Brazilian Journal of Infectious Diseases最新文献

{"title":"Hospitalization costs of patients with severe acute respiratory infections due to COVID-19 in a public teaching hospital: a micro-costing approach","authors":"Ana Carolina Esteves da Silva Pereira ,&nbsp;Luciana G. Gallo ,&nbsp;Ana Flávia de M. Oliveira ,&nbsp;Maria Regina F. de Oliveira ,&nbsp;Emanuelly Martins da Silva ,&nbsp;Henry M. Peixoto","doi":"10.1016/j.bjid.2026.105819","DOIUrl":"10.1016/j.bjid.2026.105819","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the costs associated with the hospitalization of patients with Severe Acute Respiratory Infection (SARI) due to SARS-CoV-2 in a university hospital affiliated with the Brazilian Unified Health System (SUS) in 2020 and 2021.</div></div><div><h3>Methods</h3><div>A bottom-up micro-costing approach was used to conduct a cost analysis based on data from a hospital clinical cohort. Patients with confirmed diagnoses of COVID-19 and SARI, admitted to general wards or intensive care units (with or without mechanical ventilation), were included. Healthcare activities were categorized as hospitalization, ventilation, hemodialysis, nutrition, medications, and laboratory tests. Costs were calculated based on individualized consumption of supplies and procedures, also considering the annualized cost of equipment. Comparisons were made between micro-costing and macro-costing (based on the Hospital Admission Authorizations – AIH).</div></div><div><h3>Results</h3><div>A total of 627 patients were analyzed. The total cost was R$ 5,824,366.73 (Int$ 2,307,593.80) when healthcare professionals were excluded and R$19,437,731.25 (Int$ 7,701,161.35) when they were included. Medications accounted for the largest share (52.79%). Micro-costing was 1.7-times higher than macro-costing for hospital costs alone and 2.3-times higher when professional costs were included. Multivariate analysis identified length of hospital stay as the main factor associated with increased costs, while age, sex, and referral origin showed no significant association.</div></div><div><h3>Conclusion</h3><div>This study reveals the substantial economic impact of COVID-19-related hospitalizations in high-complexity care settings. It also highlights the importance of improving financing models for the SUS, particularly given the discrepancies between actual costs and federal reimbursement values. These findings contribute to the development of public policies and response strategies for future health emergencies.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 3","pages":"Article 105819"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare morphological gem in fulminant meningococcal sepsis","authors":"Martin P. Dieterle ,&nbsp;Stefano Malvestiti ,&nbsp;Barbara Zieger ,&nbsp;Hans Fuchs ,&nbsp;Daniel Matheisl","doi":"10.1016/j.bjid.2026.105822","DOIUrl":"10.1016/j.bjid.2026.105822","url":null,"abstract":"","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 3","pages":"Article 105822"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147798317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum cytokines and tissue doppler imaging as markers of prognosis of chronic myocarditis due to chagas disease","authors":"Ivan Santana Batista Soares ,&nbsp;Edmundo Câmara ,&nbsp;Manoel Barral-Netto ,&nbsp;Carlos Rico Quintero ,&nbsp;Benelson Guimarães Carvalho ,&nbsp;Fábio Bulhões ,&nbsp;Alex Cleber Improta-Caria ,&nbsp;Roque Aras-Júnior","doi":"10.1016/j.bjid.2026.105786","DOIUrl":"10.1016/j.bjid.2026.105786","url":null,"abstract":"<div><h3>Introduction</h3><div>Insidious myocarditis due to Chagas disease evolves with low inflammatory potential. Determining biomarkers can help find individuals at risk for Heart Failure (HF) or arrhythmias. This study aimed to evaluate the role of serum cytokines and myocardial tissue Doppler imaging as prognostic markers of Chagas myocarditis.