Detection of beta-lactamase-producing Enterobacteriaceae in a veterinary hospital environment / Detecção de Enterobactérias produtoras de beta-lactamases em ambiente hospitalar veterinário

Due to the strong selective pressure resulting from the misuse of antibiotics, the natural process of bacterial resistance has been accelerated, leading to the increasingly constant appearance of multiresistant isolates. The high number of multi-resistant bacteria is a one health problem. Enterobacteriaceae are usually commensal bacteria of the gastrointestinal tract. However, they can cause infections, and the most important resistance characteristic among them is the production of ß-lactamases. This study aimed to identify ESBL-producing Enterobacteriaceae of types of TEM, SHV, and the CTX-Mgroups. To isolate the enterobacteria, swabs were collected by swiping objects that had contact with the patients and professionals, and the water of the hospital environment. Ten collections were carried out, yielding 306 samples, from which 118 enterobacteria were identified: Escherichia coli, Enterobacter spp., Klebsiella spp., Proteus mirabilis, Serratiaspp., and Citrobacter spp. Isolates. The genes TEM and CTX-M, for the production of ß-lactamases, were detected in 12.7% of the 118 enterobacterial isolates. It is very important to know the bacterial population circulating in the veterinary hospital environment and its resistance to antimicrobials so that professionals can take appropriate measures to minimize the risks of transmission, especially from cages and consultation tables. In addition, the correct control of the microbiological quality of the supply water, as well as environmental cleaning procedures, are essential to prevent the transmission of these microorganisms.(AU)

Devido à grande pressão seletiva decorrente do uso indevido de antibióticos, tem se acelerado o processo natural de resistência das bactérias, levando ao aparecimento cada vez mais constante de isolados multirresistentes. O elevado número de bactérias multirresistentes identificadas é um problema da saúde única. As enterobactérias são bactérias geralmente comensais do trato gastrointestinal, entretanto podem causar infecções, e a característica de resistência mais importante entre elas é a produção de ß-lactamases. Buscando caracterizar melhor os microrganismos circulantes e potencialmente causadores de infecções em ambiente hospitalar veterinário, este estudo objetivou identificar as enterobactérias produtoras de ESBL do tipo TEM, SHV e os cinco grupos de CTX-M presentes em isolados circulantes em hospital veterinário. Foi realizada coleta de suabes de arrasto de objetos que entram em contato com os pacientes e com os profissionais que ali trabalham, bem como de água, para a identificação das enterobactérias. Foram realizadas 10 coletas, obtendo-se 306 amostras, dessas, 118 enterobactérias foram identificadas: Escherichia coli, Enterobacter, Klebsiella, Proteus mirabilis, Serratia e Citrobacter. Dentre as enterobactérias identificadas, alguns isolados possuíam genes para a produção de ß-lactamases, do tipo TEM e CTX-M. É de grande importância conhecer a população bacteriana circulante no ambiente hospitalar veterinário, e a sua resistência aos antimicrobianos, para que os profissionais possam tomar medidas apropriadas para minimizar os riscos de transmissão, principalmente a partir de gaiolas e mesas de atendimento. Além disso, o correto controle da qualidade microbiológica da água de abastecimento, bem como dos procedimentos de higienização do ambiente, são fundamentais para evitar a transmissão destes microrganismos.(AU)

Emergence of multidrug-resistant bacteria isolated from surgical site infection in dogs and cats / [Emergência de bactérias multirresistentes isoladas da infecção no sítio cirúrgico em cães e gatos]

Surgical site infections (SSIs) and antimicrobial resistance among pathogens causing SSI are a growing concern in veterinary hospitals. One major reason, the widespread use of antimicrobials, has led to increased incidence of SSIs. This study identified bacteria and resistance profiles to antimicrobials in the SSI cases diagnosed at the Surgical Clinic of Small Animals in the Veterinary Hospital, Federal University of Viçosa, Brazil. The main genus identified was Staphylococcus, followed by Escherichia, Enterococcus, Bacillus, Shigella, Citrobacter, Proteus, Morganella, Serratia, Enterobacter, Pseudomonas and Klebsiella were also found, but in small number. The results indicated the predominance of Gram-negative bacteria among the collected samples. Most of isolates identified were resistant to more than one of the following antimicrobials: ampicillin, tetracycline, enrofloxacin, amoxicillin/clavulanic acid and cephalotin. Of the 17 Staphylococcus sp. isolates, two (11.8%) were methicillin-resistant Staphylococcus aureus (MRSA) and 11 (64.7%) of them were methicillin-resistant Staphylococcus pseudintermedius (MRSP). There were bacterial genera identified with resistance to all tested antimicrobials in different proportions. This should alert veterinary hospitals to the emergence of multidrug-resistant bacteria and to the requirement for the revision of surgical protocols with regard to antimicrobial prophylaxis and therapy.(AU)

As infecções em sítio cirúrgico (ISCs) e a resistência bacteriana entre os patógenos relacionados constituem uma preocupação crescente nos hospitais veterinários. O aumento na incidência de ISCs possui forte relação com o uso amplo e disseminado de antibióticos. O presente estudo identificou bactérias e perfis de resistência a antibióticos nos casos de ISCs diagnosticados na Clínica Cirúrgica de Pequenos Animais do Hospital Veterinário da Universidade Federal de Viçosa, Brasil. O principal gênero identificado foi Staphylococcus, seguido pelos gêneros Escherichia, Enterococcus, Bacillus, Shigella, Citrobacter, Proteus, Morganella, Serratia, Enterobacter, Pseudomonas e Klebsiella, porém, em menor quantidade. Os resultados demonstraram a predominância de bactérias Gram-negativas entre as amostras coletadas. A maioria dos isolados identificados eram resistentes a um ou a mais de um dos seguintes antibióticos: ampicilina, tetraciclina, enrofloxacina, amoxicilina/ácido clavulânico e cefalotina. Entre os 17 isolados de Staphylococcus sp., dois (11,8%) eram Staphylococcus aureus resistentes à meticilina (SARM) e 11 (64,7%) eram Staphylococcus pseudintermedius resistentes à meticilina (SPRM). Houve identificação de gêneros bacterianos com diferentes proporções de resistência para todos os antibióticos avaliados. Esses achados devem alertar os hospitais veterinários para a emergência de bactérias multirresistentes e para a necessidade de revisar a profilaxia e a terapia antimicrobiana referente aos protocolos cirúrgicos.(AU)

