a óbito em menos de 30 dias. Dos pacientes com nefrotoxicidade, 63,6% utilizaram vancomicina por mais de 14 dias e todos tiveram níveis séricos ≥15 μg/ml. Conclusão: As faixas de doses de vancomicina usadas estão dentro do que tem sido recomendado na literatura, contudo o aparecimento de toxicidade renal parece ter relação significativa não somente com o nível sérico de vancomicina, mas também com o tempo de tratamento. Sugere-se a realização de estudos que consigam confirmar essa tendência associativa entre tempo, concentração sérica de vancomicina e aparecimento de nefrotoxicidade. / Vancomycin is an antibiotic of choice for the treatment of multidrug-resistant grampositive microorganisms, as methicillin-resistant Staphylococcus aureus (MRSA). Despite the importance their indiscriminately use causes concern regarding the bacterial resistance, besides being nephrotoxic agent and there are few studies in pediatric patients. Objective: To evaluate the profile of use of vancomycin, the presence of adverse events, nephrotoxicity and clinic outcome in children admitted to the Intensive Care Unit. Method: Cross-sectional and retrospective study, with pediatric patients admitted to the intensive care unit who received vancomycin during the period from April 2013 to June 2014. Data were collected from secondary sources such as patient records, prescriptions and laboratory tests. Results: 94 selected patients, 53.2% were aged infants and the most prevalent CID was acute bronchiolitis due to other specified microorganism. The duration of vancomycin treatment averaged 13±6.7 days and an initial mean dose was 51.2±14.7 mg/kg/day. Among the adverse events observed edema was the most prevalent, followed by renal toxicity. Of the twelve patients who had MRSA identified in blood or secretions culture, three had persistent infection and one died in less than 30 days. Of patients with nephrotoxicity, 63.6% used vancomycin for more than 14 days and all had vancomycin serum levels ≥15 μg/mL. Conclusion: Vancomycin doses used are in agreement with recommended in literature, however the onset of renal toxicity seems to be related with serum level and the duration of vancomycin treatment. It is suggested to conduct studies to confirm this associative tendency among treatment duration, vancomycin serum levels and appearance of nephrotoxicity.

A vancomicina é um antimicrobiano de escolha para o tratamento de microrganismos gram-positivos multirresistentes, como Staphylococcus aureus resistente à meticilina (MRSA). Apesar da importância ouso indiscriminado gera preocupação em relação à resistências bacteriana, além de ser considerado nefrotóxico e haver carência de dados em pediatria.Objetivo:Avaliar o perfil de utilização de vancomicina, a presença de eventos adversos, nefrotoxicidade e o desfecho clínico pacientes de uma Unidade de Terapia Intensiva. Método: Estudo transversal, retrospectivo, conduzido entre pacientes pediátricos internados em unidade de terapia intensiva que receberam vancomicina durante o período de abril de 2013 a junho de 2014. Os dados foram coletados de fontes secundárias como prontuário, prescrições e exames laboratoriais. Resultados: De 94 pacientes selecionados, 53,2% eram lactentes e o CID mais prevalente foi bronquiolite aguda devido a outros microrganismos especificados. A duração do tratamento com vancomicina teve uma média de 13±6,7 dias e uma dose média inicial de 51,2±14,7 mg/kg/dia. Entre os eventos adversos observados, edema foi o mais prevalente, seguido de toxicidade renal. Dos doze pacientes que tiveram MRSA identificado em hemocultura ou cultura de secreções, três tiveram infecção persistente e um foi a óbito em menos de 30 dias. Dos pacientes com nefrotoxicidade, 63,6% utilizaram vancomicina por mais de 14 dias e todos tiveram níveis séricos ≥15 μg/ml. Conclusão: As faixas de doses de vancomicina usadas estão dentro do que tem sido recomendado na literatura, contudo o aparecimento de toxicidade renal parece ter relação significativa não somente com o nível sérico de vancomicina, mas também com o tempo de tratamento. Sugere-se a realização de estudos que consigam confirmar essa tendência associativa entre tempo, concentração sérica de vancomicina e aparecimento de nefrotoxicidade. / Vancomycin is an antibiotic of choice for the treatment of multidrug-resistant grampositive microorganisms, as methicillin-resistant Staphylococcus aureus (MRSA). Despite the importance their indiscriminately use causes concern regarding the bacterial resistance, besides being nephrotoxic agent and there are few studies in pediatric patients. Objective: To evaluate the profile of use of vancomycin, the presence of adverse events, nephrotoxicity and clinic outcome in children admitted to the Intensive Care Unit. Method: Cross-sectional and retrospective study, with pediatric patients admitted to the intensive care unit who received vancomycin during the period from April 2013 to June 2014. Data were collected from secondary sources such as patient records, prescriptions and laboratory tests. Results: 94 selected patients, 53.2% were aged infants and the most prevalent CID was acute bronchiolitis due to other specified microorganism. The duration of vancomycin treatment averaged 13±6.7 days and an initial mean dose was 51.2±14.7 mg/kg/day. Among the adverse events observed edema was the most prevalent, followed by renal toxicity. Of the twelve patients who had MRSA identified in blood or secretions culture, three had persistent infection and one died in less than 30 days. Of patients with nephrotoxicity, 63.6% used vancomycin for more than 14 days and all had vancomycin serum levels ≥15 μg/mL. Conclusion: Vancomycin doses used are in agreement with recommended in literature, however the onset of renal toxicity seems to be related with serum level and the duration of vancomycin treatment. It is suggested to conduct studies to confirm this associative tendency among treatment duration, vancomycin serum levels and appearance of nephrotoxicity.

