First known case of human bertiellosis in a child in Paraná, Brazil / Primeiro caso conhecido de bertielose humana em uma criança no Paraná, Brasil

ABSTRACT Objective: To describe the first known case of human Bertiellosis in Paraná (Brazil). Case description: A 6-year-old male residing in the Brazilian state of Paraná was suffering from intermittent nonspecific abdominal pain and abdominal distension, associated with expulsion of live tapeworms in his feces for 7 months. He had a history of interaction with monkeys on an island. His first feces analysis was inconclusive, with an initial hypothesis of an atypical Taenia. However, after additional research, the parasitologist identified pregnant proglottids of Bertiella sp. The patient was initially treated with an unknown dosage of albendazole and nitazoxanide, as it was believed he had been infected with Taenia sp. Since the symptoms persisted, praziquantel 10 mg/kg was prescribed without further proglottids elimination. Comments: Human Bertiellosis is a rare zoonosis, with less than one hundred cases reported. However, it is a cause of chronic abdominal pain and should be kept as a differential diagnosis, especially in cases reporting recurrent tapeworm expulsion in feces and refractory treatment with albendazole.

RESUMO Objetivo: Descrever o primeiro caso conhecido de bertielose humana no Paraná, Brasil. Descrição do caso: Criança de seis anos do sexo masculino, residente no Paraná, Brasil, apresentava dor abdominal inespecífica intermitente e distensão abdominal, associadas à expulsão de helmintos vivos em suas fezes havia sete meses. Tinha um histórico de interação com macacos em uma ilha. Sua primeira análise de fezes foi inconclusiva, com hipótese inicial de uma Taenia atípica. No entanto, após pesquisas adicionais, o parasitologista identificou proglótides gravídicas de Bertiella sp. O paciente foi inicialmente tratado com uma dosagem desconhecida de albendazol e nitazoxanida, pois se acreditava que havia sido infectado por Taenia sp. Diante da persistência dos sintomas, foi prescrito praziquantel 10 mg/kg, sem mais eliminação de proglótides. Comentários: A bertielose humana é uma zoonose rara, com menos de cem casos relatados. No entanto, é uma causa de dor abdominal crônica e deve ser mantida como diagnóstico diferencial, principalmente nos casos que relatam expulsão recorrente de helmintos nas fezes e que são refratários ao tratamento com albendazol.

First known case of human bertiellosis in a child in Paraná, Brazil.

OBJECTIVE: To describe the first known case of human Bertiellosis in Paraná (Brazil). CASE DESCRIPTION: A 6-year-old male residing in the Brazilian state of Paraná was suffering from intermittent nonspecific abdominal pain and abdominal distension, associated with expulsion of live tapeworms in his feces for 7 months. He had a history of interaction with monkeys on an island. His first feces analysis was inconclusive, with an initial hypothesis of an atypical Taenia. However, after additional research, the parasitologist identified pregnant proglottids of Bertiella sp. The patient was initially treated with an unknown dosage of albendazole and nitazoxanide, as it was believed he had been infected with Taenia sp. Since the symptoms persisted, praziquantel 10 mg/kg was prescribed without further proglottids elimination. COMMENTS: Human Bertiellosis is a rare zoonosis, with less than one hundred cases reported. However, it is a cause of chronic abdominal pain and should be kept as a differential diagnosis, especially in cases reporting recurrent tapeworm expulsion in feces and refractory treatment with albendazole.

Tuberculosis preventive treatment in children and adolescents: an observational study of secondary data.