Emergence of multidrug-resistant bacteria isolated from surgical site infection in dogs and cats / [Emergência de bactérias multirresistentes isoladas da infecção no sítio cirúrgico em cães e gatos]

Surgical site infections (SSIs) and antimicrobial resistance among pathogens causing SSI are a growing concern in veterinary hospitals. One major reason, the widespread use of antimicrobials, has led to increased incidence of SSIs. This study identified bacteria and resistance profiles to antimicrobials in the SSI cases diagnosed at the Surgical Clinic of Small Animals in the Veterinary Hospital, Federal University of Viçosa, Brazil. The main genus identified was Staphylococcus, followed by Escherichia, Enterococcus, Bacillus, Shigella, Citrobacter, Proteus, Morganella, Serratia, Enterobacter, Pseudomonas and Klebsiella were also found, but in small number. The results indicated the predominance of Gram-negative bacteria among the collected samples. Most of isolates identified were resistant to more than one of the following antimicrobials: ampicillin, tetracycline, enrofloxacin, amoxicillin/clavulanic acid and cephalotin. Of the 17 Staphylococcus sp. isolates, two (11.8%) were methicillin-resistant Staphylococcus aureus (MRSA) and 11 (64.7%) of them were methicillin-resistant Staphylococcus pseudintermedius (MRSP). There were bacterial genera identified with resistance to all tested antimicrobials in different proportions. This should alert veterinary hospitals to the emergence of multidrug-resistant bacteria and to the requirement for the revision of surgical protocols with regard to antimicrobial prophylaxis and therapy.(AU)

As infecções em sítio cirúrgico (ISCs) e a resistência bacteriana entre os patógenos relacionados constituem uma preocupação crescente nos hospitais veterinários. O aumento na incidência de ISCs possui forte relação com o uso amplo e disseminado de antibióticos. O presente estudo identificou bactérias e perfis de resistência a antibióticos nos casos de ISCs diagnosticados na Clínica Cirúrgica de Pequenos Animais do Hospital Veterinário da Universidade Federal de Viçosa, Brasil. O principal gênero identificado foi Staphylococcus, seguido pelos gêneros Escherichia, Enterococcus, Bacillus, Shigella, Citrobacter, Proteus, Morganella, Serratia, Enterobacter, Pseudomonas e Klebsiella, porém, em menor quantidade. Os resultados demonstraram a predominância de bactérias Gram-negativas entre as amostras coletadas. A maioria dos isolados identificados eram resistentes a um ou a mais de um dos seguintes antibióticos: ampicilina, tetraciclina, enrofloxacina, amoxicilina/ácido clavulânico e cefalotina. Entre os 17 isolados de Staphylococcus sp., dois (11,8%) eram Staphylococcus aureus resistentes à meticilina (SARM) e 11 (64,7%) eram Staphylococcus pseudintermedius resistentes à meticilina (SPRM). Houve identificação de gêneros bacterianos com diferentes proporções de resistência para todos os antibióticos avaliados. Esses achados devem alertar os hospitais veterinários para a emergência de bactérias multirresistentes e para a necessidade de revisar a profilaxia e a terapia antimicrobiana referente aos protocolos cirúrgicos.(AU)

Changes in antimicrobial susceptibility of commonly clinically significant isolates before and after the interventions on surgical prophylactic antibiotics (SPAs) in Shanghai

Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.(AU)

CONTAMINAÇÃO POR ENTEROBACTÉRIAS RESISTENTES A ANTIMICROBIANOS ISOLADAS EM CELULARES E MÃOS EM HOSPITAL VETERINÁRIO

As infecções nosocomiais representam sério problema de saúde pública, levando ao aumento da mortalidade e morbidade dos pacientes afetados. Os telefones celulares são alvo de investigações sobre sua importância na disseminação de patógenos, devido ao seu uso descontrolado e presença em todos os ambientes do dia a dia, incluindo hospitais veterinários. Nesse sentido, o objetivo deste trabalho é avaliar a presença de Escherichia coli (E. coli), Proteus mirabilis (P. mirabilis) e Klebsiella pneumoniae (K. pneumoniae), importantes bactérias associadas à infecção hospitalar, em telefones celulares da equipe cirúrgica de pequenos animais do Hospital Veterinário da Universidade Estadual Paulista Câmpus Jaboticabal. Para isso, foram coletadas amostras de telefones celulares dos cirurgiões, auxiliares, enfermeiros e anestesistas e dos responsáveis pelos pacientes, bem como também de suas mãos, mesa cirúrgica e do paciente. As bactérias foram isoladas e identificadas através do teste de reação em cadeia de polimerase (PCR), a diversidade genética por Eletroforese em gel de Campo Pulsado (PFGE) e a suscetibilidade à antimicrobianos através de antibiograma. Adicionalmente, os pacientes foram acompanhados por 4 semanas quanto à sinais de infecção nosocomial na ferida operatória. Oito amostras foram positivas para E. coli e Proteus mirabilis, provenientes da mão do anestesista, mão do tutor, mão do cirurgião, celular do cirurgião, celular do enfermeiro, celular do anestesista e duas mesas cirúrgicas. O teste de sensibilidade antimicrobiana demonstrou que todos os isolados eram resistentes à múltiplos antimicrobianos. A eletroforese de campo pulsado demonstrou alta diversidade genética entre os isolados. A identificação de E.coli e Proteus mirabilis multirresistentes em aparelhos celulares da equipe cirúrgica representa grande preocupação e, apesar de não diretamente correlacionado, o isolamento dessas bactérias no interior da área limpa do centro cirúrgico evidenciou a possibilidade de transmissão nosocomial a partir dos aparelhos celulares à pacientes susceptíveis.

