Late onset sepsis and intestinal bacterial colonization in very low birth weight infants receiving long-term parenteral nutrition / Sepse de ataque tardio e colonização bacteriana intestinal em neonatos de muito baixo peso recebendo nutrição parenteral total

INTRODUCTION: The purpose of this study was to establish the late onset sepsis (LOS) rate of our service, characterize the intestinal microbiota and evaluate a possible association between gut flora and sepsis in surgical infants who were receiving parenteral nutrition (PN). METHODS: Surveillance cultures of the gut were taken at the start of PN and thereafter once a week. Specimens for blood culture were collected based on clinical criteria established by the medical staff. The central venous catheter (CVC) tip was removed under aseptic conditions. Standard laboratory methods were used to identify the microorganisms that grew on cultures of gut, blood and CVC tip. RESULTS: 74 very low birth weight infants were analyzed. All the infants were receiving PN and antibiotics when the gut culture was started. In total, 21 (28.4%) infants experienced 28 episodes of LOS with no identified source. Coagulase negative staphylococci were the most common bacteria identified, both in the intestine (74.2%) and blood (67.8%). All infections occurred in patients who received PN through a central venous catheter. Six infants experienced episodes of microbial translocation. CONCLUSIONS: In this study, LOS was the most frequent episode in neonates receiving parenteral nutrition who had been submitted to surgery; 28.6% of this infection was probably a gut-derived phenomenon and requires novel strategies for prevention.

INTRODUÇÃO: O objetivo deste estudo foi estabelecer a taxa de sepse de ataque tardio (LOS) do nosso serviço, caracterizar a microbiota intestinal e avaliar uma possível associação entre a flora intestinal e sepse em recém-nascidos cirúrgicos que estavam recebendo nutrição parenteral (NP). MÉTODOS: Culturas do intestino foram colhidas no início da nutrição parenteral e, posteriormente, uma vez por semana. As amostras para a cultura de sangue foram coletadas com base em critérios clínicos estabelecidos pela equipe médica. A ponta do cateter venoso central (CVC) foi removida sob condições assépticas. Métodos laboratoriais padrão foram usados para identificar os microrganismos que cresceram em culturas de sangue, do intestino, e da ponta do CVC. RESULTADOS: Foram analisados 74 recém-nascidos de muito baixo peso. Todas as crianças estavam recebendo nutrição parenteral e antibióticos quando a cultura do intestino foi iniciada. No total, 21 (28,4%) crianças apresentaram 28 episódios de sepse tardia sem fonte identificada. Os estafilococos coagulase negativo foram os mais comuns das bactérias identificadas, tanto no intestino (74,2%) como no sangue (67,8%). Todas as infecções ocorreram em pacientes que receberam nutrição parenteral através de um cateter venoso central. Seis crianças experimentaram episódios de translocação microbiana. CONCLUSÕES: Neste estudo LOS foi o episódio mais frequente em recém-nascidos recebendo nutrição parenteral e submetidos a cirurgia, 28,6% da infecção provavelmente foi um fenômeno derivado do intestino o que exige novas estratégias para a prevenção.

Late onset sepsis and intestinal bacterial colonization in very low birth weight infants receiving long-term parenteral nutrition.

INTRODUCTION: The purpose of this study was to establish the late onset sepsis (LOS) rate of our service, characterize the intestinal microbiota and evaluate a possible association between gut flora and sepsis in surgical infants who were receiving parenteral nutrition (PN). METHODS: Surveillance cultures of the gut were taken at the start of PN and thereafter once a week. Specimens for blood culture were collected based on clinical criteria established by the medical staff. The central venous catheter (CVC) tip was removed under aseptic conditions. Standard laboratory methods were used to identify the microorganisms that grew on cultures of gut, blood and CVC tip. RESULTS: 74 very low birth weight infants were analyzed. All the infants were receiving PN and antibiotics when the gut culture was started. In total, 21 (28.4%) infants experienced 28 episodes of LOS with no identified source. Coagulase negative staphylococci were the most common bacteria identified, both in the intestine (74.2%) and blood (67.8%). All infections occurred in patients who received PN through a central venous catheter. Six infants experienced episodes of microbial translocation. CONCLUSIONS: In this study, LOS was the most frequent episode in neonates receiving parenteral nutrition who had been submitted to surgery; 28.6% of this infection was probably a gut-derived phenomenon and requires novel strategies for prevention.

