Prevalence of infection in patients with temporary catheter for hemodialysis in a teaching hospital / Prevalência de infecção em pacientes com cateter provisório para hemodiálise em um hospital ensino

This study aimed to determine the prevalence of infection related to the provisional catheter for hemodialysis in a teaching hospital and evaluate the risk factors associated with these infections. A cross-sectional study analyzed by descriptive statistics and parametric tests. It was found that out of 129 patients, 48.8 % had catheter-related infection in hemodialysis, 65 % were male, 33.3 % were 60 years old and over, and 88 % of patients were admitted to intensive care unit. The prevalence of infection in this group was high, and the vast majority of diagnoses of infection were empirical. Given this, it is suggested to establish the routine culture of the catheter tip in all cases of suspected catheter infection to improve the quality of patient care, and the relentless pursuit of the causes that trigger the infection process in line with good practice from across the healthcare team.

Este estudo objetivou determinar a prevalência de infecção relacionada ao cateter provisório para hemodiálise em um hospital ensino e avaliar os fatores de risco inerentes a estas infecções. Realizou-se um estudo epidemiológico transversal, analisados por estatística descritiva e testes paramétricos. Constatou-se que dos 129 pacientes avaliados, 48,8% apresentaram infecção relacionada ao cateter de hemodiálise, 65% eram do sexo masculino, 33,3% possuíam idade igual ou superior a 60 anos e 88% dos pacientes estavam internados em unidade de terapia intensiva. A prevalência de infecção neste grupo mostrou-se elevada, e a grande maioria dos diagnósticos de infecção foram feitos de forma empírica. Frente a isso, sugere-se estabelecer como rotina a cultura da ponta de cateter para todos os casos de suspeita de infecção de cateter para melhoria da qualidade do cuidado prestado ao paciente, além da incessante busca das causas que desencadeiam o processo infeccioso em consonância com as boas práticas de toda a equipe de saúde.

Risk factors asoociated with temporary catheterrelated infection in patients oon dialysis treatment / Factores de iesggo asociados a la infección de catéter proviorio en pacienttes en tratamiento dilíítico / Fators de risco associados à infecção de cateter provisório em pacientes sob tratamento dialítico

ABSTRACTThis study aims to identify risk factors associated with temporary hemodialysis catheter-related infection, in patients on dialysis treatment in a teaching hospital. This is a prospective study performed from November of 2012 to May of 2013, with 129 patients. Sociodemographic, clinical and biochemical data were collected from patient charts. In patients with a catheter,, 48.8% had catheter-related infection, 65% were male, 65% were 60 years of age or older, 85.3% had the catheter because they were diagnosed with acute renal failure, and 88% were hospitalized in an intensive care unit. There was a significant correlation between the independent variables and the outcome of infection. The risk factors associated with temporary hemodialysis catheter-related infection were: length of time of catheter use, the change of device, death, and complications during a hemodialysis session.

RESUMENEste estudio tuvo como objetivo identificar los factores de riesgo asociados a la infección de catéter provisorio para hemodiálisis en pacientes en tratamiento dialítico en un hospital escuela. Se trata de un estudio prospectivo, realizado en el período entre noviembre de 2012 y mayo de 2013, con 129 pacientes. Fueron colectados: registros sociodemográficos, clínicos y bioquímicos de los participantes se obtuvieron de los registros médicos. Entre los pacientes que fueron sometidos a la implantación del catéter, el 48,8% presentaron infección relacionada con catéter, el 65% eran del sexo masculino, el 65% tenían edad igual a 60 años o más, el 85,3% utilizaron el catéter porque hubieran sido diagnosticados con insuficiencia renal aguda y el 88% fueron hospitalizados en la unidad de terapia intensiva. Hubo correlación significativa entre las variables independientes y el resultado infección. Los factores de riesgo asociados a la infección relacionada a la implantación del catéter temporal para hemodiálisis fueron: tiempo de permanencia del catéter, la troca del dispositivo, óbito y complicaciones durante la sesión de hemodiálisis.

RESUMOEste estudo objetivou identificar os fatores de risco associados à infecção de cateter provisório para hemodiálise em pacientes em tratamento dialítico em um hospital escola. Trata-se de um estudo prospectivo, realizado no período de novembro de 2012 a maio de 2013, com 129 pacientes. Os dados sóciodemograficos, clínicos e bioquímicos dos participantes foram coletados dos prontuários. Entre os pacientes que foram submetidos à implantação do cateter, 48,8% apresentaram infecção relacionada ao cateter, 65% eram do sexo masculino, 65% possuíam idade igual ou superior a 60 anos, 85,3% utilizaram o cateter por terem sido diagnosticados com insuficiência renal aguda e 88% foram internados em unidade de terapia intensiva. Houve correlação significativa entre as variáveis independentes e o desfecho infecção. Os fatores de risco que se associaram à infecção relacionada à implantação do dispositivo foram: tempo de permanência do cateter, troca do dispositivo, óbito e intercorrências durante a sessão de hemodiálise.

Torque teno virus among dialysis and renal-transplant patients.

Patients who undergo dialysis treatment or a renal transplant have a high risk of blood-borne viral infections, including the Torque teno virus (TTV). This study identified the presence of TTV and its genome groups in blood samples from 118 patients in dialysis and 50 renal-transplant recipients. The research was conducted in a hospital in the city of Maringá, state of Paraná. The viral DNA, obtained from whole blood, was identified by using two nested Polymerase Chain Reactions (PCR). The frequencies of TTV were 17% and 36% in dialysis patients using the methodology proposed by Nishizawa et al . (1997) and Devalle and Niel (2004) , respectively, and 10% and 54% among renal-transplant patients. There was no statistically significant association between the frequency of the pathogen and the variables: gender, time in dialysis, time since transplant, blood transfusions, and the concomitant presence of hepatitis B, for either the dialysis patients or the renal-transplant recipients. Among dialysis patients and renal-transplant recipients, genogroup 5 was predominant (48% and 66% respectively), followed by genogroup 4 (37% and 48%) and genogroup 1 (23% and 25%). Genogroup 2 was present in both groups of patients. Some patients had several genogroups, but 46% of the dialysis patients and 51% of the renal-transplant recipients had only a single genogroup. This study showed a high prevalence of TTV in dialysis patients and renal-transplant recipients.

