Nosocomial bloodstream infections in Brazilian hospitals: analysis of 2,563 cases from a prospective nationwide surveillance study.

Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. Data from a nationwide, concurrent surveillance study, Brazilian SCOPE (Surveillance and Control of Pathogens of Epidemiological Importance), were used to examine the epidemiology and microbiology of nBSIs at 16 Brazilian hospitals. In our study 2,563 patients with nBSIs were included from 12 June 2007 to 31 March 2010. Ninety-five percent of BSIs were monomicrobial. Gram-negative organisms caused 58.5% of these BSIs, Gram-positive organisms caused 35.4%, and fungi caused 6.1%. The most common pathogens (monomicrobial) were Staphylococcus aureus (14.0%), coagulase-negative staphylococci (CoNS) (12.6%), Klebsiella spp. (12.0%), and Acinetobacter spp. (11.4%). The crude mortality was 40.0%. Forty-nine percent of nBSIs occurred in the intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 622 patients (24.3%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (70.3%). Methicillin resistance was detected in 157 S. aureus isolates (43.7%). Of the Klebsiella sp. isolates, 54.9% were resistant to third-generation cephalosporins. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 55.9% and 36.8%, respectively, were resistant to imipenem. In our multicenter study, we found high crude mortality and a high proportion of nBSIs due to antibiotic-resistant organisms.

Characterization of deaths and therapeutic itineraries investigated by the Porto Alegre AIDS Mortality Committee, Brazil, in 2015. / Caracterização dos óbitos e dos itinerários terapêuticos investigados pelo Comitê Municipal de Mortalidade por Aids de Porto Alegre em 2015.

OBJECTIVE: to characterize AIDS deaths eligible for Porto Alegre AIDS Mortality Committee (AIDSMC) investigation, Brazil, in 2015, and their therapeutic itineraries. METHODS: this was a descriptive study using secondary data from surveillance information systems and AIDSMC investigation forms. RESULTS: out of 336 deaths from AIDS-related causes, 113 (33.6%) were considered avoidable, of which 52 were analyzed by AIDSMC; there was predominance of males (30/52), low schooling level (29/52 incomplete elementary education), and less than 2 years between HIV infection diagnosis and death (28/52); tuberculosis was the most frequent cause of death (17/52); and in 50/52 cases at least one therapeutic itinerary inadequacy was identified. CONCLUSION: avoidable deaths of people with AIDS occurred mostly in men, those with low education level, those with recent HIV diagnosis and most deaths were due to tuberculosis.

Epidemiological aspects of the first human autochthonous visceral leishmaniosis cases in Porto Alegre, Brazil.

Human visceral leishmaniasis is a growing anthropozoonosis in Brazil, and particularly in the southern region of the country. It is an infectious disease transmitted to humans, dogs and other animals in urban and rural areas of the Americas, mainly due to the bite of Lutzomya longipalpis infected with Leishmania infantum. This article aims to portray the current epidemiological situation of the human visceral leishmaniasis arrival in Porto Alegre city, located in the southern region of Brazil. It is a descriptive study, a case series and a critical review. Six human cases with human visceral leishmaniasis were notified by the date of conclusion of the study, all human visceral leishmaniasis cases were diagnosed at late stage, leading to four deaths.

Cognitive impairment increases in older people living with HIV: a systematic review of cohort studies / Aumento do comprometimento cognitivo em idosos que vive m com HIV: revisão sistemática de estudos de corte

The progressive increase in HIV infection among older adults requires constant research and monitoring, given that geriatric syndromes associated with HIV comorbidities have become an important public health problem. We reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and it has a central question: Is the incidence of cognitive impairment higher in older patients living with HIV than in their seronegative peers? The following databases were searched for this review: MEDLINE/PubMed, EMBASE, LILACS, Web of Science, and Scopus. The inclusion criteria were studies whose samples were ≥ 50% patients aged ≥ 50 years, with and without HIV, and a main outcome related to the incidence of cognitive impairment. Only cohort studies with follow-up lasting ≥ 24 months were considered. Three reviewers independently screened the documents for eligibility criteria, extracted the data, assessed the risk of bias (Newcastle-Ottawa Scale), and evaluated the quality of evidence. A narrative synthesis was prepared. In total, 10 798 trials were screened, 8884 were excluded, 14 were analyzed, and 5 were included in this review. Only 1 applied cognitive assessment tests; the rest used secondary data from the medical records. Most found that the incidence of cognitive disorders was higher among older people living with HIV, which highlights the need for public policies aimed at primary and secondary prevention strategies. Further research from other countries is still required. PROSPERO register (CRD42022321914). (AU)

