Translation, cross-cultural adaptation, and validation of the Los Angeles Prehospital Stroke Screen for use in Brazil.

BACKGROUND: Stroke is one of the leading causes of death and neurological disability in the world. Several scales help professionals in the early recognition of the disease. However, none of these were developed in Brazil. OBJECTIVES: To translate the Los Angeles Prehospital Stroke Screen (LAPSS) into Brazilian Portuguese, and cross-culturally adapt and validate the scale in a representative sample of the Brazilian population. METHODS: This study was carried out in two phases: the first consisted in the translation and cross-cultural validation of the LAPSS, and the second in a cross-sectional study with prospectively collected data in patients with suspected stroke treated in a Brazilian prehospital and referred to a stroke center. Statistical analysis was used to assess the sensitivity, specificity, and accuracy of the scale. Cohen's Kappa coefficient (κ) was used for psychometric assessment. RESULTS: After translation and cross-cultural adaptation, the scale was applied to 86 patients. The scale presented a sensitivity of 83.8%, positive predictive value of 79.50%, specificity of 40.70%, negative predictive value of 47.80%, and accuracy of 77%. Cohen's kappa coefficient was calculated using data from 26 (30.23%) patients and the results showed excellent inter-rater reliability in the majority of the items (52.96%). CONCLUSIONS: The scale was translated and cross-culturally adapted for use in Brazil. The scale presented high sensitivity and accuracy but low specificity, and the Cohen's kappa demonstrated inter-rater reliability. The greatest difficulties occurred when the evaluation included subjective identifications. The scale excluded patients < 45 years old as stroke suspects.

Phenotypic and Molecular Characterization of Nonfermenting Gram-Negative Bacilli Causing Peritonitis in Peritoneal Dialysis Patients.

(1) Background: Peritonitis due to nonfermenting Gram-negative bacilli (NF-GNB) is a dramatic complication of peritoneal dialysis (PD) with bad outcomes. Previous studies of PD-related peritonitis due to Pseudomonas species have shown a low-resolution rate, without a high resistance rate to antipseudomonal antibiotics. This suggests that bacterial virulence factors can act and influence peritonitis evolution. This study aimed to describe the microbiological characteristics of NF-GNB causing PD-related peritonitis and analyze their influence on the outcome. (2) Methods: We analyze the 48 isolates from NF-GNB peritonitis, which were stored in our culture collection regarding bacterial resistance, biofilm, and other virulence factors' production, and clonal profile. Additionally, we collected data on treatment and outcomes from patients' clinical registers. (3) Results: The etiologies were species of Pseudomonas (50%), Acinetobacter (36%), and other NF-GNB (14%). There was a high (75%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low-resolution rate (<45%) among the episodes attributable to them. Pseudomonas species have a polyclonal profile, while we found a clone of five multiresistant Acinetobacter baumannii over an 8-year interval (2000-2008), which suggest an origin from the healthcare environment. (4) Conclusions: We are not able to identify any predictor of outcome, but it is possible that biofilm and others virulence factors can act in concert and contribute to the bad outcome.

Positividade de culturas por modalidades de banho no leito hospitalar: estudo ecológico / Positividad de culturas por modalidades de baño en cama hospitalaria: estudio ecológico / Culture positivity by hospital bath bed modalities: an ecological study

Resumo Objetivo Verificar positividade de culturas microbiológicas de pacientes hospitalizados, com prescrição de enfermagem para banho no leito, em três períodos disjuntos e sequenciais das modalidades de banho no leito: convencional (BLC), descartável (BLD) e descartável acrescido de clorexidina degermante à 2% (BLD-CX). Métodos Estudo ecológico, tipo séries temporais de 48 meses, em três períodos (P1=BLC; P2=BLD; P3=BLD-CX), com dados secundários de prontuário eletrônico, de pacientes que estiveram internados em hospital do estado de São Paulo, Brasil. Resultados Nos períodos de banhos descartáveis, o percentual de positividade foi, em média, 14,6% menor quando comparado aos meses cujo banho de leito foi convencional. No período de BLD-CX o percentual de positividade foi, em média, 19,3% menor quando comparado aos meses do período de BLC. Contudo, não há evidências de diferença no percentual de positividade entre o BLD (b = -14,6%; IC95% = (-18,9% a -10,3%) e o BLD-CX (b = - 19,3%; IC95% = (-24,4% a -14,22%). A cada ano a mais na idade média do paciente, o percentual de positividade aumenta, em média 0,3% (p=0,060). Não houve associação sazonal para positividades das culturas microbiológicas nas modalidades de banho. Conclusão A positividade de culturas microbiológicas, em pacientes com prescrição de enfermagem para banho no leito, é menor quando se utiliza as modalidades descartáveis. Recomenda-se adotar rotineiramente o BLD, deixando a prescrição de BLD-CX, somente para degermação da pele para procedimentos invasivos, operatórios e higienização das mãos de profissionais de saúde.

