Uso de celulares no ambiente hospitalar e o risco de contaminação bacteriana / Mobile phones usage in hospital settings and the risk of bacterial contamination

Este trabalho se propõe a avaliar as características do celular por funcionários, estudantes e profissionais de saúde e investigar a relação com o número e tipo de microrganismos presentes no telefone. Foram coletados dados sociodemográficos e informações sobre o uso do celular, além da avaliação microbiológica dos telefones. Os dados foram analisados no SPSS, através de estatística descritiva das variáveis. Dos 50 participantes do estudo, 82% eram do sexo feminino, 96% usam o celular no trabalho e 70% realizavam algum tipo de assepsia. Referente à coleta microbiológica, houve crescimento bacteriano em 68% dos celulares, cuja bactéria mais isolada foi o Staphylococcus coagulase negativa (47%). Além disso, houve crescimento de mais de 100.000 UFC/mL nos celulares dos residentes (26,5%) e acadêmicos (23,5%). Conclui-se que o uso do celular durante a jornada de trabalho é frequente, o que pode haver relação com o número de aparelhos contaminados.

This work aims to evaluate the characteristics of the cell phone by employees, students and health professionals and investigate the relationship with the number and type of microorganisms present on the phone. Sociodemographic data and information on cell phone use were collected, in addition to the microbiological assessment of the phones. The data were analyzed in SPSS, through descriptive statistics of the variables. Among the 50 study participants, 82% were female, 96% used their cell phones at work and 70% performed some type of asepsis. Regarding microbiological collection, there was bacterial growth in 68% of cell phones, whose most isolated bacterium was negative coagulase Staphylococcus (47%). In addition, there was a growth of more than 100.000 CFU/mL in the cell phones of residents (26.5%) and undergraduates (23.5%). It is concluded that the use of the cell phone during the working day is frequent, which may be related to the number of contaminated devices.

Associação entre escore de gravidade, níveis inflamatórios e dano no DNA em pacientes na terapia intensiva / Association between severity score, inflammatory levels and DNA damage in intensive care patients / Asociación entre puntaje de gravedad, niveles inflamatorios y daño en el ADN en pacientes de cuidados intensivos

Justificativa e Objetivos: A Unidade de Terapia Intensiva (UTI) é responsável pelo tratamento de pacientes críticos e sua monitorização contínua pode melhorar a qualidade dos cuidados prestados. O objetivo deste estudo é associar a Escala Psicológica Aguda Simplificada (SAPS 3) com os níveis inflamatórios e o dano ao DNA em pacientes internados na UTI de um hospital do Vale do Taquari, Rio Grande do Sul, Brasil. Métodos: Trata-se de uma pesquisa transversal realizada com 22 pacientes internados em uma UTI adulta, no período de janeiro a junho de 2016. O escore SAPS 3 foi pontuado pela equipe médica na admissão dos pacientes e amostras sanguíneas foram obtidas após 24 e 72 horas de internação para dosagem de Proteína C Reativa (PCR) e dano no DNA. Resultados: O escore SAPS 3 não se associou ao PCR de 24 e 72h. Entretanto, o escore SAPS 3 associou-se significativamente ao índice e a frequência de dano DNA, somente após 72 horas de internação. Conclusão: O escore de gravidade não se associou aos níveis de PCR, mas a danos no DNA, somente após 72 horas da admissão.(AU)

Background and Objectives: The Intensive Care Unit (ICU) is responsible for the treatment of critical patients and monitoring it continuously can improve the quality of care provided. This study aims to associate the Simplified Acute Physiology Score (SAPS 3) with inflammatory levels and genomic damage in patients admitted to the ICU of a hospital in Vale do Taquari, Rio Grande do Sul, Brazil. Methods: This is a cross-sectional study conducted with 22 patients from an adult ICU, between January and June 2016. The SAPS 3 was scored by the medical staff at the admission of patients and blood samples were obtained after 24 and 72 hours of hospitalization for C-Reactive Protein (CRP) dosing and DNA damage. Results: The SAPS 3 score was not associated with 24- and 72-hours CRP. However, the SAPS 3 score was significantly associated with the index and frequency of DNA damage, only after 72 hours of hospitalization. Conclusion: The severity score was not associated with CRP levels, but with DNA damage only after 72 hours of admission.