Nosocomial infections represent a serious public health problem, leading to increased mortality and morbidity for affected patients. Cell phones are the target of investigations about their importance in the spread of pathogens, due to their uncontrolled use and presence in all day-to-day environments, including veterinary hospitals. In this sense, the objective of this work is to evaluate the presence of Escherichia coli (E.coli), Proteus mirabilis (P. mirabilis) and Klebsiella pneumoniae (K. pneumoniae), important bacteria associated with hospital infection, on cell phones of the small animal surgical team at the Veterinary Hospital of Paulista State University - Campus Jaboticabal. For this, samples of cell phones were collected from surgeons, assistants, nurses and anesthetists and those responsible for patients, as well as from their hands, operating table and the patient. The bacteria were isolated and identified through the polymerase chain reaction (PCR) test, genetic diversity by Pulsed Field Gel Electrophoresis (PFGE) and susceptibility to antimicrobials through antibiogram. Additionally, the patients were followed up for 4 weeks for signs of nosocomial infection in the surgical wound. Eight samples were positive for E. coli and Proteus mirabilis, from the hand of the anesthetist, hand of the tutor, hand of the surgeon, cell of the surgeon, cell of the nurse, cell of the anesthetist and two surgical tables. The antimicrobial susceptibility test demonstrated that all isolates were resistant to multiple antimicrobials. Pulsed field electrophoresis demonstrated high genetic diversity among the isolates. The identification of multi- resistant E.coli and Proteus mirabilis in cell phones of the surgical team is of great concern and, although not directly correlated, the isolation of these bacteria within the clean area of the operating room has evidenced the possibility of nosocomial transmission from cell phones susceptible patients.

ISOLAMENTO E IDENTIFICAÇÃO DE BACTÉRIAS DA INTERNAÇÃO DE HOSPITAL VETERINÁRIO DA CAPITAL DE SÃO PAULO

A infecção hospitalar é um tema em grande destaque na medicina humana, porém com pouca abordagem na medicina veterinária. As diretrizes para a caracterização da mesma são bem descritas e padronizadas. A presença de uma Comissão de Controle de Infecção Hospitalar e de Programas de Controle de Infecção Hospitalar faz com que exista uma padronização de métodos de desinfecção e ocorra o uso racional de antibiótico durante o período de internação. O surgimento constante de bactérias multirresistentes no âmbito hospitalar veterinário tem se tornado cada vez mais frequente, o que também gera um alerta em saúde única como um potencial zoonótico. O objetivo deste trabalho foi realizar a busca ativa para o isolamento e identificação das bactérias presentes nas baias, fechaduras e carrinho de manipulação de fármacos da internação do Hospital Veterinário Pompeia. Foram selecionadas quarenta e seis amostras coletadas da estrutura da internação com suabe estéril umedecido em solução NaCl 0,9%. A identificação das colônias foi realizada por meio da técnica de MALDI-TOF MS. Foram submetidas 114 isolados para identificação do MALDI- TOF. Desta amostragem foram classificadas como bactérias um total de 66. Foi identificado 80,3% (53/ 66) destas amostras restando 19,7% (13/ 66) a serem identificadas. Houve o isolamento e a identificação de várias estirpes de bactérias o que indica a importância do conhecimento da microbiota ambiental para melhor implementação de protocolos a base de antimicrobianos e que é imperativo o desenvolvimento assertivo de um manual de procedimento operacional padrão para os diversos setores que existem dentro da estrutura hospitalar.

Nosocomial infection is a major topic in human medicine, but with little approach in veterinary medicine. The guidelines for its characterization are well described and standardized. The presence of a Hospital Infection Control Committee and Hospital Infection Control Programs causes a standardization of disinfection methods and the rational use of antibiotics during hospitalization. The constant emergence of multidrug resistant bacteria in the veterinary hospital environment has become increasingly frequent, which also generates a single health alert as a zoonotic potential. The objective is to perform active search for the isolation and identification of the bacteria present in the stalls, locks and drug handling trolley from the Pompeia Veterinary Hospital. Forty-six samples collected from the hospitalization structure were selected with sterile swab moistened in 0.9% NaCl solution. The colonies were identified using the MALDI-TOF MS technique. 114 isolates were submitted for identification of MALDI-TOF. From this sampling, a total of 66 were classified as bacteria. 80.3% (53/66) of these samples were identified, remaining 19.7% (13/66) to be identified. Isolation and identification of various bacterial strains has been indicated which indicates the importance of knowledge of the environmental microbiota for better implementation of antimicrobial protocols and that it is imperative to assertively develop a standard operating procedure manual for the various sectors that exist within the hospital structure.

Posttraumatic bacterial infections in extremities before and after osteosynthesis in dogs

Background: Posttraumatic osteomyelitis is one of the most serious complications after fracture treatment. Although haematogenous osteomyelitis is fairly common in man, it is rarely seen in small animal orthopedic surgery. Predisposing factors to osteomyelitis include bacterial contamination in combination with severe trauma, surgical intervention, the presence of dead bone, or metallic implants, especially if bone or implants are unstable. Posttraumatic osteomyelitis is nearly always infectious in etiology, caused by various pathogens. The purpose of this present study is to find out the type of aerobic bacteria, which plays an important role in the posttraumatic infection before and after fracture osteosynthesis. Materials, Methods & Results: Our study was performed on 15 patients with long bone fractures operated at the Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without an antibiotic treatment 24 h prior to surgery were included in the study. Our study was performed on 15 patients who had undergone osteosynthesis in extremities at Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without antimicrobial treatment 24 h before surgery were included in our study. The osteosynthesis procedures were performed by two experienced orthopaedists. Theywere returned to our clinic at 4-8 weeks after operation for follow-up orthopaedic and radiographic examinations. The next follow-ups were carried out at 4-6-week intervals, if needed. The implants for internal fracture were removed after clinical and radiological bone healing. All criteria were analyzed by using χ2 test and Fischer's exact test with P < 0.05 and P < 0.01 to evaluate the incidence bone infection in each group of patients. A high percentage of the bacterial isolates was coagulase-negative staphylococci resistent to cephalosporins. the highest sensitivity of all isolates (coagulase-negative Stapylococcus, Staphylococcus aureus, Bacillus spp., Corynebacterium spp., Serratia liquefaciens, Alcaligenes faecalis and Escherichia coli) was observed to ceftriaxone (100 %), as well as to danofloxacin (80.9%) and amoxicillin/clavulanic acid (57.1%). The highest resistant isolates was determined against to penicillin (66.6%) and ampicillin/sulbactam (57.1%). Although we use cephalosporins prophylactically in all patients undergoing orthopaedic surgery in our clinic, the incidence of postoperative infections was very low. Discussion: As the surgical site infection etiology is multi-factorial, the sterilization, preoperative patient preparation and operating theatre environments must be considered as the main sources of this bacterial contamination. Antiseptics used in our practice were theoretically supposed to be effective. Since povidone-iodine and chlorhexidine have a broad spectrum of antimicrobial activity against vegetative bacteria, fungi, viruses, protozoa, and yeasts, they are suitable for removing bacteria from the skin surface at preoperative surgical site. Additionally, povidone-iodine surgical scrub is also used extensively in veterinary practice for the pre-operative preparation of patients and surgeons. Therefore, it is obvious that the use of cephalosporins as preoperative prophylaxis is sufficient in most cases. In the patients at high risk of osteomyelitis development (polytraumatized or immunosuppressed patients, patients receiving prosthetic joint or large metallic implants), or in the patients where the infection is already present, it is important to know hospital-specific pathogens to select adequate complementary antibiotics (in this case we use cephalosporines together with quinolones such as danofloxacin). This emphasizes the need of epidemiologic studies, specific for each clinic.