</div></div><div><h3>Methods</h3><div>This longitudinal study was carried out in a prospective cohort in which adults living with Chagas disease who had no HF were followed up for 10-years. Tissue Doppler imaging was performed, and inflammatory cytokines were measured. Kaplan-Meier survival analysis, unadjusted and adjusted survival analyses for some variables by Cox regression and multivariate binary logistic regression analysis were performed for the primary and total outcomes.</div></div><div><h3>Results</h3><div>This study found that IL1-B and IL-13 were associated with primary and total events (<em>p</em> = 0.015 and <em>p</em> = 0.013 and <em>p</em> = 0.013 and 0.042, respectively). In the adjusted analysis, IL1-B and IL-13 remained associated with primary events, with <em>p</em> = 0.027 and <em>p</em> = 0.030, respectively, and IL1-B with total events (<em>p</em> = 0.022). In the logistic regression analysis, IL-5 independently predicted total events (<em>p</em> = 0.023). We found a significant association between tissue Doppler imaging variables and primary outcomes.</div></div><div><h3>Conclusion</h3><div>Identifying IL-5, IL1-B and IL-13 as probable independent predictors of events at an early stage of Chagas disease is a significant milestone to the understanding of this pathology evolution. Also, several tissue Doppler parameters were important as prognosis predictors.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 2","pages":"Article 105786"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147272933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NON-TRAUMATIC GLUTEUS MEDIUS RUPTURE ASSOCIATED WITH FLUOROQUINOLONE USE: A CASE REPORT","authors":"Bernardo Martins Zonta,&nbsp;Lauro Schweitzer Sebold,&nbsp;Franciani Rodrigues da Rocha,&nbsp;Caroline de Oliveira Fischer Bacca,&nbsp;Guilherme Valdir Baldo","doi":"10.1016/j.bjid.2026.104715","DOIUrl":"10.1016/j.bjid.2026.104715","url":null,"abstract":"<div><div>Fluoroquinolone-induced tendinopathy (FIT) is a recognized adverse drug reaction characterized by tendon pain, inflammation, and, in more severe cases, spontaneous tendon rupture. Although the Achilles tendon is affected in up to 90% of reported cases, injuries to other tendons remain underreported. We present an unprecedented case of a 41-year-old female patient, eutrophic and previously musculoskeletal healthy, who developed sudden, severe left hip pain radiating to the gluteal region and posterior thigh, associated with limping and functional impairment, 14 days after completing a five-day course of ciprofloxacin (500 mg) for urinary tract infection. Physical examination revealed localized tenderness over the left gluteal region without radicular neurological signs. MRI demonstrated partial rupture of the gluteus medius tendon at its insertion on the greater trochanter, accompanied by trochanteric bursitis. Application of the Naranjo algorithm yielded a score of 6, indicating a probable causal relationship between drug exposure and injury. The patient had a remote history of corticosteroid use and cervical discectomy, but no concurrent medications increasing risk. Treatment consisted of analgesia, NSAIDs, orthosis, and physiotherapy, with complete symptom resolution after approximately six weeks. The incidence of FIT ranges from 0.14% to 2.0%, being more common in elderly patients, those on corticosteroids, or with predisposing comorbidities. The risk of tendon rupture is up to 4.1 times higher among fluoroquinolone users, with peak occurrence 6–14 days after exposure. Pathophysiologically, FIT involves inhibition of tenocyte proliferation, increased metalloproteinase activity, and oxidative stress on the tendon’s extracellular matrix. The present case expands the clinical spectrum of FIT by documenting, for the first time in the literature, gluteus medius tendon rupture associated with ciprofloxacin, highlighting the need for clinical vigilance in patients presenting new musculoskeletal symptoms after fluoroquinolone use, even in the absence of classical risk factors, and the importance of early diagnosis to prevent disabling outcomes.