OBJECTIVE: To analyze the effectiveness, safety, outcomes, and associated factors of tuberculosis preventive treatment (TPT) in children and adolescents in Paraná, southern Brazil. METHOD: This was an observational cohort study with a retrospective collection of secondary data from the TPT information systems of the state of Paraná from 2009 to 2016, and tuberculosis in Brazil from 2009 to 2018. RESULTS: In total, 1,397 people were included. In 95.4% of the individuals, the indication for TPT was a history of patient-index contact with pulmonary tuberculosis. Isoniazid was used in 99.9% of the cases with TPT, and 87.7% completed the treatment. The TPT protection was 98.7%. Among the 18 people who had TB, 14 (77.8%) became ill after the second year of treatment, and four (22.2%) in the first two years (p < 0.001). Adverse events were reported in 3.3% of cases, most of them were gastrointestinal and medication was discontinued in only 2 (0.1%) patients. No risk factors associated with the illness were observed. CONCLUSIONS: The authors observed a low rate of illness in pragmatics routine conditions in TPT for children and adolescents, especially within the first two years after the end of treatment, with good tolerability and a good percentage of adherence to the treatment. TPT should be encouraged to achieve the goals of the End TB Strategy of the World Health Organization as an essential strategy to reduce the incidence rate of the disease, but studies with new schemes must continue to be carried out in real-life scenarios.

Tuberculosis preventive treatment in children and adolescents: an observational study of secondary data

Abstract Objective To analyze the effectiveness, safety, outcomes, and associated factors of tuberculosis preventive treatment (TPT) in children and adolescents in Paraná, southern Brazil. Method This was an observational cohort study with a retrospective collection of secondary data from the TPT information systems of the state of Paraná from 2009 to 2016, and tuberculosis in Brazil from 2009 to 2018. Results In total, 1,397 people were included. In 95.4% of the individuals, the indication for TPT was a history of patient-index contact with pulmonary tuberculosis. Isoniazid was used in 99.9% of the cases with TPT, and 87.7% completed the treatment. The TPT protection was 98.7%. Among the 18 people who had TB, 14 (77.8%) became ill after the second year of treatment, and four (22.2%) in the first two years (p < 0.001). Adverse events were reported in 3.3% of cases, most of them were gastrointestinal and medication was discontinued in only 2 (0.1%) patients. No risk factors associated with the illness were observed. Conclusions The authors observed a low rate of illness in pragmatics routine conditions in TPT for children and adolescents, especially within the first two years after the end of treatment, with good tolerability and a good percentage of adherence to the treatment. TPT should be encouraged to achieve the goals of the End TB Strategy of the World Health Organization as an essential strategy to reduce the incidence rate of the disease, but studies with new schemes must continue to be carried out in real-life scenarios.

String test: a potentially useful tool in the diagnosis of pulmonary tuberculosis in Brazilian children and adolescents.

This study investigated the potential use of the String Test (ST) for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. This is a case series of patients aged 4-15 years presenting with clinically presumed PTB and submitted to ST in three pediatric TB referral centers in Brazil, between November 2017 and July 2020. The ST was performed in the morning, after 4-12 h of fasting, followed by ingestion of the capsule by the patient, which was attached to the patient's malar region. The material was collected for simultaneous smear microscopy (acid-fast bacilli - AFB), culture and the molecular investigation by the GeneXpert MTB/RIF®. Thirty-three patients with presumed PTB were included and ST was performed in 26 (78.8%) of them and 7 (21.2%) patients could not swallow the cord. The diagnosis of PTB was established in 11 (42.3%) of the 26 patients who underwent the ST. The diagnosis of PTB was confirmed (by culture or GeneXpert MTB/RIF®) in 5 patients, 4 of whom were also positive by the ST. Two of them showed positivity by the GeneXpert MTB/RIF® only in the ST sample. Two other patients had a positive ST following the induced sputum test (AFB, GeneXpert MTB/RIF®, and positive culture in both specimens). Thus, ST was positive in 36.4% of the patients in whom PTB was diagnosed. ST could be a useful test for diagnosing PTB in children and adolescents.