Torque teno virus among dialysis and renal-transplant patients

Patients who undergo dialysis treatment or a renal transplant have a high risk of blood-borne viral infections, including the Torque teno virus (TTV). This study identified the presence of TTV and its genome groups in blood samples from 118 patients in dialysis and 50 renal-transplant recipients. The research was conducted in a hospital in the city of Maringá, state of Paraná. The viral DNA, obtained from whole blood, was identified by using two nested Polymerase Chain Reactions (PCR). The frequencies of TTV were 17% and 36% in dialysis patients using the methodology proposed by Nishizawa et al. (1997) and Devalle and Niel (2004), respectively, and 10% and 54% among renal-transplant patients. There was no statistically significant association between the frequency of the pathogen and the variables: gender, time in dialysis, time since transplant, blood transfusions, and the concomitant presence of hepatitis B, for either the dialysis patients or the renal-transplant recipients. Among dialysis patients and renal-transplant recipients, genogroup 5 was predominant (48% and 66% respectively), followed by genogroup 4 (37% and 48%) and genogroup 1 (23% and 25%). Genogroup 2 was present in both groups of patients. Some patients had several genogroups, but 46% of the dialysis patients and 51% of the renal-transplant recipients had only a single genogroup. This study showed a high prevalence of TTV in dialysis patients and renal-transplant recipients.

Soroprevalência do Citomegalovirus Humano em amostras de pacientes dialíticos e transplantados renais / Seroprevalence for Human Cytomegalovirus in samples from dialysis and kidney transplanted patients

Objetivou-se investigar a soroprevalência do Citomegalovírus Humano em dialíticos e transplantados renais e a associação com a hemotransfusão e o sexo. Trata-se de estudo transversal, realizado nos anos de 2011 e 2012, no município de Maringá, PA, Brasil. A população estudada foi composta por 203 pacientes dialíticos e 53 transplantados renais e a identificação viral foi realizada por meio de técnica sorológica. Encontrou-se 96% (195) de soropositividade para o anti-HCMV-IgG em dialíticos e 100% nos transplantados; 5% (10) de soropositividade para o anti-HCMV-IgM em dialíticos e 37,7% (20) em transplantados. Realizando o teste exato de Fischer, não houve associação significante entre a soropositividade do anti-HCMV com a hemotransfusão e o gênero. A grande parcela de infectados sugere a importância do cuidado de enfermagem para evitar a infecção cruzada durante os procedimentos de rotina...

The aim of this study was at investigating the seroprevalence of Human Cytomegalovirus in dialysis and kidney transplantedpatients and the association with hemodialysis and sex. It is a cross sectional study made in 2011 and 2012 in the countyof Maringá, PR, Brazil. The studied population consisted of 203 dialysis patients and 53 kidney transplanted patients andthe viral identification was made through serological technique. The study found 96% (195) seropositivity for anti-HCMVIgG in dialysis patients and 100% in the transplanted ones; 5% (10) seropositivity for anti-HCMV-IgM in dialysis patientsand 37.7% (20) in transplanted ones. Performing Fisher’s exact test, there was no significant association between theseroprevalence of anti-HCMV with hemodialysis and gender. A large number of infected patients suggest the importance ofnursing care to avoid cross-infection during routine procedures...

El objetivo fue investigar la seroprevalencia de Citomegalovirus Humano en dialíticos y trasplantados renales y la asociacióncon la transfusión de sangre y el sexo. Estudio transversal, llevado a cabo de 2011 a 2012, en Maringá, PR, Brasil. La poblaciónfue compuesta de 203 pacientes dialíticos y 53 trasplantados renales y la identificación viral se realizó mediante la técnicaserológica. Se encontró 96% (195) de seropositividad para anti-HCMV-IgG en dialíticos y 100% en los trasplantados; 5%(10) de seropositividad para anti-HCMV-IgM en dialíticos y 37,7% (20) en trasplantados. Realizándose la prueba exacta deFisher, no hubo asociación significativa entre la seropositividad del anti-HCMV con la transfusión de sangre y género. A lagran parte de los infectados se señala la importancia de la atención de enfermería para prevenir la infección cruzada durantelos procedimientos de rutina...

Prevalência e perfil de sensibilidade de staphylococcus aureus isolados em pacientes e equipe de enfermagem / Prevalence and profile of sensitivity of staphylococcus aureus isolated from patients and staff nursing / Prevalencia y el perfil de sensibilidad de los staphylococcus aureus aislados de pacientes y el equipo de enfermería

Determinar a prevalência e o perfil de susceptibilidade de amostras de Staphylococcus aureus isoladas em pacientes e membros da equipe de enfermagem. Estudo do tipo exploratório, descritivo analítico onde foram isoladas amostras dos vestíbulos nasais e das mãos de 84 pacientes e 22 funcionários de uma Unidade de Terapia Intensiva (UTI) de um hospital geral. A prevalência de Staphylococcus aureus entre os pacientes foi 54,76% e entre os funcionários 59,04%. Foram isoladas 81 amostras, 61 dos pacientes e 20 dos profissionais. Entre os pacientes, 39 (63,93%) foram resistentes à oxacilina pelo teste de concentração inibitória mínima e 42 (68,85%) pelo método de disco difusão. O gene mecA foi encontrado em 79,49%. Entre os profissionais, 80% apresentaram resistência à oxacilina pelos dois métodos, e dessas, todas expressaram o gene mecA. Todas as amostras foram sensíveis à vancomicina. Recomenda-se a implementação de medidas de prevenção para amostras multirresistentes como a higienização das mãos e descontaminação nasal na iminência de procedimentos de risco.

