Comparison of bacterial profile of gallbladder with gallstones from patients undergoing cholecystectomy due to complicated and uncomplicated cholelithiasis: changes in the epidemiological scenario.

INTRODUCTION: cholelithiasis is a highly prevalent disease of the digestive system in the world. In Brazil, it is a routine condition, whose studies suggest a prevalence of around 10% of adults. Colonization of bile and gallstone pathogens can occur when there is bacterial stasis and proliferation. This proliferation is facilitated by the adhesion and biofilm formation capacity of some bacteria. There are also lithogenic processes that involve bacterial participation. Studies have shown changes in the microbiota of the gallbladder of patients undergoing cholecystectomy, which may impact empirical treatment with antibiotics. METHODOLOGY: microbiological analyzes of the sonication fluid of the gallstones and of two samples with bile were performed. Identification and antimicrobial susceptibility testing were performed according to a standard routine. RESULTS: of the 34 patients, 76.4% were female. The age group was 48 years +/- 16.61. Acute cholecystitis occurred in 50% of cases. Bactobilia was evidenced in 32.1% of the cases. Klebisiella pneumoniae was noted as the most prevalent pathogen in acute cholecystitis; and Enterobacter sp, in cases of uncomplicated cholelithiasis. Greater sensitivity was obtained in the search for microorganisms in the sonication fluid samples of the stones in relation to the bile samples (p=0.0058). CONCLUSION: there was a higher prevalence of bactobilia in patients with acute cholecystitis compared to those with uncomplicated cholelithiasis. The use of sonication in bacterial investigation proved to be superior to the conventional method and can be considered.

Comparison of bacterial profile of gallbladder with gallstones from patients undergoing cholecystectomy due to complicated and uncomplicated cholelithiasis: changes in the epidemiological scenario / Perfil bacteriano da vesícula biliar e dos cálculos biliares de pacientes submetidos à colecistectomia por colelitíase complicada e não complicada: mudanças no cenário epidemiológico

ABSTRACT Introduction: cholelithiasis is a highly prevalent disease of the digestive system in the world. In Brazil, it is a routine condition, whose studies suggest a prevalence of around 10% of adults. Colonization of bile and gallstone pathogens can occur when there is bacterial stasis and proliferation. This proliferation is facilitated by the adhesion and biofilm formation capacity of some bacteria. There are also lithogenic processes that involve bacterial participation. Studies have shown changes in the microbiota of the gallbladder of patients undergoing cholecystectomy, which may impact empirical treatment with antibiotics. Methodology: microbiological analyzes of the sonication fluid of the gallstones and of two samples with bile were performed. Identification and antimicrobial susceptibility testing were performed according to a standard routine. Results: of the 34 patients, 76.4% were female. The age group was 48 years +/- 16.61. Acute cholecystitis occurred in 50% of cases. Bactobilia was evidenced in 32.1% of the cases. Klebisiella pneumoniae was noted as the most prevalent pathogen in acute cholecystitis; and Enterobacter sp, in cases of uncomplicated cholelithiasis. Greater sensitivity was obtained in the search for microorganisms in the sonication fluid samples of the stones in relation to the bile samples (p=0.0058). Conclusion: there was a higher prevalence of bactobilia in patients with acute cholecystitis compared to those with uncomplicated cholelithiasis. The use of sonication in bacterial investigation proved to be superior to the conventional method and can be considered.

