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.

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.

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.

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.

Diarrheagenic Escherichia coli pathotypes investigation revealed atypical enteropathogenic E. coli as putative emerging diarrheal agents in children living in Botucatu, São Paulo State, Brazil.

The aim of the present study was to investigate the prevalence of Diarrheagenic Escherichia coli (DEC) pathotypes, a leading cause of diarrhea worldwide, among diarrheal and healthy children, up to 5 years of age, living in the city of Botucatu, São Paulo, Brazil. DEC, investigated by PCR detection of virulence factor-encoding genes associated with the distinct pathotypes, was isolated from 18.0% of the patients, and 19.0% of the controls, with enteroaggregative E. coli (EAEC), the most frequent pathotype, being detected in equal proportion between patients and controls (10.0%). Among the enteropathogenic E. coli (EPEC) isolates, only one isolate was able to produce the localized adherence pattern to HeLa cells, being thus the only typical EPEC identified. All the remaining EPEC were classified as atypical (aEPEC), and detected in 8.0% and 8.5% of the patients and controls, respectively. Regarding the serotypes, 26.5% of the analyzed EPEC isolates belonged to classical EPEC-serogroups, and the only two STEC found were serotyped as O26:H11 (patient) and O119:H7 (control). Antimicrobial susceptibility tests revealed that 43.6%, 29.5% and 2.6% of the DEC isolates were resistant to ampicillin, cotrimoxazole and gentamicin, respectively. Our data indicate that EAEC remains prevalent among children living in Botucatu, and revealed atypical EPEC as emerging putative diarrheal agents in this geographical region.

Candida species biofilm and Candida albicans ALS3 polymorphisms in clinical isolates

Over the last decades, there have been important changes in the epidemiology of Candida infections. In recent years, Candida species have emerged as important causes of invasive infections mainly among immunocompromised patients. This study analyzed Candida spp. isolates and compared the frequency and biofilm production of different species among the different sources of isolation: blood, urine, vulvovaginal secretions and peritoneal dialysis fluid. Biofilm production was quantified in 327 Candida isolates obtained from patients attended at a Brazilian tertiary public hospital (Botucatu, Sao Paulo). C. albicans ALS3 gene polymorphism was also evaluated by determining the number of repeated motifs in the central domain. Of the 198 total biofilm-positive isolates, 72 and 126 were considered as low and high biofilm producers, respectively. Biofilm production by C. albicans was significantly lower than that by non-albicans isolates and was most frequently observed in C. tropicalis. Biofilm production was more frequent among bloodstream isolates than other clinical sources,in urine, the isolates displayed a peculiar distribution by presenting two distinct peaks, one containing biofilm-negative isolates and the other containing isolates with intense biofilm production. The numbers of tandem-repeat copies per allele were not associated with biofilm production, suggesting the evolvement of other genetic determinants.

Overlapped sequence types (STs) and serogroups of avian pathogenic (APEC) and human extra-intestinal pathogenic (ExPEC) Escherichia coli isolated in Brazil.

Avian pathogenic Escherichia coli (APEC) strains belong to a category that is associated with colibacillosis, a serious illness in the poultry industry worldwide. Additionally, some APEC groups have recently been described as potential zoonotic agents. In this work, we compared APEC strains with extraintestinal pathogenic E. coli (ExPEC) strains isolated from clinical cases of humans with extra-intestinal diseases such as urinary tract infections (UTI) and bacteremia. PCR results showed that genes usually found in the ColV plasmid (tsh, iucA, iss, and hlyF) were associated with APEC strains while fyuA, irp-2, fepC sitDchrom, fimH, crl, csgA, afa, iha, sat, hlyA, hra, cnf1, kpsMTII, clpVSakai and malX were associated with human ExPEC. Both categories shared nine serogroups (O2, O6, O7, O8, O11, O19, O25, O73 and O153) and seven sequence types (ST10, ST88, ST93, ST117, ST131, ST155, ST359, ST648 and ST1011). Interestingly, ST95, which is associated with the zoonotic potential of APEC and is spread in avian E. coli of North America and Europe, was not detected among 76 APEC strains. When the strains were clustered based on the presence of virulence genes, most ExPEC strains (71.7%) were contained in one cluster while most APEC strains (63.2%) segregated to another. In general, the strains showed distinct genetic and fingerprint patterns, but avian and human strains of ST359, or ST23 clonal complex (CC), presented more than 70% of similarity by PFGE. The results demonstrate that some "zoonotic-related" STs (ST117, ST131, ST10CC, ST23CC) are present in Brazil. Also, the presence of moderate fingerprint similarities between ST359 E. coli of avian and human origin indicates that strains of this ST are candidates for having zoonotic potential.