Resumen Objetivo Verificar los resultados positivos de culturas microbiológicas de pacientes hospitalizados, con prescripción de enfermería de baño en cama, en tres períodos disjuntos y secuenciales de las modalidades de baño en cama: convencional (BCC), descartable (BCD) y descartable con clorhexidina al 2 % (BCD-CX). Métodos Estudio ecológico, tipo series temporales de 48 meses, en tres períodos (P1=BCC; P2=BCD; P3=BCD-CX), con datos secundarios de historia clínica electrónica, de pacientes que estuvieron internados en hospital del estado de São Paulo, Brasil. Resultados En los períodos de baños descartables, el porcentaje de resultados positivos presentó un promedio 14,6 % inferior en comparación con los meses en que el baño en cama fue convencional. Durante el período de BCD-CX el porcentaje de resultados positivos fue, en promedio, 19,3 % inferior en comparación con los meses del período de BCC. Sin embargo, no hay evidencias de diferencias en el porcentaje de resultados positivos entre el BCD (b = -14,6 %; IC95 % = (-18,9 % a -10,3 %) y el BLD-CX (b = - 19,3 %; IC95 % = (-24,4 % a -14,22 %). Por cada año que se suma a la edad promedio del paciente, el porcentaje de resultados positivos aumenta en promedio 0,3 % (p=0,060). No se verificó una asociación estacional en las respuestas positivas de las culturas microbiológicas en las modalidades de baños. Conclusión Los resultados positivos de culturas microbiológicas de pacientes con prescripción de enfermería de baño en cama son menores cuando se utilizan las modalidades descartables. Se recomienda adoptar de forma rutinaria el BCD y dejar la prescripción de BCD-CX solo para la eliminación de los gérmenes de la piel en procedimientos invasivos, quirúrgicos e higienización de manos de los profesionales de salud.

Abstract Objective To verify microbiological culture positivity of hospitalized patients, with a nursing prescription for bed bath, in three disjoint and sequential periods of bed bath modalities: conventional (CBB), disposable (DBB) and disposable plus 2% chlorhexidine degerming (DBB-CX). Methods This is an ecological, time series study of 48 months, in three periods (P1=CBB; P2=DBB; P3=DBB-CX), with secondary data from electronic medical records of patients who were admitted to a hospital in the state of São Paulo, Brazil. Results In the periods of disposable baths, the percentage of culture positivity was, on average, 14.6% lower when compared to the months in which bed bath was conventional. In the DBB-CX period, the percentage of culture positivity was, on average, 19.3% lower when compared to the CBB period months. However, there is no evidence of difference in the percentage of culture positivity between DBB (b = -14.6%; 95%CI = (-18.9% to -10.3%) and DBB-CX (b = - 19.3%;95%CI = (-24.4% to -14.22%) For each year more in patients' mean age, the percentage of culture positivity increases by an average of 0.3% (p=0.060). There was no seasonal association for microbiological culture positivity in bath modalities. Conclusion Microbiological culture positivity in patients with a nursing prescription for bed bath is lower when disposable modalities are used. It is recommended to routinely adopt DBB, leaving the prescription of DBB-CX only for skin degermation for invasive and operative procedures and hand hygiene of health professionals.

Decontamination of stainless-steel bowls with 80% (w/v) alcohol for 30 s and 60 s: randomized experimental study.

OBJECTIVE: to compare the efficacy of 80% (w/v) alcohol, rubbed for 30 and 60 seconds, in the manual processing of stainless-steel wash bowls, after cleaning with running water and neutral detergent. METHOD: experimental study conducted in a hospital in the state of São Paulo, Brazil, on 50 bowls randomly divided into two groups of 25 bowls each for interventions of 30 and 60 seconds of rubbing with 80% (w/v) alcohol. RESULTS: based on the microbiological analyses collected, before and after the interventions for both groups, partial efficacy of the disinfectant was observed even when extending rubbing time. In both groups, there was a higher prevalence of survival of Pseudomonas aeruginosa, with 14 strains that were resistant to carbapenems, being, specifically, 11 to imipenem and three to meropenem. CONCLUSION: stainless-steel bed wash bowls decontaminated for reuse by 80% (w/v) alcohol, after cleaning with running water and neutral detergent, showed to be reservoirs of hospital pathogens. The use of bed wash bowls for patients with intact skin would not have worrying consequences, but considering those with non-intact skin and the contamination of professionals' hands, the results in this study justify the search for other decontamination methods or the adoption of disposable bed baths.

Clinical and microbiological factors predicting outcomes of nonfermenting gram-negative bacilli peritonitis in peritoneal dialysis.