RESUMO Introdução: a colelitíase é uma doença do sistema digestivo de alta prevalência no mundo. No Brasil, trata-se de uma condição rotineira, cujos estudos sugerem uma prevalência em torno de 10% dos adultos. A colonização de patógenos da bile e do cálculo biliar pode ocorrer quando há estase e proliferação bacteriana. Esta proliferação é facilitada pela capacidade de adesão e de formação de biofilme de algumas bactérias. Também há processos litogênicos que envolvem a participação bacteriana. Estudos evidenciaram mudanças na microbiota da vesícula biliar de pacientes submetidos à colecistectomia, o que pode impactar no tratamento empírico com antibióticos. Metodologia: Realizou-se análises microbiológicas do fluido de sonicação dos cálculos biliares e de duas amostras com bile. A identificação e o teste de sensibilidade aos antimicrobianos foram realizados de acordo com uma rotina padrão. Resultados: Nos 34 pacientes, 76,4% deles foram do sexo feminino. A faixa etária foi de 48 anos +/- 16,61. A colecistite aguda ocorreu em 50% dos casos. A bactobilia foi evidenciada em 32,1% dos casos. Notou-se Klebisiella pneumoniae como o patógeno mais prevalente em quadros de colecistite aguda; e Enterobacter sp, nos casos de colelitíase não complicada. Obteve-se maior sensibilidade na pesquisa de microrganismos nas amostras de fluido de sonicação dos cálculos em relação às de bile (p=0,0058). Conclusão: Houve maior prevalência de bactobilia nos pacientes com colecistite aguda em relação àqueles com colelitíase não complicada. A utilização da sonicação na investigação bacteriana se mostrou superior ao método convencional e pode ser considerada.

Impact of negative pressure system on microbiological air quality in a Central Sterile Supply Department.

OBJECTIVE: Guidelines recommend that the cleaning area in a Central Sterile Supply Department (CSSD) maintain a negative pressure of the environmental air, but how much this system can impact the contamination of the air by bioaerosols in the area is not known. The objective of this study was to assess the impact of negative pressure on CSSD by evaluating the microbiological air quality of this sector. METHODS: Microbiological air samples were collected in two CSSD in the same hospital: one with and one without a negative air pressure system. Outdoor air samples were collected as a comparative control. Andersen six-stage air sampler was used to obtain the microbiological air samples. RESULTS: The concentration of bioaerosols in the CSSD without negative pressure was 273.15 and 206.71 CFU/m3 , while in the CSSD with negative pressure the concentration of bioaerosols was 116.96 CFU/m3 and 131.10 CFU/m3 . The number of isolated colonies in the negative pressure CSSD was significantly lower (P = .01541). CONCLUSION: The findings showed that the negative pressure system in the CSSD cleaning area contributed to the quantitative reduction in bioaerosols. However, the concentration of bioaerosols was lower than that established in the guideline for indoor air quality of many countries. Therefore, it cannot be concluded that CSSDs which do not have a negative pressure system in their cleaning area offer occupational risk.

High prevalence of clindamycin resistance in Staphylococcus aureus blood culture isolates in São Paulo, Brazil.

BACKGROUND: Clindamycin has become an important antimicrobial option for the treatment of Staphylococcus aureus. However, little is known about the current patterns of clindamycin-susceptibility in S. aureus invasive isolates, both in our country and in other developing countries in the world. AIMS: The aim of this study was to determine the prevalence of constitutive and inducible clindamycin resistance in methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) blood culture isolates in São Paulo, Brazil. MATERIALS AND METHODS: From July 2011 to June 2012, all S. aureus isolates from blood cultures collected at our hospital were included in the study. Antimicrobial susceptibility testing was performed according to recommendations of the Clinical and Laboratory Standards Institute. RESULTS: Total prevalence of clindamycin resistance was 68%, including 7.2% with inducible resistance. In MRSA resistance rate was 90.8% whereas in MSSA the rate was 32.7%. CONCLUSIONS: Our high prevalence of clindamycin resistance highlights the importance of performing D-test in a routine base, as well of maintaining continued surveillance for the prevalence of clindamycin resistance.

Enterococcus spp. and S. aureus colonization in neutropenic febrile children with cancer.