Posttraumatic bacterial infections in extremities before and after osteosynthesis in dog / Posttraumatic bacterial infections in extremities before and after osteosynthesis in dogs

Background: Posttraumatic osteomyelitis is one of the most serious complications after fracture treatment. Although haematogenous osteomyelitis is fairly common in man, it is rarely seen in small animal orthopedic surgery. Predisposing factors to osteomyelitis include bacterial contamination in combination with severe trauma, surgical intervention, the presence of dead bone, or metallic implants, especially if bone or implants are unstable. Posttraumatic osteomyelitis is nearly always infectious in etiology, caused by various pathogens. The purpose of this present study is to find out the type of aerobic bacteria, which plays an important role in the posttraumatic infection before and after fracture osteosynthesis.Materials, Methods & Results: Our study was performed on 15 patients with long bone fractures operated at the Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without an antibiotic treatment 24 h prior to surgery were included in the study. Our study was performed on 15 patients who had undergone osteosynthesis in extremities at Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without antimicrobial treatment 24 h before surgery were included in our study. The osteosynthesis procedures were performed by two experienced orthopaedists. Theywere returned to our clinic at 4-8 week

Background: Posttraumatic osteomyelitis is one of the most serious complications after fracture treatment. Although haematogenous osteomyelitis is fairly common in man, it is rarely seen in small animal orthopedic surgery. Predisposing factors to osteomyelitis include bacterial contamination in combination with severe trauma, surgical intervention, the presence of dead bone, or metallic implants, especially if bone or implants are unstable. Posttraumatic osteomyelitis is nearly always infectious in etiology, caused by various pathogens. The purpose of this present study is to find out the type of aerobic bacteria, which plays an important role in the posttraumatic infection before and after fracture osteosynthesis.Materials, Methods & Results: Our study was performed on 15 patients with long bone fractures operated at the Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without an antibiotic treatment 24 h prior to surgery were included in the study. Our study was performed on 15 patients who had undergone osteosynthesis in extremities at Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without antimicrobial treatment 24 h before surgery were included in our study. The osteosynthesis procedures were performed by two experienced orthopaedists. Theywere returned to our clinic at 4-8 week

Farnesol in combination with N-acetylcysteine against Staphylococcus epidermidis planktonic and biofilm cells

Staphylococcus epidermidis is the most frequent cause of nosocomial sepsis and catheter-related infections, in which biofilm formation is considered to be the main virulence mechanism. In biofilm environment, microbes exhibit enhanced resistance to antimicrobial agents. This fact boosted the search of possible alternatives to antibiotics. Farnesol and N-acetylcysteine (NAC) are non-antibiotic drugs that have demonstrated antibacterial properties. In this study, the effect of farnesol and NAC isolated or in combination (farnesol+NAC) was evaluated. NAC at 10 × MIC caused a total cell death in planktonic cells. On the other hand, S. epidermidis biofilms exhibited 4 log reduction in viable cell number after a 24h treatment with NAC at the former concentration. Our results demonstrated that there was a higher CFU log reduction of S. epidermidis planktonic cells when farnesol was combined with NAC at 1 × MIC relatively to each agent alone. However, these results were not relevant because NAC alone at 10 × MIC was always the condition which gave the best results, having a very high killing effect on planktonic cells and a significant bactericidal effect on biofilm cells. This study demonstrated that no synergy was observed between farnesol and NAC. However, the pronounced antibacterial effect of NAC against S. epidermidis, on both lifestyles, indicates the use of NAC as a potential therapeutic agent in alternative to antibiotics.

Prevalence, aetiology and antibiotic resistance profiles of coagulase negative staphylococci isolated in a teaching hospital

In this paper we carried out a study about prevalence of the clinically significant coagulase negative staphylococcal (CNS) isolates found in an university hospital. Two hundred four CNS isolates from 191 patients obtained between the period of 1998 to 2002, were studied. About 27% (52/191) of the infection cases studied were confirmed as CNS-associated diseases. Blood stream infection (BSI) was the most frequent CNS associated-disease (25%; 13/52). The great majority of the BSI was verified in the Neonatal Intensive Care Unit (NICU). The analysis of the 52 patients medical history showed that 85% of the BSI was acquired in hospital. Most of the CNS nosocomial infections were associated with the use of indwelling medical devices. The incidence of methicillin-resistance among significant CNS isolates was 38%. In this study, a high percentage of exogenous contaminant was verified (60%), indicating that contamination of clinical specimens during sample collection is critical.

Extended-spectrum beta-lactamase-producing bacteria isolated from hematologic patients in Manaus, State of Amazonas, Brazil

Antibiotic therapy in hematologic patients, often weak and susceptible to a wide range of infections, particularly nosocomial infections derived from long hospitalization periods, is a challenging issue. This paper presents ESBL-producing strains isolated from such hematologic patients treated at the Amazon Hematology and Hemotherapy Foundation (HEMOAM) in the Brazilian Amazon Region to identify the ESBL genes carried by them as well as the susceptibility to 11 antimicrobial agents using the E-test method. A total of 146 clinical samples were obtained from July 2007 to August 2008, when 17 gram-negative strains were isolated in our institution. The most frequent isolates confirmed by biochemical tests and 16S rRNA sequencing were E. coli (8/17), Serratia spp. (3/17) and B.cepacia (2/17). All gram-negative strains were tested for extended-spectrum-beta-lactamases (ESBLs), where: (12/17) strains carried ESBL; among these, (8/12) isolates carried blaTEM, blaCTX-M, blaOXA, blaSHV genes, (1/12) blaTEM gene and (3/12) blaTEM, blaCTX-M, blaOXA genes. Antibiotic resistance was found in (15/17) of the isolates for tetracycline, (12/17) for ciprofloxacin, (1/17) resistance for cefoxitin and chloramphenicol, (1/17) for amikacin and (3/17) cefepime. This research showed the presence of gram-negative ESBL-producing bacteria infecting hematologic patients in HEMOAM. These strains carried the blaTEM, blaSHV, blaCTX-M and blaOXA genes and were resistant to different antibiotics used in the treatment. This finding was based on a period of 13 months, during which clinical samples from specific populations were obtained. Therefore, caution is required when generalizing the results that must be based on posological orientations and new breakpoints for disk diffusion and microdilution published by CLSI 2010.