Intolerância à lactose: diagnóstico clínico laboratorial e genético / Lactose intolerance: clinical and genetic diagnosis

Introdução: A intolerância à lactose é síndrome decorrente da má digestão do dissacarídeo lactose por deficiência da enzima lactase, gerando sintomas principalmente gastrintestinais. Ela envolve 4 causas principais: deficiência congênita de lactase; deficiência de lactase de desenvolvimento; intolerância primária à lactose; e deficiência secundária à lactase. Objetivo: Revisão da apresentação clínica da intolerância à lactose e os principais métodos disponíveis para seu diagnóstico clínico. Método: Revisão narrativa da base de dados PubMed, por meio das palavras-chave "lactose intolerance" e "genetic test" utilizando o descritor boleano and. Foram incluídos somente artigos em língua inglesa e publicados entre os anos de 2017 e 2022, totalizando 8 artigos. Resultado: O diagnóstico de intolerância à lactose relaciona-se com o seu tipo e utiliza-se dos principais métodos: teste oral de tolerância à lactose, teste genético, teste do hidrogênio expirado. Conclusão: Quanto aos métodos de diagnóstico, o teste do hidrogênio expirado é o de escolha, por não ser invasivo, possuir execução fácil e baixo custo. Entretanto, ele não dispensa associação com outras técnicas diagnósticas. O teste genético também é muito útil e sua vantagem é que não há necessidade da realização do teste oral de tolerância.

Introduction: Lactose intolerance is a syndrome resulting from maldigestion of the disaccharide lactose due to lactase enzyme deficiency causing symptoms mainly gastrointestinal. It involves 4 main causes: congenital lactase deficiency; developmental lactase deficiency; primary lactose intolerance; and secondary lactase deficiency. Objective: Review of the clinical presentation of lactose intolerance and the main methods available for its clinical diagnosis. Methods: Literature review in the PubMed database, using the keywords "lactose intolerance" and "genetic test" and using the Boolean data type and. Only articles in English and published between the years 2017 and 2022 were included, totalizing 8 articles. Results: The diagnosis of lactose intolerance is related to its type and uses the main diagnostic tests: oral lactose tolerance, genetic, expired hydrogen. Conclusion: Regarding diagnostic methods, the expired hydrogen test is the one of choice, as it is not invasive, is easy to perform and has low cost. However, it does not dispense association with other diagnostic techniques. Genetic testing is also very usefull and its advantage is that there is no need to use the oral lactose tolerance test.

Perfil dos anestesiologistas e os aspectos que interferem na sua satisfação profissional / Profile of anesthesiologists and the aspects that interfere in professional satisfaction

Introdução: Aspectos emocionais, sociais e de remuneração na população de anestesiologistas permanecem parcialmente obscuros. O interesse em reconhecer as características desse grupo pode permitir estratégias de saúde ocupacional que melhorem a qualidade social e profissional dos anestesiologistas. Objetivos: Conhecer o perfil dos médicos anestesiologistas e aspectos que interferem na satisfação profissional. Método: Estudo individual, observacional, transversal, caracterizado como inquérito, de abordagem quantitativa, entre os médicos anestesiologistas do estado do Paraná. Resultados: A taxa de satisfação profissional foi de 82%. A amostra teve predomínio de homens, com percentual de 58,8%, autônomos, com 40,4%, faixa etária entre 30 a 39 anos 45,1%, formados entre 10 a 29 anos, com 47,2% e os que realizam carga horária de 40 a 59 h semanais, com 50,6%. A estrutura de trabalho foi referida como boa em 54,3% das vezes e a remuneração salarial média foi de 10 a 29 mil reais 50,6% dos casos. Os resultados apontam que 75,1% realizam plantões noturnos e 55,8% não dormem bem. Conclusão: A baixa qualidade da estrutura de trabalho, a carga horária elevada, a falta de vínculo empregatício, a baixa remuneração, o sedentarismo, a realização de plantões noturnos e a privação de sono, associados a relação familiar ruim, ambiente e situações estressantes, são fatores que alteram consideravelmente a satisfação profissional do médico anestesiologista, podendo gerar problemas físicos e psicológicos, fazendo com que percam o interesse por atualizarem-se. Isso também faz com que esses profissionais encurtem suas carreiras.