Candida species biofilm and Candida albicans ALS3 polymorphisms in clinical isolates.

Over the last decades, there have been important changes in the epidemiology of Candida infections. In recent years, Candida species have emerged as important causes of invasive infections mainly among immunocompromised patients. This study analyzed Candida spp. isolates and compared the frequency and biofilm production of different species among the different sources of isolation: blood, urine, vulvovaginal secretions and peritoneal dialysis fluid. Biofilm production was quantified in 327 Candida isolates obtained from patients attended at a Brazilian tertiary public hospital (Botucatu, Sao Paulo). C. albicans ALS3 gene polymorphism was also evaluated by determining the number of repeated motifs in the central domain. Of the 198 total biofilm-positive isolates, 72 and 126 were considered as low and high biofilm producers, respectively. Biofilm production by C. albicans was significantly lower than that by non-albicans isolates and was most frequently observed in C. tropicalis. Biofilm production was more frequent among bloodstream isolates than other clinical sources, in urine, the isolates displayed a peculiar distribution by presenting two distinct peaks, one containing biofilm-negative isolates and the other containing isolates with intense biofilm production. The numbers of tandem-repeat copies per allele were not associated with biofilm production, suggesting the evolvement of other genetic determinants.

Detection of SPM and IMP metallo-β-lactamases in clinical specimens of Pseudomonas aeruginosa from a Brazilian public tertiary hospital

Phenotypic and genotypic SPM and IMP metallo-β-lactamases (MBL) detection and also the determination of minimal inhibitory concentrations (MIC) to imipenem, meropenem and ceftazidime were evaluated in 47 multidrug-resistant Pseudomonas aeruginosa isolates from clinical specimens. Polymerase chain reaction detected 14 positive samples to either blaSPM or blaIMP genes, while the best phenotypic assay (ceftazidime substrate and mercaptopropionic acid inhibitor) detected 13 of these samples. Imipenem, meropenem and ceftazidime MICs were higher for MBL positive compared to MBL negative isolates. We describe here the SPM and IMP MBL findings in clinical specimens of P. aeruginosa from the University Hospital of Botucatu Medical School, São Paulo, Brazil, that reinforce local studies showing the high spreading of blaSPM and blaIMP genes among brazilian clinical isolates.

Detection of SPM and IMP metallo-ß-lactamases in clinical specimens of Pseudomonas aeruginosa from a Brazilian public tertiary hospital.

Phenotypic and genotypic SPM and IMP metallo-ß-lactamases (MBL) detection and also the determination of minimal inhibitory concentrations (MIC) to imipenem, meropenem and ceftazidime were evaluated in 47 multidrug-resistant Pseudomonas aeruginosa isolates from clinical specimens. Polymerase chain reaction detected 14 positive samples to either blaSPM or blaIMP genes, while the best phenotypic assay (ceftazidime substrate and mercaptopropionic acid inhibitor) detected 13 of these samples. Imipenem, meropenem and ceftazidime MICs were higher for MBL positive compared to MBL negative isolates. We describe here the SPM and IMP MBL findings in clinical specimens of P. aeruginosa from the University Hospital of Botucatu Medical School, São Paulo, Brazil, that reinforce local studies showing the high spreading of blaSPM and blaIMP genes among brazilian clinical isolates.