Cognitive impairment among older adults with HIV: a systematic review protocol of cohort studies / Transtornos cognitivos em idosos vivendo com HIV: protocolo de revisão sistemática com estudos de coorte

OBJECTIVES: This review will determine whether the incidence of cognitive impairment in HIV patients aged ≥ 50 years is greater than that of their HIV-negative peers. METHODS: The MEDLINE, EMBASE, LILACS, Web of Science, and Scopus databases will be searched for studies with a sample of individuals aged ≥ 50 years or a mixed population with ≥ 50% aged ≥ 50 years). It will include studies that evaluate seropositive patients compared to and an unexposed control group. STUDY DESIGN: Cohort studies with follow-up ≥ 24 months will be included. Three reviewers will independently screen for eligibility criteria, extract data, and assess the risk of bias in the included studies, as well as evaluate the overall quality of evidence. A narrative synthesis will be prepared according to synthesis without meta-analysis guidelines. EXPECTED RESULTS: We expect to find correlations between older age, HIV, and cognitive impairment. RELEVANCE: The association of geriatric syndromes and HIV is becoming an important field of study. Increased life expectancy accompanied by an active sex life is contributing to this public health problem. This protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and is registered in PROSPERO (CRD42022321914). This study was financed in part by the CAPES foundation (financial code: 001)

OBJETIVOS: Esta revisão abordará o questionamento: a incidência de comprometimento cognitivo é maior em pacientes com 50 anos ou mais com o vírus da imunodeficiência humana do que em idosos soronegativos? METODOLOGIA: As bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Web of Science e Scopus serão pesquisadas. A estratégia de busca considerará estudos com amostra de 50 anos ou mais e população mista (pelo menos 50% com 50 anos ou mais). Incluirá estudos que avaliam pacientes soropositivos, e o controle considerará pesquisas que abordem pessoas não expostas. DESENHO DO ESTUDO: Serão incluídos estudos de coorte com seguimento de pelo menos 24 meses. Três revisores, de forma independente, farão a triagem dos artigos quanto aos critérios de elegibilidade, extrairão dados, avaliarão o risco de viés dos trabalhos e avaliarão a qualidade geral das evidências. Uma síntese narrativa será preparada de acordo com a diretriz SWiM. RESULTADOS ESPERADOS: Esperamos encontrar maior incidência de comprometimento cognitivo em idosos que vivem com o vírus da imunodeficiência humana. RELEVÂNCIA: As síndromes geriátricas associadas ao HIV tornam-se um importante escopo de estudo, uma vez que, o aumento da expectativa de vida acompanhado de uma vida sexual ativa sustenta o ciclo de contaminação desse problema de saúde pública. Este protocolo é relatado de acordo com os Itens Preferenciais de Relatórios para Protocolos de Revisão Sistemática e Metanálise e está registrado no International Prospective Register of Systematic Reviews ­ PROSPERO (CRD42022321914). Este estudo foi parcialmente financiado pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior ­ Brasil ­ Código de financiamento: 001

O desafio do HIV em idosos: uma análise qualitativa da atuação de médicos da atenção primária à saúde em Porto Alegre/RS / The challenge of HIV among the elderly population: a qualitative analysis of the performance of primary care physicians in Porto Alegre city, Brazil / El desafio del HIV en ancianos: una analisis qualitativa de la atuación de los medicos de la atención primária de la salud en Porto Alegre/RS

Introdução: A transição demográfica que ocorre no território brasileiro traz para discussão o processo de transição epidemiológica que vivemos, onde as doenças infectas parasitárias somam-se às doenças crônicas não transmissíveis. Objetivo: Descrever a atuação dos médicos da Atenção Básica na prevenção primária e secundária em relação à infecção pelo HIV na população idosa atendida pela Atenção Primária à Saúde (APS) do município de Porto Alegre/RS. Metodologia: Estudo transversal, misto, realizado com médicos que atuam na APS em Porto Alegre/RS. Resultados: Evidenciou-se que a temática da sexualidade, infecções sexualmente transmissíveis, situações e grupos de risco e tratamento para o HIV são temas de menos conhecimento. Conclusões: Os médicos da rede básica de saúde não realizam prevenção primária e secundária para a infecção pelo HIV em idosos de forma rotineira