To determine the prevalence and susceptibility profile of strains of Staphylococcus aureus isolated from patients and members of the nursing staff. A descriptive, exploratory, where samples were isolated from the nasal vestibules and hands of 84 patients and 22 employees of an Intensive Care Unit (ICU) of a general hospital. The prevalence of Staphylococcus aureus among patients was 54.76% and 59.04% among employees. Were isolated from 81 samples, 61 patients and 20 professionals. Among patients, 39 (63.93%) were resistant to oxacillin by the test of minimum inhibitory concentration and 42 (68.85%) by disk diffusion method. The mecA gene was found in 79.49%. Among professionals, 80% were resistant to oxacillin by both methods, and of these, all expressed the mecA gene. All samples were sensitive to vancomycin. We recommend the implementation of preventive measures for multiresistant strains as hand hygiene and decontamination procedures on the verge of nasal risk.

Determinar la prevalencia y el perfil de susceptibilidad de muestras de Staphylococcus aureus aisladas en pacientes y miembros del equipo de enfermería. Estudio del tipo exploratorio, descriptivo analítico, en que fueron aisladas muestras de los vestíbulos nasales y de las manos de 84 pacientes y 22 empleados de una Unidad de Cuidados Intensivos (UCI) de un hospital general. La prevalencia de Staphylococcus aureus entre los pacientes fue de 54,76% y 59,04% entre los empleados. Fueron aisladas 81 muestras, 61 de los pacientes y 20 de los profesionales. Entre los pacientes, 39 (63,93%) fueron resistentes a la oxacilina por la prueba de concentración mínima inhibitoria y 42 (68,85%) por el método de difusión en disco. El gen mecA se encontró en 79,49%. Entre los profesionales, 80% presentaron resistencia a la oxacilina por ambos métodos, y de éstas, todas expresaron el gen mecA. Todas las muestras fueron sensibles a la vancomicina. Se recomienda la implementación de medidas de prevención para muestras multirresistentes como la higienización de las manos y descontaminación nasal en la inminencia de procedimientos de riesgo.

Perfil epidemiológico dos óbitos em terapia renal substitutiva e custo do tratamento / Epidemiological profile of deaths in renal replacement therapy and cost of treatment

OBJETIVO: Descrever o perfil epidemiológico dos óbitos de pacientes em terapia renal substitutiva e o custo do tratamento. MÉTODOS: Estudo transversal e retrospectivo realizado com os dados da Base Nacional de Terapia Renal Substitutiva. Foram incluídos 2029 óbitos por insuficiência renal. Os dados foram analisados por inferência estatística e estatística não paramétrica. RESULTADOS: Houve maior número de óbitos entre os pacientes do sexo masculino e da raça branca. O custo do tratamento aumentou 6,7% nos gastos do estado e 45,3% no município. CONCLUSÃO: O maior número de óbitos ocorreu no sexo masculino, raça branca, variações bruscas nas taxas de mortalidade hospitalar e aumentou o custo do tratamento nos últimos três anos.

OBJECTIVE: Determine the epidemiological profile of patient deaths related to renal replacement therapy and the cost of treatment. METHODS: Cross-sectional retrospective study carried out with data from the National Renal Replacement Therapy Database. It included 2009 deaths due to renal failure. Data were analyzed using statistical inference and nonparametric statistics. RESULTS: A greater number of deaths was observed among white, male patients. The cost of treatment increased 6.7% in the state and 45.3% in the city. CONCLUSION: The highest number of deaths occurred among white males; there were marked variations in hospital mortality rates; and the cost of treatment increased over the past three years.

Chronic kidney disease: information on southern brazilian patients with kidney disease / Insuficiência renal crônica: conhecendo o paciente nefropata sulbrasileiro

The profile of patients undergoing haemodialysis in the dialysis unit of Hospital Santa Casa de Maringá, Maringá PR Brazil, is provided. A questionnaire on social and economic data and underlying diseases prior to the Chronic Kidney Disease (CKD) identified the patients' profile. The project was approved by the Ethics Committee of the institution. Eighty-three patients, with 54.21% males, were interviewed. Age bracket ranged between 20 and 59 years in 65.06% of patients. Only 27.71% maintained jobs after the diagnosis and the start of treatment; 63.86% had an average personal income between 1 and 3 minimum wages; 63.85% did not practice any physical activity. Moreover, 53.01% belonged to the European-Brazilian white group; 20.48% to the Afro-Brazilian brown group; 19.28% to the Afro-Brazilian Negro group; 6.02% to other ethnic groups. Further, 85.54% patients reported having an underlying disease prior to the CKD, namely, 61.45% were hypertensive; 31.33% were diabetics and 20.48% had other diseases. Results show the need of a greater attention to these patients' health care to reduce the negative impacts related to the chronic disease focused.

