[Nosocomial sinusitis in an intensive care unit: a microbiological study]. / Rinossinusite nosocomial em unidade de terapia intensiva: estudo microbiológico.

UNLABELLED: Nosocomial sinusitis is a common complication of patients in ICUs. Its diagnosis is important, and early treatment is required to avoid serious complications such as pneumonia, sepsis, meningitis, and intracranial abscesses. AIM: To identify the germs causing sinusitis in ICUs by nasal swabs and maxillary sinus puncture, and to correlate these results. METHODS: ICU patients with a diagnosis (CT confirmed) of maxillary sinusitis underwent nasal swab and puncture of the sinus to collect material for culture and antibiogram. RESULTS: This study evaluated 22 patients. The microbial agent isolated in the swab correlated with the agent in the puncture in 14 of 22 cases (63%). Gram-negative bacteria were the most frequent, as follows: Pseudomonas aeruginosa (29% of punctures), following by Proteus mirabillis (26%) and Acinetobacter baumanni (14%). The resistance index in the antibiogram was high to antibiotics. CONCLUSION: Maxillary sinus puncture of ICU patients with sinusitis appears to be the best method for identifying bacteria; antibiograms demonstrate resistance to therapy. The swab has little diagnostic value; the correlation was 63%. It may be used when sinus puncture is contraindicated.

Rinossinusite nosocomial em unidade de terapia intensiva: estudo microbiológico / Nosocomial sinusitis in an intensive care unit: a microbiological study

Rinossinusite Nosocomial é uma complicação frequente de pacientes tratados em UTI. É importante o diagnóstico e tratamento precoce para prevenir complicações graves como pneumonia, sepse, meningite e abscesso intracraniano. OBJETIVO: Identificar os agentes causadores de sinusite em UTI através do swab nasal e da punção de seio maxilar, correlacionando seus resultados. MÉTODO: Pacientes atendidos nas unidades de terapia intensiva com diagnóstico tomográfico de sinusopatia maxilar uni ou bilateral foram submetidos ao swab nasal e punção do seio acometido com material enviado para cultura e antibiograma. RESULTADOS: O presente estudo avaliou 22 pacientes. Houve concordância entre o agente microbiano isolado no swab e na punção em 14 dos 22 casos (63 por cento). A flora aeróbia gram negativa foi a mais encontrada com predomínio da Pseudomonas aeruginosa (29 por cento nas punções), seguido de Proteus mirabillis (26 por cento) e Acinetobacter baumanni (14 por cento). Houve alto índice de resistência aos antibióticos usados. CONCLUSÃO: A punção direta do seio maxilar acometido em pacientes em UTI com sinusite parece ser o melhor método para identificar os agentes bacterianos e, através do seu antibiograma, direcionar a conduta terapêutica antimicrobiana. O swab mostrou ter pouco valor diagnóstico, com concordância de 63 por cento, podendo ser reservado para casos onde a punção está contraindicada.

Nosocomial sinusitis is a common complication of patients in ICUs. Its diagnosis is important, and early treatment is required to avoid serious complications such as pneumonia, sepsis, meningitis, and intracranial abscesses. AIM: To identify the germs causing sinusitis in ICUs by nasal swabs and maxillary sinus puncture, and to correlate these results. METHODS: ICU patients with a diagnosis (CT confirmed) of maxillary sinusitis underwent nasal swab and puncture of the sinus to collect material for culture and antibiogram. RESULTS: This study evaluated 22 patients. The microbial agent isolated in the swab correlated with the agent in the puncture in 14 of 22 cases (63 percent). Gram-negative bacteria were the most frequent, as follows: Pseudomonas aeruginosa (29 percent of punctures), following by Proteus mirabillis (26 percent) and Acinetobacter baumanni (14 percent). The resistance index in the antibiogram was high to antibiotics. CONCLUSION: Maxillary sinus puncture of ICU patients with sinusitis appears to be the best method for identifying bacteria; antibiograms demonstrate resistance to therapy. The swab has little diagnostic value; the correlation was 63 percent. It may be used when sinus puncture is contraindicated.