Associação entre formigas (Hymenoptera: Formicidae) e bactérias patogênicas em cinco hospitais do município de Pelotas, RS / Association between ants (Hymenoptera: Formicidae) and pathogenic bacteria in five hospitals in the city of Pelotas, state of Rio Grande do Sul, Brazil

O presente estudo teve por objetivo verificar a ocorrência de formigas em cinco hospitais do Município de Pelotas, analisar sua sazonalidade e identificar bactérias patogênicas a elas associadas. Para tal, foram utilizadas duas iscas, uma contendo mel, açúcar e minhoca da espécie Eisenia foetida, e outra contendo sardinha da marca Coqueiro®. Ambas foram fixadas próximas aos rodapés de 19 a 21 setores de cada hospital (99 setores no total), e retiradas após 24h. O trabalho foi realizado durante as quatro estações de 2008 e 2009, totalizando 792 pontos amostrais. Foram encontradas sete espécies de formigas, distribuídas em 13 setores dentre os 99 amostrados (13,1%). O verão foi a estação onde a maior porcentagem de amostras foi coletada, 57,6%, sendo o menor número no inverno, 9,1%. Foram coletadas assepticamente formigas de 28 pontos amostrais, sendo que 25 (89,3%) apresentaram a ocorrência de bactérias patogênicas. As Enterobactérias estiveram presentes em 17 amostras, seguidas por Staphylococcus epidermidis e Staphylococcus saprophyticus em 13 e 9 amostras, respectivamente. Além disso, formigas de 20 pontos amostrais apresentaram mais de uma espécie bacteriana, com um máximo de cinco. Concluiu-se que as formigas são importantes carreadoras de bactérias patogênicas nos hospitais do município, e devem ser controladas a fim de se evitar maior ocorrência de infecções nosocomiais. Deve ser dada atenção ao controle na área externa dos hospitais, onde ocorre a nidificação da maioria dos espécimes coletados.

The aim of the present study was to verify the occurrence of ants in 5 hospitals in the city of Pelotas, analyzing their seasonality and identifying associated pathogenic bacteria. For this, 2 baits were used, one containing honey, sugar and the earthworm Eisenia foetida. and another containing Coqueiro® brand sardines. Both baits were fixed close to the floor skirtings in 19 to 21 sectors in each hospital (99 sectors in total), and collected after 24h. The study was developed over the seasons of 2008 and 2009, for a total of 792 sampling points. A total of 7 ant species were found, distributed among 13 of the 99 sectors sampled (13.1%). Summer was the season with the highest percentage of specimens gathered, 57.6%, with the lowest number in the winter, 9.1%. A total of 28 ant samples were aseptically collected, from which 25 (89.3%) showed the occurrence of pathogenic bacteria. Enterobacteriaceae were found on 17 ant samples, followed by Staphylococcus epidermidis and Staphylococcus saprophyticus in 13 and 9 samples, respectively. Furthermore, ants from 20 sampling points showed the occurrence of more than one bacteria species, the maximum being 5. It was concluded that the ants are important carriers of pathogenic bacteria in hospitals, and must be controlled in order to avoid a higher occurrence of nosocomial infections. Moreover, attention must be given to the ant management in the external areas of the hospitals, where the colonies of most of the specimens collected are located.

ASSOCIAÇÃO ENTRE FORMIGAS (HYMENOPTERA:FORMICIDAE) E BACTÉRIAS PATOGÊNICAS EM CINCO HOSPITAIS DO MUNICÍPIO DE PELOTAS, RS

ABSTRACT The aim of the present study was to verify the occurrence of ants in 5 hospitals in the city of Pelotas, analyzing their seasonality and identifying associated pathogenic bacteria. For this, 2 baits were used, one containing honey, sugar and the earthworm Eisenia foetida. and another containing Coqueiro® brand sardines. Both baits were fixed close to the floor skirtings in 19 to 21 sectors in each hospital (99 sectors in total), and collected after 24h. The study was developed over the seasons of 2008 and 2009, for a total of 792 sampling points. A total of 7 ant species were found, distributed among 13 of the 99 sectors sampled (13.1%). Summer was the season with the highest percentage of specimens gathered, 57.6%, with the lowest number in the winter, 9.1%. A total of 28 ant samples were aseptically collected, from which 25 (89.3%) showed the occurrence of pathogenic bacteria. Enterobacteriaceae were found on 17 ant samples, followed by Staphylococcus epidermidis and Staphylococcus saprophyticus in 13 and 9 samples, respectively. Furthermore, ants from 20 sampling points showed the occurrence of more than one bacteria species, the maximum being 5. It was concluded that the ants are important carriers of pathogenic bacteria in hospitals, and must be controlled in order to avoid a higher occurrence of nosocomial infections. Moreover, attention must be given to the ant management in the external areas of the hospitals, where the colonies of most of the specimens collected are located.

RESUMO O presente estudo teve por objetivo verificar a ocorrência de formigas em cinco hospitais do Município de Pelotas, analisar sua sazonalidade e identificar bactérias patogênicas a elas associadas. Para tal, foram utilizadas duas iscas, uma contendo mel, açúcar e minhoca da espécie Eisenia foetida, e outra contendo sardinha da marca Coqueiro®. Ambas foram fixadas próximas aos rodapés de 19 a 21 setores de cada hospital (99 setores no total), e retiradas após 24h. O trabalho foi realizado durante as quatro estações de 2008 e 2009, totalizando 792 pontos amostrais. Foram encontradas sete espécies de formigas, distribuídas em 13 setores dentre os 99 amostrados (13,1%). O verão foi a estação onde a maior porcentagem de amostras foi coletada, 57,6%, sendo o menor número no inverno, 9,1%. Foram coletadas assepticamente formigas de 28 pontos amostrais, sendo que 25 (89,3%) apresentaram a ocorrência de bactérias patogênicas. As Enterobactérias estiveram presentes em 17 amostras, seguidas por Staphylococcus epidermidis e Staphylococcus saprophyticus em 13 e 9 amostras, respectivamente. Além disso, formigas de 20 pontos amostrais apresentaram mais de uma espécie bacteriana, com um máximo de cinco. Concluiu-se que as formigas são importantes carreadoras de bactérias patogênicas nos hospitais do município, e devem ser controladas a fim de se evitar maior ocorrência de infecções nosocomiais. Deve ser dada atenção ao controle na área externa dos hospitais, onde ocorre a nidificação da maioria dos espécimes coletados.