Species distribution and susceptibility profile of Candida species in a Brazilian public tertiary hospital.

BACKGROUND: Species identification and antifungal susceptibility tests were carried out on 212 Candida isolates obtained from bloodstream infections, urinary tract infections and dialysis-associated peritonitis, from cases attended at a Brazilian public tertiary hospital from January 1998 to January 2005. FINDINGS: Candida albicans represented 33% of the isolates, Candida parapsilosis 31.1%, Candida tropicalis 17.9%,Candida glabrata 11.8%, and others species 6.2%. In blood culture, C. parapsilosis was the most frequently encountered species (48%). The resistance levels to the antifungal azoles were relatively low for the several species, except for C. tropicalis and C. glabrata. Amphotericin B resistance was observed in 1 isolate of C. parapsilosis. CONCLUSIONS: The species distribution and antifungal susceptibility herein observed presented several epidemiological features common to other tertiary hospitals in Latin American countries. It also exhibited some peculiarity, such as a very high frequency of C. parapsilosis both in bloodstream infections and dialysis-associated peritonitis. C. albicans also occurred in an important number of case infections, in all evaluated clinical sources. C. glabrata presented a high proportion of resistant isolates. The data emphasize the necessity to carry out the correct species identification accompanied by the susceptibility tests in all tertiary hospitals.

Estudo epidemiológico, clínico e microbiológico prospectivo de pacientes portadores de fraturas expostas etendidos em hospital universitário / Epidemiological, clinical and microbiological prospective study of patients with open fractures assisted at a university hospital

Foram estudados 117 pacientes com fraturas expostas, submetidos a protocolo para identificação do paciente e características do trauma, internados para tratamento cirúrgico, durante um período de dois anos. A avaliação microbiológica da ferida foi realizada em 45 pacientes antes do desbridamento cirúrgico, com predomínio dos germes gram positivos. A antibioticoterapia foi utilizada profilaticamente em todos os pacientes, podendo, no entanto, ser melhor padronizada. O perfil da maioria dos pacientes da amostra foi: sexo masculino, branco, casado, com idade entre 21 e 30 anos, trabalhador industrial com Primeiro Grau completo, vítima de acidente de automóvel ou motocicleta. As fraturas foram agrupadas segundo a classificação de Gustilo, sendo que a maioria dos casos encontrados foram do tipo III. Os índices de infecção estiveram relacionados ao grau da classificação, sendo mais frequente no tipo III. No entanto, o estudo também revelou índice elevado de infecção no tipo II, comparado com a literatura. O tempo médio de exposiçao foi de cinco horas e trinta e nove minutos, sendo o fixador externo o meio de tratamento mais utilizado. Foi também avaliada a freqüencia de politraumatizados, 15 por cento. O período de internaçao foi em médiaa de 9,14 dias, com uma média de aproximadamente oito retornos por pacientes nos ambulaórios. As principais complicações foram a infecção e a pseudoartrose, sendo a tíbia o osso mais acometido.

Atividade comparada da cefepima, cefpiroma e amicacina em amostras bacterianas hospitalares / Comparative study of cefepime, cefpirome and amikacin activities against nosocomial bacteria isolates

