Pediatric tracheostomy: epidemiology and characterization of tracheal secretion - a literature review

SUMMARY INTRODUCTION Despite the benefits, tracheostomized children are susceptible to respiratory infections, since the tube is located in a strategic region where there is colonization by several bacteria and biofilm formation. Biofilm is formed when the bacteria adhere strongly to the surfaces of the tubes, providing protection against various types of aggression, such as antibiotic treatment. OBJECTIVE To carry out a literature review of the last ten years on tracheostomized pediatric patients, in order to characterize the bacteria isolated in children's tracheal secretions, and verify which ones are the most frequent. METHODS Two authors searched the Lilacs, SciELO, Medline Plus, and PubMed databases. The MeSH terms used were: 'tracheostomy' and 'tracheotomy' associated with 'infections', 'children', 'child', and 'bacterial' as qualifiers. RESULTS Of the 512 studies on the subject, 19 were selected for review. The total number of children evaluated in the studies was 4,472, with a mean age of 7.5 years. As for the bacteria found in the secretions of tracheostomized children, 12 species of bacteria were more frequent, P. aeruginosa was the predominant bacterium, followed by S. aureus (63.1%), Klebsiella pneumoniae (57.8%), Streptococcus pneumoniae (47.3%), and Stenotrophomonas maltophilia (47.3%). CONCLUSION One of the main complications treated in tracheostomized patients were infections, since the respiratory system is colonized by several bacteria that can cause serious infections, which are associated with the formation of biofilms. The predominant bacterium in most of the studies was P. aeruginosa, and the second species commonly reported was S. aureus.

RESUMO INTRODUÇÃO Apesar dos benefícios, crianças traqueostomizadas estão suscetíveis a adquirir infecções respiratórias, pois o tubo se encontra em uma região estratégica, na qual existe colonização de diversas bactérias e formação de biofilme. O biofilme é formado quando as bactérias aderem fortemente às superfícies dos tubos, conferindo proteção contra diversos tipos de agressões, como o tratamento por antibióticos. OBJETIVO Realizar uma revisão de literatura dos últimos dez anos sobre pacientes pediátricos traqueostomizados, no intuito de caracterizar as bactérias isoladas em secreções traqueais de crianças, verificando-se quais são as mais frequentes. MÉTODOS Dois autores pesquisaram nas bases de dados do Lilacs, SciELO, Medline Plus e PubMed. Termos MeSH utilizados: tracheostomy e tracheotomy usados associados a infections, children, chlid e bacterial como qualificadores. RESULTADOS Dos 512 estudos relacionados ao tema, 19 foram selecionados para a revisão. O total de crianças avaliadas nos estudos foi de 4.472, com idade média de 7,5 anos. Quanto às bactérias encontradas nas secreções de crianças traqueostomizadas, 12 espécies de bactérias foram mais frequentes; P. aeruginosa foi a bactéria predominante, seguida de S. aureus (63,1%), Klebsiella pneumoniae (57,8%), Streptococcus pneumoniae (47,3%) e Stenotrophomonas maltophilia (47,3%). CONCLUSÃO Umas das principais complicações abordadas em pacientes traqueostomizados foram as infecções, já que o sistema respiratório é colonizado por diversas bactérias, que podem causar infecções graves, sendo estas associadas à formação de biofilmes. A bactéria predominante na maioria dos estudos foi a P. aeruginosa, e a segunda espécie comumente relatada foi a S. aureus.

[ARTICLE PARTIAL RETRACTION] PREVALENCE OF HELICOBACTER PYLORI INFECTION IN DYSPEPTIC PATIENTS AND ITS ASSOCIATION WITH CLINICAL RISK FACTORS FOR DEVELOPING GASTRIC ADENOCARCINOMA.