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104715"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SUCCESSFUL EXPERIENCE IN REDUCING THE USE OF BROAD-SPECTRUM ANTIBIOTICS","authors":"Priscila Gabriella Carraro Merlos,&nbsp;Jaqueline Barp,&nbsp;Camile Nutti,&nbsp;Fernando Merlos","doi":"10.1016/j.bjid.2026.104666","DOIUrl":"10.1016/j.bjid.2026.104666","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of antimicrobials is high among hospitalized patients, often empirical and not always appropriately indicated. The <em>National Guideline for the Development of Antimicrobial Stewardship Programs in Healthcare Services</em>(ANVISA, 2023) recommends, among other actions, the prospective audit of antimicrobial prescriptions. The implementation of such audits through the joint work of clinical pharmacists and the Hospital Infection Control Committee, coordinated by an infectious disease specialist, in September 2023 marked a milestone and enabled this study.</div></div><div><h3>Objective</h3><div>To compare the consumption of meropenem, piperacillin-tazobactam, and vancomycin before and after implementation of the audit, using Defined Daily Dose (DDD) as a consumption indicator, to evaluate its impact on antimicrobial prescribing.</div></div><div><h3>Methods</h3><div>A retrospective study analyzed DDD data from the hospital management system between January–August 2023 and September 2023–June 2024 in a public general hospital in Joinville, Santa Catarina. Numerical variables were compared using the Student’s <em>t</em>-test.</div></div><div><h3>Results</h3><div>Reductions in DDD were observed for all evaluated antibiotics: meropenem decreased by 20.9% (mean pre = 188.5 ± 95.5; post = 141.8 ± 59.2; p = 0.159), piperacillin-tazobactam by 27.5% (mean pre = 549.9 ± 73.4; post = 403.1 ± 68.4; p = 0.009), and vancomycin by 43.4% (mean pre = 114.9 ± 19.1; post = 59.5 ± 20.0; p &lt; 0.001). These results demonstrate more effective antimicrobial control after audit implementation.</div></div><div><h3>Conclusion</h3><div>Antimicrobial stewardship is essential for infection control and combating microbial resistance. The joint efforts of clinical pharmacists and infectious disease specialists significantly reduced broad-spectrum antibiotic use, contributing to the prevention of multidrug-resistant microorganism selection and dissemination.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104666"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THERAPEUTIC DRUG MONITORING EXPERIENCE WITH VANCOMYCIN IN A MEDIUM-SIZED HOSPITAL IN SOUTHERN BRAZIL","authors":"Guilherme Felipe Raimundo ,&nbsp;Helena Iturvides Cimarosti ,&nbsp;José Elias Amaral","doi":"10.1016/j.bjid.2026.104665","DOIUrl":"10.1016/j.bjid.2026.104665","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Vancomycin is widely used to treat severe infections caused by resistant Gram-positive bacteria, such as methicillin-resistant <em>Staphylococcus aureus</em> (MRSA). Due to its narrow therapeutic window and high risk of nephrotoxicity, its safe use requires rigorous therapeutic drug monitoring (TDM). Although current recommendations favor estimating the area under the concentration–time curve over the minimum inhibitory concentration (AUC/MIC) as a more precise parameter, many institutions still rely solely on trough levels (Cmin), which can hinder dose individualization.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed vancomycin monitoring practices in a medium-sized hospital in southern Brazil between October 2023 and October 2024. Thirty-three adult inpatients treated with vancomycin were included, divided into four groups: HDV (hemodialysis with TDM), HDNV (hemodialysis without TDM), NDV (non-dialysis with TDM), and NDNV (non-dialysis without TDM). Serum levels were classified as subtherapeutic (&lt;15 mg/L), therapeutic (15–20 mg/L), or supratherapeutic (&gt; 20 mg/L).