Justificación y objetivos: La Unidad de Cuidados Intensivos (UCI) es responsable del tratamiento de pacientes críticos, y su monitoreo continuo puede mejorar la calidad de la atención ofrecida. El presente estudio tuvo como objetivo asociar la Puntuación Fisiológica Simplificada Aguda (SAPS 3) con los niveles inflamatorios y el daño al ADN en pacientes de la UCI de un hospital del Valle de Taquari, Rio Grande do Sul, Brasil. Métodos: Este es un estudio transversal realizado con 22 pacientes ingresados en una UCI de adultos, entre enero y junio de 2016. El equipo médico calificó la puntuación SAPS 3 al ingreso de los pacientes, y se obtuvieron muestras de sangre después de 24 y 72 h de hospitalización para la medición del PCR y el daño al ADN. Resultados: La puntuación SAPS 3 no se asoció con la Proteína C Reactiva (PCR) a 24 y 72 horas. Sin embargo, lo asoció significativamente con el índice y la frecuencia de daño al ADN solo después de 72 horas de hospitalización. Conclusiones: El puntaje de gravedad no se asoció con los niveles de PCR, sino con el daño al ADN solamente 72 horas después del ingreso de los pacientes.(AU)

Seroprevalence of HIV, hepatitis B and C and syphilis infection in prisoners of the central region of Rio Grande do Sul, Brazil / Soroprevalência de infecção pelo HIV, hepatites B e C e sífilis em presidiários da região central do Rio Grande do Sul, Brasil

The living conditions of the prison population favors the spread of often asymptomatic infectious diseases which can betaken to the community. The aim of this study was to estimate the prevalence of syphilis, HIV, hepatitis B and C, as well aspossible co-infections among prison inmates in the central region of Rio Grande do Sul. We conducted a cross-sectionalstudy of records of serological analyses of the Regional Prison of Santa Cruz do Sul, state of Rio Grande do Sul (Brazil)performed between January 2016 and June 2017. Data were obtained from files of the 13th Regional Laboratory of SantaCruz do Sul. We included in the study all serological records obtained regarding the following diseases: syphilis, HIV, andhepatitis B and C. We analyzed data from 349 convicts with the mean age of 31 (± 8.56) years, ranging from 18 to 59 years,with the predominance of males 86%. Positive results: 6% for syphilis, 4.9% for HIV, and 8.3% for hepatitis C. Regardinghepatitis B the data obtained were 86% of subjects were susceptible to the virus, 1.1% were in the acute phase, 1.4% inchronic phase, 5.7% with past infection and 2.2% in immunological window period. Co-infections detected were: 0.3%(n = 1) syphilis/hepatitis C, 0.6% (n = 2) HIV/ hepatitis B, and 0.9% (n = 3) HIV/hepatitis C and HIV/syphilis. The prisonenvironment provides data from a population at high risk for spread of infectious diseases and we found a high prevalencein this study. Combative measures such as information, identification and treatment are urgent to prevent the spread of these diseases(AU)

As condições de vida da população prisional favorecem a disseminação de doenças infecciosas muitas vezes assintomáticasque podem ser disseminadas à comunidade. O objetivo desse trabalho foi estimar a prevalência de sífilis, HIV, hepatite B eC, bem como possíveis co-infecções em população prisional de presídio na região central do Rio Grande do Sul. Trata-sede um estudo descritivo transversal dos registros de análises sorológicas de apenados do Presídio Regional de Santa Cruzdo Sul, Rio Grande do Sul, realizadas entre janeiro de 2016 e junho de 2017. Os dados foram obtidos dos registros do13º Laboratório Regional de Santa Cruz do Sul. No estudo foram incluídos todos os registros sorológicos obtidos referentesàs seguintes doenças: sífilis, HIV e hepatites B e C. Foram analisados dados de 349 apenados com idade média de 31 (±8,56) anos, variando de 18 a 59 anos, com predomínio do sexo masculino 86%. Resultados positivos: 6% para sífilis, 4,9%para HIV e 8,3% para hepatite C. Com relação a hepatite B obteve-se 86% dos indivíduos suscetíveis ao vírus, 1,1% emfase aguda, 1,4% em fase crônica, 5,7% como infecção passada e 2,2% na fase de janela imunológica. As co-infecçõesdiagnosticadas foram: sífilis/hepatite C, 0,3% (n = 1); HIV/hepatite B, 0,6% (n = 2) e HIV/hepatite C e sífilis/HIV ambas comprevalência de 0,9% (n = 3). O ambiente prisional fornece dados de uma população de alto risco para disseminação dedoenças infecciosas e encontramos alta prevalência neste estudo. Medidas de combate como informação, identificação etratamento são urgentes para evitar a disseminação destas doenças(AU)