BACKGROUND: In Brazil, particularly in the underdeveloped localities, the prevalence of Helicobacter pylori (H. pylori) infections can range up to 90%. These rates are higher in older individuals and vary by country region. H. pylori infections are linked to the development of gastric pathologies, namely mild to moderate gastritis, gastroenteritis, peptic ulcer, intestinal metaplasia, and gastric cancer. In 1994, this organism was classified by the International Agency for Research on Cancer (IARC) as pertaining to the Group 1 carcinogen for gastric adenocarcinoma etiology. Gastric cancer represents a significant public health problem, being the fourth most common malignant tumor and the second largest cause of cancer-related deaths. OBJECTIVE: To investigate the prevalence of H. pylori infection in dyspeptic patients and determine the link between clinical risk factors and gastric adenocarcinoma diagnosis. METHODS: Polymerase chain reaction (PCR) analysis was employed for molecular diagnosis of gastric tissue biopsies collected from 113 dyspeptic patients at the University Hospital of Federal University of Goiás. Molecular analyses allowed the identification of H. pylori infections. Furthermore, histopathological examinations were performed to determine the clinical risks of developing gastric malignancies. RESULTS: The test results identified 69 individuals older than 44 years, from 75 (66.4%) positive H. pylori infection samples. The prevalence of gastric adenocarcinoma in this study was 1.3%. Among the infected patients, six (8.2%) had high risk, and 67 (91.8%) had a low risk of developing gastric cancer (P<0.05). CONCLUSION: This study shows a high prevalence of H. pylori infection and identifies its contribution to gastric inflammations, which in the long term are manifested in high-risk clinical factors for the development of gastric adenocarcinoma.

Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization.

INTRODUCTION: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. MATERIAL AND METHODS: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. RESULTS: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. CONCLUSIONS: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.

[Artigo Parcialmente Retratado] Prevalência da infecção por Helicobacter pylori em pacientes dispépticos e associação com fatores de riscos clínicos para o desenvolvimento de adenocarcinoma gástrico / [article partial retraction] prevalence of helicobacter pylori infection in dyspeptic patients and its association with clinical risk factors for developing gastric adenocarcinoma

ABSTRACT BACKGROUND: In Brazil, particularly in the underdeveloped localities, the prevalence of Helicobacter pylori (H. pylori) infections can range up to 90%. These rates are higher in older individuals and vary by country region. H. pylori infections are linked to the development of gastric pathologies, namely mild to moderate gastritis, gastroenteritis, peptic ulcer, intestinal metaplasia, and gastric cancer. In 1994, this organism was classified by the International Agency for Research on Cancer (IARC) as pertaining to the Group 1 carcinogen for gastric adenocarcinoma etiology. Gastric cancer represents a significant public health problem, being the fourth most common malignant tumor and the second largest cause of cancer-related deaths. OBJECTIVE: To investigate the prevalence of H. pylori infection in dyspeptic patients and determine the link between clinical risk factors and gastric adenocarcinoma diagnosis. METHODS: Polymerase chain reaction (PCR) analysis was employed for molecular diagnosis of gastric tissue biopsies collected from 113 dyspeptic patients at the University Hospital of Federal University of Goiás. Molecular analyses allowed the identification of H. pylori infections. Furthermore, histopathological examinations were performed to determine the clinical risks of developing gastric malignancies. RESULTS: The test results identified 69 individuals older than 44 years, from 75 (66.4%) positive H. pylori infection samples. The prevalence of gastric adenocarcinoma in this study was 1.3%. Among the infected patients, six (8.2%) had high risk, and 67 (91.8%) had a low risk of developing gastric cancer (P<0.05). CONCLUSION: This study shows a high prevalence of H. pylori infection and identifies its contribution to gastric inflammations, which in the long term are manifested in high-risk clinical factors for the development of gastric adenocarcinoma.