</div></div><div><h3>Results</h3><div>Among the 19 patients monitored, supratherapeutic concentrations predominated, with an overall mean of 29.6 mg/L. In the HDV group, all patients had initial levels above 20 mg/L (mean = 33.7 mg/L), and only three reached the therapeutic range during treatment. In the NDV group, variability was higher: three patients started within range, two below, and four above; only four achieved target levels during hospitalization. The analysis revealed that monitoring alone was insufficient to ensure adequate drug exposure. The lack of effective dose adjustment, particularly in dialysis patients, suggests reliance on fixed dosing regimens without considering individual pharmacokinetic factors. Laboratory data also appeared not fully integrated into clinical decision-making, limiting the overall impact of TDM.</div></div><div><h3>Conclusion</h3><div>Vancomycin monitoring practices were inadequate to achieve safe therapeutic levels in most patients. Implementation of AUC/MIC-based protocols, supported by clinical pharmacists and therapeutic decision-support tools, is essential to optimize vancomycin use and minimize risks associated with under or overexposure.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104665"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RESISTANCE PROFILE AND PHENOTYPIC CHARACTERIZATION OF GRAM-NEGATIVE BACILLI IN THE METROPOLITAN REGION OF MANAUS: A SURVEILLANCE STUDY","authors":"Francielle Sousa Belem ,&nbsp;Ivanildes dos Santos Bastos ,&nbsp;Lucas de Souza Andrade ,&nbsp;Caroline Sousa Martins de Almeida ,&nbsp;Ana Carolina Moura Xavier ,&nbsp;Cristiane Nazaré Fidelis Aparicio ,&nbsp;Natalia Aparecida de Souza Lima ,&nbsp;Laerzio Chiesorin Neto ,&nbsp;Patricia Puccinelli Orlandi ,&nbsp;Alessandra Ferreira Dales Nava","doi":"10.1016/j.bjid.2026.104702","DOIUrl":"10.1016/j.bjid.2026.104702","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Antimicrobial resistance is a growing threat to global public health. Gram-negative bacilli stand out in this context due to their high resistance rates and associated mortality. In the Amazon region, little is known about the presence and spread of these microorganisms in wild animals and the environment. The objective was to evaluate the occurrence of resistant Gram-negative bacilli in water, soil, and fecal samples from wild animals in the Metropolitan Region of Manaus, from the perspective of the One Health approach.</div></div><div><h3>Methods</h3><div>Rectal samples were collected from 34 animals from the Wildlife Screening Center, as well as environmental samples (water and soil) from their places of origin. Samples were cultured on selective media, and bacterial isolates were identified by colony morphology, Gram staining, and conventional biochemical tests. Antimicrobial susceptibility was determined by disk diffusion (CLSI, 2023) using 12 antimicrobials: amoxicillin + clavulanic acid, cefoxitin, amikacin, ceftazidime, meropenem, ampicillin, cephalothin, cefuroxime, ciprofloxacin, sulfamethoxazole/trimethoprim, gentamicin, and cefepime. The project was approved by CEUA/FIOCRUZ, Protocol n° 4/23-5.</div></div><div><h3>Results</h3><div>From the collected samples, 438 isolates of Gram-negative strains were obtained, of which 29.7% were from fecal samples, 36.1% from water, and 34.2% from soil. Most isolates were identified as <em>Escherichia coli</em> (18%), <em>Klebsiella pneumoniae</em> (11.4%), <em>Enterobacter cloacae</em> (11%), <em>Proteus mirabilis</em> (8.2%), <em>Klebsiella aerogenes</em> (5%), <em>Shigella</em> spp.(4.8%), <em>Klebsiella oxytoca</em> (3.4%), and <em>Salmonella</em> spp. (3.2%). The highest sensitivity levels were observed for gentamicin (95.3%), ciprofloxacin (89.3%), and sulfamethoxazole/trimethoprim (84.2%). Resistance was highest for amoxicillin + clavulanic acid (66.9%), followed by ampicillin (59%) and cephalothin (43%). The analysis showed that 91% of the strains were resistant to at least one antibiotic, and only 9% were sensitive to all antibiotics tested for Gram-negative isolates.</div></div><div><h3>Conclusion</h3><div>The findings show the wide dissemination of resistant Gram-negative bacilli in natural environments of the Amazon region, possibly influenced by human activity. The data reinforce the urgency of implementing integrated surveillance actions in line with the principles of One Health.