Epidemiologic surveillance of multidrug-resistant bacteria in a teaching hospital: A 3-year experience.

BACKGROUND: The objective of this prospective study was to verify the effectiveness of a multidisciplinary surveillance program that was implemented in a teaching hospital in southern Brazil, to prevent and control the spread of multidrug-resistant organisms. METHODS: The program implemented involved establishment of prevention guidelines, hand-hygiene promotion, isolation of patients colonized or infected by such organisms, enforced contact precautions, and terminal cleaning and disinfection of isolation rooms. A microbiology service, previously provided by an external laboratory, was established in the hospital. Detection of bacteria-resistant genes and molecular typing were performed also. RESULTS: Statistically significant differences were observed between the pre- and post-intervention periods (P = .00198). Control measures were effective in blocking the dissemination of a previously endemic clone of Acinetobacter baumannii. Changes were observed in the dissemination pattern, from a monoclonal to a polyclonal mode. The incidence of vancomycin-resistant Enterococcus during the surveillance period was low. Only 2 isolates of BLAKPC-positive Klebsiella pneumoniae (distinct profiles), and 5 isolates of BLASPM-positive Pseudomonas aeruginosa (a single cluster), were detected. CONCLUSIONS: These results indicate that the surveillance program implemented was effective in preventing the spread of multidrug-resistant organisms in the hospital.

Biomarcadores para avaliação da exposição humana às micotoxinas / Biomarkers for assessment of human exposure to mycotoxins

Atualmente, as micotoxinas representam um risco de contaminação ambiental, acarretando sérios prejuízos à saúde humana. Essas toxinas podem estar presentes em diferentes tipos de alimentos, que constituem a principal fonte de exposição para o homem. As exposições podem ser monitoradas através do uso de biomarcadores, que elucidam a relação causa/efeito e dose/efeito na avaliação de risco à saúde para fins de diagnóstico clínico e laboratorial. Realizou-se uma revisão bibliográfica do período de 1981-2005, no MEDLINE, sobre utilização e propostas de biomarcadores para a exposição a aflatoxinas, fumonisinas, desoxinivalenol e ocratoxina A. Os possíveis biomarcadores para avaliar a exposição humana às aflatoxinas foram os metabólitos urinários de aflatoxina B1, como aflatoxina M1, aflatoxina P1, aflatoxina Q1, aflatoxina livre em soro ou plasma, os adutos de AFB-N7-guanina, os adutos de albumina ou mutação no gene supressor de tumor p53, presentes em fluidos biológicos. Para as fumonisinas, os biomarcadores foram os níveis de fumonisina B1 e fumonisina B2 livres, ou de esfinganina e esfingosina em sangue e urina. O desoxinivalenol tem como biomarcadores de exposição os produtos de seu metabolismo e adutos macromoleculares (proteína/DNA) presentes nos fluidos biológicos. Para a exposição à ocratoxina A (OA) os biomarcadores se restringem à quantificação da própria toxina nos fluidos biológicos. A avaliação da exposição às micotoxinas constitui um importante aspecto para a saúde pública, tendo em vista a possibilidade de prevenir ou minimizar a incidência de doenças decorrentes da sua interação com o organismo.

Currently, mycotoxins represent a risk of environmental contamination, causing serious damages to human health. Those toxins can be found in different kinds of foods, and they constitute the main source of human exposure. The evaluation of such exposures can be monitored through the use of biomarkers, which elucidates the cause/effect and dose/effect relation in the evaluation of health risks for clinical and laboratory diagnostic purposes. The MEDLINE review about the use of biomarkers for assessment of aflatoxins, fumonisins, deoxynivalenol and ochratoxin A was carried out from 1981 to 2005. The biomarkers for assessment of human exposure to aflatoxins were the urinary metabolites of aflatoxin B1: aflatoxin M1, aflatoxin P1, aflatoxin Q1, the free aflatoxin in serum or plasma, the AFB-N7-guanine adducts and the albumin adducts or mutation in the tumour suppressor gene p53 present in human biological fluids. As far as fumonisins are concerned, levels of free fumonisin B1 and fumonisin B2, or levels of sphinganine and sphingosin, were quantified in blood and urine. As exposure biomarkers, deoxynivalenol has its own metabolism products and adducts (protein/DNA) present in human fluids. As to ochratoxin A exposure, we measure it in biological fluids, once it enables us to prevent or minimize the incidence of deaths or illnesses provoked by chemical exposure.

[Virulence factors for Candida spp recovered from intravascular catheters and hospital workers hands]. / Fatores de virulência de Candida spp isoladas de cateteres venosos e mãos de servidores hospitalares.

The virulence potential of 23 yeasts recovered from intravascular catheters and the hands of workers in a hospital in the northwestern region of Paraná were evaluated. Yeasts recovered from catheters presented greater adherence and were more hydrophobic (p<0.05) than yeasts recovered from hands. Candida non-albicans species expressed the virulence factors evaluated more intensely.

Fatores de virulência de Candida spp isoladas de cateteres venosos e mãos de servidores hospitalares / Virulence factors for Candida spp recovered from intravascular catheters and hospital workers hands

Avaliou-se o potencial de virulência de 23 leveduras isoladas de cateteres e mãos de trabalhadores em um hospital do Noroeste do Paraná. As leveduras isoladas de cateter foram mais aderentes e hidrofóbicas (P<0,05) que as leveduras isoladas das mãos. Candida não-albicans expressaram com mais intensidade os fatores de virulência avaliados.

The virulence potential of 23 yeasts recovered from intravascular catheters and the hands of workers in a hospital in the northwestern region of Paraná were evaluated. Yeasts recovered from catheters presented greater adherence and were more hydrophobic (p<0.05) than yeasts recovered from hands. Candida non-albicans species expressed the virulence factors evaluated more intensely.