Introduction: The demographic transition that takes place in the Brazilian territory brings to the discussion the process of epidemiological transition that we live in, where infectious diseases add to non-communicable chronic diseases. Objective: To compare the performance of the doctors regarding primary and secondary prevention for HIV infection in the elderly population in Primary Care in the city of Porto Alegre/RS. Methodology: This is a cross-sectional, mixed study, applied to physicians working at Primary Care in Porto Alegre/RS. Results: It was evident that the theme of sexuality, sexually transmitted infections, situations and groups at risk and treatment for HIV are less well-known topics. Conclusions: Primary care physicians do not perform primary and secondary prevention for HIV infection in the elderly on a routine basis

Introducción: La transición demográfica que ocurre en el territorio brasileño trae para discusión el proceso de transición epidemiológica que vivimos, donde las enfermedades infectoparasitarias se suman a las enfermedades crónicas no transmisibles. Objetivo: Describir la actuación de los médicos en la prevención primaria y secundaria en relación a la infección por el VIH en la población anciana atendida por la Atención Primaria a la Salud (APS) del municipio de Porto Alegre/ RS. Metodología: Es un estudio transversal, mixto, relaizado con los médicos de la APS en Porto Alegre / RS. Resultados: Se envidenció que la tematica de la sexualidad, infecciones sexualmente trasmisibles, situaciones y grupos de riesgo y tratamiento para el VIH son temas de menos conocimiento. Conclusiones: Los médicos de la red basica de salud no pratican la prevención primária y secundária para la infección por el VIH en ancianos de manera rutinera

Leishmaniose visceral humana: um retrato da situação de casos em idosos e longevos / Human visceral leishmaniosis: a closure of the situation of cases in elderly and longlived people

Objetivo: analisar a atual situação epidemiológica brasileira e gaúcha da leishmaniose visceral (LVH), em idosos e verificar o coeficiente de letalidade. Métodos: trata-se um estudo transversal realizado com fonte de dados secundária, em consulta à base de dados do Sistema de Informação de Agravos de Notificação (SINAN), de janeiro de 2013 a dezembro de 2017, de casos confirmados de leishmaniose visceral no Brasil e no Rio Grande do Sul, que foram tabulados em Excel e analisados com Epiinfo 7.0. Resultados: casos de LVH em idosos têm aumentado nos últimos 5 anos, dentro do cenário brasileiro e gaúcho. Embora pouco divulgado, é frequente o comprometimento e o aumento da proporção de idosos que vão a óbito pelo LHV, que foi de 20,3% dos casos no período de 2013 a 2017, demonstrando a gravidade da infecção nesse público. Em nosso estudo também encontramos forte relação da idade com o aumento do coeficiente de letalidade, chegando a 46,87% em 2016. Discussão: uma das estratégias recentes no combate à LVH é o abate de cães que contêm o parasita responsável pela transmissão da doença, porém esse método de controle não tem sido muito efetivo. Com isso, constata-se que a medida imunoprofilática, através da vacina Leish-Tec®, tem um efeito favorável no combate à doença somente em animais que não estão em áreas de alta transmissão.

Aims: to analyze the current Brazilian and of the state of Rio Grande do Sul epidemiological situation of visceral leishmaniasis (LVH) in the elderly and verify the mortality coefficient. Methods: This is a cross-sectional study with a secondary data source, taken from SINAN data from January 2013 to December 2017, with confirmed visceral leishmaniasis in Brazil and Rio Grande do Sul, which are tabulated in Excel and analyzed with Epiinfo 7. Results: cases of LVH in the elderly have increased in the last 5 years, within the Brazilian and the state of Rio Grande do Sul settings. Although not widely reported, it is frequent to compromise and increase the proportion of elderly people who die from LVH, which was 20,3% of the cases in the period from 2013 to 2017, demonstrating the seriousness of the infection in this public. In our study we also found a strong relation between age and the increase in the lethality coefficient, reaching 46.87% in 2016. Discussion: One of the recent strategies in the fight against HVL is the slaughter of dogs that contains the parasite responsible for the transmission of the disease, but this method of control has not been very effective. Thus, the immunoprophylactic measurement by Leish-Tec® vaccine has a favorable effect in the fight against the disease only in animals that are not in high transmission areas.

