Bacteria which are highly resistant to antibiotics are not resistant hydro-alcoholic products.

BACKGROUND: Preventing the emergence of antibiotic-resistant bacteria requires strict adherence to standard precautions, including hand hygiene by hydro-alcoholic friction, a technique now recommended. Our study evaluates the in vitro efficacy of an hydro-alcoholic product on four emerging resistant bacteria. METHODS AND MATERIALS: The product was tested using the dilution-neutralization method using the NF/EN 13727+A2 standard on Staphylococcus epidermidis which is resistant to methicillin and has a reduced reaction to glycopeptide antibiotics, on Enterococcus faecium which is resistant to glycopeptides, as well as on Klebsiella pneumoniae and Pseudomonas aeruginosa which produce carbapenemases. Each of the steps was performed as a blind test on the test product as on the comparator. The surviving bacteria count was measured after 24 and 48 hours' incubation and the rate of reduction was calculated. RESULTS: A reduction which was higher than 5 decimal logarithms was observed 30seconds after contact. The test product had an 80% bactericidal concentration on Pseudomonas aeruginosa and 40% on the three other germs. The bactericidal concentration of the comparator was 80% on the four micro-organisms. DISCUSSION: The present study confirms the effect of hydro-alcoholic products on emerging resistant bacteria. The results make it possible to answer questions from healthcare professionals who often confuse antibiotics and antiseptics and question whether using hydro-alcoholic hand sanitizer is worth it. Proof of efficacy at 30seconds is reassuring since this time is close to that observed when evaluating practices. The data could be completed by performing in vitro tests using the NF/EN 1500 standard.

[Uncomplicated acute myocardial infarction -- when should the patient be discharged?]. / Enfarte agudo do miocárdio não complicado--quando dar alta hospitalar?

INTRODUCTION AND OBJECTIVES: Hospital discharge on day 10 after acute myocardial infarction (AMI) is still frequent in our hospital. The present study aims at evaluating the occurrence of cardiac events on day 5, 7 and 10, in patients with AMI who had an uncomplicated course for 72 hours after thrombolysis, as well as a cost-effectiveness analysis on an earlier discharge. METHODS: We retrospectively studied consecutive patients admitted with AMI for a period of 5 years, submitted to thrombolysis who suffered no events (recurrent ischemia, reinfarction, coronary revascularization, heart failure, arrhythmias implicating electric cardioversion or dysfibrilation, pacemaker or death) within the first 72 hours (n = 128; 101 males and 27 females, mean age 64.1 +/- 12.8). Patients were divided into two groups, with no events occurring by discharge (group I, n = 119) or with events between 72 hours and discharge (group II, n = 9). The latter were subdivided according to whether events occurred between 72 hours and day 5, between days 6 and 7 or between 8 and 10. RESULTS: Group I and II were not significantly different regarding vascular risk factors, prior coronary disease and infarction location. Group I was mainly constituted of males, younger than those in group II and with preserved systolic LV function. Between 72 hours and discharge, there were no events in 93% of the patients (119) and events occurred in 7% (9 patients). Two cases of cardiac events occurred until day 5 (1.6%) one angina and one death, two patients with complications between days 6 and 7 (1.6%), both heart failure, and 5 patients suffered events after day 7 (4%), 3 angina and 2 deaths. Dead patients (3 cases--2.3%) were older, had prior AMI, mostly with unpreserved systolic LV function and prior ischemic heart disease. All of them had sudden death. The most frequent non-fatal complications were recurrent ischemia and heart failure. CONCLUSIONS AND IMPLICATIONS: In patients with AMI who had an uncomplicated course for 72 hours after thrombolysis, the risk of cardiac events by the 10th day is low. It occurs randomly in time. In this group of patients it seems of no effectiveness to lengthen hospitalization. An earlier discharge may be advantageous since it does not significantly increase the risk that a longer hospitalization could prevent.