RESUMO CONTEXTO: No Brasil, particularmente nas áreas mais pobres, a prevalência da infecção por Helicobacter pylori pode variar até 90%. Esses índices aumentam com o envelhecimento da população e são distintos entre as diferentes regiões do país. Podendo manifestar diferentes sintomatologias, essa infecção está diretamente relacionada com o desenvolvimento de patologias gástricas como gastrite leve a moderada, gastroenterites, úlcera péptica, metaplasia intestinal e principalmente, o câncer gástrico. Em 1994 a bactéria foi categorizada pela International Agency for Research on Cancer (IARC) como carcinógeno do Grupo 1 para adenocarcinoma gástrico, tipo de câncer que representa um importante problema de saúde pública, sendo o quarto tumor maligno mais comum e a segunda maior causa de mortes por câncer no mundo. OBJETIVO: Analisar a prevalência da bactéria em pacientes dispépticos e avaliar a associação de fatores de risco clínicos para desenvolvimento de adenocarcinoma gástrico. MÉTODOS: Biópsias de tecido gástrico coletadas de 113 pacientes dispépticos, atendidos no Hospital das Clínicas da Universidade Federal de Goiás, foram submetidas a diagnóstico molecular por meio de Reação em Cadeia da Polimerase, para identificação da infecção por Helicobacter pylori, e exame histopatológico, para avaliar o risco clínico de desenvolvimento de adenocarcinoma gástrico. RESULTADOS: Foram diagnosticadas 75 (66,4%) amostras positivas para infecção por Helicobacter pylori, sendo 69 indivíduos maiores de 44 anos de idade. A prevalência do adenocarcinoma gástrico nesse estudo foi de 1,3% e dentre os pacientes positivos para a infecção bacteriana seis (8,2%) possuem alto risco e 67 (91,8%) baixo risco de desenvolver esse tipo de câncer (P<0,05). CONCLUSÃO: Esse estudo mostra uma alta prevalência da infecção por H. pylori na população estudada e identifica sua intrínseca contribuição para inflamações gástricas, que a longo prazo se manifestam em fatores clínicos de alto risco para o desenvolvimento de adenocarcinoma gástrico.

Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization

ABSTRACT Introduction: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. Material and methods: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. Results: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. Conclusions: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.

Pediatric tracheostomy: epidemiology and characterization of tracheal secretion - a literature review.

INTRODUCTION: Despite the benefits, tracheostomized children are susceptible to respiratory infections, since the tube is located in a strategic region where there is colonization by several bacteria and biofilm formation. Biofilm is formed when the bacteria adhere strongly to the surfaces of the tubes, providing protection against various types of aggression, such as antibiotic treatment. OBJECTIVE: To carry out a literature review of the last ten years on tracheostomized pediatric patients, in order to characterize the bacteria isolated in children's tracheal secretions, and verify which ones are the most frequent. METHODS: Two authors searched the Lilacs, SciELO, Medline Plus, and PubMed databases. The MeSH terms used were: 'tracheostomy' and 'tracheotomy' associated with 'infections', 'children', 'child', and 'bacterial' as qualifiers. RESULTS: Of the 512 studies on the subject, 19 were selected for review. The total number of children evaluated in the studies was 4,472, with a mean age of 7.5 years. As for the bacteria found in the secretions of tracheostomized children, 12 species of bacteria were more frequent, P. aeruginosa was the predominant bacterium, followed by S. aureus (63.1%), Klebsiella pneumoniae (57.8%), Streptococcus pneumoniae (47.3%), and Stenotrophomonas maltophilia (47.3%). CONCLUSION: One of the main complications treated in tracheostomized patients were infections, since the respiratory system is colonized by several bacteria that can cause serious infections, which are associated with the formation of biofilms. The predominant bacterium in most of the studies was P. aeruginosa, and the second species commonly reported was S. aureus.

Occurrence of heavy metals and contaminants on the surface of adjacent rivers.

Water is fundamental to the survival of living beings. It registers every impact and can function as an indicator of environmental stressors. Our objective in the current study was to assess the sanitary conditions of the waters in the Açude, Maria Lucinda and Santa Rosa streams. This was done by checking pH, running quantitative analyses of heavy metals and testing for total coliforms. The effect of ultraviolet (UV) rays on samples positive for coliforms was evaluated. The average pH of the streams ranged between 4 and 7 and changed between drought and rainy season conditions. Chromium and nickel values were above those permitted by the Brazilian National Council on the Environment, CONAMA. In the dry season, zinc values were above those established by CONAMA for waterbodies of Classes 1 and 2. Thermotolerant coliforms were present in all samples collected and above permitted values. After exposing the bacteria to UV light, it was noted that UV irradiation was unable to decrease the bacteria count. Ninety residents who use stream water were interviewed: 24% of interviewees said they use the waters of the Açude and Mary Lucinda streams and along the Santa Rosa stream, 95% of inhabitants said they use the water.