INTRODUCTION: Febrile neutropenia is one of the most serious treatment-related complications in cancer patients. Susceptible to rapidly progressing infections, which result in prolonged hospitalization and use of broad-spectrum antibiotics, neutropenic patients are subject to colonization by multiresistant agents, which enhances the risk of infections. METHODS: In this study we included samples collected with nasal, oropharyngeal and anal swabs from hospitalized children with febrile neutropenia following chemotherapy, between March 2014 and 2015, aiming to elucidate colonization by S. aureus and Enterococcus spp., as well as their resistance profile. RESULTS: S. aureus was found in 22% of the patients and 14% of the events. Methicillin-resistant S. aureus colonized 13.6% of patients. Including anal swabs in the screening increased the identification of colonized patients by 20%. Enterococcus spp. was found in 27% of patients and 17% of episodes. Enterococcal isolates resistant to vancomycin, accounting for 25% of the total, were not isolated in anal swabs at any time, with the oropharyngeal site being much more important. The rate of infection by Enterococcus spp. was 4.5% of all patients and 16% among the colonized patients. CONCLUSION: Especially in this population, colonization studies including more sites can yield a higher chance of positive results. Establishing the colonization profile in febrile neutropenic children following chemotherapy may help to institute an empirical antibiotic treatment aimed at antibiotic adequacy and lower induction of resistance, thereby decreasing the risk of an unfavorable clinical outcome.

Accuracy of a vancomycin brain heart infusion screening plate for the screening of Staphylococcus aureus isolates with increased vancomycin minimum inhibitory concentrations.

Vancomycin susceptibility was determined in 125 S. aureus isolates by disk diffusion, microdilution, Etest and vancomycin brain heart infusion (BHI) plate. A 2.0 mg/L vancomycin BHI was highly sensitive (100% and 91% compared to Etest and microdilution) for detecting a MIC≥2 mg/L, and could be used as a simple and affordable screening test.

Vancomycin minimum inhibitory concentrations and lethality in Staphylococcus aureus bacteremia.

BACKGROUND: After the dissemination of penicillin and oxacillin resistance in Staphylococcus aureus, vancomycin-intermediate and vancomycin resistant isolates have been reported. Even between isolates with minimum inhibitory concentrations (MICs) within the susceptible range, some authors have demonstrated that higher MICs correlate with higher lethality. METHODS: To test this hypothesis in our setting, we compared vancomycin MICs evaluated by two methods and clinical outcomes in hospitalized patients with S. aureus bacteremia. RESULTS: We compared lethality in patients infected with isolates that had MICs under or over 2 mg/L. Among patients infected with isolates that had microdilution MICs <2 mg/L, the lethality was 25%; among patients infected with strains that had microdilution MICs ≥2 mg/L, 33% died. Among patients infected with isolates that had Etest MICs <2 mg/L, 23% died; in comparison, patients infected with strains that had Etest MICs ≥2 mg/L had a lethality of 44%. CONCLUSION: Our results showed a slight tendency of higher lethality when higher MICs were present. However, this difference did not reach statistical significance, possibly due to the relatively small number of patients included in the study. Future prospective studies are needed to further evaluate this correlation and to help clinicians guide antimicrobial therapy.

The use of ozonized oil in the treatment of dermatophitosis caused by Microsporum canis in rabbits

The ozone is effective against most microorganisms due to its high oxidant power. Low concentrations and short-term contact are sufficient to inactivate bacteria, mold, yeast, parasites, seaweeds, protozoa and fungi. Microsporum canis is an important agent of dermatophitosis in human and animal. The aim of the current study was to assess the efficacy of ozonized oil over Microsporum canis in rabbits. Eighteen male New Zealand white rabbits, weight ranging from 2 to 3.2 kg were depilated in the cranial dorso-lateral and right caudal, and cranial and left caudal regions. The regions were inoculated with Microsporum canis, excepting the right caudal region, and were denominated TM, O, OM and M, respectively. After seven days, the treatment of lesions in TM began with 0.12g of terbinaphine 1 percent cream; in OM and O with 0.12g of ozonized oil; all animals were treated once a day for 28 days. Region M was not treated. Material was collected from those regions for cultivation in Sabouraud agar at day 28 of treatment. In the evolution of the treatment with terbinaphine, of 14 contaminated regions with Microsporum canis ten evolved to cure. With the ozonized oil, of 15 contaminations, four were cured. Clinically, that is, the macroscopic evaluation of lesions showed improvement in the TM and OM treated regions. We can conclude that there was statistical evidence of the protection action of the oil against the dermatophyte.