O objetivo deste estudo foi avaliar a atividade in vitro da cefepima, da cefpiroma e da amicacina em bactérias hospitalares prevalentes. Inicialmente, procurou-se caracterizar a sensibilidade às três drogas em 1.022 amostras patogênicas isoladas consecutivamente de pacientes internados no Hospital da Clínicas da Faculdade de Medicina de Botucatu, SP, de março a dezembro de 1996, utilizando-se o método da difusäo proposto por Bauer-Kirby. Os resultados expressaram, em geral, elevada atividade das 3 drogas frente a maioria das bactérias, destacando-se que a atuaçäo da cefepima foi significativamente maior que a da cefpiroma e da amicacina (X2, p 0,05) para o total de germes (79,5 por cento x 74,3 por cento x 76,8 porcento) e amostras de Pseudomonas aeruginosa (72 porcento x 56 porcento x 64 porcento) e de Enterobacter cloacae (98 porcento x 88 porcento x 86 porcento, respectivamente). A cefpiroma apresentou maior atividade que a cefepima apenas frente ao Enterococcus faecalis. Nos doze outros grupos bacterianos estudados houve sensibilidade semelhante (X2, p> 0,05) às três drogas. A seguir, determinou-se a concentraçäo inibitória mínima (CIM) pelo E-test para 127 amostras bacterianas, de mesma origem daquelas descritas antes e isoladas em 1997: E.cloacae (12), Citrobacter sp (15), P.aeruginosa (50), acinetobacter baumanni (12), bastonetes Gram-negativos näo-fermentadores (BGNFs) outros (22) e E. faecalis (16). Os resultados expressos pela faixa de variaçäo das CIMs, CIM50 porcento, CIM90 porcento e pela proporçäo de amostras sensíveis, permitiram concluir que a atividade da cefepima contra as bactérias Gram-negativas foi duas vezes maior, ou mais, que a da cefpiroma e da amicacina, especialmente quando a CIM90 porcento foi considerada. Estes dados confirmam os resultados do antibiograma e acrescentam importante informaçäo de natureza quantitativa. Espera-se que estes resultados possam contribuir para o uso racional destas drogas em nosso meio, sobretudo nos pacientes com infecçäo hospitalar. (Au);

Modelo de peritonite fecal no rato / Model of faecal peritonite in the rat

Com o objetivo de padronizar um modelo de peritonite fecal, para estudar a fisiopatologia e o tratamento das peritonites, inoculamos uma suspensao de fezes humanas, em dosagens de 5 ml/kg ou 10 ml/kg de peso copóreo na cavidade peritoneal do rato, sendo observada sua evoluçao por 48 horas. Foi estudada a taxa de mortalidade dos animais, realizado estudo microbiológico do líquido colhido da cavidade peritoneal e feita avaliaçao macro e microscópica de diversos órgaos da cavidade abdominal. A taxa de mortalidade foi de 50 por cento (24 horas), 60 por cento (48 horas) com 5 ml/kg e de 76,6 por cento (24 horas), 100 por cento (48 horas) com 10 ml/kg de suspensao contaminante. O estudo macro e microscópico demonstrou o caráter evolutivo da infecçao peritoneal nos diversos momentos de estudo, caracterizando este modelo de peritonite fecal no rato semelhante à peritonite observada na clínica

Vigilância da sensibilidade à amicacina e a outros antimicrobianos em amostras bacterianas isoladas em Hospital Universitário-Botucatú, 1980-1987 / Bacterial susceptibility surveillance to amikacin and other antimicrobial drugs of strains isolated in a University Hospital-Botucatú, from 1980 to 1987

A sensibilidade à amicacina e a 23 outros antimicrobianos foi investigada em 2.761 amostras bacterianas patogênicas isoladas de pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu, 1980 a 1987. Os dados computados revelaram Pseudomonas, Serratia, Klebsiella e S. faecalis como germes mais resistentes. Para o total de amostras houve maiores índices de sensibilidade para amicacia (entre as drogas de largo espectro) e vancomicina. Evolução dos índices de sensibilidade mostraram-se mais ou menos estáveis para amicacina e surpreendentemente, em elevação para laguns aminoglicosídios e beta-lactâmicos, a partir de 1984.

Imunoglobulinas e C3 no granuloma paracoccidióidico / Immunoglobins and C3 in paracoccidioidal granuloma