[Air contamination levels in operating rooms during surgery of total hip and total knee arthroplasty, hemiarthroplasty and osteosynthesis in the surgical center of a Brazilian hospital]. / Contaminação do ar em salas cirúrgicas durante cirurgias de artroplastias total de quadril e joelho, hemiartroplastias e osteossínteses no centro cirúrgico de um hospital Brasileiro.

INTRODUCTION: The air contamination levels during orthopedic surgeries were evaluated. METHODS: The air of operating rooms (ORs) was examined through exposure to microbiological plates placed near the surgical table for an hour. RESULTS: values above that recommended (369 CFU/m³) for conventional ORs and ORs with ultraclean air were determined. Contamination was predominantly by Staphylococcus sp (86.9%). In all surgeries a high number of people were present inside the ORs and the doors were opened frequently. CONCLUSIONS: The contamination levels are above the values accepted by regulatory agencies, representing risk for patients.

Contaminação do ar em salas cirúrgicas durante cirurgias de artroplastias total de quadril e joelho, hemiartroplastias e osteossínteses no centro cirúrgico de um hospital Brasileiro / Air contamination levels in operating rooms during surgery of total hip and total knee arthroplasty, hemiarthroplasty and osteosynthesis in the surgical center of a Brazilian hospital

INTRODUÇÃO: Avaliou-se o nível da contaminação do ar em cirurgias ortopédicas. MÉTODOS: O ar das salas cirúrgicas foi analisado microbiologicamente através da exposição de placas próximas à mesa cirúrgica por uma hora. RESULTADOS: Foram evidenciados valores acima do recomendado (369 UFC/m³) nas salas convencionais, assim como naquelas com ar ultralimpo. A contaminação foi predominantemente por Staphylococcus sp (86,9 por cento). verificou-se um número alto de pessoas presentes no interior das salas cirúrgicas, assim como de abertura da porta. CONCLUSÕES: Os níveis de contaminação se apresentaram acima dos valores aceitos por agências reguladoras, representando risco para os pacientes.

INTRODUCTION: The air contamination levels during orthopedic surgeries were evaluated. METHODS: The air of operating rooms (ORs) was examined through exposure to microbiological plates placed near the surgical table for an hour. RESULTS: values above that recommended (369 CFU/m³) for conventional ORs and ORs with ultraclean air were determined. Contamination was predominantly by Staphylococcus sp (86.9 percent). In all surgeries a high number of people were present inside the ORs and the doors were opened frequently. CONCLUSIONS: The contamination levels are above the values accepted by regulatory agencies, representing risk for patients.

Qualidade do ar interno de uma instituição de ensino superior brasileira / Internal air quality in a brazilian college

O objetivo desta pesquisa foi avaliar a qualidade microbiológica do ar interno de uma instituição de ensino superior de Itumbiara-GO. Foram avaliadas 51 salas de aula, incluindo os laboratórios de química, zoologia e microbiologia e o ar do pátio externo da Instituição para uma análise comparativa. O ar das salas foi avaliado pela técnica de exposição (método de sedimentação espontânea) utilizando-se três conjuntos de duas placas de petri (90mm) dispostas pelo tempo de 30min. Foram utilizados os seguintes meios de cultura: agar trypticase de soja, agar manitol salgado e agar macConkey. Os isolados bacterianos foram identificados utilizando-se métodos bioquímicos clássicos. Foi detectado que 51 por cento das salas de aula (inclusive o laboratório de microbiologia) apresentaram contagens bacterianas acima do limite aceitável (maior ou igual a 7,5x102 UFC/m3) proposto pela ANVISA. Houve uma maior freqüência de S.aureus (100 por cento), seguido de Staphylococcus coagulase negativo (88,2 por cento) e Escherichia coli (78,4 por cento). A análise microbiológica do ar do pátio externo demonstrou um crescimento bacteriano elevado (>2,0x103 UFC/m3). A contaminação do ar das salas pode ter sido causada pelos próprios ocupantes das salas e suas atividades ocupacionais, contribuindo para o transporte de microrganismos.