Introduction: Emotional, social and remuneration aspects in the population of anesthesiologists remain partially unclear. The interest in recognizing the characteristics of this group may allow for occupational health strategies that improve the social and professional quality of anesthesiologists. Objectives: To know the profile of anesthesiologists and aspects that interfere with professional satisfaction. Method: Individual, observational, cross-sectional study, characterized as a survey, with a quantitative approach, among anesthesiologists in the state of Paraná. Results: The job satisfaction rate was 82%. The sample had a predominance of men, with a percentage of 58.8%, self-employed, with 40.4%, aged between 30 and 39 years 45.1%, graduated between 10 and 29 years, with 47.2% and those who work 40 to 59 hours per week, with 50.6%. The work structure was referred to as good in 54.3% of the cases and the average salary was between R$ 10,000.00 and 29,000.00 in 50.6% of the cases. The results indicate that 75.1% work night shifts and 55.8% do not sleep well. Conclusion: The low quality of the work structure, the high workload, the lack of employment, low pay, sedentary lifestyle, performing night shifts and sleep deprivation, associated with poor family relationships, environment and stressful situations, these are factors that considerably alter the professional satisfaction of anesthesiologists, and may cause physical and psychological problems, causing them to lose interest in updating themselves. This also causes these professionals to shorten their careers.

Diagnosis of pulmonary tuberculosis in children and adolescents: comparison of two versions of the Brazilian Ministry of Health scoring system.

The aim of this study was to evaluate the concordance between two versions of the scoring system (2011 and 2019), recommended by the Brazilian Ministry of Health, for the diagnosis of pulmonary tuberculosis (PTB) in children and adolescents. A retrospective descriptive study was performed to assess the medical records of children and adolescents with PTB, in TB units from Brazilian cities located in Rio de Janeiro, Minas Gerais, and Parana States, from January 1 st , 2004, to December 1 st , 2018. Patients aged 0 to 18 years old with a diagnosis of PTB were included. The comparison between the two scoring systems showed a moderate concordance according to the κ coefficient value = 0.625. Fourteen patients showed a reduction in the TB score, going from 30 points in the 2011, to 25 points or less in the 2019 one. Seventy one percent of these 14 patients had radiological changes suggestive of PTB and 86% had tuberculin skin tests greater than 10 mm. The study concluded that a moderate agreement was observed between the 2011 and 2019 scoring systems, with an increase in the number of patients scoring 25 points or less in 2019, which can eventually hinder the diagnosis of PTB.

HOW CAN NEW TECHNOLOGIES HELP REDUCE ABSENTEEISM IN PEDIATRIC CONSULTATION?

OBJECTIVE: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. METHODS: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment: telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. RESULTS: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made: 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient's guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. CONCLUSIONS: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.

How can new technologies help reduce absenteeism in pediatric consultation? / Como as novas tecnologias podem auxiliar na redução do absenteísmo em consulta pediátrica?

ABSTRACT Objective: To identify the most effective form of contact, as a possible intervention to reduce absenteeism in consultations of children with suspected or confirmed pulmonary tuberculosis. Methods: A randomized clinical trial was conducted with prospective data collection, between March 2017 and February 2018. Patients were randomized into three groups to be reminded about the appointment: telephone contact, SMS or WhatsApp, or no intervention. A convenience sample was obtained, with a significance level of 5%. Results: 78 children were included, with a median age of four years old (zero to 14); 59.0% of them were in treatment for a latent infection and 6.4% had active tuberculosis. Among the 78 children, 74.4% lived in Curitiba (Sourhern Brazil); 62.8% lived with both parents; 38.5% of the parents had formal employment and 47.4% of the mothers were housewives; 50.8% of the fathers and 55.7% of the mothers had more than nine years of schooling. In 78.2% of the families, per capita income was up to 0.5 minimum wages; 27.3% were enrolled in social programs; 28.2% lived in homes provided by the government. There was a total of 238 interventions made: 85 (35.7%) by telephone contact, 78 (32.8%) by text message (WhatsApp was 97.2% of these) and 75 (31.5%) had no further contact. There was no statistical difference among the sociodemographic and cultural characteristics studied. The absenteeism rate was 24.0% and the abandonment rate was 16.7%. Giving a reminder to the patient's guardian prior to the consultation, regardless of the intervention (p=0.021) and specifically by WhatsApp message (p=0.032) was associated with no absenteeism, though it was not associated with abandonment of the treatment. Conclusions: Using new tools, such as WhatsApp, to remind guardians of appointments reduces absenteeism. Consequently, it may lead to a reduction in abandoning treatment and it may improvetreatment outcome of children with a tuberculosis infection or disease.

