Antibiotic prophylaxis in breast cancer surgery: a randomized controlled trial

Purpose To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. Methods This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. Results Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. Conclusion Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.(AU)

Fixation of the short-term central venous catheter. A comparison of two techniques

Purpose: To compare the fixation of the central venous catheter (CVC) using two suture techniques. Methods: A clinical, analytical, interventional, longitudinal, prospective, controlled, single-blind and randomized study in adult, intensive care unit (ICU) patients. After admission and indication of CVC use, the patients were allocated to the Wing group (n = 35, catheter fixation with clamping wings and retainers) or Shoelace group (n = 35, catheter fixation using shoelace cross-tied sutures around the device). Displacement, kinking, fixation failure, hyperemia at the insertion site, purulent secretion, loss of the device, psychomotor agitation, mental confusion, and bacterial growth at the insertion site were evaluated. Results: Compared with the Wing group, the Shoelace group had a lower occurrence of catheter displacement (n=0 versus n =4; p = 0.04), kinking (n=0 versus n=8; p=0.001), and fixation failure (n=2 versus n=8; p=0.018). No significant difference was found in bacterial growth (n=20 versus n=14; p=0.267) between groups. Conclusion: The Shoelace fixation technique presented fewer adverse events than the Wing fixation technique.(AU)

Antimicrobial activity of Melaleuca sp. oil against clinical isolates of antibiotics resistant Staphylococcus aureus

PURPOSE: To extract the Melaleuca sp. oil and to assess its in vitro inhibitory effect against Staphylococcus aureus isolates obtained from lower limb wounds and resistant to several antibiotics. METHODS: A total of 14 test-tubes containing Mueller-Hinton broth were used to determine the Minimum Inhibitory Concentration (MIC). The following concentrations of the Melaleuca sp. oil were added to the first 11 tubes: 8; 4; 2; 1; 0.5; 0.2; 0.1; 0.05; 0.025; 0.0125 and 0.00625%. The 12th and 13th tubes, with and without oil, were used as the positive and negative controls, respectively. The experimental study was carried out in triplicate at 37ºC for 18 hours. The Minimum Bactericidal Concentration (MBC), able of killing all the microorganisms, was also determined. Two S. aureus isolates were obtained from lower limb wounds of female patients and the identification of the microorganisms (Staphylococcus aureus) and the test for susceptibility to the antimicrobial agents were carried out by automation using the apparatus MicroScan(r). After identification, the isolates were preserved in liquid Trypticase Soy medium, and inoculated for determination of the MIC and MBC. RESULTS: The MIC was 0.2% and the MBC was 0.4%. CONCLUSION: The Melaleuca sp. oil showed antimicrobial properties in vitro against strains isolated from lower limb wounds which were resistant to multiple antibiotics.(AU)

Antimicrobial activity of Melaleuca sp. oil against clinical isolates of antibiotics resistant Staphylococcus aureus

PURPOSE: To extract the Melaleuca sp. oil and to assess its in vitro inhibitory effect against Staphylococcus aureus isolates obtained from lower limb wounds and resistant to several antibiotics.METHODS:A total of 14 test-tubes containing Mueller-Hinton broth were used to determine the Minimum Inhibitory Concentration (MIC). The following concentrations of the Melaleuca sp. oil were added to the first 11 tubes: 8; 4; 2; 1; 0.5; 0.2; 0.1; 0.05; 0.025; 0,0125 and 0.00625%. The 12th and 13thtubes, with and without oil, were used as the positive and negative controls, respectively. The experimental study was carried out in triplicate at 37ºC for 18 hours. The Minimum Bactericidal Concentration (MBC), able of killing all the microorganisms, was also determined. Two S. aureus isolates were obtained from lower limb wounds of female patients and the identification of the microorganisms (Staphylococcus aureus) and the test for susceptibility to the antimicrobial agents were carried out by automation using the apparatus MicroScan(r). After identification, the isolates were preserved in liquid Trypticase Soy medium, and inoculated for determination of the MIC and MBC.RESULTS:The MIC was 0.2% and the MBC was 0.4%.CONCLUSION:The Melaleuca sp. oil showed antimicrobial properties in vitro against strains isolated from lower limb wounds which were resistant to multiple antibiotics.(AU)