Este estudo teve como objetivo identificar o perfil dos pacientes em tratamento hemodialítico do setor de diálise do Hospital Santa Casa de Maringá - Paraná, Brasil. Para a identificação do perfil destes pacientes foi utilizado um questionário contendo questões que abrangem dados socioeconômicos e doenças de base anteriores à Insuficiência Renal Crônica (IRC). O projeto foi aprovado pelo Comitê de Ética em Pesquisa da instituição. Entre os 83 pacientes entrevistados, 54,21% eram do sexo masculino. A faixa etária variou de 20 a 59 anos para 65,06% dos pacientes. Somente 27,71% continuaram trabalhando após o diagnóstico e início do tratamento. A renda pessoal média ficou entre um e três salários mínimos para 63,86% dos indivíduos. A atividade física está ausente em 63,85%. Quanto à etnia, foi verificado que 53,01% eram brasileiros descendentes de europeus/brancos, 20,48% brasileiros afrodescendentes/pardos, 19,28% brasileiros afrodescendentes/negros e 6,02% declararam como pertencentes à outras etnias. Entre os pacientes, 85,54% declararam possuir outra doença de base anterior à IRC sendo: 61,45% hipertensão arterial, 31,33% diabetes e 20,48% outras doenças. Estes resultados indicam a necessidade de uma melhor atenção ao cuidado da saúde desses pacientes para a redução dos impactos negativos relacionados à cronicidade da doença.

Carriage frequency, phenotypic and genotypic characteristics of Staphylococcus aureus isolated from dialysis and kidney tranplant patients at a hosptial in northern Paraná

The objective of the present study was to determine the frequency of Staphylococcus aureus nasal carriage among dialysis and kidney transplant patients, to identify the antimicrobial resistance profile of these strains and to verify their genetic profiles with the RW3A primer. The study included 159 individuals, comprising 111 dialysis and 48 kidney transplant patients. Of the 48 transplant patients, 75% were positive for S. aureus, whereas 49% of the 111 dialysis patients were carriers. Two samples yielded conflicting results for oxacillin sensitivity between the disk diffusion and minimum inhibitory concentration (MIC) assays: both were sensitive by the disk diffusion assay and resistant by MIC (4 μg/ml). In the antibiogram by disk diffusion, ten samples were resistant to cefoxitin, among which eight were also resistant to oxacillin. The resistance of the ten samples to cefoxitin by the disk diffusion assay was confirmed by MIC. Of the ten oxacillin-resistant samples, eight harbored the mecA gene. All samples were sensitive to vancomycin, and most were resistant to penicillin and demonstrated high rates of resistance to the other antimicrobials tested. The samples from dialysis patients exhibited a more homogenous genetic profile. Among the samples with a high percent similarity, no correlation with sensitivity or resistance to oxacillin was observed. According to the results of this study, the implementation of prevention and control measures, such as increased restrictions on prescriptions for antimicrobial drugs and nasal decontamination prior to high-risk procedures, is recommended.

Tipagem molecular de Staphylococcus aereus isolados de pacientes e membros da equipe de enfermagem / Molecular typing of Staphylococcus aereus isolated from patients and members of the nursing team

Estudo quantitativo, exploratório e analítico realizado no período de março a junho de 2010, na Unidade de Terapia Intensiva de um hospital paranaense com o objetivo de identificar o perfil genético das amostras de Staphylococcus aureus isoladas de pacientes e membros da equipe de enfermagem. A suscetibilidade à oxalicina foi avaliada pelo teste de determinação da concentração inibitória mínima e a técnica da reação em cadeia da polimerase foi empregada para a realização da genotipagem

Infecção hospitalar na perspectiva dos profissionais de enfermagem: um estudo bibliográfico / Hospital-acquired infections from the perspective of nursing professionals: a bibliographical study / Infección hospitalar en la perspectiva de los profesionales de enfermería: un estudio bibliográfico

Estudo bibliográfico teve por objetivo identificar, na produção científica nacional, a forma como o profissional de enfermagem tem abordado o tema infecção hospitalar. Foram analisadas 15 publicações do período de dez anos - 1999 a 2009 - na base de dados SciELO; a busca foi feita no mês de março de 2010 e os dados analisados por meio da análise de conteúdo. Foram encontradas cinco categorias temáticas: o conceito de infecção hospitalar; a compreensão dos profissionais sobre infecção hospitalar e Comissão de Controle de Infecção Hospitalar; responsabilidade dos profissionais no controle de infecção hospitalar; a prevenção e controle da Infecção Hospitalar; e necessidade de formação adequada durante a graduação. Conclui-se que o tema deveria ser mais pesquisado, principalmente no que tange à Enfermagem e ao cuidado ao paciente; o presente estudo serve de subsídio para instigar discussões sobre o tema...

This bibliographical study of Brazilian research output aimed to identify the way in which nursing professionals have approached the theme of hospital-acquired infections. Fifteen publications from the ten-year period 1999- 2009 from the SciELO database were analyzed; the search was carried out in March 2010 and the data analyzed by content analysis. Five thematic categories were found: the concept of hospital-acquired infections; healthcare professionals' understanding of hospital-acquired infections and the Hospital-Acquired Infection Control Commission; healthcare professionals' responsibility in the control of hospital-acquired infections; the prevention and control of hospital-acquired infections; and the necessity for appropriate training during the undergraduate course. It is concluded that more research is needed, principally where nursing and patient care are affected. This study should serve as a base for discussion on the matter...

Estudio bibliográfico cuyor objetivo fue identificar, en la producción científica nacional, la forma como el profesional de enfermería viene abordando el tema infección hospitalar. Fueron analizadas 15 publicaciones del periodo de diez años - 1999 a 2009 - en la base de datos SciELO; la búsqueda fue hecha en el mes de marzo de 2010 y los datos fueron analizados por medio del análisis de contenido. Surgieron cinco categorías temáticas: el concepto de infección hospitalar; la comprensión de los profesionales sobre infección hospitalar y Comisión de Control de Infección Hospitalar; responsabilidad de los profesionales en control de infección hospitalar; la prevención y control de Infección Hospitalar; y necesidad de formación adecuada durante la graduación. Se concluye que el tema debería ser más investigado, principalmente en lo que se refiere a la enfermería y al cuidado al paciente; el presente estudio sirve de subsidio para instigar discusiones sobre el tema...