Peritonitis due to gram-negative bacilli (GNB), particularly nonfermenting GNB (NF-GNB), is a serious complication of peritoneal dialysis with a low resolution rate. Beyond the patient's condition, microbiological properties such as antimicrobial resistance, biofilm production and other virulence factors can explain the poor outcomes. This study aimed to evaluate the influence of patient condition, microbiological characteristics, including biofilm production, and treatment on peritonitis outcome. We reviewed the records of 62 index episodes caused by NF-GNB that occurred between 1997 and 2015 in our center. The etiologies were species of Pseudomonas (51.6%), Acinetobacter (32.2%), and other NF-GNB (16.1%). There was a high (72.9%) proportion of biofilm producer lineages. The in vitro susceptibility rate of Pseudomonas spp. to amikacin, ciprofloxacin, and ceftazidime was significantly greater than that of Acinetobacter spp. and other species; however, there was a similar low resolution rate (< 45%) among the episodes attributable to them. Preexisting exit-site infection was independently associated with nonresolution. No other factor, including biofilm production, was associated with the outcome. The higher in vitro susceptibility of Pseudomonas compared to other NF-GNB that presented a similar resolution rate suggests that bacterial virulence factors such as biofilms can act in concert, thereby worsening the outcome.

Translation, cross-cultural adaptation and validation of the Cincinnati prehospital stroke scale in Brazil.

BACKGROUND: Use of internationally standardized instruments to assist healthcare professionals in accurately recognizing stroke early is recommended. The process of translation and cross-cultural adaptation is important for ensuring that scales are interpreted in the same way in different languages, thus ensuring applicability in several countries. OBJECTIVE: To translate into Brazilian Portuguese, cross-culturally adapt and validate the Cincinnati Prehospital Stroke Scale, using a representative sample of the Brazilian population. METHOD: The present study included patients with suspected stroke who were treated at a Brazilian emergency medical service and referred to a stroke center. A systematic process of translation and cross-cultural adaptation of the original scale and application of the final instrument was performed. Statistical analysis was used to assess the sensitivity, specificity and accuracy of the scale. Cohen's kappa coefficient was used to assess inter-rater reliability. RESULTS: After translation and cross-cultural adaptation, the scale was applied to 64 patients. It showed 93.0% accuracy and 92.4% sensitivity in relation to the final "gold standard" diagnosis. Cohen's kappa coefficient was calculated using data from 26 patients (40.6%) and showed excellent inter-rater reliability between items on the scale (0.8385 to 1.0000). CONCLUSION: The scale demonstrated excellent accuracy, sensitivity and inter-rater reliability. It was a useful tool for assisting healthcare professionals during initial assessments on patients with suspected stroke and significantly contributed to early recognition of stroke in a simple and quick manner.

Translation, cross-cultural adaptation and validation of the Cincinnati prehospital stroke scale in Brazil / Tradução, adaptação transcultural e validação da escala de Cincinnati no Brasil

ABSTRACT Background: Use of internationally standardized instruments to assist healthcare professionals in accurately recognizing stroke early is recommended. The process of translation and cross-cultural adaptation is important for ensuring that scales are interpreted in the same way in different languages, thus ensuring applicability in several countries. Objective: To translate into Brazilian Portuguese, cross-culturally adapt and validate the Cincinnati Prehospital Stroke Scale, using a representative sample of the Brazilian population. Method: The present study included patients with suspected stroke who were treated at a Brazilian emergency medical service and referred to a stroke center. A systematic process of translation and cross-cultural adaptation of the original scale and application of the final instrument was performed. Statistical analysis was used to assess the sensitivity, specificity and accuracy of the scale. Cohen's kappa coefficient was used to assess inter-rater reliability. Results: After translation and cross-cultural adaptation, the scale was applied to 64 patients. It showed 93.0% accuracy and 92.4% sensitivity in relation to the final "gold standard" diagnosis. Cohen's kappa coefficient was calculated using data from 26 patients (40.6%) and showed excellent inter-rater reliability between items on the scale (0.8385 to 1.0000). Conclusion: The scale demonstrated excellent accuracy, sensitivity and inter-rater reliability. It was a useful tool for assisting healthcare professionals during initial assessments on patients with suspected stroke and significantly contributed to early recognition of stroke in a simple and quick manner.

