Bacterial resistance is a global problem with serious consequences: increased mortality, prolonged hospitalizations, higher rates of surgical site infection, and increased costs. We monitor resistance profiles for epidemiological assessment, guidance of targeted antimicrobial therapies, and identification of new strains. Rapid in vitro multiplex immunoassays exist for phenotypic detection and differentiation of five carbapenemase families (KPC, OXA-48-like, VIM, IMP, and NDM) directly from bacterial colonies. NG-Test Carba 5 is a rapid in vitro multiplex immunoassay (≤ 15 min) for phenotypic detection and differentiation of these five common carbapenemase families produced by Enterobacteriales and Pseudomonas. Tests were performed in the laboratory from August 2024 to March 2025. Sixty strains were tested (49 Enterobacteriales and 11 Pseudomonas aeruginosa) resistant to carbapenems identified by Vitek MS Prime (Biomerieux), selecting the carbapenem-resistant bacteria. NG-Test Carba 5 was used to identify the enzyme responsible for the resistance mechanism. We found 60 carbapenem-resistant bacteria, 49 (81.67%) Enterobacteriales, of which 45 (75%) were Klebsiella pneumoniae (88.89% KPC producers, 2.22% NDM metallo-β-lactamase, and 8.88% with no enzyme identified) and 4 (6.67%) other Enterobacteriales: 1 (25%) Klebsiella cloacae producing NDM metallo-β-lactamase, 2 (50%) Escherichia coli producing KPC, and 1 (25%) Proteus mirabilis with no enzyme identified. KPC production is the main isolated enzymatic mechanism among enterobacteria, but other enzymes such as metallo-β-lactamases are emerging. Eleven (18.33%) Pseudomonas aeruginosa were isolated: 1 (9.10%) KPC producer, 2 (18.18%) VIM producers, and 8 (72.72%) negative tests. A multicenter study conducted between 2018 and 2019 showed that KPC and VIM are the main enzymes isolated in Pseudomonas. In 13 (21.67%) bacteria the test was negative, either because they did not produce enzymes targeted by the test or because they produced other resistance mechanisms. These tests allow monitoring the emergence of new enzymes that confer antimicrobial resistance, enabling preventive measures and therapeutic adjustments that improve cost-effectiveness in clinical practice.
Purpose Our objective was to update and organize information about the safety of using nonsteroidal anti-inflammatory drugs (NSAIDs) during lactation and assess whether the available information in the prescribing information (PI) of the approved drugs allows a health care professional to orient a lactating woman whether to use the drug. Methods For this systematic review, we searched MEDLINE, Embase, Cochrane, and LILACS for published articles from inception to 2024, reviewed the PI, and collected risk classifications for use during lactation for 23 NSAIDs from 5 widely available sources. No language restrictions were placed on the search. Data were synthesized, and the risk of bias and certainty of evidence were analyzed. A protocol was registered on the PROSPERO database (CRD42022295292). Findings We identified 3327 articles, removed 292 duplicates, and, after screening, retained 34 studies examining NSAID and acetaminophen excretion in breast milk and neonatal safety outcomes. Ten studies revealed acetaminophen, ibuprofen, flurbiprofen, mesalazine, and dipyrone adverse effects in infants. The relative infant dose was usually below 10%. Pharmacokinetic reasoning indicated that the infant must drink more milk than 150 ml/kg/d to reach the pediatric-approved dose. Only five PI of 16 NSAIDs approved in all jurisdictions had adequate information for decision making. The lists classifying the risks of drug use during lactation usually agree; however, they occasionally differ with the PI and each other, making it difficult to interpret. Implications Despite recent efforts to adequate labeling, NSAIDs still lack enough data to establish whether lactating women should use them.
Bacterial resistance is a global problem with serious consequences: increased mortality, prolonged hospitalizations, higher surgical site infection rates, and elevated costs. Resistance monitoring allows epidemiological assessment, targeted antimicrobial therapy, and detection of new strains. Rapid immunoassay-based multiplex tests are available for phenotypic detection and differentiation of five carbapenemase families (KPC, OXA-48-like, VIM, IMP, and NDM) directly from bacterial colonies. The NG-Test Carba 5® is a rapid (≤ 15 min) in vitro multiplex immunoassay for the phenotypic detection and differentiation of these common carbapenemase families produced by Enterobacterales and Pseudomonas. Tests were performed between August 2024 and March 2025. Sixty carbapenem-resistant strains (49 Enterobacterales and 11 Pseudomonas aeruginosa) identified by Vitek MS Prime® (BioMérieux) were tested using NG-Test Carba 5® to identify the resistance mechanism. Among Enterobacterales, 42 (70%) were KPC-producing, including 40 (95.24%) Klebsiella pneumoniae: 14 (35%) were sensitive to polymyxins, 27 (67%) to amikacin, 10 (25%) to gentamicin, and 21 (52.2%) to ceftazidime-avibactam. Two (4.76%) Escherichia coli isolates were both sensitive to polymyxin and gentamicin, one sensitive to amikacin, and the single isolate tested for ceftazidime-avibactam was sensitive. Beta-lactamases of the KPC, IMP, VIM, NDM, and OXA-48 types are the main enzymes produced by Enterobacterales that confer carbapenem resistance. A 2022 study showed that 77% of K. pneumoniae isolates were carbapenem-resistant due to KPC production, with polymyxin resistance at 29.5% and amikacin resistance at 19.6%. Strains resistant to these antimicrobials often have mutations in enzyme-coding alleles, mainly due to clinical antimicrobial use. This technology enables monitoring of resistance enzyme emergence and correlation between enzyme production and cross-resistance among antimicrobial classes.
O estudo aborda a eficácia das técnicas de fixação com placa e haste intramedular no tratamento de fraturas da tíbia distal, com ênfase na consolidação óssea, complicações pós-operatórias e preservação da função do tornozelo. Realizou-se uma revisão integrativa da literatura, incluindo artigos publicados entre 2010 e 2025 em bases de dados como PubMed, Scopus, Web of Science, LILACS e SciELO, que comparassem os dois métodos cirúrgicos e apresentassem dados clínicos e funcionais relevantes. A análise revelou que ambas as técnicas apresentam altas taxas de consolidação, variando de 92% a 97%, sendo a fixação com placa associada a maior precisão anatômica em fraturas intra-articulares complexas e a haste intramedular relacionada a menor tempo cirúrgico, menor agressão aos tecidos moles e reabilitação precoce. As complicações pós-operatórias diferem conforme o método: a placa associa-se mais frequentemente a infecção de sítio cirúrgico e retardo de cicatrização de tecidos moles, enquanto a haste intramedular apresenta maior risco de desalinhamento mecânico e dor anterior no joelho. Em relação à função do tornozelo, os resultados indicam equivalência em fraturas extra-articulares, com leve vantagem funcional da placa em fraturas articulares complexas. A pesquisa demonstra que não existe superioridade absoluta entre os métodos, sendo a escolha dependente do padrão da fratura e do perfil clínico do paciente. Os achados reforçam a importância da individualização do tratamento, da prevenção de complicações e da otimização da função articular, além de evidenciar a necessidade de estudos prospectivos com seguimento prolongado e instrumentos de avaliação padronizados.