HLA molecules and nasal carriage of Staphylococcus aureus isolated from dialysis and kidney transplant patients at a hospital in Southern Brazil.

BACKGROUND: Healthy individuals can host Staphylococcus aureus in the nasopharynx, body surface and vagina. Most invasive infections by this bacterium are endogenous, caused by strains spread from the nasopharynx of carriers. S. aureus is a pathogen involved in the etiology of hospital- and community-acquired infections. Transplant and dialysis patients are at risk of colonization or infection by multi-resistant S. aureus. Infection is directly linked to individual immunity, and the major histocompatibility complex (MHC) plays a crucial role in determining susceptibility to diseases. Different MHC specificities have been shown to be more frequent in individuals suffering from certain diseases. This study aimed to investigate the association between HLA class I (HLA-A and -B) and class II (HLA-DRB1) molecules and nasal carriage of S. aureus in dialysis and kidney transplant patients at a hospital in Southern Brazil. RESULTS: The sample consisted of 70 dialysis and 46 kidney transplant patients, totaling 116 patients. All subjects were typed for HLA molecules using LABType® SSO (One Lambda). Nasal swab samples of S. aureus were isolated from the nasal cavity (both nostrils) of patients undergoing dialysis or kidney transplantation.In renal dialysis patients, HLA-A*02 was the most frequent allele in both carriers (25.5%) and non-carriers (21.2%) of S. aureus. Allele A*68 was not observed in the carrier group, but the allele was observed six times in the non-carrier group (p = 0.0097). Regarding HLA-B and HLA-DRB1, no allele was shown to be involved in protection against or susceptibility to carriage of S. aureus. In kidney transplant patients, allele A*03 was more frequent in the non-carrier (20.83%) than in the carrier (5.88%) group (p = 0.0486). HLA-B*15 was present in carriers (5.88%) and non-carriers (25%) (p = 0.0179). Regarding class II alleles, DRB1*03 appeared to be related to susceptibility to carriage of S. aureus (p = 0.0319). CONCLUSIONS: Our findings suggest that HLA-DRB1*03 may be involved in susceptibility to nasal carriage of S. aureus in transplant patients. In addition, HLA-A*68 (dialysis patients) and HLA-A*03 and HLA-B*15 (transplant patients) appear to be associated with increased resistance to S. aureus nasal carriage.

Carriage frequency, phenotypic and genotypic characteristics of Staphylococcus aureus isolated from dialysis and kidney tranplant patients at a hosptial in northern paraná.

The objective of the present study was to determine the frequency of Staphylococcus aureus nasal carriage among dialysis and kidney transplant patients, to identify the antimicrobial resistance profile of these strains and to verify their genetic profiles with the RW3A primer. The study included 159 individuals, comprising 111 dialysis and 48 kidney transplant patients. Of the 48 transplant patients, 75% were positive for S. aureus, whereas 49% of the 111 dialysis patients were carriers. Two samples yielded conflicting results for oxacillin sensitivity between the disk diffusion and minimum inhibitory concentration (MIC) assays: both were sensitive by the disk diffusion assay and resistant by MIC (4 µg/ml). In the antibiogram by disk diffusion, ten samples were resistant to cefoxitin, among which eight were also resistant to oxacillin. The resistance of the ten samples to cefoxitin by the disk diffusion assay was confirmed by MIC. Of the ten oxacillin-resistant samples, eight harbored the mecA gene. All samples were sensitive to vancomycin, and most were resistant to penicillin and demonstrated high rates of resistance to the other antimicrobials tested. The samples from dialysis patients exhibited a more homogenous genetic profile. Among the samples with a high percent similarity, no correlation with sensitivity or resistance to oxacillin was observed. According to the results of this study, the implementation of prevention and control measures, such as increased restrictions on prescriptions for antimicrobial drugs and nasal decontamination prior to high-risk procedures, is recommended.

[Evaluation of quality of life in elders undergoing hemodialysis]. / Avaliação da qualidade de vida em idosos submetidos ao tratamento hemodialítico.

Hemodialysis affects not only physical but psychological and social aspects, with repercussions on personal and family life. Considering the increase in the elderly population in Brazil, this study aims to evaluate the quality of life of elderly patients with chronic renal failure undergoing hemodialysis. This is a quantitative, descriptive exploratory study with elderly patients held in a facility specializing in hemodialysis in Guarapuava, Paraná, Brazil. The data were collected between May and June 2010, through a structured instrument and were submitted to the statistical software Statistica 7.1. Analyzing the domains of the questionnaire the highest score refers to the social domain (70.42) and the lowest, to the physical domain (49.37). Thus, the quality of life of these elderly had to be low, with variations according to the analyzed field. Researches aimed at assessing quality of life are relevant and instrumentalize the daily practice of care.

Infections in patients with chronic renal failure and kidney transplant recipients in Brazil.

Patients with chronic renal failure who are undergoing dialysis and kidney transplant recipients are susceptible to infection for several reasons. In this study, the profile of infections in patients with chronic renal failure and kidney transplant recipients treated at a hospital in northern Paraná, Brazil, from 2007 to 2009 was examined. The study involved 187 patients: 59 kidney transplant recipients and 128 patients undergoing dialysis. The frequency of infection was 25% (32/128) in dialysis patients and 8% (5/59) in transplant recipients (P = .008). Staphylococcus aureus was the most prevalent infectious agent, cultured from 27% (13/48) of samples, followed by Escherichia coli at 17% (8/48). All isolates of S aureus were sensitive to vancomycin and resistant to penicillin, and 43% were resistant to oxacillin. Most S aureus samples (43%) were isolated from cultures of blood samples. As for the E coli, 75% were resistant to cephalothin and 38% were resistant to sulfamethoxazole/trimethoprim. Most isolates of E coli (62%) were cultured from specimens of patients with suspected urinary tract infection.