RESUMO Introdução: O uso de instrumentos padronizados internacionalmente para auxiliar os profissionais de saúde a reconhecer precocemente o AVC é recomendado. O processo de tradução e adaptação transcultural tem sido importante para garantir que a escala seja interpretada da mesma maneira em diferentes idiomas, assegurando sua aplicabilidade em vários países. Objetivo: Traduzir para o idioma português do Brasil, adaptar transculturalmente e validar a Cincinnati Prehospital Stroke Scale na população brasileira. Método: O estudo incluiu pacientes com suspeita de acidente vascular cerebral (AVC) atendidos por um Serviço de Atendimento Móvel Urgência (SAMU) 192 e encaminhados para uma Unidade de Cuidado Integral ao AVC. Foram realizados um processo sistemático de tradução e adaptação transcultural da escala original e a aplicação do instrumento final, que possibilitou a realização dos testes de sensibilidade, especificidade e acurácia, de acordo com o estudo original, além do índice de Cohen de Kappa, para avaliar a confiabilidade interobservador. Resultados: Após a tradução e a adaptação transcultural, a escala foi aplicada em 64 pacientes, apresentando acurácia de 93,0% e sensibilidade de 92,4% em relação ao diagnóstico final, considerado padrão-ouro. Em 26 pacientes (40,6%) foi possível calcular o índice de Cohen de Kappa, evidenciando excelente confiabilidade interobservador entre os itens da escala (0,8385 a 1,0000). Conclusão: A escala apresenta ótima acurácia, sensibilidade e concordância interobservador. Trata-se de um instrumento útil para auxiliar os profissionais da saúde durante a avaliação inicial do paciente com suspeita de AVC, uma vez que contribui significativamente para o reconhecimento precoce da doença de uma maneira simples e rápida.

Incidence and characteristics of methicillin-resistant coagulase-negative Staphylococcus aureus in peritoneal dialysis-associated peritonitis in a single center using molecular methods.

PURPOSE: Peritonitis is a serious complication of peritoneal dialysis and coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-infections in many centers. This study aimed to investigate the molecular epidemiology of CNS isolated from PD-peritonitis in a Brazilian single center, focusing on the genetic determinants conferring methicillin resistance. METHODS: Bacterial strains were isolated from peritoneal fluid of patients presenting PD-peritonitis, identified by phenotypic and molecular methods, and those identified as CNS were submitted to mecA detection, SCCmec, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS: Over the 18-year period of this study (1995-2011), a total of 878 peritonitis episodes were diagnosed in this unit, 115 were caused by coagulase-negative staphylococci of which 72 by Staphylococcus epidermidis. mecA gene was detected in 55 CNS (47.8%), more frequently on the more recent years. SCCmec type III was the most frequent cassette, followed by SCCmec type IV and SCCmec type II. A diverstity of pulsotypes was observed among the S. epidermidis isolates, but five clusters (based on the 80% cutoff) were identified. Diversified sequence types (ST02, ST05, ST06, ST09, ST23, ST59 and ST371) were detected. CONCLUSIONS: Detection of SCCmec type III among coagulase-negative Staphylococcus underscores the role of hospital environments as potential source of methicillin-resistant Staphylococcus causing peritonitis in PD patients.

Decontamination of stainless-steel bowls with 80% (w/v) alcohol for 30 s and 60 s: randomized experimental study / Descontaminação de bacias inoxidáveis com álcool 80% (p/v) por 30 s e 60 s: estudo experimental randomizado / Descontaminación de palanganas de acero inoxidable con alcohol al 80% (p/v) durante 30 s y 60 s: estudio experimental aleatorizado

Objective: to compare the efficacy of 80% (w/v) alcohol, rubbed for 30 and 60 seconds, in the manual processing of stainless-steel wash bowls, after cleaning with running water and neutral detergent. Method: experimental study conducted in a hospital in the state of São Paulo, Brazil, on 50 bowls randomly divided into two groups of 25 bowls each for interventions of 30 and 60 seconds of rubbing with 80% (w/v) alcohol. Results: based on the microbiological analyses collected, before and after the interventions for both groups, partial efficacy of the disinfectant was observed even when extending rubbing time. In both groups, there was a higher prevalence of survival of Pseudomonas aeruginosa, with 14 strains that were resistant to carbapenems, being, specifically, 11 to imipenem and three to meropenem. Conclusion: stainless-steel bed wash bowls decontaminated for reuse by 80% (w/v) alcohol, after cleaning with running water and neutral detergent, showed to be reservoirs of hospital pathogens. The use of bed wash bowls for patients with intact skin would not have worrying consequences, but considering those with non-intact skin and the contamination of professionals' hands, the results in this study justify the search for other decontamination methods or the adoption of disposable bed baths.

Objetivo: comparar a eficácia do álcool 80% (p/v), friccionado por 30 e 60 segundos, no processamento manual de bacias de banho em aço inoxidável, após limpeza com água corrente e detergente neutro. Método: estudo experimental realizado em hospital do estado de São Paulo, Brasil, com 50 bacias randomicamente distribuídas em dois grupos de 25, para as intervenções de 30 e 60 segundos de fricção com álcool 80% (p/v). Resultados: das análises microbiológicas coletadas, antes e após as intervenções para os dois grupos, verificou-se eficácia parcial do desinfetante, mesmo ampliando o tempo de fricção. Em ambos os grupos, observou-se maior prevalência de sobrevida de Pseudomonas aeruginosa, 14 cepas resistentes a carbapenens, especificamente, 11 ao imipenen e três ao meropenen. Conclusão: bacias de banho no leito em aço inoxidável, descontaminadas para reuso com álcool 80% (p/v), após limpeza com água corrente e detergente neutro, apresentam-se como reservatórios de patógenos hospitalares. O uso das bacias de banho no leito para pacientes com pele íntegra não teria consequências preocupantes, mas para aqueles com pele não íntegra e pensando na contaminação das mãos dos profissionais, os resultados dessa pesquisa justificam a busca de outros métodos de descontaminação ou a adoção de banho de leito descartável.

