Fatores de risco para colonização por bactérias hospitalares multiresistentes em pacientes críticos, cirúrgicos e clínicos em um hospital universitário brasileiro / Risk factors for colonization by multiresistant hospital bacterias in critical, surgical and clinical patients in aBrazilian university hospital

Objetivos: avaliar os fatores de risco intrínsecos e extrínsecos associados à colonização por microrganismos resistentes aos antibióticos em pacientes clínicos, cirúrgicos e críticos internados no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU). Casuística: foi realizado um estudo em pacientes colonizados (n=78) e não-colonizados (n=155), incluindo pacientes clínicos (n=126), cirúrgicos (n=72) e críticos (n=35), com idade média de 56,5 anos e tempo de internação de 10,5 dias. A pesquisa de colonização foi realizada na narina e intestino a partir da coleta de material com auxílio de swab e o cultivo primário em meios de ágar MacConkey contendo 2 µg/mL de ceftazidima e ágar manitol salgado com 6 µg/mL de oxacilina. A multirresistência foi caracterizada pelo teste de difusão com disco. Foi preenchida uma ficha individual contendo dados demográficos, fatores de risco intrínsecos e extrínsecos e uso de antimicrobianos. Resultados: no total, aproximadamente 35,0% dos pacientes estavam colonizados; 39,7% estavam colonizados por estafilococos e 35,9% por bacilos gram-negativos (multirresistentes). Os pacientes críticos representaram 54,3% do total. Os fatores de risco associados à presença desses microrganismos incluíram: internação igual ou superior a sete dias (p<0,0001; OR=7,97; IC=3,54-18,47); uso de antibióticos(p=0,003; OR=2,38; IC=1,31-4,32), uso de ? 2 antibióticos (p=0,0004; OR=2,83; IC=1,54-5,21); e internação na Unidade de Terapia Intensiva (p=0,008; OR=2,80; IC=1,27-6,19). Conclusção: a taxa de colonização dos pacientes por Staphylococcus aureus e bacilos gram negativo resistentes foi alta e associada principalmente ao uso de antibióticos e internamento na UTI.

Objectives: to evaluate the intrinsic and extrinsic risk factors related to the colonization by antibiotics resistant microorganisms in clinical, surgical and critical patients in the Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU). Casuistic:"a study was carried out in colonized (n=78) and non-colonized (n=155) patients, included clinical (n=126), surgical (n=72) and critical (n=35) patients, with average age 56,5 years and hospital treatment for 10,5 days. The colonization research was carried out in the nostrils and intestine from material collection with the aid of a ?swab? and the primary cultivation in MacConkey agar environment containing 2 µg/mL of ceftazidime and Manitol agar salty with 6 µg/mL of oxaciline. The multirresistance was found by the diffusion test with disk. An individual card was filled in with demographic data, intrinsic and extrinsic risk factors and use of antimicrobials. Results: in the total, approximately 35,0% of the patients were colonized; 39,7% were colonizedby Staphylococcus and 35,9% by gram-negative bacilli (multirresistant). The critical patients represented 54,3% of the total. The risk factors related to the presence of thesemicroorganisms included: internment equal or over seven days (p<0,0001; OR=7,97; IC=3,54-18,47); use of antibiotics (p=0,003; OR=2,38; IC=1,31-4,32), use of ? 2 antibiotics (p=0,0004; OR=2,83; IC=1,54-5,21); and internment in theIntensive Therapy Unit (p=0,008; OR=2,80; IC=1,27-6,19). Conclusion: patients? colonization rate by resistant Staphylococcus aureus and gram negative bacilli was high and related mainly to the use of antibiotics and UTI internment.