Utilizou-se o modelo experimental de paracoccidioidomicose, em camundogos, induzida pela inoculaçäo endovenosa de suspensäo de formas cerebriformes do P. brasiliensis (cepa Bt2; 1x10**6 formas viáveis/animal), para avaliar, após 2, 4, 8, 16 e 20 semanas: 1. A presença de imunoglobulinas e C3 nos granulomas pulmonares, por imunofluorescência direta; 2. A resposta imune humoral (imunodifusäo) e celular (teste do coxim plantar), e 3. A histopatologia das lesöes. Os camundongos apresentaram resposta imunocelular positiva desde a 2a. semana, com depressäo transitória na 16a. semana, e anticorpos desde a 4a. semana, com pico na 16a. semana. O sgranulomas pulmonares foram epitelióides, com numerosos fungos e microabscessos; a extensäo das lesöes foi progressiva até a 16a. semana, com regressäo discreta na 20a. semana. Desde a 2a. semana, houve deposiçäo de IgG e C3 na parede dos fungos no interior dos granulomas e a presença de células IgG positivas no halo linfomononuclear periférico; estes achados foram máximos entre a 4a. e 16a. semanas. Näo se detectou depósito de IgG e C3 no interstício dos granulomas. IgG e C3 parecem exercer papel precoce e importante na defesa do hospedeiro contra o P. brasiliensis, contribuindo possivelmente para a destruiçäo dos fungos e bloqueando a difusäo de antígenos para fora dos granulomas

Associaçäo rifampicina-trimetoprim: aspectos microbiológicos e uso clínico / Rifampicin-trimethoprim combination: microbiological aspects and clinical use

Com o objetivo de caracterizar a atividade da associaçäo rifampicina-trimetoprim (RIF + TRI), estudamos in vitro sua atuaçäo comparada a de 11 outros antimicrobianos, frente a 320 amostras bacterianas isoladas de urinocultura significativas de pacientes com infecçäo urinária (IU), por meio da determinaçäo da concentraçäo inibitória mínima (CIM). Investigamos 30 pacientes de ambulatório com quadro clínico e laboratorial de IU, aos quais administramos duas drágeas por dia de RIF (300 mg) + TRI (80 mg), durante 10 dias consecutivos. Observamos, por meio dos parâmetros - variaçäo das CIM, CI50% e CI90% -, que RIF+TRI supera a atuaçäo isolada de seus dois componentes e das demais drogas testadas, em relaçäo a todos os germes, com exceçäo de - gentamicina para Escherichia coli, cefoxitina para Klebsiella e contrimoxazol para enterococos. A avaliaçäo do seu uso terapêutico revelou 28 (93%) pacientes curados e boa tolerância, em geral. Conclui-se que RIF+TRI apresentou elevada atuaçäo frente às bactérias estudadas e efetividade na terapêutica da IU. Dada a presença de rifampicina nesta associaçäo, droga de alto valor no combate à tuberculose, sugere-se que se deva utilizá-la com critério e racionalidade em países onde esta infecçäo é de alta prevalência

A comparative study of the immunoantigenicity of eight Paracoccidioides brasiliensis isolates

Para se detectar diferenças imuno-antigênicas entre 8 amostras de P. brasiliensis isoladas de diferentes áreas endêmicas (Botucatu: Pb 1, 2 e 3; Säo Paulo: Pb: 18,192 e 265; Venezuela: Pb 9 e 73), estudaram-se: 1. A reatividade antigênica de cada amostra nas reaçöes de imunofluorescência indireta (II) e de imunodifusäo dupla em gel de ágar (ID) contra painel de 20 soros controles positivos para paracoccidioidomicose; 2. A capacidade de induzir resposta imune humoral (medida por imunodifusäo) e celular (medida pelo teste de coxim plantar) em camundongos imunizados com antígenos de cada amostra. Observamos: 1. As amostras Pb 265 e Pb 9 mostraram-se mais reativas na II; 2. Os antígenos das amostras Pb 192 e Pb 73 foram significativamente mais reativas na ID; 3. Estes dados demonstram diferenças de antigenicidade entre estas amostras; 4. A amostra Pb 18 mostrou baixo poder indutor de resposta imune celular e alta capacidade de induçäo de resposta imune humoral em camundongos imunizados, revelando dissociaçäo de sua imunogenicidade. Estas diferenças podem indicar a existência de cepas distintas do fungo ou refletir modificaçöes do parasita no hospedeiro ou durante seu cultivo