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104702"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SYNERGISTIC POTENTIAL BETWEEN SPARATTOSPERMA LEUCANTHUM AND VANCOMYCIN AGAINST STAPHYLOCOCCUS AUREUS","authors":"Denise de Oliveira Scoaris,&nbsp;Julia Chaia Mattos de Souza,&nbsp;Cláudia Gontijo Silva,&nbsp;Vera Lúcia de Almeida","doi":"10.1016/j.bjid.2026.104704","DOIUrl":"10.1016/j.bjid.2026.104704","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Antimicrobial resistance is listed by the World Health Organization (WHO) as one of the ten main global health threats. It is estimated that by 2050, this problem will cause the loss of 10 million lives per year due to the emergence of multidrug-resistant microorganisms, making the search for new therapeutic alternatives urgent. In this context, the investigation of medicinal plants combined with antibiotic action is highly promising. The objective of this study was to evaluate the synergistic potential between <em>Sparattosperma leucanthum</em> and vancomycin against <em>Staphylococcus aureus</em> ATCC 25923.</div></div><div><h3>Methods</h3><div>Leaf extracts were prepared using hexane, dichloromethane, ethyl acetate, and methanol for the determination of the minimum inhibitory concentration (MIC₁₀₀) against <em>S. aureus</em>. The most active extract was selected for evaluation of its synergistic potential with vancomycin using the checkerboard technique. Extract concentrations ranged from 1.95 to 250 µg/mL, and vancomycin concentrations from 0.0005 to 0.075 µg/mL, resulting in 64 combinations of both agents. Inoculum standardization, incubation, and controls followed CLSI procedures. All assays were performed in triplicate. Results were calculated using the fractional inhibitory concentration index (FICI): FICI ≤ 0.9 = synergistic effect; 0.9 &lt; FICI &lt; 1.1 = additive effect; FICI &gt; 1.1 = antagonistic effect.</div></div><div><h3>Results</h3><div>The most active extract was the dichloromethane extract, which presented an isolated MIC of 250 μg/mL and remained unchanged during the synergy evaluation. The isolated MIC of vancomycin was 0.0375 µg/mL, and when combined with the extract, it was reduced to 0.004 µg/mL. The FICI was 1.1, indicating a relevant additive effect between vancomycin and the extract, which reduced the antibiotic concentration by more than ninefold.</div></div><div><h3>Conclusion</h3><div>The combined action between antibiotics and plant extracts represents a relevant alternative for the treatment of infectious diseases, potentially contributing to controlling the advancement of antimicrobial resistance.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104704"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AZITHROMYCIN AND TEA TREE OIL NANOCAPSULES COATED WITH CHITOSAN: A NEW STRATEGY AGAINST RESISTANT PATHOGENS","authors":"Mariana Simões de Oliveira,&nbsp;Vitória Batista Clemente,&nbsp;Michel de Oliveira Sales Júnior,&nbsp;Bernardo Canêdo Martins,&nbsp;Taleessa Vieira Gomes,&nbsp;Ana Carolina Morais Apolônio","doi":"10.1016/j.bjid.2026.104693","DOIUrl":"10.1016/j.bjid.2026.104693","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>The problem of antimicrobial resistance has led to the study and development of new drug systems that combine natural compounds with classical antimicrobials. This study aimed to produce nanocapsules of <em>Melaleuca alternifolia</em> essential oil (TEO) and azithromycin (AZI) coated with chitosan (CH) with antimicrobial activity.</div></div><div><h3>Methods</h3><div>The nanocapsule suspensions were prepared by the interfacial deposition method of a preformed polymer. They were then coated with CH solution at a 2% concentration. Physicochemical characterization included evaluation of pH, average hydrodynamic diameter (AHD), zeta potential (ZP), polydispersity index (PI), and morphological evaluation using Scanning Electron Microscopy (SEM). Biological tests performed included Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of free AZI and encapsulated AZI against resistant microorganisms: <em>Staphylococcus aureus</em> ATCC 33591, <em>Klebsiella pneumoniae</em> ATCC BAA2814, <em>Enterococcus faecalis</em>ATCC 51299, and <em>Streptococcus sobrinus</em> ATCC 27531.