Seroprevalence of HIV, hepatitis B and C and syphilis infection in prisoners of the central region of Rio Grande do Sul, Brazil / Soroprevalência de infecção pelo HIV, hepatites B e C e sífilis em presidiários da região central do Rio Grande do Sul, Brasil

The living conditions of the prison population favors the spread of often asymptomatic infectious diseases which can be taken to the community. The aim of this study was to estimate the prevalence of syphilis, HIV, hepatitis B and C, as well as possible co-infections among prison inmates in the central region of Rio Grande do Sul. We conducted a cross-sectional study of records of serological analyses of the Regional Prison of Santa Cruz do Sul, state of Rio Grande do Sul (Brazil) performed between January 2016 and June 2017. Data were obtained from files of the 13th Regional Laboratory of Santa Cruz do Sul. We included in the study all serological records obtained regarding the following diseases: syphilis, HIV, and hepatitis B and C. We analyzed data from 349 convicts with the mean age of 31 (± 8.56) years, ranging from 18 to 59 years, with the predominance of males 86%. Positive results: 6% for syphilis, 4.9% for HIV, and 8.3% for hepatitis C. Regarding hepatitis B the data obtained were 86% of subjects were susceptible to the virus, 1.1% were in the acute phase, 1.4% in chronic phase, 5.7% with past infection and 2.2% in immunological window period. Co-infections detected were: 0.3% (n = 1) syphilis/hepatitis C, 0.6% (n = 2) HIV/ hepatitis B, and 0.9% (n = 3) HIV/hepatitis C and HIV/syphilis. The prison environment provides data from a population at high risk for spread of infectious diseases and we found a high prevalence in this study. Combative measures such as information, identification and treatment are urgent to prevent the spread of these diseases

As condições de vida da população prisional favorecem a disseminação de doenças infecciosas muitas vezes assintomáticas que podem ser disseminadas à comunidade. O objetivo desse trabalho foi estimar a prevalência de sífilis, HIV, hepatite B e C, bem como possíveis co-infecções em população prisional de presídio na região central do Rio Grande do Sul. Trata-se de um estudo descritivo transversal dos registros de análises sorológicas de apenados do Presídio Regional de Santa Cruz do Sul, Rio Grande do Sul, realizadas entre janeiro de 2016 e junho de 2017. Os dados foram obtidos dos registros do 13º Laboratório Regional de Santa Cruz do Sul. No estudo foram incluídos todos os registros sorológicos obtidos referentes às seguintes doenças: sífilis, HIV e hepatites B e C. Foram analisados dados de 349 apenados com idade média de 31 (± 8,56) anos, variando de 18 a 59 anos, com predomínio do sexo masculino 86%. Resultados positivos: 6% para sífilis, 4,9% para HIV e 8,3% para hepatite C. Com relação a hepatite B obteve-se 86% dos indivíduos suscetíveis ao vírus, 1,1% em fase aguda, 1,4% em fase crônica, 5,7% como infecção passada e 2,2% na fase de janela imunológica. As co-infecções diagnosticadas foram: sífilis/hepatite C, 0,3% (n = 1); HIV/hepatite B, 0,6% (n = 2) e HIV/hepatite C e sífilis/HIV ambas com prevalência de 0,9% (n = 3). O ambiente prisional fornece dados de uma população de alto risco para disseminação de doenças infecciosas e encontramos alta prevalência neste estudo. Medidas de combate como informação, identificação e tratamento são urgentes para evitar a disseminação destas doenças

What are the risk factors and agents responsible for bacterial infections in ICUS? / Quais os fatores de risco e agentes responsáveis por infecções bacterianas em UTI?

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult andneonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted inadult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU,58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulasenegative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantlypresented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) andEnterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but withinfections caused by Gram positive cocci, mainly CNS(AU)

Este estudo objetivou analisar os principais fatores de risco e a prevalência de microrganismos em infecções bacterianasde pacientes internados em UTIs Adulto e Neonatal. Estudo retrospectivo onde foram incluídos dados de culturas dosmicrorganismos e dos respectivos pacientes internados nas UTIs Adulto e Neonatal de um hospital escola do Vale doRio Pardo, localizado na região central do RS. Na UTI Adulto 58,8% dos pacientes apresentaram problemas cardíacos,foram encontradas 60 culturas positivas com a prevalência de Staphylococcus coagulase negativa (SCN) (30%) eStaphylococcus aureus (13,3%). Na UTI Neonatal os pacientes apresentaram predomínio de doenças pulmonares(52,6%), foram 31 culturas positivas neste período com maior prevalência de SCN (35,5%) e Enterococcus spp. (16,1%).Desta forma, conclui-se que as duas unidades analisadas possuem pacientes diferentes com fatores de risco distintos,mas com o predomínio de infecções por cocos Gram positivos, principalmente SCN(AU)