Avaliação da qualidade de vida em idosos submetidos ao tratamento hemodialítico / Evaluación de la calidad de vida en personas mayores sometidos a hemodiálisis / Evaluation of quality of life in elderly undergoing hemodialysis

A hemodiálise afeta não só aspectos físicos, como psicológicos e sociais, com repercussão na vida pessoal e familiar. Considerando que no Brasil está ocorrendo um aumento da população idosa, esta pesquisa objetivou avaliar a qualidade de vida dos idosos com insuficiência renal crônica, submetidos ao tratamento hemodialítico. Trata-se de uma pesquisa quantitativa, de caráter descritivo exploratório, com idosos de um serviço especializado em hemodiálise de Guarapuava, Paraná. Os dados foram coletados entre maio a junho de 2010, através de um instrumento estruturado e, após, submetidos ao programa estatístico Statistica 7.1. Analisando os domínios do questionário, o maior escore diz respeito ao domínio social (70,42) e o menor, ao domínio físico (49,37). Assim, a qualidade de vida desses idosos apresentou-se baixa, com variações de acordo com o domínio analisado. Pesquisas voltadas à avaliação de qualidade de vida são relevantes e instrumentalizam a prática diária do cuidado.

Hemodiálisis afecta aspectos física y psicológica y social, con repercusiones en la vida personal y familiar. Mientras que en Brasil está experimentando un aumento de la población de edad avanzada, este estudio tuvo como objetivo evaluar la calidad de vida de los pacientes ancianos con insuficiencia renal crónica sometidos a hemodiálisis. Se trata de un estudio cuantitativo, exploratorio descriptivo con pacientes ancianos en un centro especializado en hemodiálisis Guarapuava, Paraná, Brasil. Los datos fueron recogidos entre mayo y junio de 2010 a través de un instrumento estructurado y, después someterse el programa estadístico Statistica 7.1. Analizar los dominios del cuestionario, la puntuación más alta con respecto al ámbito social (70,42) y menor dominio físico (49,37). Lo tanto, la calidad de vida de estos ancianos tenían ser bajo, con variaciones según ámbito analizado. La investigación destinada a evaluar la calidad de vida son relevantes e instrumentalizar la práctica diaria de atención.

Hemodialysis affects not only physical, and psychological and social, with repercussions on personal and family life. Whereas in Brazil is experiencing a increase in the elderly population, this study aimed to evaluate the quality of life of elderly patients with chronic renal failure undergoing hemodialysis. This is a quantitative, descriptive exploratory study with elderly patients at a facility specializing in hemodialysis Guarapuava, Paraná, Brazil. Data were collected between May and June 2010 through a structured instrument and, after undergoing the statistical program Statistica 7.1. Analyzing the domains of the questionnaire, the highest score with respect to the social domain (70.42) and the lowest physical domain (49.37). Thus, the quality of life of these elderly had to be low, with variations according to the analyzed field. Research aimed at assessing quality of life are relevant and instrumentalize daily practice of care.

Perfil fenotípico e genotípico de Staphylococcus aureus isolados de estudantes de enfermagem, 2008 / Phenotypic and genotypic profile of Staphylococcus aureus isolated in nursing students, 2008 / Perfil fenotípico y genotípico del Staphylococcus aureus aislados de estudiantes de enfermería, 2008

OBJETIVO: Verificar a prevalência de carreamento nasal, perfil fenotípico e genotípico de S. aureus isolados de estudantes de enfermagem. MÉTODOS: Estudo transversal, com população composta por 101 alunos, cursando as três primeiras séries do curso de graduação em Enfermagem no ano de 2008. S. aureus foi isolado de material biológico obtido dos vestíbulos nasais através de swab. A susceptibilidade à oxacilina e vancomicina foi determinada pelo teste de concentração inibitória mínima. A presença do gene MecA foi determinada pelo teste de reação em cadeia da polimerase. RESULTADOS: Verificou-se 90,1 por cento de positividade para S. aureus. A frequência de resistência à oxacilina foi de 9,8 por cento e todas as amostras foram sensíveis à vancomicina. A oito amostras resistentes À oxacilina apresentaram o gene MecA. CONCLUSÃO: A prevalência foi elevada. A resistência à oxacilna foi expressiva e todas as amostras foram sensíveis à vancomicina. As amostras resistentes à oxacilina carreavam o gene MecA.

OBJECTIVE: To investigate the prevalence of nasal entrainment, phenotypic and genotypic profile of Staphylococcus aureus, asisolated from nursing students. METHODS: A cross-sectional population of 101 students enrolled in the first three grades of the undergraduate nursing course in 2008. Staphylococcus aureus was isolated from biological material obtained from the swab through the nasal vestibules. Susceptibility to oxacillin and vancomycin was determined by minimum inhibitory concentration test. The mecA gene was identified by testing the polymerase chain reaction. RESULTS: There was a 90.1 percent positive finding of Staphylococcus aureus. The frequency of oxacillin resistance was 9.8 percent; all samples were sensitive to vancomycin. The eight strains resistant to oxacillin carried the mecA gene. CONCLUSION: The prevalence of Staphylococcus aureus was high. Oxacillin resistance was significant, but all strains were sensitive to vancomycin. Isolates resistant to oxacillin carried the mecA gene.

