Prevalence and antimicrobial susceptibility profile of microorganisms in a university hospital from Vitória (ES), Brazil / Prevalência de microrganismos e perfil de suscetibilidade antimicrobiana em um hospital universitário de Vitória (ES), Brasil

ABSTRACT INTRODUCTION: Healthcare associated infections (HAIs) occur during the hospital stay as a result of underlying morbidity, invasive procedures, acute pathology or medical treatment. They lead prolonged stay and, consequently, to an increase in financial charges. The main tool to control these infections is the use of antimicrobials. However, the increase in resistance and the low frequency of discovery of new drugs justify the research that evaluates the resistance profile of microorganisms to antimicrobials. OBJECTIVE: To evaluate the prevalence and antimicrobial susceptibility profile of HAIs at a philanthropic reference hospital in Espírito Santo, Brazil. METHODS: Observational, retrospective and cross-sectional study, between July 2014 and June 2016. Data on blood, urine and corporal secretions culture were collected from the data base of the Hospital Infection Control Commission. RESULTS: There was a high prevalence of HAIs in patients older than 60 years. Two hundred and forty three (47.55%) patients were female. The four most prevalent bacteria were: Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Polymyxin was the drug which presented the best antimicrobial effects. CONCLUSION: Polymyxin was active in vitro against all isolates of Acinetobacter spp. Regarding K. pneumoniae, both polymyxin and amikacin showed a significant effectiveness. Regarding Pseudomonas aeruginosa, polymyxin was effective in all samples. Regarding S. aureus, teicoplanin, daptomycin and vancomycin were effective in all samples. Polymyxin showed a good overall in vitro activity.

RESUMO INTRODUÇÃO: As infecções relacionadas com a assistência à saúde (IRAS) ocorrem durante a internação como resultado de morbidade subjacente, procedimentos invasivos, patologia aguda ou tratamento médico. Elas levam à prolongada permanência e, consequentemente, à carga econômica. A principal ferramenta para conter essas infecções são os antimicrobianos. No entanto, o aumento da resistência e a baixa taxa de descoberta de novos medicamentos justificam a pesquisa que avalia o perfil de resistência de microrganismos aos antimicrobianos. OBJETIVO: Avaliar a prevalência e o perfil de suscetibilidade antimicrobiana das IRAS ocorridas em um hospital filantrópico de referência do Espírito Santo, Brasil. MÉTODOS: Estudo observacional, retrospectivo e transversal, entre julho de 2014 e junho de 2016. Os dados sobre cultura de sangue, urina e secreções corporais foram coletados da base de dados do Centro de Controle de Infecção Hospitalar. RESULTADOS: Houve alta prevalência de IRAS em pacientes com mais de 60 anos. Duzentos e quarenta e três (47.55%) pacientes eram do sexo feminino. As quatro bactérias mais prevalentes foram: Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa e Staphylococcus aureus. A polimixina foi a droga que apresentou os melhores efeitos antimicrobianos. CONCLUSÃO: A polimixina foi ativa in vitro contra todos os isolados de Acinetobacter spp. Quanto à K. pneumoniae, tanto a polimixina quanto a amicacina apresentaram eficácia significativa. Em relação à Pseudomonas aeruginosa, a polimixina foi efetiva em todas as amostras. Já em relação ao S. aureus, teicoplanina, daptomicina e vancomicina foram efetivas em todas as amostras. A polimixina demonstrou um bom desempenho geral in vitro.

Evaluation of Audiometric Thresholds and Speech Perception Sentence Test in Adults and Elderly After Cochlear Implantation.

AIM: To compare the audiometric thresholds and speech perception sentence test, between two groups with bilateral post-lingual, severe to profound sensorineural hearing loss. METHODS: Retrospective and analytical study, with 59 patients divided into 2 groups (under 60 years and above 60 years old) implanted between May/2002 and February/2007. RESULTS: The first group (control) included 30 patients with a mean age of 44 years. The audiometric threshold value in this group was 26 dB, and the average value of speech perception test was 94%. The second group included 29 patients with a mean age of 69 years. The average audiometric threshold was 29 dB, and the average value of SPT was 90%. The Mann-Whitney U-test was considered significant (P<0.05) only for 6-8 KHz frequencies and for SPT. CONCLUSION: Both groups had excellent outcomes in audiometric and speech testing with the use of CI, but with a significantly better performance in the adult group.

Satisfaction of Children with Auditory Neuropathy and Cochlear Implant.

OBJECTIVE: In auditory neuropathy (AN) a dyssynchrony in the nerve conduction of the auditory nerve fibers is observed. Typically, patients with AN exhibit moderate to profound sensorineural hearing loss, and treatment using cochlear implants (CIs) or hearing aids should be performed as early as possible for a better hearing rehabilitation. The aim of this study is to evaluate the satisfaction level of patients with AN spectrum disorder treated using CIs. The Satisfaction with Amplification in Daily Life questionnaire was selected to evaluate 10 patients with AN treated using CIs. MATERIALS AND METHODS: Clinical study of patients with AN spectrum disorder submitted to CI. A retrospective data analysis, genetic and clinical evaluation in a tertiary referral center was done. RESULTS: The means of the subscales for positive effects, services and costs, negative factors, and personal image were 6.15, 4.6, 3.26, and 3.33, respectively. CONCLUSIONS: Patients with AN treated using CIs consider themselves satisfied.

Hearing Preservation after Cochlear Implantation: UNICAMP Outcomes.

Background. Electric-acoustic stimulation (EAS) is an excellent choice for people with residual hearing in low frequencies but not high frequencies and who derive insufficient benefit from hearing aids. For EAS to be effective, subjects' residual hearing must be preserved during cochlear implant (CI) surgery. Methods. We implanted 6 subjects with a CI. We used a special surgical technique and an electrode designed to be atraumatic. Subjects' rates of residual hearing preservation were measured 3 times postoperatively, lastly after at least a year of implant experience. Subjects' aided speech perception was tested pre- and postoperatively with a sentence test in quiet. Subjects' subjective responses assessed after a year of EAS or CI experience. Results. 4 subjects had total or partial residual hearing preservation; 2 subjects had total residual hearing loss. All subjects' hearing and speech perception benefited from cochlear implantation. CI diminished or eliminated tinnitus in all 4 subjects who had it preoperatively. 5 subjects reported great satisfaction with their new device. Conclusions. When we have more experience with our surgical technique we are confident we will be able to report increased rates of residual hearing preservation. Hopefully, our study will raise the profile of EAS in Brazil and Latin/South America.

Causes of rejection of blood samples handled in the clinical laboratory of a University Hospital in Porto Alegre.

OBJECTIVE: Errors in clinical laboratories have a great impact on safety and care of patients. The pre-analytical phase is responsible for about 70% of errors. Hence, the objective was to determine what types of pre-analytical errors for improvements at this stage, and contribute data to the literature. DESIGN AND METHODS: Every three months during the study, the rejected blood samples were assessed for type of pre-analytical error and home care. RESULTS: 77,051 blood samples were collected in the search period, whereof 441 (0.57%) were rejected by some type of pre-analytical error and therefore had to be recollected. Clot was found to be the major cause of rejection of samples, 43.8%, followed by insufficient sample volume, 24%. CONCLUSION: This study has shown that the most frequent causes of pre-analytical errors and rejection of samples corroborate those found in the literature.