Activity of carbapenems and tigecycline against ESBL-producing Escherichia coli and Klebsiella spp / Atividade de carbapenêmicos e tigeciclina diante de Escherichia coli e Klebsiella spp. produtoras de ESBL

ABSTRACT The indiscriminate use of carbapenems in the fight against multidrug resistant Gram-negative bacteria leads to the emergence of resistance to these antimicrobial agents. We examine the in vitro activity of carbapenems and tigecycline against ESBL-producing E. coli and Klebsiella spp. isolated in a single hospital at two different periods eight years apart. Overall resistance to carbapenems ranged from 18.7% in 2007 to 19.1% in 2015/2016. We found no isolates resistant to tigecycline, but two intermediary profiles in the 2015/2016 period. Tigecycline is an important option for treating multidrug resistant Gram-negative infections and helps in the fight against global dissemination of resistance to carbapenems.

RESUMO O uso indiscriminado de carbapenêmicos na luta contra bactérias Gram-negativas multirresistentes favorece o aparecimento de resistência a esses agentes antimicrobianos. Examinamos a atividade in vitro de carbapenêmicos e tigeciclina em Escherichia coli e Klebsiella spp. isolados de um único hospital, em dois períodos diferentes, separados por oito anos. A resistência aos carbapenêmicos variou de 18,7% em 2007 a 19,1% em 2015/2016. Não encontramos isolados resistentes a tigeciclina, mas dois isolados intermediários no período 2015/2016. A tigeciclina é uma importante opção de tratamento para infecções causadas por bactérias Gram-negativas multirresistentes e ajuda na luta contra a disseminação da resistência aos carbapenêmicos.

What are the risk factors and agents responsible for bacterial infections in ICUS? / Quais os fatores de risco e agentes responsáveis por infecções bacterianas em UTI?

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult andneonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted inadult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU,58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulasenegative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantlypresented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) andEnterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but withinfections caused by Gram positive cocci, mainly CNS

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult andneonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted inadult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU,58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulasenegative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantlypresented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) andEnterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but withinfections caused by Gram positive cocci, mainly CNS

Este estudo objetivou analisar os principais fatores de risco e a prevalência de microrganismos em infecções bacterianas de pacientes internados em UTIs Adulto e Neonatal. Estudo retrospectivo onde foram incluídos dados de culturas dos microrganismos e dos respectivos pacientes internados nas UTIs Adulto e Neonatal de um hospital escola do Vale do Rio Pardo, localizado na região central do RS. Na UTI Adulto 58,8% dos pacientes apresentaram problemas cardíacos,foram encontradas 60 culturas positivas com a prevalência de Staphylococcus coagulase negativa (SCN) (30%) eStaphylococcus aureus (13,3%). Na UTI Neonatal os pacientes apresentaram predomínio de doenças pulmonares(52,6%), foram 31 culturas positivas neste período com maior prevalência de SCN (35,5%) e Enterococcus spp. (16,1%).Desta forma, conclui-se que as duas unidades analisadas possuem pacientes diferentes com fatores de risco distintos,mas com o predomínio de infecções por cocos Gram positivos, principalmente SCN

Coagulase-negative staphylococci in Southern Brazil: looking toward its high diversity.

INTRODUCTION: Coagulase-negative staphylococci (CoNS) are the most prevalent pathogens in nosocomial infections and may serve as a reservoir of mobile genetic elements such as the staphylococcal cassette chromosome mec (SCCmec) encoding methicillin resistance. Molecular characterization of SCCmec types combined with advanced molecular typing techniques may provide essential information for understanding the evolution and epidemiology of CoNS infections. We therefore aimed to investigate the SCCmec distribution, multidrug-resistance (MDR), and biofilm formation in CoNS blood culture isolates from a hospital in Southern Brazil. METHODS: We analyzed 136 CoNS blood culture isolates obtained during 2002-2004 from patients admitted to a tertiary care hospital in Brazil. SCCmec types I to V were determined using multiplex PCR. The clonal relationship of Staphylococcus epidermidis was determined using pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Molecular epidemiological data were interpreted along with data on biofilm formation, presence of the icaD gene, and MDR. RESULTS: The most prevalent species were S. epidermidis, Staphylococcus haemolyticus, and Staphylococcus hominis harboring mainly SCCmec types II, III, and V. Overall, the presence of multiple SCCmec was associated with non-MDR, except for S. epidermidis. S. epidermidis isolates showed a high prevalence of icaD, but had low phenotypic biofilm formation. PFGE and MLST revealed high genetic diversity in the S. epidermidis population. CONCLUSIONS: Our results suggest a major shift in SCCmec types within a short period and reveal a different behavior of S. epidermidis with regard to the association between the presence of multiple SCCmec types and MDR profile.