OBJETIVO: Verificar la prevalencia de transporte nasal, perfil fenotípico y genotípico de S. aureus aislados de estudiantes de enfermería. MÉTODOS: Estudio transversal, con población compuesta por 101 alumnos, cursando las tres primeras series del Pregrado en Enfermería en el año 2008. El S. aureus fue aislado del material biológico obtenido de los vestíbulos nasales a través de swab. La susceptibilidad a la oxacilina y vancomicina fue determinada por el test de concentración inhibitoria mínima. La presencia del gen MecA fue determinada por el test de reacción en cadena de la polimerasa. RESULTADOS: Se verificó el 90,1 por ciento de positividad para el S. aureus. La frecuencia de resistencia a la oxacilina fue de 9,8 por ciento y todas las muestras fueron sensibles a la vancomicina. Las ocho muestras resistentes a la oxacilina presentaron el gen MecA. CONCLUSION: La prevalencia fue elevada. La resistencia a la oxacilina fue expresiva y todas las muestras fueron sensibles a la vancomicina. Las muestras resistentes a la oxacilina transportaban el gen MecA.

Resistência antimicrobiana de amostras de staphylococcus aureus isoladas de recém-nascidos saudáveis / Antimicrobial resistance of staphylococcus aureus isolates obtained from healthy newborns / La resistencia a los antibióticos de staphylococcus aureus aisladas de recién nacidos saludables

Staphylococcus aureus oxacilina resistente é um dos principais patógenos associados à etiologia das infecções nosocomiais. Em recém-nascidos, a transmissão de S. aureus pode ocorrer durante o parto, mas também por meio de contato com familiares, profissionais da saúde e ambiente. O estudo foi realizado num hospital universitário no período de fevereiro a abril de 2007 e teve como objetivo determinar a frequência de portadores nasais de S. aureus entre recém-nascidos saudáveis, verificar o perfil de susceptibilidade das espécies isoladas frente aos antimicrobianos usualmente empregados na prática clínica e identificar a presença do gene mecA, que codifica a resistência a oxacilina. S. aureus foram isolados em 45 (90%) dos 50 indivíduos estudados e a resistência à oxacilina, determinada pelo método da Concentração Inibitória Mínima, foi observada em 5 amostras (11,1%). Destas amostras, em 4 (80%) foi detectada a presença do gene mecA. Destarte, os profissionais de saúde precisam estar particularmente atentos para a identificação de carreadores de S. aureus; pois estão diretamente envolvidos no cuidado e devem tomar precauções para controlar e prevenir sua disseminação.

Oxacillin resistant Staphylococcus aureus is a major pathogen associated with the etiology of nosocomial infections. Transmission of S.aureus may occur in newborns during delivery, however, it can also occur through contact with relatives, healthcare professionals and the environment. This study was carried out in a University hospital from February to April of 2007, in order to investigate the frequency of S.aureus nasal carriers among healthy newborns; the profile of susceptibility of isolated species to the antibiotics usually administered in clinical practice; and to identify the presence of gene which encodes resistance to Oxacillin (mecA gene). Staphylococcus aureus was isolated in 45 (90%), out of the 50 subjects investigated. Oxacillin resistance, determined by measuring the Minimum Inhibitory Concentration, was observed in 5 samples (11.1%). In 4 of the samples analyzed (80%), it was detected the presence of the mecA gene. Therefore, healthcare professionals are advised to take particular attention in order to identify the bearers/carriers of S. aureus, since such professionals are directly involved in providing care to patients; thus they must take precautions to control and prevent the germ spread.

Staphylococcus aureus oxacilina resistente es uno de los principales patógenos asociados a la etiología de las infecciones nosocomiales. En recién nacidos, la transmisión del S. aureus puede darse durante el parto, pero también puede ocurrir por medio del contacto con familiares, profesionales de la salud o por el medio ambiente. El estudio se realizó en un hospital universitario, en el período de febrero a abril de 2007 y tuvo como objetivo determinar la frecuencia de portadores nasales del S. aureus entre recién nacidos sanos, comprobar el perfil de susceptibilidad de las especies aisladas frente a los antimicrobianos que se emplean generalmente en la práctica clínica y identificar la presencia del gene mecA, que codifica la resistencia a la oxacilina. Se aislaron S. aureus en 45 (90%) de los 50 sujetos estudiados y en 5 muestras (11,1%) se observó resistencia a la oxacilina, determinada por el método de la Concentración Inhibitoria Mínima. De esas muestras, en 4 de ellas (80%) se detectó la presencia del gene mec. A. Por lo tanto, es necesario que los profesionales de salud estén particularmente atentos para la identificación de agentes del S. aureus, porque se encuentran directamente involucrados en el cuidado y deben tomar precauciones para controlar y prevenir su diseminación.

Prevalência de Streptococcus do grupo B em gestantes / Prevalence of Streptococcus agalactiae in pregnant women

Este artigo apresenta um estudo realizado com o objetivo de analisar a prevalência de colonização por Streptococcus do grupo B (EGB) em gestantes no terceiro trimestre de gestação, comparando a taxa de detecção de EGB entre os diferentes meios de cultura seletivos e não-seletivos em amostras vaginais e anorretais e avaliar a associação da colonização com variáveis maternas, socioeconômicas e clínicas. É um estudo transversal com 102 gestantes, a partir de 35 semanas de gestação, atendidas pelo Serviço de Ginecologia e Obstetrícia do Hospital e Maternidade Santa Casa de Maringá. A coleta dos materiais biológicos foi realizada com quatro swabs estéreis, sendo dois vaginais e dois anorretais e semeados em ágar sangue, contendo gentamicina e ácido nalidixico (ASA), Todd-Hewitt e Hich-Pike-Todd-Hewitt (HPTH). A prevalência da colonização pelo EGB na amostra estudada foi de 24,5 porcento. A detecção de EGB isoladamente nos meios HPTH, ASA e Todd-Hewitt foi de 21,6, 12,8 e 11,8 porcento, respectivamente. Os resultados de prevalência de colonização por EGB foram altos e estão de acordo com os detectados em outras regiões no Brasil. O meio de HPTH apresentou melhor capacidade de isolamento de EGB tanto em amostras vaginais como anorretais. As associações de coleta, nos sítios anorretais e vaginais, aumentaram a taxa de detecção de colonização por EGB. O tratamento da infecção urinária diminui a incidência de cultura positiva para EGB