Experimental model in the qualitative and quantitative assessment of non-Helicobacter gastric microflora under proton pump inhibitors action / Modelo experimental na avaliação qualitativa e quantitativa da microflora gástrica não-Helicobacter sob ação de inibidores de bomba de próton

PURPOSE: To evaluate models of gastric material collection from Wistar rats with and without using proton pump inhibitors(PPIs). METHODS: Twenty-four rats underwent intraperitoneal omeprazol treatment, and other 12 received similar treatment with 0.9 percent saline. All animals underwent collection of gastric material samples, after stomach removal, by either biopsies, or aspirates, or swabs. Samples were bacteriologically processed in order to identify species and strains. Values are described as natural logarithm of colony former units per mL [Ln(CFU/mL)]. Kruskal-Wallis and Mann-Whitney non-parametric tests were used, and p<0.05 was set as statistically significant. RESULTS: Significant difference was not seen for Ln (UFC/mL) values among the three methods of collection irrespective of using or not omeprazol. Also, significant difference was not seen in Ln (UFC/mL) values when comparing a method with each others, either using omeprazol or placebo. A significant increase of bacteria strains occurred when PPI was used, and this was seen on the three ways of collection, mainly in biopsy and swab. CONCLUSION: No difference occurred among the three methods of collecting bacteria samples from stomachs of rats, either when using placebo or omeprazol. A remarkable change is seen on animals bacterial microflora when PPIs are used, and bacteria are better identified when swab and biopsy are used.

OBJETIVO: Avaliar modelos de coleta de material gástrico de ratos da linhagem Wistar, com e sem o uso de inibidores de bomba de próton (IBPs). MÉTODOS: 24 ratos foram submetidos a tratamento com omeprazol intraperitoneal e 12 outros ratos receberam tratamento semelhante com solução salina a 0,9 por cento. Os animais foram submetidos a coleta de amostras de material gástrico, após retirada do estômago, utilizando-se de biópsias, aspirados ou swabs. Os materiais obtidos foram processados bacteriologicamente para identificação de espécimes quanto ao gênero. Os valores são descritos em logaritmo natural das unidades formadoras de colônias por mL [Ln(UFC/mL)]. Utilizou-se os testes não-paramétricos de Kruskal-Wallis e Mann-Whitney, considerando-se p<0,05 como estatisticamente significativo. RESULTADOS: Não se observou diferença significativa da quantidade de Ln(UFC/mL) entre os três métodos de coleta, independente do uso de omeprazol. Também não se observou diferença significativa de Ln(UFC/mL) ao comparar-se os métodos individualmente entre si nas condições de uso de omeprazol ou placebo. Houve aumento significativo da variedade de gêneros de bactérias com o uso de IBP, nos 3 métodos de coleta, sendo isto mais perceptível na biópsia e swab. CONCLUSÃO: Não houve diferença entre os três métodos de coleta de amostras bacterianas de estômago de ratos, tanto em uso de placebo quanto em uso de omeprazol. Nota-se uma mudança evidente da microflora bacteriana nos animais em uso de IBPs, sendo melhor identificado pelos métodos de swab e biópsia.

Experimental model in the qualitative and quantitative assessment of non-Helicobacter gastric microflora under proton pump inhibitors action.

PURPOSE: To evaluate models of gastric material collection from Wistar rats with and without using proton pump inhibitors(PPIs). METHODS: Twenty-four rats underwent intraperitoneal omeprazol treatment, and other 12 received similar treatment with 0.9% saline. All animals underwent collection of gastric material samples, after stomach removal, by either biopsies, or aspirates, or swabs. Samples were bacteriologically processed in order to identify species and strains. Values are described as natural logarithm of colony former units per mL [Ln(CFU/mL)]. Kruskal-Wallis and Mann-Whitney non-parametric tests were used, and p<0.05 was set as statistically significant. RESULTS: Significant difference was not seen for Ln (UFC/mL) values among the three methods of collection irrespective of using or not omeprazol. Also, significant difference was not seen in Ln (UFC/mL) values when comparing a method with each others, either using omeprazol or placebo. A significant increase of bacteria strains occurred when PPI was used, and this was seen on the three ways of collection, mainly in biopsy and swab. CONCLUSION: No difference occurred among the three methods of collecting bacteria samples from stomachs of rats, either when using placebo or omeprazol. A remarkable change is seen on animals bacterial microflora when PPIs are used, and bacteria are better identified when swab and biopsy are used.