Coagulase-negative staphylococci in Southern Brazil: looking toward its high diversity

Abstract: INTRODUCTION: Coagulase-negative staphylococci (CoNS) are the most prevalent pathogens in nosocomial infections and may serve as a reservoir of mobile genetic elements such as the staphylococcal cassette chromosome mec (SCCmec) encoding methicillin resistance. Molecular characterization of SCCmec types combined with advanced molecular typing techniques may provide essential information for understanding the evolution and epidemiology of CoNS infections. We therefore aimed to investigate the SCCmec distribution, multidrug-resistance (MDR), and biofilm formation in CoNS blood culture isolates from a hospital in Southern Brazil. METHODS: We analyzed 136 CoNS blood culture isolates obtained during 2002-2004 from patients admitted to a tertiary care hospital in Brazil. SCCmec types I to V were determined using multiplex PCR. The clonal relationship of Staphylococcus epidermidis was determined using pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Molecular epidemiological data were interpreted along with data on biofilm formation, presence of the icaD gene, and MDR. RESULTS: The most prevalent species were S. epidermidis, Staphylococcus haemolyticus, and Staphylococcus hominis harboring mainly SCCmec types II, III, and V. Overall, the presence of multiple SCCmec was associated with non-MDR, except for S. epidermidis. S. epidermidis isolates showed a high prevalence of icaD, but had low phenotypic biofilm formation. PFGE and MLST revealed high genetic diversity in the S. epidermidis population. CONCLUSIONS: Our results suggest a major shift in SCCmec types within a short period and reveal a different behavior of S. epidermidis with regard to the association between the presence of multiple SCCmec types and MDR profile.

Evaluation of four different DNA extraction methods in coagulase-negative staphylococci clinical isolates.

Currently there are several methods to extract bacterial DNA based on different principles. However, the amount and the quality of the DNA obtained by each one of those methods is highly variable and microorganism dependent, as illustrated by coagulase-negative staphylococci (CoNS) which have a thick cell wall that is difficult to lyse. This study was designed to compare the quality and the amount of CoNS DNA, extracted by four different techniques: two in-house protocols and two commercial kits. DNA amount and quality determination was performed through spectrophotometry. The extracted DNA was also analyzed using agarose gel electrophoresis and by PCR. 267 isolates of CoNS were used in this study. The column method and thermal lyses showed better results with regard to DNA quality (mean ratio of A260/280 = 1.95) and average concentration of DNA (), respectively. All four methods tested provided appropriate DNA for PCR amplification, but with different yields. DNA quality is important since it allows the application of a large number of molecular biology techniques, and also it's storage for a longer period of time. In this sense the extraction method based on an extraction column presented the best results for CoNS.

Evaluation of fuur different dna extraction metods in coagulase-negative staphhylococci clinical isolates / Avaliacao de quatro metodos diferentes de extracao de DNA em isolados clinicos de estafilococos coagulase negativos (SCoN)

Currently there are several methods to extract bacterial DNA based on different principles. However, the amount and the quality of the DNA obtained by each one of those methods is highly variable and microorganism dependent, as illustrated by coagulase-negative staphylococci (CoNS) which have a thick cell wall that is difficult to lyse. This study was designed to compare the quality and the amount of CoNS DNA, extracted by four different techniques: two in-house protocols and two commercial kits. DNA amount and quality determination was performed through spectrophotometry. The extracted DNA was also analyzed using agarose gel electrophoresis and by PCR. 267 isolates of CoNS were used in this study. The column method and thermal lyses showed better results with regard to DNA quality (mean ratio of A260/280 = 1.95) and average concentration of DNA (), respectively. All four methods tested provided appropriate DNA for PCR amplification, but with different yields. DNA quality is important since it allows the application of a large number of molecular biology techniques, and also it's storage for a longer period of time. In this sense the extraction method based on an extraction column presented the best results for CoNS.