AVALIAÇÃO MICROBIOLÓGICA DA PRÉ-ESTERILIZAÇÃO DE INSTRUMENTAL CIRÚRGICO NO HOSPITAL VETERINÁRIO DA UNIVERSIDADE FEDERAL DA PARAÍBA.

O risco de infecção hospitalar, assim como o processo de infecção propriamente dito, ocorre por uma série de diferentes fatores inerentes ao ambiente e ao público alvo. A partir do momento em que um paciente é submetido a uma intervenção cirúrgica, sua integridade física é comprometida e suas barreiras de proteção naturais são lesadas. Aprimorar os métodos de desinfecção e esterilização é, consequentemente, reduzir o índice de infecção. Assim, faz-se necessário lançar mão de técnicas eficazes para combater as possíveis infecções por agentes nosocomiais. O primeiro objetivo do trabalho foi identificar os agentes microbianos existentes nos 20 instrumentais cirúrgicos (utilizados em cavidades abdominais), separados em 4 grupos de 5 artigos, após pré-esterilização com álcool 70%, Clorexidina Degermante 2% e detergentes enzimáticos ácido e alcalino. Foram encontrados apenas isolados Gram Positivas nos 20 instrumentais cirúrgicos investigados. Quatro amostras apresentaram crescimento de dois isolados distintos e três instrumentais não apresentaram crescimento bacteriano após o processo de desinfecção. Foram identificados bactérias dos gêneros Staphylococcus spp., Streptococcus spp. e bacilos Gram Positivos. A análise dos métodos de pré-esterilização demonstrou que a Clorexidina foi a mais eficiente, eliminando a presença de microrganismos em três dos cinco instrumentais submetidos ao uso, eliminando todos os Staphylococcus spp. O Álcool 70% eliminou os Staphylococcus sp., porém não os Bacilos. O Grupo dos Enzimáticos demonstrou presença de agentes microbiológicos, apontando uma contaminação prévia que o tratamento químico não foi capaz de aniquilar, mostrando-se o mais ineficaz dos agentes químicos eleitos para a pesquisa.

The risk of nosocomial infection, and the infection process itself, occurs for a number of different factors inherent to the environment and the target audience. From the moment a patient undergoes on surgery, their physical integrity is compromised and the natural protective barrier is damaged. Improve desinfection and sterilization methods is therefore to reduce the infection rate. Thus, it is necessary to use effective techniques to combat the possible nosocomial infections agents. The main objective of this research was to identify the microbial agents on surgical instruments after a pre-sterilization (disinfection) with 70% alcohol, Chlorhexidine 2% Scrub, and Enzymatic Detergents Acid and Alkaline. Twenty investigated surgical instruments were found Gram Positive strains. Some samples showed growth of two different strains, and three instruments showed no bacterial growth after the disinfection process. Staphylococcus sp. aureus, Streptococcus spp. and a large number of Gram Positive bacilli were not found. Chlorhexidine 2% Scrub was the most efficient by eliminating the presence of microorganisms in three of the five instrumental submitted to the process specially by eliminating all S. aureus. 70% Alcohol eliminated Staphylococcus spp. but not the Gram Positive Bacillus. The Group of Enzymatic showed the presence of the same microbiological agents of the Control Group indicating a previous infection that chemical treatment was not able to annihilate, being the most incompetent method.

Carbapenem-resistant Acinetobacter baumannii outbreak at university hospital

Nineteen clonally related imipenem-resistant Acinetobacter baumannii isolates were recovered from eight intensive care unit patients. All isolates harboured blaOXA-51-like -lactamase genes and showed the absence of 22 kDa fraction in outer membrane porin profile analysis. It suggests a combination of two mechanisms as responsible for carbapenemresistant phenotypes.

Foram isoladas 19 cepas monoclonais de 8 pacientes da unidade de terapia intensiva, resistentes aos carbapenêmicos. Todas as cepas apresentaram o gene blaOXA-51-like e por análise do perfil de proteínas de membrana notou-se ausência da fração de 22 kDa, sugerindo a combinação de dois mecanismos de resistência aos carbapenêmicos.

Epidemiologically relevant antimicrobial resistance phenotypes in pathogens isolated from critically ill patients in a Brazilian Universitary Hospital

Antimicrobial resistance is a threat to public health worldwide and is associated with higher mortality and morbidity. Despite the extensive knowledge about this problem, drug resistance has continued to emerge, especially in intensive care units (ICUs). The objective of this study was to evaluate the frequencies of epidemiologically relevant resistance phenotypes in pathogens isolated from ventilator-associated pneumonia (VAP), bloodstream infections (BSI) and urinary tract infections (UTI) in patients admitted in the adult intensive care unit (AICU) of the Clinical Hospital of Federal University of Uberlândia, during an one year period. Additionally, at the period of the study, the antibiotic consumption in AICU was verified. Coagulase-negative staphylococci and S. aureus were the main agents of BSI (43.9%), with 60.0% of oxacilin-resistance for both microorganisms, Klebsiella-Enterobacter group predominated in UTI (23.4%), with resistance to third generation cephalosporins in 58.0% of the isolates; and, Pseudomonas aeruginosa in VAP (42.0%), with 72.0% of resistance to imipenem. Cephalosporins (49.6%), vancomycin (37.4%) and carbapenems (26.6%) were the most prescribed antibiotics in the unit. The comparison of the results with a publication of the NNIS program evidenced a worse situation in the studied hospital, mainly between Gram-negative, that had surpassed the percentile 90% elaborated by that system. Based on these results a reconsideration on the empirical use of antibiotics and on prevention and control of nosocomial infections practices is recommended.