The use of ozonized oil in the treatment of dermatophitosis caused by microsporum canis in rabbits.

The ozone is effective against most microorganisms due to its high oxidant power. Low concentrations and short-term contact are sufficient to inactivate bacteria, mold, yeast, parasites, seaweeds, protozoa and fungi. Microsporum canis is an important agent of dermatophitosis in human and animal. The aim of the current study was to assess the efficacy of ozonized oil over Microsporum canis in rabbits. Eighteen male New Zealand white rabbits, weight ranging from 2 to 3.2 kg were depilated in the cranial dorso-lateral and right caudal, and cranial and left caudal regions. The regions were inoculated with Microsporum canis, excepting the right caudal region, and were denominated TM, O, OM and M, respectively. After seven days, the treatment of lesions in TM began with 0.12g of terbinaphine 1% cream; in OM and O with 0.12g of ozonized oil; all animals were treated once a day for 28 days. Region M was not treated. Material was collected from those regions for cultivation in Sabouraud agar at day 28 of treatment. In the evolution of the treatment with terbinaphine, of 14 contaminated regions with Microsporum canis ten evolved to cure. With the ozonized oil, of 15 contaminations, four were cured. Clinically, that is, the macroscopic evaluation of lesions showed improvement in the TM and OM treated regions. We can conclude that there was statistical evidence of the protection action of the oil against the dermatophyte.

Analysis of the bactericidal effect of ozone pneumoperitoneum.

PURPOSE: To assess the bactericidal action of ozone pneumoperitonium, and to compare the results with CO2. METHODS: It was used 36 Wistar rats. The animals, under anesthesia, were inoculated with 2ml of E. coli ATCC at a concentration of 10(10)UFC, and 1ml of BaSO4, into the peritoneal cavity. They were divided into three groups: Group 1, CO2 pneumoperitoneum was performed for 15 minutes; Group 2, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 42microg/ml, and Group 3, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 62microg/ml. Six animals from each group were sacrificed after the experiment, and the remaining 6 observed for 24 hours. Material was collected from the cavity of all animals for microbiological study. RESULTS: Ozone presented a greater bactericidal effect than CO2 in those animals sacrificed immediately after pneumoperitoneum. In the animals studied 24 hours after pneumoperitoneum evidenced no difference in bactericidal effect between the two gases. Moreover, no difference in mortality was observed. CONCLUSION: Ozone has a more potent bactericidal effect than carbon dioxide gas, although this did not influence survival of the animals.

Analysis of the bactericidal effect of ozone pneumoperitoneum / Análise do efeito bactericida do pneumoperitônio de ozônio

PURPOSE: To assess the bactericidal action of ozone pneumoperitonium, and to compare the results with CO2. METHODS: It was used 36 Wistar rats. The animals, under anesthesia, were inoculated with 2ml of E. coli ATCC at a concentration of 10(10)UFC, and 1ml of BaSO4, into the peritoneal cavity. They were divided into three groups: Group 1, CO2 pneumoperitoneum was performed for 15 minutes; Group 2, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 42µg/ml, and Group 3, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 62µg/ml. Six animals from each group were sacrificed after the experiment, and the remaining 6 observed for 24 hours. Material was collected from the cavity of all animals for microbiological study. RESULTS: Ozone presented a greater bactericidal effect than CO2 in those animals sacrificed immediately after pneumoperitoneum. In the animals studied 24 hours after pneumoperitoneum evidenced no difference in bactericidal effect between the two gases. Moreover, no difference in mortality was observed. CONCLUSION: Ozone has a more potent bactericidal effect than carbon dioxide gas, although this did not influence survival of the animals.