Atualmente, para extrair o DNA bacteriano, existem diversos métodos baseados em diferentes princípios. Entretanto, a quantidade e qualidade do DNA obtido por cada um destes métodos é variável e depende do tipo de micro-organismo em questão; os estafilococos coagulase-negativos (CoNS), por exemplo, possuem parede celular espessa difícil de lisar. O objetivo deste estudo foi comparar a quantidade e a qualidade do DNA extraído de isolados clínicos de CoNS utilizando quatro metodologias diferentes: dois protocolos caseiros e dois kits comerciais. A determinação da quantidade e da qualidade do DNA foi realizada por espectrofotometria. O DNA extraído também foi analisado em eletroforese em gel de agarose e por PCR. A concentração média de DNA foi mais alta no método de lise térmica (). Entretanto, com relação à qualidade do DNA, o kit comercial que utiliza um método de extração baseado em uma coluna de separação apresentou melhor resultado (média da relação A260/280 = 1,95). As quatro técnicas testadas forneceram DNA passível de amplificação por PCR, porém com diferentes rendimentos. A qualidade do DNA extraído de bactérias é importante, pois possibilita a realização de maior número de técnicas de biologia molecular e também armazenamento do material por maior período de tempo. Neste sentido, a técnica de extração por coluna de separação apresentou melhor desempenho frente aos CoNS.

Bacterial skin colonization and infections in patients with atopic dermatitis.

Atopic Dermatitis is a chronic inflammatory skin disease that affects a large number of children and adults. The disease results from an interaction between genetic predisposition, host environment, skin barrier defects, and immunological factors. A major aggravating factor associated with Atopic Dermatitis is the presence of microorganisms on the patient's skin surface. Staphylococcus aureus and Streptococcus pyogenes, for instance, can exacerbate chronic skin inflammation. As a result, antimicrobials have often been prescribed to control the acute phase of the disease. However, increased bacterial resistance to antimicrobial agents has made it difficult for dermatologists to prescribe appropriate medication. In the presence of disseminated dermatitis with secondary infection, systemic antibiotics need to be prescribed; however, treatment should be individualized, in an attempt to find the most effective antibiotic with fewer side effects. Also, the medication should be used for as short as possible in order to minimize bacterial resistance.

Bacterial skin colonization and infections in patients with atopic dermatitis / Colonização bacteriana e infecções da pele em pacientes com dermatite atópica

Atopic Dermatitis is a chronic inflammatory skin disease that affects a large number of children and adults. The disease results from an interaction between genetic predisposition, host environment, skin barrier defects, and immunological factors. A major aggravating factor associated with Atopic Dermatitis is the presence of microorganisms on the patient's skin surface. Staphylococcus aureus and Streptococcus pyogenes, for instance, can exacerbate chronic skin inflammation. As a result, antimicrobials have often been prescribed to control the acute phase of the disease. However, increased bacterial resistance to antimicrobial agents has made it difficult for dermatologists to prescribe appropriate medication. In the presence of disseminated dermatitis with secondary infection, systemic antibiotics need to be prescribed; however, treatment should be individualized, in an attempt to find the most effective antibiotic with fewer side effects. Also, the medication should be used for as short as possible in order to minimize bacterial resistance.

A dermatite atópica é uma doença inflamatória crônica da pele que afeta um grande número de crianças e adultos. A doença resulta da interação entre predisposição genética, fatores ambientais, defeitos da barreira cutânea e fatores imunológicos. Um dos grandes fatores agravantes associados à dermatite atópica é a presença de microorganismos na superfície cutânea desses pacientes. Staphylococcus aureus e Streptococcus pyogenes, por exemplo, podem exacerbar a inflamação crônica da pele. Como resultado, antimicrobianos são prescritos para controlar a fase aguda da doença. O constante crescimento da resistência bacteriana aos antimicrobianos tem tornado a escolha do mais adequado medicamento uma difícil decisão para os dermatologistas. Na presença de dermatite disseminada com infecção secundaria, antibióticos sistêmicos necessitam ser prescritos; no entanto, o tratamento deve ser individualizado, de forma a encontrar o antimicrobiano mais eficaz e com menores efeitos colaterais. Além disso, esse medicamento deve ser utilizado pelo menor tempo possível, a fim de minimizar a resistência bacteriana.