A resistência aos antimicrobianos é uma ameaça a saúde pública mundial e está associada a uma maior mortalidade e morbidade. Apesar dos vastos conhecimentos sobre este problema, a resistência aos antibióticos continua a emergir, especialmente em unidades de terapia intensiva (UTI). O objetivo deste estudo foi avaliar a freqüência de fenótipos de resistência epidemiologicamente importantes em patógenos isolados de pneumonia associada à ventilação mecânica (PAV), infecções de corrente sangüínea (ICS) e de infecções de trato urinário (UTI) nos pacientes atendidos na unidade de terapia intensiva de adultos (UTIA) do Hospital de Clínicas da Universidade Federal de Uberlândia, durante o período de um ano. Adicionalmente, no período do estudo, foi analisado o consumo de antibióticos na UTIA. Staphylococcus spp coagulase negativo e S. aureus foram os principais agentes de ICS (43,9%), com 60,0% de resistência à oxacilina em ambos os microrganismos. O grupo Klebsiella-Enterobacter predominou nas ITU (23,4%), com resistência às cefalosporinas de terceira geração em 58,0% dos isolados; e, Pseudomonas aeruginosa nas PAV (42,0%), com 72,0% de resistência ao imipenem. As cefalosporinas (49,6%), vancomicina (37,4%) e os carbapenêmicos (26,6%) foram os antibióticos mais prescritos na unidade. A comparação dos resultados com publicações do programa NNIS evidenciou uma pior situação no hospital estudado, especialmente entre os Gram-negativos, que ultrapassaram o percentil 90% elaborado por este programa. De acordo com os resultados apresentados neste estudo, uma revisão do uso empírico de antibióticos e da prevenção e controle de infecções hospitalares é recomendada.

An outbreak of Streptococcus dysgalactiae subsp equisimilis in a hospital in the south of Brazil

The beta-hemolytic group C streptococci (Lancefield's group) has been considered an emergent human pathogen, showing an important role as an opportunist agent, being responsible for nosocomial infections and outbreaks. This study is reporting the first outbreak of nosocomial infection caused by Streptococcus dysgalactiae subsp. equisimilis in Brazil. From January, 2002, to December, 2004, S. equisimilis was isolated in 67/207 (32.37%) samples from secretions of patients' infected wounds, interned at the Hospital of Sanitary Dermatology in the State of Paraná (HDSPR). The prevalence of this microorganism increased from 11/42 (26.19%) in 2002, 14/65 (21.54%) in 2003 to 42/100 (42.00%) in 2004. This increase was statistically significant (p=0.024), and this microorganism became the most frequently isolated in these patients, overtaking the rates of isolation of Pseudomonas aeruginosa. The S. equisimilis grew in pure culture, as a unique microorganism, in six samples (2.9%) out of 207. Fresh feces of 15 animals (horses and sheep) living in the proximities of the hospital were also examined and three of them positive for S. equisimilis. The biochemical profile of the strains isolated from the patients and from the animals was the same. These animals might have been the source of the dissemination of the outbreak in the hospital. New studies will be necessary to confirm the genetic relationship between the strains isolated from patients and animals.

O estreptococo beta-hemolítico do grupo C de Lancefield tem sido considerado patógeno humano emergente, mostrando importante papel como agente oportunista, implicado algumas vezes em infecções hospitalares e surtos. Este estudo está relatando o primeiro surto de infecção hospitalar causado pelos Streptococcus dysgalactiae subsp. equisimilis no Brasil. De janeiro de 2002 a dezembro de 2004, isolou-se S. equisimilis em 67/207 (32,37%) das amostras de secreções de lesões de feridas coletadas de pacientes internados no Hospital de Dermatologia Sanitária do Paraná (HDSPR). A prevalência deste microrganismo aumentou de 11/42 (26,19%) em 2002, 14/65 (21,54%) em 2003 para 42/100 (42,00%) em 2004. Este aumento foi estatisticamente significante (p=0.024), tornando este microrganismo o mais freqüentemente isolado nos pacientes, ultrapassando as taxas de isolamento de Pseudomonas aeruginosa. Em seis amostras (2,9%) entre as 207 examinadas, S. equisimilis cresceu em cultivo puro, como único microrganismo. Também foram examinadas fezes frescas de 15 animais (cavalos e ovelhas) que vivem nas proximidades do hospital, e três amostras foram positivas para S. equisimilis. O perfil bioquímico encontrado entre os isolados dos pacientes foi o mesmo encontrado entre os isolados das fezes dos animais. Acredita-se que estes animais possam ter sido a fonte de disseminação do surto no hospital. Novos estudos serão necessários para confirmar o relacionamento genético entre os isolados dos pacientes e animais.

Posttraumatic bacterial infections in extremities before and after osteosynthesis in dog / Posttraumatic bacterial infections in extremities before and after osteosynthesis in dogs

Background: Posttraumatic osteomyelitis is one of the most serious complications after fracture treatment. Although haematogenous osteomyelitis is fairly common in man, it is rarely seen in small animal orthopedic surgery. Predisposing factors to osteomyelitis include bacterial contamination in combination with severe trauma, surgical intervention, the presence of dead bone, or metallic implants, especially if bone or implants are unstable. Posttraumatic osteomyelitis is nearly always infectious in etiology, caused by various pathogens. The purpose of this present study is to find out the type of aerobic bacteria, which plays an important role in the posttraumatic infection before and after fracture osteosynthesis.Materials, Methods & Results: Our study was performed on 15 patients with long bone fractures operated at the Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without an antibiotic treatment 24 h prior to surgery were included in the study. Our study was performed on 15 patients who had undergone osteosynthesis in extremities at Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without antimicrobial treatment 24 h before surgery were included in our study. The osteosynthesis procedures were performed by two experienced orthopaedists. Theywere returned to our clinic at 4-8 week

Background: Posttraumatic osteomyelitis is one of the most serious complications after fracture treatment. Although haematogenous osteomyelitis is fairly common in man, it is rarely seen in small animal orthopedic surgery. Predisposing factors to osteomyelitis include bacterial contamination in combination with severe trauma, surgical intervention, the presence of dead bone, or metallic implants, especially if bone or implants are unstable. Posttraumatic osteomyelitis is nearly always infectious in etiology, caused by various pathogens. The purpose of this present study is to find out the type of aerobic bacteria, which plays an important role in the posttraumatic infection before and after fracture osteosynthesis.Materials, Methods & Results: Our study was performed on 15 patients with long bone fractures operated at the Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without an antibiotic treatment 24 h prior to surgery were included in the study. Our study was performed on 15 patients who had undergone osteosynthesis in extremities at Department of Surgery, Small Animal Clinic, University of Adnan Menderes, Aydin. The patients without antimicrobial treatment 24 h before surgery were included in our study. The osteosynthesis procedures were performed by two experienced orthopaedists. Theywere returned to our clinic at 4-8 week