Objetivo: comparar la eficacia del alcohol al 80% (p/v), frotado durante 30 y 60 segundos, en el proceso de descontaminación manual de palanganas de baño de acero inoxidable, después de lavarlas con agua corriente y detergente neutro. Método: estudio experimental realizado en un hospital del estado de São Paulo, Brasil, con 50 palanganas divididas aleatoriamente en dos grupos de 25, para intervenciones de 30 y 60 segundos de frotamiento con alcohol al 80% (p/v). Resultados: los análisis microbiológicos recolectados, antes y después de las intervenciones para ambos grupos, demostraron efectividad parcial del desinfectante, incluso cuando se extendió el tiempo de fricción. En ambos grupos, se observó una mayor prevalencia de supervivencia de Pseudomonas aeruginosa, 14 cepas resistentes a carbapenemas, específicamente 11 a imipenem y tres a meropenem. Conclusión: las palanganas de baño de cama de acero inoxidable, descontaminadas para su reutilización con alcohol al 80% (p/v), después del lavado con agua corriente y detergente neutro, actúan como reservorios de patógenos hospitalarios. El uso de las palanganas de baño de cama no tendría consecuencias preocupantes para pacientes con la piel íntegra, pero para aquellos cuya piel no conserva su integridad y pensando en la contaminación de las manos de los profesionales, los resultados de esta investigación justifican la búsqueda de otros métodos de descontaminación o la adopción del baño de cama desechable.

Concordance analysis between dosed serum bicarbonate and that calculated by gas analysis in chronic renal patients / Análise de concordância entre o bicarbonato sérico dosado e o calculado pela gasometria em pacientes renais crônicos

Abstract Introduction: The control of metabolic acidosis in dialysis patients focuses on the supply of bicarbonate during the dialysis session, and it is not standard in all hemodialysis to assess serum bicarbonate concentrations. Bicarbonate expressed in blood gas analysis is the most sensitive standard of analysis and it is measured indirectly, using the Henderson-Hasselbalch equation. There are no studies in this population evaluating the concordance between the calculated bicarbonate with the direct method of biochemical analysis. The aim of this study was to analyze the concordance between the measured and calculated serum bicarbonate levels using blood gas analysis. Methods: We analyzed blood samples from chronic kidney patients undergoing hemodialysis, using the same sample of bicarbonate analysis by biochemistry and gasometry. The concordance was assessed using the Bland-Altman method. Results: 51 samples were analyzed. The analysis revealed a high correlation (r = 0.73) and a mean difference (bias) of 1.15 ± 3 mmol/L. The median time between collection and examination was 241 minutes. Discussion: We can conclude that the biochemical bicarbonate analysis compared to that calculated from blood gas analysis in chronic renal patients was consistent. For greater concordance between the data, it is important that the time between the collection of the samples and the referral to the laboratory for carrying out the dosages does not exceed four hours. The serum bicarbonate dosage can result in cost savings when compared to that of bicarbonate in blood gas analysis.

Resumo Introdução: O controle da acidose metabólica em pacientes dialíticos está voltado, principalmente, para o suprimento de bicarbonato durante a sessão de diálise, não sendo padrão em todas as hemodiálises avaliar as concentrações séricas do bicarbonato. O bicarbonato expresso na gasometria é considerado o padrão mais sensível de análise e é medido indiretamente por meio da equação de Henderson-Hasselbalch. Não há estudos nessa população avaliando a concordância do bicarbonato calculado com o método direto de análise bioquímica. O objetivo deste estudo é analisar a concordância entre o bicarbonato sérico medido e o calculado por meio da gasometria. Métodos: Foram analisadas amostras de sangue de pacientes renais crônicos em hemodiálise sendo feito na mesma amostra de análise do bicarbonato pela bioquímica e análise pela gasometria. A concordância foi avaliada pelo método de Bland-Altman. Resultados: Foram analisados um total de 51 amostras. A análise de correlação revelou alta correlação (r = 0.73) e a diferença média (bias) de 1.15 ± 3 mmol/L. O tempo mediano entre a realização da coleta e do exame foi de 241 minutos. Discussão: Podemos concluir que a realização da dosagem bioquímica do bicarbonato comparada com a calculada a partir da gasometria em pacientes renais crônicos foi concordante. Para maior concordância entre os dados, é importante que o tempo entre a coleta das amostras e o encaminhamento ao laboratório para a realização das dosagens não exceda quatro horas. A dosagem do bicarbonato sérico pode resultar numa economia de custos comparada à do bicarbonato da gasometria.