RESUMO Objetivo: Identificar a forma mais efetiva de contato, como possibilidade de intervenção, para diminuir o absenteísmo em consultas de crianças com suspeita ou com tuberculose pulmonar. Métodos: Ensaio clínico randomizado com coleta de dados prospectiva, entre março de 2017 e fevereiro de 2018. Os pacientes foram aleatorizados em três grupos para relembrar a consulta: contato telefônico; mensagens curtas (SMS) ou WhatsApp; e nenhuma intervenção. Amostra de conveniência, com nível de significância de 5%. Resultados: Incluídas 78 crianças, mediana de idade quatro anos (zero a 14); 59,0% em tratamento para infecção latente e 6,4% com tuberculose ativa; 74,4% moravam em Curitiba, Paraná; 62,8% residiam com ambos os pais; 38,5% dos pais possuíam emprego formal e 47,4% das mães eram do lar; 50,8% dos pais e 55,7% das mães possuíam mais de nove anos de estudo; em 78,2% das famílias a renda per capita foi de até 0,5 salário mínimo; 27,3% estavam inscritas em programas sociais; e 28,2% residiam em casa cedida. Foram 238 intervenções: 85 (35,7%) por contato telefônico, 78 (32,8%) por mensagem de texto (WhatsApp 97,2%) e 75 (31,5%) sem nenhum contato adicional. Nas características sociodemográficas e culturais estudadas não houve diferença estatística. O absenteísmo foi de 24,0% e o abandono, de 16,7%. Lembrar o responsável previamente à consulta, independente da intervenção (p=0,021) e especificamente por mensagem por WhatsApp (p=0,032) foi associado ao não absenteísmo, porém não associado ao abandono. Conclusões: O uso de novas ferramentas, como o aplicativo WhatsApp, pode reduzir o absenteísmo, diminuir a possibilidade de abandono no seguimento e melhorar o desfecho do tratamento de crianças com tuberculose, seja a infecção ou a doença.

Risk factors for recurrence of stage I/II (TNM) colorectal adenocarcinoma in patients undergoing surgery with curative intent / Fatores de risco para recidiva em pacientes com adenocarcinoma colorretal estádio I e II (TNM) submetidos a cirurgia com intenção curativa

OBJECTIVE: Evaluate risk factors for colorectal cancer recurrence after surgical treatment. METHODS: Sixty-five patients with colorectal adenocarcinoma, stage I and II (TNM), undergoing curative-intent surgery and followed for five years were studied. Presence of adjuvant/neoadjuvant therapy, tumor differentiation degree, lymphatic and venous vascular infiltration, depth of tumor invasion, and disease staging was analyzed, using recurrence relative risk ratios for each parameter calculated at two years, after two years and five years of follow up. RESULTS:At five years, recurrence was 21.4% (14/65), with equal incidence (10.7%) for the separated periods. Only lymphatic and venous vascular infiltration showed statistically significant association with recurrence during times analyzed. Relative risk (RR) of recurrence was significantly related to the presence of lymphatic infiltration [RR = 6 (1.3 - 28.5) p = 0.01] and venous infiltration [RR = 9.5 (2.6 - 34.9) p < 0.001] after two years of follow-up. At five years follow-up, only venous infiltration remained with significant relative risk for recurrence [RR = 3.9 (1.8 - 8.8) p < 0.001]. In a multivariate analysis, only venous vascular infiltration was associated with recurrence [accuracy 81.5% (p < 0.001)]. CONCLUSION: In this series, the factors associated with risk of colorectal cancer recurrence were the presence of lymphatic and venous vascular infiltration. (AU)