Prevalence and bacterial susceptibility of hospital acquired urinary tract infection

PURPOSE: Urinary tract infection is the most common nosocomially acquired infection. It is important to know the etiology and antibiotic susceptibility infectious agents to guide the initial empirical treatment. OBJECTIVE: To determine the prevalence of bacterial strains and their antibiotic susceptibility in nosocomially acquired urinary tract infection in a university hospital between January and June 2003. METHODS: We analyzed the data of 188 patients with positive urine culture (= 10(5) colony-forming units/mL) following a period of 48 hours after admission. RESULTS: Half of patients were male. Mean age was 50.26 ± 22.7 (SD), range 3 months to 88 years. Gram-negative bacteria were the agent in approximately 80% of cases. The most common pathogens were E. coli (26%), Klebsiella sp. (15%), P. aeruginosa (15%) and Enterococcus sp. (11%). The overall bacteria susceptibility showed that the pathogens were more sensible to imipenem (83%), second or third generation cephalosporin and aminoglycosides; and were highly resistant to ampicillin (27%) and cefalothin (30%). It is important to note the low susceptibility to ciprofloxacin (42%) and norfloxacin (43%). CONCLUSION: This study suggests that if one can not wait the results of urine culture, the best choices to begin empiric treatment are imipenem, second or third generation cephalosporin and aminoglycosides. Cefalothin and ampicillin are quite ineffective to treat these infections.

INTRODUÇÃO: A infecção urinária é a mais comum das infecções hospitalares. O conhecimento da prevalência das cepas bacterianas e do antibiograma é importante para orientar a escolha inicial do antibiótico. OBJETIVO: Determinar a prevalência bacteriana e a sensibilidade aos antibióticos na infecção urinária hospitalar, em um hospital universitário, período janeiro-junho de 2003. MÉTODOS: Foram analisados os prontuários de 188 pacientes com urocultura positiva (³ 10(5) c olônias/ml), depois de decorrido um período de pelo menos 48h da internação. RESULTADOS: Metade dos pacientes era homens. A idade média da amostra foi 50,2±22.7 anos com variação de 3 meses a 88 anos. Em 80% dos casos a bactéria identificada era Gram-negativa. Os micróbios mais comuns foram E. coli (26%), Klebsiella sp (15%), P. aeruginosa (15%) e Enterococcus sp (11%). O antibiograma mostrou maior sensibilidade bacteriana ao imipenem (83%), cefalosporinas de segunda e terceira geração e aminoglicosídeos e grande resistência à ampicilina e cefalotina. A sensibilidade foi baixa também para ciprofloxacina (42%) e norfloxacina (43%). CONCLUSÃO: Este estudo sugere que se não for possível aguardar os resultados da cultura e antibiograma a melhor escolha para início do tratamento seria o imipenem, cefalosporinas de segunda e terceira geração e aminoglicosídeos. A cefalotina e a ampicilina não constituem boa opção para o tratamento empírico inicial.

Prevalence and bacterial susceptibility of hospital acquired urinary tract infection

PURPOSE: Urinary tract infection is the most common nosocomially acquired infection. It is important to know the etiology and antibiotic susceptibility infectious agents to guide the initial empirical treatment. OBJECTIVE: To determine the prevalence of bacterial strains and their antibiotic susceptibility in nosocomially acquired urinary tract infection in a university hospital between January and June 2003. METHODS: We analyzed the data of 188 patients with positive urine culture (= 10(5) colony-forming units/mL) following a period of 48 hours after admission. RESULTS: Half of patients were male. Mean age was 50.26 ± 22.7 (SD), range 3 months to 88 years. Gram-negative bacteria were the agent in approximately 80% of cases. The most common pathogens were E. coli (26%), Klebsiella sp. (15%), P. aeruginosa (15%) and Enterococcus sp. (11%). The overall bacteria susceptibility showed that the pathogens were more sensible to imipenem (83%), second or third generation cephalosporin and aminoglycosides; and were highly resistant to ampicillin (27%) and cefalothin (30%). It is important to note the low susceptibility to ciprofloxacin (42%) and norfloxacin (43%). CONCLUSION: This study suggests that if one can not wait the results of urine culture, the best choices to begin empiric treatment are imipenem, second or third generation cephalosporin and aminoglycosides. Cefalothin and ampicillin are quite ineffective to treat these infections.

INTRODUÇÃO: A infecção urinária é a mais comum das infecções hospitalares. O conhecimento da prevalência das cepas bacterianas e do antibiograma é importante para orientar a escolha inicial do antibiótico. OBJETIVO: Determinar a prevalência bacteriana e a sensibilidade aos antibióticos na infecção urinária hospitalar, em um hospital universitário, período janeiro-junho de 2003. MÉTODOS: Foram analisados os prontuários de 188 pacientes com urocultura positiva (³ 10(5) c olônias/ml), depois de decorrido um período de pelo menos 48h da internação. RESULTADOS: Metade dos pacientes era homens. A idade média da amostra foi 50,2±22.7 anos com variação de 3 meses a 88 anos. Em 80% dos casos a bactéria identificada era Gram-negativa. Os micróbios mais comuns foram E. coli (26%), Klebsiella sp (15%), P. aeruginosa (15%) e Enterococcus sp (11%). O antibiograma mostrou maior sensibilidade bacteriana ao imipenem (83%), cefalosporinas de segunda e terceira geração e aminoglicosídeos e grande resistência à ampicilina e cefalotina. A sensibilidade foi baixa também para ciprofloxacina (42%) e norfloxacina (43%). CONCLUSÃO: Este estudo sugere que se não for possível aguardar os resultados da cultura e antibiograma a melhor escolha para início do tratamento seria o imipenem, cefalosporinas de segunda e terceira geração e aminoglicosídeos. A cefalotina e a ampicilina não constituem boa opção para o tratamento empírico inicial.