OBJETIVO: Avaliar a ação bactericida do pneumoperitônio de ozônio comparando-o à ação do CO2. MÉTODOS: Foram utilizados 36 ratos Wistar. Após anestesia e inoculação de 2ml de E. coli ATCC na concentração de 10(10) UFC e 1ml de BaSO4 na cavidade peritoneal, os animais foram divididos em três grupos: Grupo 1, realização de pneumoperitônio de CO2 por 15 minutos; Grupo 2, realização de pneumoperitônio de ozônio durante 5 minutos na concentração de 42µg/ml, e Grupo 3, realização de pneumoperitônio de ozônio durante 5 minutos na concentração de 62µg/ml. Seis animais de cada grupo foram sacrificados após experimento e os outros seis foram observados por 24 horas. Em todos os animais colheu-se material da cavidade para estudo microbiológico. RESULTADOS: O ozônio teve maior efeito bactericida em comparação ao CO2 nos animais sacrificados logo após pneumoperitônio. Nos animais estudados após 24 horas não houve diferença do efeito bactericida entre os gases. Também não se observou alteração da mortalidade. CONCLUSÃO: O ozônio tem efeito bactericida mais potente que o gás carbônico, embora não tenha influenciado a sobrevida dos animais.

Diagnóstico de infecção por Candida: avaliação de testes de identificação de espécies e caracterização do perfil de suscetibilidade / Candida infection diagnosis: evaluation of Candida species identification and characterization of susceptibility profile

INTRODUÇÃO: Infecções invasivas provocadas por Candida são importantes causas de morbidade e mortalidade. O sucesso do tratamento dessas infecções depende da identificação da espécie e do padrão de sensibilidade aos antifúngicos. Portanto, diagnóstico rápido e específico é fundamental para a precoce introdução de terapêutica adequada. OBJETIVOS: Avaliar diferentes métodos diagnósticos de determinação de espécies de Candida e caracterizar, entre as espécies identificadas, o padrão de sensibilidade aos diferentes antifúngicos. MATERIAL E MÉTODOS: A identificação das espécies de Candida presentes em amostras de diferentes materiais biológicos foi realizada pelo cultivo em CHROMagar® Candida e pela técnica de reação em cadeia da polimerase tipo Nested (N-PCR). O padrão de sensibilidade das amostras foi avaliado pela utilização de Etest®. RESULTADO: CHROMagar® caracterizou 50 por cento das amostras como Candida albicans; 20,8 por cento, Candida tropicalis; 2,4 por cento, Candida krusei e 26,9 por cento, outras espécies (não determinadas). As cepas de C. albicans e C. tropicalis foram caracterizadas por CHROMagar® e N-PCR. Porém cepas de outras espécies, indeterminadas em CHROMagar®, caracterizaram-se como C. parapsilosis em N-PCR. Cepas de C. krusei e C. tropicalis apresentaram perfil de resistência a, respectivamente, fluconazol e 5-fluocitosina. Quanto ao itraconazol, observou-se padrão de resistência em cepas de C. albicans e C. tropicalis. DISCUSSÃO: As técnicas metodológicas utilizadas são de fácil reprodutibilidade e alta especificidade, fornecendo diagnóstico complementar, e o emprego do Etest® viabiliza a precoce introdução de tratamento específico. CONCLUSÃO: O crescente aparecimento de espécies de Candida resistentes aos azólicos confirma a importância de monitorar possíveis mudanças na distribuição das espécies patogênicas e dos padrões de sensibilidade.