Evaluate the microbiological quality of the internal air of an institution of higher education of Itumbiara-GO. We evaluated 51 classrooms, including laboratories for chemistry, zoology, microbiology and the air of the outer courtyard of the institution of a comparative analysis. The air of the rooms was assessed by the technique of exposure (sedimentation method) using three sets of two petri dishes (90mm) exposed for 30 minutes. We used the following methods of culture: from trypticase soy agar agar, mannitol salty, and agar macConkey. The bacterial isolates were identified using a traditional biochemical methods. It was found that 51 percent of classrooms (including the laboratory, microbiology) had bacterial counts above the acceptable limit (smaller ore qual to 7,5x102 UFC/m3) proposed by ANVISA. Overall, there was a higher frequency of S.aureus (100 percent), followed by coagulase negative Staphylococcus (88.2 percent) and Escherichia coli (78.4 percent). The microbiological analysis of air from outer courtyard of the institution demonstrated a high bacterial growth of Bacillus sp (> 2,0x103 UFC/m3). Probably the air contamination of the rooms was caused by occupants and their occupational activity, contributing to the transport of microorganisms.

Avaliação microbiológica das mãos de profissionais da saúde de um hospital particular de Itumbiara, Goiás / Microbiological evaluation of the hands of health professionals of a private hospital in Itumbiara, Goiás, Brazil

Objetivo Avaliar qualitativa e quantitativamente os microorganismos presentes na microbiota das mãos dos profissionais de saúde de um hospital particular de Itumbiara (GO). Métodos Foi realizado um estudo com 48 profissionais de saúde, incluindo três enfermeiros, 29 técnicos enfermeiros, cinco auxiliares de enfermagem, nove médicos e dois técnicos em Raios X. As amostras foram obtidas a partir da mão dominante do profissional, pela técnica do saco estéril de polietileno, contendo Tripticase Soy Broth. Resultados A contagem bacteriana da microbiota das mãos demonstrou uma alta contaminação (>106) nas mãos dos enfermeiros, técnicos de enfermagem e auxiliares de enfermagem. Os Staphylococcus coagulase negativa (44,5%) foram os microorganismos mais isolados, seguidos de Staphylococcus aureus (40,0%); cerca de 70,0% dos estafilococos foram resistentes à oxacilina. Não houve detecção de bacilos Gram-negativos. Conclusão Houve uma alta contaminação por bactérias epidemiologicamente importantes no ambiente hospitalar, demonstrando a necessidade de maior frequência e cuidado na higienização das mãos.

Objective The purpose of this study was to evaluate qualitatively and quantitatively the microorganisms present in the hands of health professionals in a private hospital in Itumbiara (GO), Brazil. Methods The study was conducted with 48 health professionals, including three nurses, 29 nurse technicians, five nursing assistants, nine physicians and two radiography technicians. Samples were obtained by placing the dominant hand of the health professional in a sterile polyethylene bag containing trypticase soy broth. Results Bacterial count (>106) showed that the hands of nurses, nurse technicians and nursing assistants were very contaminated. The most common microorganisms were coagulase-negative Staphylococcus (44.5%) followed by Staphylococcus aureus (40.0%). Roughly 70% of the staphylococci were oxacillin-resistant. Gramnegative bacilli were not detected. Conclusion Hands were very contaminated with bacteria that are epidemiologically important in the hospital environment, demonstrating the need for more frequent and careful hand washing.