Class of 2008 Abstract / Objectives: A novel method of predicting vancomycin trough levels at steady state was studied to determine whether it could effectively predict vancomycin trough levels compared to an established predictor method (Matzke). Methods: Adult patients who received at least two consecutive doses of vancomycin and had at least one reported vancomycin trough at steady state were considered. Data extracted and analyzed included patient gender, age, weight, height, and serum creatinine as well as vancomycin dose and interval, number of consecutive doses prior to the trough, time between trough and preceding dose, and measured vancomycin trough level. This data was applied to each of the prediction methods to determine how accurately they predicted actual measured vancomycin trough levels at steady state. Results: Data from 103 patients was analyzed. Vancomycin trough predictions using the Bergstrom method averaged 12.2 mg/dl, with a standard deviation of 3.4. The average actual trough concentration was 10.7 mg/dl with a standard deviation of 3.9, while the Matzke method predicted an average trough concentration of 19.2 mg/dl with a standard deviation of 8.6. Predictions made using the Bergstrom Method were not significantly different than the actual trough concentrations (p = 0.91). The Bergstrom method predicted concentrations within 25% of actual concentrations 42% of the time and within 50% of actual concentrations 78% of the time. Conclusions: The Bergstrom method was a more reliable predictor of vancomycin trough concentrations than the Matzke method in this patient population. Although more research is needed, the Bergstrom method may prove to be a useful tool for pharmacists to predict vancomycin trough concentrations quickly and with relative accuracy for individual patients.

The effect of the new peptolide LY146032 (LY) was studied in a hamster model of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. In vivo, after infection with one of two well-encapsulated strains of MRSA, A83 and A116 (type 8 and type 5), LY was protective only in A116 pneumonia. An in vitro assay of the effect of subinhibitory concentrations of LY on opsonophagocytic killing by pulmonary phagocytes demonstrated marked enhancement of killing of A116 (92.6 and 63.8% kill with 1/10 MIC and 1/50 MIC LY; no kill in the absence of LY). This effect was dependent on the presence of fresh serum. LY in subinhibitory concentrations produces a surface effect that may allow complement binding and activation and subsequent phagocytosis and killing to take place. The opsonizing effect of subinhibitory concentrations of LY was not demonstrable for the A83 strain. Differences in capsular types may be determinants of response to therapy of MRSA infections.

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No description available.