Caracterização dos óbitos e dos itinerários terapêuticos investigados pelo Comitê Municipal de Mortalidade por Aids de Porto Alegre em 2015 / Caracterización de óbitos e itinerario terapéutico investigados por el Comité de Mortalidad por Sida de Porto Alegre, Brasil, en 2015 / Characterization of deaths and therapeutic itineraries investigated by the Porto Alegre AIDS Mortality Committee, Brazil, in 2015

Objetivo: caracterizar os óbitos por aids elegíveis para investigação pelo Comitê Municipal de Mortalidade por Aids (CMAids) de Porto Alegre, Brasil, em 2015, e seus itinerários terapêuticos. Métodos: estudo descritivo, com dados secundários de sistemas de informações de vigilância e das fichas de investigação do CMAids. Resultados: entre 336 óbitos por causas relacionadas à aids, 113 (33,6%) foram considerados evitáveis, dos quais 52 foram investigados pelo CMAids; verificou-se predomínio do sexo masculino (30/52), baixa escolaridade (29/52 casos até a 8ª série incompleta) e tempo de até 2 anos entre o diagnóstico da infecção pelo HIV e a morte (28/52); a tuberculose foi a causa de morte mais frequente (17/52); em 50/52 casos, identificou-se pelo menos uma falha no itinerário terapêutico. Conclusão: os óbitos evitáveis de pessoas com aids ocorreram, majoritariamente, em pessoas do sexo masculino, de baixa escolaridade, com diagnóstico recente de HIV e em decorrência da tuberculose.

Objetivo: caracterizar los óbitos por sida elegibles para investigación por el Comité de Mortalidad por Sida (CMSida) de Porto Alegre, Brasil, en 2015, y sus itinerarios terapéuticos. Métodos: estudio descriptivo con datos secundarios de los sistemas de información de vigilancia y formulario de investigación de CMSida. Resultados entre 336 muertes por sida, 113 (33,6%) se consideraron evitables, de las cuales 52 fueron investigadas por el CMSida; predominó el sexo masculino (30/52), el bajo nivel de educación (29/52 hasta 8º grado incompleto de primaria) y hasta 2 años entre el diagnóstico de la infección por VIH y la muerte (28/52); la tuberculosis fue la causa más frecuente de muerte (17/52); y en 50/52 casos, se identificó al menos una falla en los itinerarios terapéuticos. Conclusión: las muertes evitables de personas con sida ocurrieron principalmente en hombres, con baja escolaridad, diagnóstico reciente de VIH y debido a la tuberculosis.

Objective: to characterize AIDS deaths eligible for Porto Alegre AIDS Mortality Committee (AIDSMC) investigation, Brazil, in 2015, and their therapeutic itineraries. Methods: this was a descriptive study using secondary data from surveillance information systems and AIDSMC investigation forms. Results: out of 336 deaths from AIDS-related causes, 113 (33.6%) were considered avoidable, of which 52 were analyzed by AIDSMC; there was predominance of males (30/52), low schooling level (29/52 incomplete elementary education), and less than 2 years between HIV infection diagnosis and death (28/52); tuberculosis was the most frequent cause of death (17/52); and in 50/52 cases at least one therapeutic itinerary inadequacy was identified. Conclusion: avoidable deaths of people with AIDS occurred mostly in men, those with low education level, those with recent HIV diagnosis and most deaths were due to tuberculosis.

Sífilis adquirida: uma revisão epidemiológica dos casos em adultos e idosos no município de Porto Alegre/RS / Syphilis acquired: an epidemiological review of cases in adults and elderly in the municipality of Porto Alegre/RS / Sífilis adquirida: una revisión epidemiológica de casos en adultos y ancianos en la ciudad de Porto Alegre/RS

Justificativa e Objetivos: Sabe-se que a sífilis adquirida, no cenário epidemiológico gaúcho, configura-se como doença de extrema importância devido a sua alta prevalência e ascensão. A partir disso, o seguinte trabalho visa revisar as medidas utilizadas na assistência dos pacientes adultos e idosos com diagnóstico de sífilis adquirida e sua epidemiologia no município de Porto Alegre/RS. Conteúdo: Segundo dados publicados em 2016 pelo Ministério da Saúde, o crescimento da infecção por sífilis em indivíduos adultos e idosos está em grande expansão no Brasil. Através das conquistas pelos idosos nas últimas décadas, o prolongamento da vida sexual é ponto merecedor de destaque, além do incentivo à socialização e a falta de informação sobre saúde sexual. Conclusão: As infecções sexualmente transmissíveis crescem nestes dois públicos e necessita-se medidas preventivas mais efetivas no âmbito da saúde pública.(AU)

