Antimicrobial susceptibility of coagulase-negative staphylococci and characterization of isolates with reduced susceptibility to glycopeptides.

The antimicrobial susceptibility of 239 coagulase-negative staphylococci (CNS) isolates consecutively collected from blood culture in patients admitted in a 600-bed teaching hospital was evaluated. The isolates were identified to the species level by conventional methods and the MicroScan Positive Combo Panel type 6 system, and their susceptibility to vancomycin, teicoplanin, and oxacillin were tested by agar dilution, disk diffusion, and MicroScan-WalkAway system. The species distribution was as follows: Staphylococcus epidermidis 120 (50.2%), S. hominis 29 (12.1%), S. haemolyticus 24 (10.0%), S. cohnii 14 (5.9%), and isolates from other CNS species 52 (21.8%). The percentage of resistance to oxacillin was 74.5% by agar dilution. The highest percentages of oxacillin resistance were found among S. haemolyticus (95.8%) and S. epidermidis (80.8%). Teicoplanin resistance (MIC > or = 32 micrograms/mL) was detected in five S. haemolyticus isolates, whereas intermediate resistance (MIC = 16 micrograms/mL) was detected in nine strains. These isolates with reduced susceptibility to teicoplanin were resistant to oxacillin, but remained susceptible to vancomycin (MIC < or = 4 micrograms/mL). Two isolates, one S. haemolyticus and one S. epidermidis, showed a vancomycin MIC of 8 micrograms/mL, and both MicroScan and disk diffusion methods classified these isolates as susceptible. Our results showed that glycopeptide resistance is emerging among CNS isolates in our institution and the disk diffusion method may not detect isolates with decreased susceptibility to these antimicrobial agents.

Comparative evaluation of the in vitro activity of three combinations of beta-lactams with beta-lactamase inhibitors: piperacillin/tazobactam, ticarcillin/clavulanic acid and ampicillin/sulbactam.

Recently, two new combinations of Beta-lactam antibiotics with Beta-lactamase inhibitors became commercially available in Brazil: piperacillin/tazobactam and ampicillin/sulbactam. This study was designed to assess and compare the in-vitro activity of these new compounds, as well as that of ticarcillin/clavulanic acid, against bacteria isolated in our environment. A total of 749 bacteria isolated at São Paulo Hospital were tested using the disk diffusion method, in compliance with NCCLS standardization, using strict quality control. Only one sample per patient was included in the study. Oxacillin-resistant staphylococcus samples were not included in this study. Of the total samples tested, 84.5% were susceptible to piperacillin/tazobactam, 81.2% to ticarcillin/clavulanic acid, and 77.6% to ampicillin/sulbactam. Piperacillin/tazobactam was also found to be the most active combination of the three against Enterobacteriaceae ( n = 312), inhibiting 91.7% of the bacteria tested. Ticarcillin/clavulanic acid was active against 85.8% of the Enterobacteriaceae, while ampicillin/sulbactam inhibited 83.2% of the samples. This order of the spectrum of action (piperacillin/tazobactam > ticarcillin/clavulanic acid >ampicillin/sulbactam )was maintained for the majority of Enterobacteriaceae species analyzed. Pseudomonas aeruginosa ( n = 117) showed extremely high resistance to the three combinations. Piperacillin/tazobactam was active against 61.5% of the samples, while ticarcillin/clavulanic acid was active against 56.4% of the samples of this species. The activity of ampicillin/sulbactam against P. aeruginosa was extremely low; however, this was the most active combination against Acinetobacter baumannii ( 87.0% susceptibility). Piperacillin/tazobactam was the most active combination against Stenotrophomonas (Xanthomonas )maltophilia (100% susceptibility) and Burkholderia cepacia (90.9% susceptibility). The three combinations showed excellent activity against the Gram-positive cocci tested (97.3% to 98.2% susceptibility). In sum, piperacillin/tazobactam was more active against all Gram-negative species than the other two combinations, with the exception of A. baumannii, and showed similar activity against Gram-positive cocci.

[Occurrence of Campylobacter spp among food handlers in hospital kitchens in urban areas of the southern region of Brazil]. / Ocorrência de Campylobater spp entre manipuladores de alimentos em cozinhas hospitalares de localidade urbana da região Sul do Brasil.

