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Objective: The stewardship strategy refers to a consistent practice to promoting responsible antimicrobial use. Optimizing the use of antibiotics is critical to mitigating adverse effects and combating bacterial resistance. The pillars of a stewardship program include: i) clinical pharmacist and infectologist with expertise; ii) educational measures for prescribers, nurses and pharmacists; iii) prophylaxis and therapeutic protocol; iv) monitoring of indicators. In this scenario of antimicrobial rational use, the older population are more susceptible to infection because immunocenescence and, therefore, greater use of antimicrobials is expected. Thus, the aim of the present study is to evaluate the prescription compliance of antimicrobial whose use is restricted in a hospitalized elderly population. Method: observational, controlled study in a Brazilian hospital, from January 2021 to January 2022. Based on the electrotonic antimicrobial form, the compliance of the prescriptions was evaluated. The definition used for elderly corresponded to individuals over 60 years old, according to the Brazilian Nation Principles for Older Persons, ordinance number 2528, of October 2006. Restricted drugs were considered: carbapenems, polymyxin, ceftazidime-avibactam, linezolid, tigecycline, ceftaroline, echinocandins and amphotericin. Results: A total of 1.688 requests for restricted use were received, of which 53% corresponded use in elderly group. Neutropenic fever was more common in young people and the inpatient unit was the sector with the highest percentage of antimicrobials. Furthermore, teicoplanin was the main drug that required intervention. Conclusion: Faced with the increase in bacterial resistance, the rational use of antimicrobials is extremely important, especially in older age group.

IntroductionA wide variety of viruses can cause rash diseases (RDs) or acute febrile illness (AFIs) in children, adolescents and adults; however, approximately 19% of RD cases and 40% of AFI cases remain without a defined etiology. Parvovirus B19 (B19V) and herpesvirus infection can also cause RD and/or AFI, and in some risk groups, these infections can become persistent (or latent) and may require hospital treatment. Since these infections do not have mandatory reporting, they can be hidden by other diseases, such as those caused by arboviruses (e.g., dengue virus). In this context, the aim of this study was to pursue the differential laboratory diagnoses of B19V and herpesvirus infections in patients with RD and AFI, without a defined etiology, seen in hospitals and/or reference centers for infectious diseases in Rio de Janeiro.MethodsA total of 114 participants were enrolled in the study, including 54 children and 60 adults. B19V infection was assessed by real-time PCR (qPCR) and ELISA (anti-B19V IgM and IgG). EBV was assessed through qPCR, and betaherpesviruses (HCMV, HHV-6 and HHV-7) were assessed through multiplex qPCR. Sociodemographic and clinical data were obtained from the medical record data of these participants.ResultsThe median age of children with RD was 2 years (interquartile range (IQR): 5), and 55.6% were male. Among adults with AFI, the median age was 38 years (IQR: 21), and 56.7% were female. Regarding RD patients, viral prevalence (and load) were 5.5%(104IU/mL), 3.4%(104IU/mL), 5.5%(104IU/mL) and 11.1%(105IU/mL) for B19V, EBV, HCMV and HHV-6 infection, respectively, and in AFI patients they were 6.6%(105IU/mL), 1.6%(103IU/mL), 3.3%(104IU/mL) for B19V, HCMV and HHV-6, respectively. HHV-7 was not detected in RD or AFI patients.ConclusionThese results suggest the importance of including B19V and herpesviruses in the differential laboratory diagnoses for patients with RD and AFI, not only for epidemiological purposes but also for the proper management of the patient.

Pulmonary tuberculosis (TB) is a preventable treatable and infectious disease caused by Mycobacterium tuberculosis (Mtb). The infection occurs through the inhalation of droplets expelled by an individual with the active disease. Most cases develop latent infection, and a minority manifest the active form of the disease. As in adults, TB in children has predominantly pulmonary involvement, and usually present with non specific symptoms such as fever, respiratory distress, cough, weight loss or no gain, rales and wheezing. The etiological diagnosis is difficult due to the reduced number of bacilli in the lesions. This is the case of a 5 month old infant, female, previously healthy, with a persistent cough for three months, with chest wheeze and inappetence, but without manifestation of fever. The chest X-ray showed extensive lung consolidation affecting the entire right hemithorax. During hospitalization, the patient showed no improvement in the radiological appearance despite the use of broad-spectrum antibiotics. The diagnosis of Mtb infection was confirmed by a polymerase chain reaction test (Xpert Ultra MTB-RIF®). The patient was discharged to complete the treatment - rifampicin-isoniazid-pyrazinamide in an outpatient clinic with good clinical outcome. Due to the particularities of pediatric TB, highlightining the non-specificity of the signs and symptoms and the paucibacillary lesions, one must beawared of this diagnosis, especially in the presence of radiological clinical dissociation.

OBJETIVOS: Descrever uma série de casos de crianças diagnosticadas com infecção pelo vírus Chikungunya (CHIKV) com manifestações dermatológicas atípicas, a fim de ampliar as possibilidades de diagnósticos diferenciais em casos de apresentações clínicas semelhantes. MÉTODOS: Trata-se de uma série de casos em que foram incluídos todos os pacientes com idade entre 0 e 18 anos e que, entre janeiro de 2018 e novembro de 2020, deram entrada no pronto socorro de um hospital público pediátrico apresentando manifestações cutâneas atípicas associadas a diagnóstico clínico-epidemiológico ou laboratorial do CHIKV. RESULTADOS: Um total de seis pacientes foram triados de uma coorte de 432 pacientes. Desses seis, quatro eram do sexo feminino e cinco eram menores de um ano. As manifestações mais relatadas foram febre de início súbito, além de exantema e lesões cutâneas bolhosas, acometendo principalmente os membros. Houve internação de cinco pacientes ao todo, sem óbitos. CONCLUSÃO: As apresentações cutâneas são de magnitude diferente de acordo com a faixa etária acometida pelo CHIKV, principalmente em menores de um ano de idade, acometendo especialmente áreas de extremidades da superfície corporal. Portanto, vale ressaltar que os pacientes pediátricos merecem maior atenção e cuidados precoces, a fim de reduzir as complicações da infecção e, portanto, também a morbidade da população acometida.