Background and Objectives: It is known that acquired syphilis, in the "gaúcho" epidemiological scenario, is a disease of extreme importance due to its high prevalence and rise. From this, the following work aims to review the measures used in the care of adult and elderly patients diagnosed with acquired syphilis and its epidemiology in the city of Porto Alegre / RS. Contents: According to data published in 2016 by the Ministry of Health, the growth of syphilis infection in adults and elderly individuals is in great expansion in Brazil. Through the achievements of the elderly in the last decades, the prolongation of sexual life is a point worth highlighting, besides the incentive to socialization and the lack of information on sexual health. Conclusion: Sexually transmitted infections grow in these two publics and more effective preventive measures in the field of public health are needed.(AU)

Justificación y Objetivos: Se sabe que la sífilis adquirida, en el escenario epidemiológico"gaúcho", se configura como una enfermedad de extrema importancia debido a su alta prevalencia y ascenso. A partir de ello, el siguiente trabajo busca revisar las medidas utilizadas en la asistencia de los pacientes adultos y ancianos con diagnóstico de sífilis adquirida y su epidemiología en la ciudad de Porto Alegre / RS. Contenido: Según datos publicados en 2016 por el Ministerio de Salud, el crecimiento de la infección por sífilis en individuos adultos y ancianos está en gran expansión en Brasil. A través de los logros alcanzados por los ancianos en las últimas décadas, la prolongación de la vida sexual es un punto merecedor de hincapié, además del incentivo a la socialización y la falta de información sobre salud sexual. Conclusiones: Las infecciones sexualmente transmisibles crecen en estos dos públicos y se necesitan medidas preventivas más efectivas en el ámbito de la salud pública.(AU)

Epidemiological aspects of the first human autochthonous visceral leishmaniosis cases in Porto Alegre, Brazil

ABSTRACT Human visceral leishmaniasis is a growing anthropozoonosis in Brazil, and particularly in the southern region of the country. It is an infectious disease transmitted to humans, dogs and other animals in urban and rural areas of the Americas, mainly due to the bite of Lutzomya longipalpis infected with Leishmania infantum. This article aims to portray the current epidemiological situation of the human visceral leishmaniasis arrival in Porto Alegre city, located in the southern region of Brazil. It is a descriptive study, a case series and a critical review. Six human cases with human visceral leishmaniasis were notified by the date of conclusion of the study, all human visceral leishmaniasis cases were diagnosed at late stage, leading to four deaths.

Nosocomial bloodstream infections in Brazilian pediatric patients: microbiology, epidemiology, and clinical features.

BACKGROUND: Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients. METHODS: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project). RESULTS: In our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem. CONCLUSIONS: In our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.

Presença e susceptibilidade aos antifúngicos do Cryptococcus spp. em excretas de pombos nos arredores dos grandes hospitais de Porto Alegre / Presence and susceptibility to antifungal agents of Cryptococcus spp. in the excreta of pigeons on the outskirts of large hospitals in Porto Alegre

Introdução: Os fungos do gênero Cryptococcus, principalmente as espécies C. neoformans e C. gattii, são patógenos que causam a meningoencefalite, principalmente em indivíduos imunocomprometidos. O fungo é inalado, sendo as excretas de aves o nicho mais evidente do C. neoformans e as árvores do C. gattii. O presente estudo visa pesquisar o fungo Cryptococcus spp. nos arredores de grandes hospitais de Porto Alegre e verificar a susceptibilidade destes isolados ambientais aos antifúngicos. Métodos: Foram coletadas 87 amostras de excretas de pombos no entorno de seis hospitais de Porto Alegre e semeadas. As colônias leveduriformes foram analisadas macro e microscopicamente e submetidas a provas bioquímicas e moleculares. Posteriormente, estes isolados foram submetidos aos testes de susceptibilidade aos antifúngicos Etest® (Biomérieux) e MIC Strip Test® (Leofilchem). Resultados: Os fungos do gênero Cryptococcus foram isolados em seis amostras, sendo que cinco foram identificados, pelas provas convencionais, como o C. neoformans e uma o C. gattii, porém estas espécies não foram confirmadas pelas provas moleculares. No antifungigrama se encontraram entre os isolados de C. neoformans faixas de valores de concentração inibitória mínima (CIM) de 0,25-8 μg/ml para anfotericina B, 0,125->32 μg/ml para cetoconazol, 0,75->256 μg/ml para fluconazol, 0,125->32 μg/ml para voriconazol, e todas apresentaram CIM >32 μg/ml para itraconazol. Conclusões: A presença deste fungo em áreas hospitalares pode configurar um risco biológico, já que nestas áreas circulam muitos indivíduos imunocomprometidos, e a presença de cepas resistentes aos antifúngicos pode levar a uma diferente forma de conduzir o tratamento das patologias provocadas por esta levedura.