The lack of information regarding the occurrence of Campylobacter spp in food handlers and the potential public health risk involved, led to the undertaking of this work. The main purpose was to verify the presence of asymptomatic Campylobacter spp carries in food handlers of hospital and commercial foodservice kitchens. The average prevalence of carriers in kitchens was of 6.2%; that in commercial foodservice kitchens (10.5%) being higher than that found in hospital kitchens (2.2%) in a universe of 177 individuals studied. A close relationship was found between Campylobacter spp, carriers of masculine sex and age group, which was of about 20 to 35 years of age. There was also strong evidence suggesting a higher prevalence of Campylobacter spp among handlers of masculine sex than among those of feminine sex.

[Experience with knowledge development in food handlers with te implementation of Hazard Analysis Critical control points (HACCP) in a hospital food service]. / Uma experiência de construção de conhecimento com manipuladores de alimentos a partir da implantação da análise de perigos e pontos críticos de controle (APPCC) em uma unidade de alimentação e nutrição hospitalar.

The present article has as objective to describe the methodology of an experience of implantation of Hazard Analyses Critical Control Points (HACCP) with food handlers in a hospital food service establishment, inside of a conception of relationship and construction of knowledge. Meetings with the food handlers and nutritionists, with the objective of raising the difficulties poined for the sector and the work to be developed. The HACCP consisted of the evaluation of the operations, following the sequential steps recommended, looking itself to instruct the food handlers on the methods of the operations and its interpretations. The detected critical points, the measures of control, the criteria of correction and the monitoring have widely been argued, serving as didactic elements for the reconstruction of quality of the preparations. The discussions generated actions that were developed in short term, revealing the need of a more effective and continuous partnership for the new proposals.

Piperacillin/Tazobactam: Evaluation of Its In vitro Activity against Bacteria Isolated in Two Brazilian Hospitals and an Overview of Its Antibacterial Activity, Pharmacokinetic Properties and Therapeutic Potential.

Piperacillin/tazobactam is a highly active antibiotic against most clinically important species of Gram-negative and positive bacteria, including anaerobes. It has never been used or tested against bacteria isolated in Brazil. In this article we report the in vitro activity of piperacillin/tazobactam against clinical isolates from two tertiary hospitals in São Paulo and Rio de Janeiro and review the evolving clinical literature. The study was performed before its commercialization in Brazil. Its activity was compared to that of several broad-spectrum antimicrobial agents commercially available in Brazil. Piperacillin/tazobactam was active against 83% of the isolates tested, while imipenem was active against 91%, cefepime 77%, and ciprofloxacin 73%. Against Enterobacteriaceae (n=398), cefepime was more active than piperacillin/tazobactam (92% versus 88%). Klebsiella pneumoniae strains (n=95) presented low susceptibility to piperacillin/tazobactam (79%), ceftazidime (67%), and to cefepime (82%) indicating a high percentage of ESBL-producing strains. The most active compounds against this species were imipenem (100%) and ciprofloxacin (93%). Piperacillin/tazobactam was the most active compound against Gram-positive cocci (n=238; percentage of susceptibility rank order: piperacillin/tazobactam = imipenem > ciprofloxacin > cefepime) and the second most active against nonenteric Gram-negative bacilli (n=250, rank order: imipenem [72%] > piperacillin/tazobactam [60%] > cefepime [56%] > ceftazidime [52%] > gentamicin [45%] > ciprofloxacin = aztreonam [42%]). Cefepime was the most active compound against P. aeruginosa (n=128, only 67%), followed by ceftazidime (64%), piperacillin/tazobactam (63%) and imipenem (59%). Only imipenem (91%) was active against more than 50% of the A. baumannii isolates (n=79) tested. Piperacillin/tazobactam was the second most active compound against A. baumannii (49%) and the most active against B. cepacia (91%). Our results demonstrated a high level of antimicrobial resistance in the hospitals evaluated, especially among nonenteric Gram-negative bacilli; and clonal dissemination of multiresistant strains. Piperacillin/tazobactam may contribute to the treatment of nosocomial infections in Brazil, however, some degree of resistance was detected in some species in the instance of frequent multiresistant bacteria in the tertiary level hospitals where the drug was evaluated.