Rifampicin fails to eradicate mature biofilm formed by methicillin-resistant Staphylococcus aureus / Rifampicina falha na erradicação de biofilmes maduros formados por Staphylococcus aureus resistentes à meticilina

INTRODUCTION: Antimicrobial activity on biofilms depends on their molecular size, positive charges, permeability coefficient, and bactericidal activity. Vancomycin is the primary choice for methicillin-resistant Staphylococcus aureus (MRSA) infection treatment; rifampicin has interesting antibiofilm properties, but its effectivity remains poorly defined. METHODS: Rifampicin activity alone and in combination with vancomycin against biofilm-forming MRSA was investigated, using a twofold serial broth microtiter method, biofilm challenge, and bacterial count recovery. RESULTS: Minimal inhibitory concentration (MIC) and minimal bactericidal concentration for vancomycin and rifampicin ranged from 0.5 to 1mg/l and 0.008 to 4mg/l, and from 1 to 4mg/l and 0.06 to 32mg/l, respectively. Mature biofilms were submitted to rifampicin and vancomycin exposure, and minimum biofilm eradication concentration ranged from 64 to 32,000 folds and from 32 to 512 folds higher than those for planktonic cells, respectively. Vancomycin (15mg/l) in combination with rifampicin at 6 dilutions higher each isolate MIC did not reach in vitro biofilm eradication but showed biofilm inhibitory capacity (1.43 and 0.56log10 CFU/ml reduction for weak and strong biofilm producers, respectively; p<0.05). CONCLUSIONS: In our setting, rifampicin alone failed to effectively kill biofilm-forming MRSA, demonstrating stronger inability to eradicate mature biofilm compared with vancomycin.

INTRODUÇÃO: A atividade dos antimicrobianos em biofilmes depende do seu peso molecular, de cargas positivas, coeficiente de permeabilidade e atividade bactericida. Vancomicina é a escolha primária para o tratamento de infecções causadas por Staphylococcus aureus resistentes à meticilina (MRSA) e rifampicina possui interessante propriedade antibiofilme, apesar da sua efetividade ainda ser fracamente definida. MÉTODOS: Foi investigada a atividade da rifampicina sozinha e em combinação com vancomicina frente à MRSA formadores de biofilme, utilizando o método das microplacas com diluição seriada e recuperação bacteriana em biofilme após exposição antimicrobiana. RESULTADOS: Concentração inibitória minima (MIC) e concentração bactericida mínima (MBC) para vancomicina e rifampicina foi de 0,5-1mg/l e 0,008-4mg/l; 1-4mg/l e 0,06-32mg/l, respectivamente. Biofilmes maduros foram expostos à vancomicina e rifampicina, e a concentração mínima para erradicar o biofilme (MBEC) foi 64-32.000 e 32-512 vezes maior do que para células planctônicas, respectivamente. A combinação de vancomicina (15mg/l) com rifampicina (6-diluições maior do que o MIC de cada isolado) não atingiu erradicação do biofilme in vitro, porém apresentou capacidade inibitória do biofilme formado (redução de 1,43 e 0,56log10 UFC/ml para produtores fracos e fortes, respectivamente; p<0,05). CONCLUSÕES: Rifampicina sozinha falhou em efetivamente matar MRSA formadores de biofilme, demonstrando fraca habilidade para erradicação de biofilmes maduros comparado com vancomicina.

Prevalence of extended-spectrum beta-lactamases-producing microorganisms in nosocomial patients and molecular characterization of the shv type isolates

The emergence of Extended-Spectrum Beta-Lactamase (ESBL)-producing microorganisms in Brazilian hospitals is a challenge that concerns scientists, clinicians and healthcare institutions due to the serious risk they pose to confined patients. The goal of this study was the detection of ESBL production by clinical strains of Escherichia coli and Klebsiella sp. isolated from pus, urine and blood of patients at Hospital Universitário Santa Maria, Rio Grande Sul, RS, Brazil and the genotyping of the isolates based on bla SHV genes. The ESBL study was carried out using the Combined Disc Method, while Polymerase Chain Reaction (PCR) was used to study the bla SHV genes. Of the 90 tested isolates, 55 (61.1 percent) were identified as ESBL-producing by the combined disk method. The bla SHV genes were found in 67.8 percent of these microorganisms. K. pneumoniae predominated in the samples, presenting the highest frequency of positive results from the combined disk and PCR.

[Prevalence of the TEM, SHV and CTX-M families of extended-spectrum beta-lactamases in Escherichia coli and Klebsiella spp at the University Hospital of Santa Maria, State of Rio Grande do Sul]. / Prevalência das famílias TEM, SHV e CTX-M de beta-lactamases de espectro estendido em Escherichia coli e Klebsiella spp no Hospital Universitário de Santa Maria, Estado do Rio Grande do Sul.