Airborne fungi in an intensive care units and a surgical center of a university hospital / Micota no ar da unidade de terapia intensiva e centro cirúrgico de um hospital universitário

Esporos de fungos filamentosos disseminados no ambiente podem colonizar o trato respiratório, causando doenças em pacientes imunocomprometidos. Em hospitais e clínicas de saúde, é necessário determinar a concentração de micro-organismos anemófilos nas áreas internas e externas, no intuito de identificar fontes de contaminação e disseminação de agentes etiológicos. O valor máximo permitido deve ser <750UFC/m³ de fungos para a relação ambiente interno/externo V/E<1,5, sendo inaceitável a presença de fungos patogênicos. O objetivo deste estudo foi reconhecer a diversidade taxonômica de fungos anemófilos em ambientes externos e internos de um hospital universitário, com ênfase nos isolados potencialmente patogênicos. As coletas foram realizadas quinzenalmente, durante o inverno de 2008 e o verão de 2009, antes da limpeza dos aparelhos de ar condicionado. A avaliação da micota nas unidades de terapia intensiva e centro cirúrgico foi realizada pela técnica de sedimentação passiva. Os fungos isolados foram submetidos ao teste de crescimento a 37°C, e identificados por meio de características macroscópicas e micromorfológicas. As colotas realizadas no inverno apresentaram o resultado de 93 isolados no interior do hospital e 356 em seu exterior (I/E=0,2), sendo que 3 cepas do interior (A. clavatus, A. fumigatus, Penicillium sp.) e 2 do exterior (Paecilomyces sp. E Penicillium sp.) obtiveram crescimento a 37°C (I/E=1,5). Já na coleta realizada no verão, foram encontrados 116 isolados no interior do hospital e 142 em seu exterior (I/E= 0,8), sendo que 11 cepas do interior (Aspergillus sp., A. fumigatus, Fusarium sp.) e 17 do exterior (Fusarium sp., Aspergillus sp., A. versicolor, A. Niger, A. fumigatus) obtiveram crescimento a 37°C (I/E=0,64).

Mould spores are widespread in the environment and can colonize the host's respiratory tract. In hospitals and health clinics, it is necessary to determine the concentration of anemophilous microorganisms from indoor and/or external areas, with the purpose of identifying possible sources of contamination and potential diffusion of these pathogens. The maximum recommended value should be <750 CFU/m³ of fungi for the I/E environment ratio of <1.5, the presence of pathogenic fungi being unacceptable. The aim was to monitor and characterize airborne fungi in a General Hospital, to evaluate the pathogenic potential of isolated strains and to compare internal and external mycoflora. Samples were collected during the winter of 2008 and the summer of 2009, prior to the cleaning of the air-conditioning system. The evaluation of mycota in intensive care units and the surgical center was performed using the passive sedimentation technique. The strains of isolated filamentous fungi were subjected to a growth test at a temperature of 37°C. The colonies were identified using macroscopic and micromorphological features. During winter, 93 strains were isolated from inside the hospital and 356 outside the hospital (I/E = 0.2). Three strains (A. clavatus, A. fumigatus, Penicillium sp.) from inside the hospital and 2 strains (Paecilomyces sp. and Penicillium sp.) from outside the hospital grew at 37°C (I/E = 1.5). During the summer, 116 strains from inside and 142 from outside the hospital were isolated (I/E = 0.8). Eleven strains (Aspergillus sp., A. fumigatus, Fusarium sp.) from inside and 17 (Fusarium sp., Aspergillus sp., A. versicolor, A. niger, A. fumigatus) from outside the hospital grew at 37°C (I/E = 0.64).