Prevalência de Streptococcus pyogenes em orofaringe de crianças que freqüentam creches: estudo comparativo entre diferentes regiões do país / Prevalence of Streptococcus pyogenes as an oropharynx colonizer in children attending daycare: a comparative study of different regions in Brazil

Trinta por cento das faringotonsilites agudas são de etiologia estreptocócica com potencial de complicações como a glomerulonefrite difusa aguda e febre reumática. Crianças de creches apresentam maior incidência destas infecções. OBJETIVO: Identificar e comparar a prevalência do Streptococcus pyogenes na orofaringe entre crianças que freqüentam creches e crianças não-institucionalizadas, em duas regiões do Brasil. CASUíSTICA E MÉTODO: Estudo prospectivo com 200 crianças, provenientes da cidade de Porto Velho/RO e São Paulo/SP, em quatro grupos, freqüentadoras ou não de creches. Realizou-se swab de orofaringe e cultura para identificação do Streptococcus pyogenes. RESULTADOS: Prevalência de 8 por cento e 2 por cento entre as crianças de São Paulo que atendem a creches e do grupo controle, respectivamente, apresentando valor estatístico (p=0,02). Prevalência de 24 por cento e 16 por cento nos grupos de Porto Velho/RO que freqüentam creche e controle respectivamente, não caracterizando diferença estatisticamente significante (p=0,18). Observou-se diferença estatisticamente significante entre os grupos creche e controle de São Paulo/SP aos seus correspondentes de Porto Velho/RO (p < 0,01). CONCLUSÃO: Os resultados deste estudo nos permitem sugerir que freqüência em creches representa um fator de risco para a colonização de orofaringe pelo Streptococcus pyogenes, fato observado em populações distintas, porém com significância estatística em apenas uma das duas amostras.

Thirty percent of acute pharyngotonsillitis is caused by Streptococcus pyogenes, which increased the risk of glomerulonephritis and rheumatic fever. Children attending daycare centers have a higher incidence of these infections. AIM: to identify and compare the prevalence of Streptococcus pyogenes in the oropharynx of children who are enrolled and who are not enrolled in daycare centers in different regions of Brazil. MATERIALS AND METHODS: A prospective study of two hundred children from Sao Paulo/SP and Porto Velho/RO. Children from each city were divided into two groups: those attending, and those not attending daycare centers. Swabs of the oropharynx were taken for bacteriological culture and identification. RESULTS: The prevalence of Streptococcus pyogenes in the Sao Paulo groups were 8 percent and 2 percent for daycare and control groups, which was statistically significant (p=0.02). The prevalence in children from Porto Velho/RO was 24 percent and 16 percent for daycare and control groups, which was statistically significant (p=0.015). Statistical analysis also showed a significant difference between the corresponding groups in the two locations (p<0.01). CONCLUSION: These results show that daycare attendance is a risk factor for oropharyngeal streptococcal colonization; this was seen in different populations, but was statistically significance in only one of the two samples.

Prevalence of Streptococcus pyogenes as an oropharynx colonizer in children attending daycare: a comparative study of different regions in Brazil.

UNLABELLED: Thirty percent of acute pharyngotonsillitis is caused by Streptococcus pyogenes, which increased the risk of glomerulonephritis and rheumatic fever. Children attending daycare centers have a higher incidence of these infections. AIM: to identify and compare the prevalence of Streptococcus pyogenes in the oropharynx of children who are enrolled and who are not enrolled in daycare centers in different regions of Brazil. MATERIALS AND METHODS: A prospective study of two hundred children from Sao Paulo/SP and Porto Velho/RO. Children from each city were divided into two groups: those attending, and those not attending daycare centers. Swabs of the oropharynx were taken for bacteriological culture and identification. RESULTS: The prevalence of Streptococcus pyogenes in the Sao Paulo groups were 8% and 2% for daycare and control groups, which was statistically significant (p=0.02). The prevalence in children from Porto Velho/RO was 24% and 16% for daycare and control groups, which was statistically significant (p=0.015). Statistical analysis also showed a significant difference between the corresponding groups in the two locations (p<0.01). CONCLUSION: These results show that daycare attendance is a risk factor for oropharyngeal streptococcal colonization; this was seen in different populations, but was statistically significance in only one of the two samples.