BACKGROUND: Invasive infections by Candida are an important cause of morbidity and mortality. The successful treatment of these infections depends on the identification of the species and on the sensitivity pattern to antifungal agents. A quick and specific diagnosis is essential to introduce appropriate therapy. OBJECTIVES: Assess different diagnostic methods to determine Candida species and evaluate the sensitivity pattern to different antifungal agents among the identified ones. MATERIAL AND METHODS: The identification of Candida species present in samples of different biological materials was conducted through CHROMagar® Candida culture and Nested-PCR. The sensitivity pattern was assessed using Etest®. RESULTS: The culture of samples on CHROMagar® revealed 50 percent Candida albicans, 20.8 percent Candida tropicalis, 2.4 percent Candida krusei, and 26.9 percent other undetermined species. Samples of Candida albicans and Candida tropicalis were identified through CHROMagar® and N-PCR. Species that were not determined through CHROMagar® were characterized as Candida parapsilosis by N-PCR. Resistance to fluconazole, 5-fluocytosine was detected, respectively, in Candida krusei and Candida tropicalis samples. Both Candida albicans and Candida tropicalis samples showed resistance to itraconazole. DISCUSSION: The methods applied are easily reproducible and highly specific, which allows complementary diagnosis. The determination of the susceptibility profile by Etest® enables the early introduction of specific treatment. CONCLUSION: The growing appearance of Candida species resistant to azole confirms the importance of monitoring possible changes in the distribution of pathogenic species and in the sensitivity pattern.

Efeito de diferentes gases sobre o crescimento bacteriano: estudo experimental "in vitro" / Effect of different gases on bacterial growth: experimental study \"in vitro\"

OBJETIVO: Criar um modelo experimental in vitro para estudar isolada e controladamente o efeito direto de alguns gases utilizados em vídeo-laparoscopia sobre o crescimento bacteriano, além de compará-los ao efeito do ozônio, um gás sabidamente bactericida. MÉTODO: Exposição de grupos de quinze laminocultivos do tipo URIBAC (Probac do Brasil, São Paulo/Brasil), semeados com uma de três cepas das seguintes bactérias: Escherichia coli, Pseudomonas aeruginosa, e Staphylococcus aureus. A concentração utilizada de bactéria foi de 10(4) ufc/ml, o tempo de exposição foi de uma hora, o fluxo dos gases e a pressão foram mantidos constantes em 2L/m e 11 mmHg, respectivamente. Os gases utilizados foram o dióxido de carbono e o hélio na concentração de 99,99 por cento para ambos, o ozônio a 0,4 por cento e ar comprimido como controle. Foram também deixados um grupo de quatro placas de cada bactéria sem exposição aos gases como um controle da técnica de diluição. A leitura foi realizada após vinte e quatro horas em estufa. RESULTADOS: O ozônio promoveu esterilização de 100 por cento dos laminocultivos; os demais gases não alteraram significativamente nenhuma das culturas em relação aos controles. CONCLUSÕES: O modelo de exposição criado é prático e eficiente. Os gases atualmente utilizados para a realização do pneumoperitônio não apresentam efeito bactericida significativo sobre as bactérias testadas. O Ozônio têm efeito bactericida superior aos demais gases estudados.

BACKGROUND: Our aim was to create an "in vitro" experimental model to study the direct effect of some gases used in videolaparoscopy, on bacterial growth, and compare them to the effect of ozone, a bactericidal gas. METHODS: We performed some assays with display of fifteen slide cultures of URIBAC type (Probac do Brasil, São Paulo- Brasil) sown with one of the three strains of different bacterias: Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Bacterial concentration was 104 ufc/ml. Exposure time was of one hour, with the flux of gases and the pressure kept constant in 2L/mm and 11mmHg, respectively. The used gases were carbon dioxide and helium, in a concentration of 99,99 percent for both, ozone 0.4 percent and compressed air as control. A group of four boards of each bacteria was left without display to the gases as a control for the dilution technique. The reading was carried through twenty four hours in incubator. RESULTS: The ozone promoted sterilization of 100 percent of the slide culture; the other gases did not promote significant changes in any of the slide cultures exposed to them, including controls. CONCLUSION: The expository model bred is practical and efficient. The gases currently used do no exert direct effect up on the tested bacteria. The ozone has a high bacterial effect, much greater than the other gases.