Concordance analysis between dosed serum bicarbonate and that calculated by gas analysis in chronic renal patients.

INTRODUCTION: The control of metabolic acidosis in dialysis patients focuses on the supply of bicarbonate during the dialysis session, and it is not standard in all hemodialysis to assess serum bicarbonate concentrations. Bicarbonate expressed in blood gas analysis is the most sensitive standard of analysis and it is measured indirectly, using the Henderson-Hasselbalch equation. There are no studies in this population evaluating the concordance between the calculated bicarbonate with the direct method of biochemical analysis. The aim of this study was to analyze the concordance between the measured and calculated serum bicarbonate levels using blood gas analysis. METHODS: We analyzed blood samples from chronic kidney patients undergoing hemodialysis, using the same sample of bicarbonate analysis by biochemistry and gasometry. The concordance was assessed using the Bland-Altman method. RESULTS: 51 samples were analyzed. The analysis revealed a high correlation (r = 0.73) and a mean difference (bias) of 1.15 ± 3 mmol/L. The median time between collection and examination was 241 minutes. DISCUSSION: We can conclude that the biochemical bicarbonate analysis compared to that calculated from blood gas analysis in chronic renal patients was consistent. For greater concordance between the data, it is important that the time between the collection of the samples and the referral to the laboratory for carrying out the dosages does not exceed four hours. The serum bicarbonate dosage can result in cost savings when compared to that of bicarbonate in blood gas analysis.

Genomic and Clinical Characterization of IMP-1-Producing Multidrug-Resistant Acinetobacter bereziniae Isolates from Bloodstream Infections in a Brazilian Tertiary Hospital.

Acinetobacter baumannii is the main species of the Acinetobacter genus; however, non-baumannii Acinetobacter (NBA) species causing infections have been described for the past years, as well as antimicrobial resistance. In this study, we describe the occurrence of two multidrug-resistant (MDR) IMP-1-producing Acinetobacter bereziniae isolates recovered from bloodstream infections in different patients but in the same intensive care unit among 134 carbapenem-resistant Acinetobacter screened. Antimicrobial susceptibility testing revealed resistance to carbapenems, extended spectrum, and antipseudomonad cephalosporins, amikacin, and trimethoprim-sulfamethoxazole. Both A. bereziniae isolates shared the same ApaI-pulsed-field gel electrophoresis (PFGE) pattern. Whole-genome sequencing of both isolates revealed that blaIMP-1 was embedded into an In86 Class I integron carrying also sul1, aac(6')-31, and aadA genes. A new sequence type (ST1309 Pasteur) was deposited. The virulence genes lpxC and ompA, seen in A. baumannii, were detected in the A. bereziniae strains. Recognition of A. bereziniae causing invasive MDR infection underscores the role of NBA species as human pathogens especially in at-risk patients.

Detection of the mecA gene and identification of Staphylococcus directly from blood culture bottles by multiplex polymerase chain reaction.

INTRODUCTION: Staphylococcus spp. - both S. aureus, including methicillin-resistant strains (MRSA) and coagulase negative staphylococci (CoNS) - are relevant agents of healthcare-associated infections. Therefore, the rapid recognition of MRSA and methicillin-resistant CoNS from blood stream infections is critically important for patient management. It is worth noting that inappropriate empiric therapy has been associated with higher in-hospital mortality. MATERIAL AND METHODS: In this study we evaluated a multiplex polymerase chain reaction (multiplex PCR) standardized to detect Staphylococcus spp., S. aureus, and mecA gene-encoded oxacillin resistance directly from blood culture bottles. A total of 371 blood cultures with Gram-positive microorganisms confirmed by Gram-stain were analyzed. Results from multiplex PCR were compared to phenotypic characterization of isolates. RESULTS: Staphylococcus aureus was detected in 85 (23.0%) blood cultures and CoNS in 286 (77.0%). There was 100% agreement between phenotypic and multiplex PCR identification. Forty-three (50.6%) of the 85 S. aureus carried the mecA gene and among the 286 CoNS, 225 (78.7%) were positive for the mecA gene. CONCLUSIONS: The multiplex PCR assay developed here was found to be sensitive, specific, rapid, and showed good agreement with the phenotypic results besides being less expensive. This PCR method could be used in clinical laboratories for rapid identification and initiation of specific and effective treatment, reducing patient mortality and morbidity. Furthermore, this method may reduce misuse of antimicrobial classes that are more expensive and toxic, thus contributing to the selection of antibiotic-resistant Staphylococcus spp.