In this study, the distribution and prevalence of extended-spectrum beta-lactamases belonging to the TEM, SHV and CTX-M families were estimated among samples of Escherichia coli and Klebsiella spp. at the university hospital of Santa Maria, Rio Grande do Sul. Over a 14-month period, 90 microorganisms were selected as likely ESBL producers. The isolates were subjected to confirmatory phenotype tests for the presence of ESBL. Through investigating the respective genes using the polymerase chain reaction, the ESBL types present in each microorganism were then determined. Fifty-five samples (61.1%) were confirmed as ESBL-positive by means of the combined disc method, and 57 (63.3%) were found to be ESBL producers by means of the double disc method. From the polymerase chain reaction, ESBLs of TEM and SHV types were more frequently present in Klebsiella pneumoniae, while ESBL of CTX-M type was more frequently present in Klebsiella oxytoca.

Prevalência das famílias TEM, SHV e CTX-M de -lactamases de espectro estendido em Escherichia coli e Klebsiella spp no Hospital Universitário de Santa Maria, Estado do Rio Grande do Sul / Prevalence of the TEM, SHV and CTX-M families of extended-spectrum -lactamases in Escherichia coli and Klebsiella spp at the University Hospital of Santa Maria, State of Rio Grande do Sul

Neste estudo estimou-se a distribuição e prevalência de β-lactamases de espectro estendido pertencentes às famílias TEM, SHV e CTX-M entre amostras de Escherichia coli e Klebsiella spp. no Hospital Universitário de Santa Maria, Rio Grande do Sul. Durante 14 meses, 90 microrganismos foram selecionados como prováveis produtores de ESBL. Os isolados foram submetidos a testes fenotípicos confirmatórios para a presença de ESBL. A seguir, os tipos de ESBLs presentes em cada microrganismo foram determinados através da pesquisa dos respectivos genes através da reação em cadeia da polimerase. Empregando-se o método do disco combinado, a presença de ESBLs foi confirmada em 55 (61,1 por cento) amostras; quando o método do duplo disco foi utilizado, 57 (63,3 por cento) amostras foramprodutoras de ESBLs. Com base na PCR, as ESBLs do tipo TEM e SHV foram mais presentes em Klebsiella pneumoniae enquanto que ESBL do tipo CTX-M foram mais presentes em Klebsiella oxytoca.

In this study, the distribution and prevalence of extended-spectrum β-lactamases belonging to the TEM, SHV and CTX-M families were estimated among samples of Escherichia coli and Klebsiella spp. at the university hospital of Santa Maria, Rio Grande do Sul. Over a 14-month period, 90 microorganisms were selected as likely ESBL producers. The isolates were subjected to confirmatory phenotype tests for the presence of ESBL. Through investigating the respective genes using the polymerase chain reaction, the ESBL types present in each microorganism were then determined. Fifty-five samples (61.1 percent) were confirmed as ESBL-positive by means of the combined disc method, and 57 (63.3 percent) were found to be ESBL producers by means of the double disc method. From the polymerase chain reaction, ESBLs of TEM and SHV types were more frequently present in Klebsiella pneumoniae, while ESBL of CTX-M type was more frequently present in Klebsiella oxytoca.

Prevalência de patógenos bacterianos e susceptibilidade aos antimicrobianos em infecções do trato urinário de amostras ambulatoriais / Bacterial pathogens prevalence and antimicrobial susceptibility in community-acquired urinary tract infection

Este estudo descreve a distribuição e a susceptibilidade de micro-organismos isolados de pacientes com infecção do trato urinário (ITU) em Santa Cruz do Sul-RS no período de 2001 a 2006. Das 7571 amostras de urinas analisadas, 1276 (16,8%) apresentaram bacteriúria significativa (≥105 UFC/mL). A maioria das amostras com crescimento significativo pertencia ao sexo feminino (91,4%). O micro-organismo mais frequente foi a Escherichia coli, isolada em 70,5% das uroculturas. Os antimicrobianos aos quais os uropatógenos foram mais resistentes foram ampicilina (31,0%), amoxilina (30,2%), ácido pipemídico (19,6%), sulfametoxazol-trimetoprim (19,2%) e ácido nalidíxico (18,8%). Este estudo contribui para o conhecimento de taxas de resistência locais, sendo essa uma das etapas básicas para o estabelecimento de estratégias particularizadas em relação ao uso racional de antimicrobianos. Estudos sistemáticos da resistência em uropatógenos causadores de ITUs não complicadas podem fornecer informações relevantes para médicos e outros profissionais da saúde no desenvolvimento de protocolos terapêuticos.