Introduction: Fungi of the Cryptococcus genus, mainly the species C. neoformans and C. gattii, are pathogens that cause meningoencephalitis, especially in immunocompromised individuals. The fungus is inhaled, with the excreta of birds being the most obvious niche of C. neoformans and trees of C. gattii. This study aims to fi nd the Cryptococcus spp. fungus on the outskirts of large hospitals in Porto Alegre and check the susceptibility of these environmental isolates to antifungal agents. Methods: We collected 87 samples of pigeon feces in the surroundings of six hospitals in Porto Alegre and cultured them. The yeast colonies were analyzed macroscopically and microscopically and subjected to biochemical and molecular tests. Subsequently these isolates were submitted to susceptibility tests to antifungals Etest® (Biomerieux) and MIC Strip Test® (Leofi lchem). Results: Fungi of the Cryptococcus genus were isolated in 6 samples, of which 5 were identifi ed by conventional tests, such as C. neoformans and C. gattii, but these species were not confi rmed by molecular tests. On antifungal susceptibility tests in C. neoformans isolates showed minimum inhibitory concentration values (MIC) ranging from 0.25 to 8 g/ml for amphotericin B, 0.125-> 32 ug/ml for ketoconazole, 0,75-> 256/ml for fl uconazole, and 0.125->32 ug/ml for voriconazole, and all showed MIC>32 mg/ml for itraconazole. Conclusion: The presence of this fungus in hospital areas may pose a biohazard, as many immunocompromised individuals circulate in these areas, and the presence of antifungal resistant strains can lead to a different way of conducting the treatment of disorders caused by this yeast.

Infecções hospitalares por enterobactérias produtoras de Kpc em um hospital terciário do sul do Brasil / Nosocomial infections by KPC-producing enterobacteria in a tertiary hospital in Southern Brazil

Introdução: A prevalência do gene blaKpc entre as bactérias gram-negativas continua a aumentar globalmente e está se disseminando em nosso hospital desde 2009. O tratamento de infecções causadas por esses patógenos constitui um desafio para os médicos. Métodos: Estudo retrospectivo descritivo. Descrevemos as características clínicas e epidemiológicas dos pacientes que apresentam, em exames de espécimes clínicos, enterobactérias produtoras do gene blaKpc (KPC) entre 2009 e 2012 em um hospital terciário em Porto Alegre, Brasil. Resultados: Setenta e sete pacientes foram incluídos nesse estudo. Destes, 47 (61%) desenvolveram quadro de infecção por KPC. A taxa de mortalidade associada à infecção por KPC foi de 18% entre todos 77 pacientes. Conclusão: A infecção por KPC está associada à alta mortalidade. A implementação de medidas de controle de infecção e política de uso de antimicrobianos são importantes para a redução da disseminação de KPC

Introduction: The prevalence of the gene blaKpc among gram-negative bacteria continues to increase globally and is spreading in our hospital since 2009. The treatment of infections caused by these pathogens is a major challenge for physicians. Methods: A retrospective descriptive study. We describe the clinical and epidemiological characteristics of patients who presented gene blaKpc-producing (KPC) enterobacteria in clinical specimens tests between 2009 and 2012 in a tertiary hospital in Porto Alegre, Brazil. Results: Seventy-seven patients were included in this study. Of these, 47 (61%) developed a picture of KPC infection. The mortality rate associated with KPC infection was 18% among all 77 patients. Conclusion: KPC infection is associated with high mortality. The implementation of infection control measures and antimicrobial use policy are important for reducing the spread of KPC