Detection of the mecA gene and identification of Staphylococcus directly from blood culture bottles by multiplex polymerase chain reaction

ABSTRACT Introduction: Staphylococcus spp. - both S. aureus, including methicillin-resistant strains (MRSA) and coagulase negative staphylococci (CoNS) - are relevant agents of healthcare-associated infections. Therefore, the rapid recognition of MRSA and methicillin-resistant CoNS from blood stream infections is critically important for patient management. It is worth noting that inappropriate empiric therapy has been associated with higher in-hospital mortality. Material and methods: In this study we evaluated a multiplex polymerase chain reaction (multiplex PCR) standardized to detect Staphylococcus spp., S. aureus, and mecA gene-encoded oxacillin resistance directly from blood culture bottles. A total of 371 blood cultures with Gram-positive microorganisms confirmed by Gram-stain were analyzed. Results from multiplex PCR were compared to phenotypic characterization of isolates. Results: Staphylococcus aureus was detected in 85 (23.0%) blood cultures and CoNS in 286 (77.0%). There was 100% agreement between phenotypic and multiplex PCR identification. Forty-three (50.6%) of the 85 S. aureus carried the mecA gene and among the 286 CoNS, 225 (78.7%) were positive for the mecA gene. Conclusions: The multiplex PCR assay developed here was found to be sensitive, specific, rapid, and showed good agreement with the phenotypic results besides being less expensive. This PCR method could be used in clinical laboratories for rapid identification and initiation of specific and effective treatment, reducing patient mortality and morbidity. Furthermore, this method may reduce misuse of antimicrobial classes that are more expensive and toxic, thus contributing to the selection of antibiotic-resistant Staphylococcus spp.

Eficácia do banho no leito descartável na carga microbiana: ensaio clínico / Eficacia del baño en cama descartable respecto de la carga microbiana: ensayo clínico / Effectiveness of bag bath on microbial load: clinical trial

Resumo Objetivo: Avaliar a eficácia do banho no leito descartável sobre a carga microbiana da pele de pacientes hospitalizados. Métodos: Ensaio clínico paralelo, randomizado em grupo intervenção (banho no leito descartável) e grupo controle (banho no leito convencional), realizado em Hospital Público de São Paulo, Brasil, de novembro de 2014 a dezembro de 2015. Participaram deste estudo pacientes hospitalizados, adultos e idosos, acamados e dependentes do procedimento. Bag Bath® foi o produto avaliado. Resultados: A carga microbiana nos grupos de seguimento: intervenção (20 pacientes) reduziu, enquanto a no controle (20 pacientes) aumentou significantemente (p<0,001). Estimou-se em 90% a eficácia do produto para banho de leito descartável, comparada à de 20% do banho no leito convencional. Conclusão: A eficácia do produto avaliado foi 4,5 vezes maior sobre a carga microbiana da pele de pacientes hospitalizados, quando comparada à do banho no leito convencional, sinalizando à Enfermagem a necessidade de revisar esse procedimento.

Resumen Objetivo: Evaluar la eficacia del baño en cama descartable respecto de la carga microbiana en la piel de pacientes hospitalizados. Métodos: Ensayo clínico paralelo, randomizado en grupo intervención (baño en cama descartable) y grupo control (baño en cama convencional), realizado en Hospital Público de São Paulo, Brasil, de noviembre 2014 a diciembre 2015. Participaron pacientes hospitalizados, adultos y ancianos, en cama y dependientes del procedimiento. El producto evaluado fue Bag Bath®. Resultados: La carga microbiana de los grupos en seguimiento: intervención (20 pacientes) se redujo, mientras que control (20 pacientes) aumentó significativamente (p<0,001). Se estimó la eficacia del producto para baño en cama descartable en 90%, en tanto que fue del 20% en la cama convencional. Conclusión: La eficacia del producto evaluado fue 4,5 veces mayor sobre la carga microbiana de la piel de pacientes hospitalizados, comparada con baño en cama convencional, determinando Enfermería la necesidad de revisar dicho procedimiento.

Abstract Objective: To assess the effectiveness of bag bath on inpatient skin microbial load. Methods: This was a parallel, randomized clinical trial with an intervention group (bag bath) and a control group (conventional bed bath), conducted in a public hospital in São Paulo, Brazil, from November 2014 to December 2015. The participants were adult and older inpatients, bedridden and depending on the procedure. The product assessed was Bag Bath®. Results: The microbial load decreased in the intervention group (20 patients), while it increased significantly (p < 0.001) in the control group (20 patients). The estimated efficacy of the product for bag bath was 90%, compared with 20% for the conventional bed bath. Conclusion: The product assessed was 4.5 times more effective to decrease the inpatient skin microbial load when compared with the conventional bed bath, suggesting the need for nursing teams to re-evaluate this procedure.

Emergence and Persistence of High-Risk Clones Among MDR and XDR A. baumannii at a Brazilian Teaching Hospital.