Streptococcus spp em faringotonsilite aguda recorrente: frequência e perfil mde susceptibilidade a antimicrobianos / Streptococcus spp in recurrent acute sore throat: frequency and susceptibility profile to antimicrobial

O objetivo deste trabalho foi determinar a frequência e o perfil de susceptibilidade a antimicrobianosde Streptococcus em faringotonsilite aguda recorrente. Para o estudo foram coletadas tonsilas de122 pacientes com idade entre 3 e 38 anos (66 pacientes do sexo masculino e 56 do sexo feminino)com histórico de faringotonsilite aguda recorrente, associada à hipertrofia tonsilar, e submetidosà tonsilectomia em um hospital escola. Após isolamento e identificação bacteriana, testes deantibiograma foram realizados para determinar o perfil de susceptibilidade a antimicrobianos. Foram isoladas e identificadas 151 amostras bacterianas pertencentes ao gênero Streptococcus.Destas, 41,1 por cento foram identificadas como Streptococcus grupo viridans não hemolítico; 39,1 por cento como Streptococcus grupo viridans a-hemolítico; 7,3 por cento como Streptococcus dos grupos C, F ou G;5,3 por cento como Streptococcus spp. Beta-hemolítico; 4,6 por cento como Streptococcus spp. não hemolítico; 1,3 por cento como Streptococcus spp. grupo a-hemolítico e 1,3 por cento como Streptococcus Beta-hemolíticos do grupo A. Observou-se nos testes de antibiograma resistência aos antibióticos Beta-lactâmicos. É importante omonitoramento da microbiota que coloniza a orofaringe, visto que alguns de seus componentes têmse tornado resistentes aos medicamentos mais utilizados no tratamento das faringotonsilites, o quepode contribuir para os processos de recidiva.

The aim of this study was to determine the frequency and the antimicrobial susceptibility profileof Streptococcus spp. obtained from recurrent acute pharyngo-tonsillitis. For this study, tonsilsfrom 122 patients ranging from 3 to 38 years old (66 males and 56 females) were collected. Allpatients had a history of recurrent acute pharyngo-tonsillitis associated with tonsillar hypertrophyand were submitted for tonsillectomy at a teaching hospital. After isolation and identification,antimicrobial susceptibility tests were performed. A hundred and fifty one isolates of Streptococcusspp. were obtained from tonsils, consisting of 41.06 percent non-hemolytic Streptococcus viridans group,39.07 percent a-hemolytic Streptococcus viridans group, 7.30 percent Streptococcus of C, F or G groups, 5.30 percent beta-hemolytic Streptococcus spp., 4.63 percent non-hemolytic Streptococcus spp., 1.32 percent a-hemolytic Streptococcus spp. and 1.32 percent group A beta hemolytic Streptococcus. Some of the isolates were resistantto beta-lactamic antibiotics. The study showed that components of the oropharynx microbiotapresented resistance to drugs commonly used to treat pharyngo-tonsillitis infections. Correctdiagnosis would improve treatment and could prevent recurrent infections.

Isolamento e identificação da microbiota periodontal de cães da raça Pastor Alemão / Isolate and identify of periodontal microbiota of German Shepherd dogs

A microbiota indígena gengival de cães não está totalmente descrita, sendo sua identificação uma etapa importante no estabelecimento da etiopatogenia e terapia da doença periodontal. O objetivo deste trabalho foi isolar e identificar a microbiota periodontal de cães da raça Pastor Alemão, considerando sítios saudáveis e com doença periodontal. Foram utilizados 29 cães, com idade variando de três a seis anos, sendo analisados espécimes clínicos de sítios periodontais saudáveis de 12 cães e sítios com periodontite de outros 17. Foram isoladas 672 amostras microbianas, com predomínio dos gêneros Pasteurella, Staphylococcus, Porphyromonas e Fusobacterium. A microbiota dos sítios saudáveis equiparou-se à dos sítios doentes, tratando-se de uma microbiota indígena. A microbiota dos sítios doentes apresentou-se aumentada em relação a dos sítios saudáveis, indicando mudança do ambiente do sítio periodontal.