This article presents a study which had the purpose to analyze the prevalence of colonization by EGB in pregnant women in the third pregnancy term; compare EGB detection rate among distinct selective and non-selective culture media of vaginal and anorectic samples; evaluate colonization to maternal, social, economical and clinical variables. It is a transversal study with 102 pregnant women, starting from the 35th week of pregnancy, attended at Service of Obstetrics and Gynecology of the Santa Casa Hospital and Maternity of Maringá; collection of biological samples was carried with four sterile swabs, or rather, two vaginal and two anorectic swabs, inoculated in blood agar plates with gentamicin and nalidixic acid (ASA), Todd-Hewitt and HPTH. Whereas prevalence of colonization by EGB in samples reached 24.5 percent, EGB detection in HPTH, ASA and Todd-Hewitt media was respectively 21.6 percent, 12.8 percent and 11.8 percent. Results on the prevalence of colonization by EGB were high, albeit similar to those detected in other regions of Brazil. HPTH medium had a better capacity of isolating EGB in vaginal and anorectic samples. Colletion associations in anorectic and vaginal sites increased the detection rate of colonization by EGB. Treatment of urinary infection reduces the incidence of positive EBG culture

Prevalência e perfil de sensibilidade de amostras de Staphylococcus aureus isoladas de casos clínicos de infecções hospitalares / Prevalence and sensibility profiles of Staphylococcus aureus samples isolated from clinical cases of hospital infections / Prevalencia y perfil de sensibilidad de muestras de Staphylococcus aureus isoladas de casos clínicos de infecciones hospitalares

Este estudo investigou a prevalência e o perfil de sensibilidade de amostras de Staphylococcus aureus isoladas de casos clínicos de infecções hospitalares, em um hospital de ensino, Londrina ? Paraná, no período de 2004. Foi também comparado os resultados dos testes de susceptibilidade a oxacilina e vancomicina de 74 cepas, obtidos pelo sistema automatizado MicroScan® (Dade Bering, Sacramento, Califórnia, USA, utilizando Painéis MicroScan® PC 12 (Gram Positivo), com os resultados da técnica de diluição em ágar com diferentes concentrações destes antimicrobianos. As informações foram procedentes do banco de dados das infecções hospitalares da Comissão de Controle de Infecção Hospitalar (CCIH). As amostras de S. aureus apresentaram amplo espectro de resistência frente as drogas testadas. A taxa média de prevalência de infecções hospitalares por S. aureus foi de 16,3% e a taxa média de prevalência de amostras oxacilina resistentes foi de 70,75%. Não se detectou amostras resistentes a vancomicina pelos 2 métodos. O método de diluição em ágar confirmou a resistência a oxacilina em 65 das 74 (83,75%) e as amostras avaliadas pelo sistema MicroScan® não apresentaram diferenças estatisticamente significantes. Para o antimicrobiano vancomicina, houve concordância em 100% entre os dois métodos.

This study investigated the prevalence and the susceptibility profile of Staphylococcus aureus samples isolated from clinical infections in a teaching hospital, Paraná - Londrina, cases between 2001 and 2004. The sensitivity test results for 74 strains to oxacillin and vancomycim, obtained by MicroScan® automated system (Dada Bering, Sacramento, California, USA, employing MicroScan® PC 12- gram positive Panels) were compared with the results obtained from the dilution agar method using different concentrations of antimicrobials. The data was obtained from the Hospital Infection Committee Control Data bank. The Staphylococcus aureus samples showed a large spectrum of resistance to the antimicrobials tested. The medium rate of prevalence of the S. aureus hospital infections was 16,3% and the medium rate of prevalence of the hospital infection, by oxacillin resistant S. aureus strains was 70,75%. It was not detected samples resistant to vancomycin using both methods. Among this 74 samples identified as oxacillin-resistant by MicroScan® system, 65 (83,75%) had their resistance confirmed by Dilution Agar Method. The difference between the results was not statistically significant. To the vancomycin, there was 100% of concordance in both methods.

En este estudio se investigó la prevalencia y el perfil de sensibilidad de muestras de Staphylococcus aureus aisladas de casos clínicos de infecciones hospitalarias, en un hospital de enseñanza, Londrina - Paraná, en el período de 2001 a 2004. Fue también comparado los resultados de las pruebas de susceptibilidad a la oxacilina y vancomicina de 74 cepas, obtenidos por el sistema automatizado MicroScan® (Dade Bering, Sacramento, California, EE.UU., utilizando Paneles MicroScan® PC 12 (Gram Positivo), con los resultados de la técnica de dilución en agar con diferentes concentraciones de estos antimicrobianos. Las informaciones fueron procedentes del banco de datos de las infecciones hospitalarias de de Control de Infección Hospitalaria (CCIH). Las muestras de S. aureus presentaron un amplio espectro de resistencia frente a las drogas probadas. La tasa promedio de prevalencia de infecciones hospitalarias por S. aureus fue de 16,3% y la tasa promedio de prevalencia de muestras oxacilina resistentes fue de 70,75%. No se detectó muestras resistentes a la vancomicina por los 2 métodos. El método de dilución en agar confirmó la resistencia a la oxacilina en 65 de las 74 (83,75%). Muestras evaluadas por el sistema MicroScan® siendo que esta diferencia entre osa 2 métodos no fue estadísticamente significante. Para el antimicrobiano vancomicina, hubo concordancia de 100% entre los dos métodos.