OBJETIVO: Analisar fatores de risco para recidiva de câncer colorretal após tratamento cirúrgico. MÉTODO: Avaliou-se 65 pacientes com adenocarcinoma colorretal, estádio I e II (TNM), submetidos à cirurgia com intenção curativa, acompanhados por cinco anos após a operação. Analisou-se presença de tratamento adjuvante/neoadjuvante, grau de diferenciação do tumor, infiltração vascular linfática e venosa, profundidade de invasão tumoral e estadiamento da doença, estabelecendo-se para cada um o risco relativo de recidiva aos dois anos, após dois anos e aos cinco anos de seguimento. RESULTADOS: Recidiva global em cinco anos foi 21,4% (14/65), com idêntica incidência (10,7%) nos períodos separados. Somente as infiltrações vasculares linfáticas e venosas apresentaram associação estatisticamente significativa com a recidiva nos períodos de análise. Encontrou-se risco relativo (RR) estatisticamente significativo após dois anos relacionados à presença de infiltração linfática [RR = 6 (1,3 - 28,5) p = 0,01] e infiltração venosa [RR = 9,5 (2,6 - 34,9) p < 0,001]. Após cinco anos, apenas a infiltração venosa manteve a significância estatística, com risco relativo elevado para ocorrência de recidiva [RR = 3,9 (1,8 - 8,8) p < 0.001]. Na análise multivariada apenas a presença de infiltração vascular venosa com 81,5% de acerto foi associada à recidiva (p < 0.001). CONCLUSÃO: Nesta série, os únicos fatores associados com risco de recidiva do câncer colorretal foram a presença de infiltração vascular linfática e venosa. (AU)

Acute bacterial meningitis caused by Streptococcus pneumoniae resistant to the antimicrobian agents and their serotypes.

The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15% were resistant to penicillin, 1% to cephalosporin and 0% to vancomycin. The serotypes most found were 14 (19%), 3 and 23F (10% each). When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44%. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01) and previous use of antibiotic (p=0.046). The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.

Acute bacterial meningitis caused by Streptococcus pneumoniae resistant to the antimicrobian agents and their serotypes / Meningite bacteriana aguda por Streptococcus pneumoniae resistente aos antimicrobianos e seus sorotipos

The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15 percent were resistant to penicillin, 1 percent to cephalosporin and 0 percent to vancomycin. The serotypes most found were 14 (19 percent), 3 and 23F (10 percent each). When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44 percent. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01) and previous use of antibiotic (p=0.046). The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.

Este estudo teve como objetivo avaliar as taxas de resistência de Streptococcus pneumoniae, isolados de pacientes com meningite, à penicilina G, ceftriaxona e vancomicina; avaliar possíveis fatores de risco para resistência antimicrobiana; descrever os sorotipos encontrados e sugerir a terapêutica empírica inicial para meningite. Foram isoladas 100 amostras de S. pneumoniae, encontrando-se 15 por cento de resistência à penicilina, 1 por cento à cefalosporina e 0 por cento à vancomicina. Os sorotipos mais encontrados foram 14 (19 por cento), 3 e 23F (10 por cento cada). Analisando-se os resistentes, o sorotipo 14 (44 por cento) também foi o mais freqüente. Os fatores de risco para resistência de S. pneumoniae encontrados foram: idade menor que um ano (p=0,01) e o uso prévio de antibiótico (p=0,046). As taxas de resistência encontradas, moderada a penicilina, baixa para cefalosporina e nula para vancomicina, sugerem como terapêutica empírica inicial para tratamento da meningite bacteriana aguda de origem comunitária, a cefalosporina de terceira geração isoladamente.