</div></div><div><h3>Results</h3><div>The average AHD of the nanocapsule suspension before CH coating (206.2 ± 2.2 nm) at 2% was lower than after coating (238.5 ± 1.7 nm), suggesting the formation of a thin CH layer around the nanocapsules. The PI values (0.173 ± 0.005 before and 0.245 ± 0.010 after) show that the suspension maintained its homogeneity in particle size and distribution even after coating. The ZP, which was negative (–28.66 ± 1.40 mV), became positive (+28.06 ± 1.10 mV) after coating. The pH became more acidic (4.38) due to the presence of CH in the suspension. SEM images after CH coating revealed the spherical/oval shape of the nanocapsules. MIC values for encapsulated AZI were lower than those for the free form of the drug for all tested bacteria after 24 hours.</div></div><div><h3>Conclusion</h3><div>The nanocapsules proved to be a promising approach to combat infections caused by the bacterial species tested.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104693"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"NATURE-BASED SOLUTION FOR PUBLIC HEALTH PROTECTION: MITIGATING ANTIMICROBIAL RESISTANCE IN HOSPITAL EFFLUENT","authors":"Rafael Shinji Akiyama Kitamura ,&nbsp;João Vitor Mota Chiaratti ,&nbsp;Guilherme de Andrade Braz Fronchetti ,&nbsp;Cauê Sprocatti Baldani ,&nbsp;Joana Rosar Corbellini ,&nbsp;Marcus Vinícius de Liz","doi":"10.1016/j.bjid.2026.104717","DOIUrl":"10.1016/j.bjid.2026.104717","url":null,"abstract":"<div><h3>Introduction</h3><div>Antimicrobial resistance (AMR) is one of the foremost global public health challenges. Hospital effluents release resistant bacteria, resistance genes, and antimicrobial residues into aquatic ecosystems, fostering the spread of AMR. In this context, nature-based solutions (NbS), such as phytoremediation, have emerged as low-cost alternatives for mitigation. This study aimed to evaluate the potential of two aquatic plant species in removing antimicrobials, resistant bacteria, and carbapenemase genes from hospital wastewater.</div></div><div><h3>Methods</h3><div>Effluent samples were collected from a hospital in Lapa (Paraná) and subjected to three 10-L treatments in triplicate: EFL (effluent without plants), SAL (<em>Salvinia molesta</em>), and PTC (<em>Pontederia crassipes</em>). After seven days, samples were analyzed for antimicrobial residues (tetracyclines and beta-lactams) using the TwinSensor rapid test. Colony-forming units (CFUs) were quantified, resistant strains identified on ESBL agar, and carbapenemase genes (KPC, IMP, NDM, VIM, OXA-48) detected using Medomics rapid tests.</div></div><div><h3>Results</h3><div>In the EFL group, antimicrobials were detected (tetracycline 80 µg/L, oxytetracycline 60 µg/L, amoxicillin 2 µg/L, penicillin 3 µg/L), along with KPC, IMP, and NDM genes. Resistant isolates included <em>Klebsiella pneumoniae</em>, <em>Escherichia coli</em>, <em>Pseudomonas</em> spp.<em>,</em> and <em>Proteus</em> spp<em>.</em> Phytoremediation with <em>S. molesta</em> achieved complete removal of antimicrobials and resistance genes, total elimination of <em>E. coli</em>, and 99% reduction of other resistant species. <em>P. crassipes</em> achieved 100% beta-lactam removal, 56% tetracycline reduction, and partial gene suppression (IMP and NDM). Given that the hospital mainly treats respiratory diseases, these findings reinforce the relevance of NbS in preventing AMR dissemination into aquatic ecosystems and its implications for public health.</div></div><div><h3>Conclusion</h3><div>Phytoremediation proved to be an effective and innovative NbS for reducing microbial and genetic AMR load in hospital effluent. The results reinforce the contribution of this ecotechnology to the protection of public and environmental health.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104717"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}