Dissemination of carbapenem-resistant Acinetobacter baumannii is currently one of the priority themes discussed around the world, including in Brazil, where this pathogen is considered endemic. A total of 107 carbapenem-resistant A. baumannii (CRAB) isolates were collected from patients with bacteraemia attended at a teaching hospital in Brazil from 2008 to 2014. From these samples, 104 (97.2%) carried bla OXA-23-like, all of them associated with ISAba1 The bla OXA-231 (1.9%) and bla OXA-72 (0.9%) genes were also detected in low frequencies. All isolates were susceptible to minocycline, and 38.3% of isolates presented intermediate susceptibility to tigecycline (MIC = 4 µg/ml). Molecular typing assessed by multi-locus sequence typing demonstrated that the strains were mainly associated with clonal complexes CC79 (47.4%), followed by CC1 (16.9%), and CC317 (18.6%), belonging to different pulsotypes and in different prevalences over the years. Changes in the clones' prevalence reinforce the need of identifying and controlling CRAB in hospital settings to preserve the already scarce therapeutic options available.

Correlation of phenotypic tests with the presence of the blaZ gene for detection of beta-lactamase

Abstract Staphylococcus aureus and Staphylococcus saprophyticus are the most common and most important staphylococcal species associated with urinary tract infections. The objective of the present study was to compare and to evaluate the accuracy of four phenotypic methods for the detection of beta-lactamase production in Staphylococcus spp. Seventy-three strains produced a halo with a diameter ≤28 mm (penicillin resistant) and all of them were positive for the blaZ gene. Among the 28 susceptible strain (halo ≥29 mm), 23 carried the blaZ gene and five did not. The zone edge test was the most sensitive (90.3%), followed by MIC determination (85.5%), but the specificity of the former was low (40.0%). The nitrocefin test was the least sensitive (28.9%). However, the nitrocefin test together with the disk diffusion method showed the highest specificity (100%). The present results demonstrated that the zone edge test was the most sensitive phenotypic test for detection of beta-lactamase, although it is still not an ideal test to detect this type of resistance since its specificity was low. However, the inhibition halo diameter of the penicillin disk can be used together with the zone edge test since the same disk is employed in the two tests. Combined analysis of the two tests shows a sensitivity of 90.3% and specificity of 100%, proving better sensitivity, especially for S. saprophyticus. This is a low-cost test of easy application and interpretation that can be used in small and medium-sized laboratories where susceptibility testing is usually performed by the disk diffusion method.

Correlation of phenotypic tests with the presence of the blaZ gene for detection of beta-lactamase.

Staphylococcus aureus and Staphylococcus saprophyticus are the most common and most important staphylococcal species associated with urinary tract infections. The objective of the present study was to compare and to evaluate the accuracy of four phenotypic methods for the detection of beta-lactamase production in Staphylococcus spp. Seventy-three strains produced a halo with a diameter ≤28mm (penicillin resistant) and all of them were positive for the blaZ gene. Among the 28 susceptible strain (halo ≥29mm), 23 carried the blaZ gene and five did not. The zone edge test was the most sensitive (90.3%), followed by MIC determination (85.5%), but the specificity of the former was low (40.0%). The nitrocefin test was the least sensitive (28.9%). However, the nitrocefin test together with the disk diffusion method showed the highest specificity (100%). The present results demonstrated that the zone edge test was the most sensitive phenotypic test for detection of beta-lactamase, although it is still not an ideal test to detect this type of resistance since its specificity was low. However, the inhibition halo diameter of the penicillin disk can be used together with the zone edge test since the same disk is employed in the two tests. Combined analysis of the two tests shows a sensitivity of 90.3% and specificity of 100%, proving better sensitivity, especially for S. saprophyticus. This is a low-cost test of easy application and interpretation that can be used in small and medium-sized laboratories where susceptibility testing is usually performed by the disk diffusion method.

Comparison of methods for the identification of microorganisms isolated from blood cultures.

BACKGROUND: Bloodstream infections are responsible for thousands of deaths each year. The rapid identification of the microorganisms causing these infections permits correct therapeutic management that will improve the prognosis of the patient. In an attempt to reduce the time spent on this step, microorganism identification devices have been developed, including the VITEK(®) 2 system, which is currently used in routine clinical microbiology laboratories. METHODS: This study evaluated the accuracy of the VITEK(®) 2 system in the identification of 400 microorganisms isolated from blood cultures and compared the results to those obtained with conventional phenotypic and genotypic methods. In parallel to the phenotypic identification methods, the DNA of these microorganisms was extracted directly from the blood culture bottles for genotypic identification by the polymerase chain reaction (PCR) and DNA sequencing. RESULTS: The automated VITEK(®) 2 system correctly identified 94.7 % (379/400) of the isolates. The YST and GN cards resulted in 100 % correct identifications of yeasts (15/15) and Gram-negative bacilli (165/165), respectively. The GP card correctly identified 92.6 % (199/215) of Gram-positive cocci, while the ANC card was unable to correctly identify any Gram-positive bacilli (0/5). CONCLUSIONS: The performance of the VITEK(®) 2 system was considered acceptable and statistical analysis showed that the system is a suitable option for routine clinical microbiology laboratories to identify different microorganisms.