Staphylococcus spp. Causatives of Infections and Carrier of blaZ, femA, and mecA Genes Associated with Resistance.

Staphylococcus spp. have been associated with cases of healthcare associated infections due to their high incidence in isolates from the hospital environment and their ability to cause infections in immunocompromised patients; synthesize biofilms on medical instruments, in the case of negative coagulase species; and change in genetic material, thus making it possible to disseminate genes that code for the acquisition of resistance mechanisms against the action of antibiotics. This study evaluated the presence of blaZ, femA, and mecA chromosomal and plasmid genes of Staphylococcus spp. using the qPCR technique. The results were associated with the phenotypic expression of resistance to oxacillin and penicillin G. We found that the chromosomal femA gene was present in a greater proportion in S. intermedius when compared with the other species analyzed, while the plasmid-borne mecA gene was prevalent in the S. aureus samples. The binary logistic regression performed to verify the association among the expression of the genes analyzed and the acquisition of resistance to oxacillin and penicillin G were not significant in any of the analyses, p > 0.05.

Tratamiento de las infecciones hospitalarias por staphylococcus aureus meticilino resistente / Treatment of hospital-acquired methicillin-resistant staphylococcus aureus infections / Tratamento de infecções por Staphylococcus aureus resistentes à meticilina, adquiridas em hospitais

Introducción: la infección por Staphylococcus aureus meticilino resistente, una de las principales bacterias causantes de infecciones hospitalarias, se ha convertido en una preocupación mundial dada la alta tasa de morbilidad y mortalidad que produce. La resistencia bacteriana es un factor que agrava la problemática de infecciones hospitalarias y se asocia fundamentalmente al uso inadecuado de antibióticos. El uso prudente de los mismos ayuda a controlar la resistencia bacteriana, sin embargo, cada vez se detectan más cepas resistentes a diversos antibióticos. Se realiza una revisión de tratamientos antibióticos disponibles para las infecciones hospitalarias producidas por Staphylococcus aureus meticilino resistente en paciente adulto, con la finalidad de proporcionar una guía sobre los mismos, que permita un uso racional de los antibióticos disponibles evitando así que se continúe desarrollando el fenómeno de resistencia bacteriana. Metodología: se realizó un estudio observacional, descriptivo, de tipo revisión literaria, restringiéndose la búsqueda a guías de práctica clínica. Para conocer las guías existentes en Uruguay se consultó la Cátedra de Enfermedades Infecciosas de la Facultad de Medicina, Universidad de la República y en el Ministerio de Salud Pública. Se encontraron y analizaron guías de diferentes países. Existe acuerdo en los lineamientos generales del tratamiento farmacológico de las infecciones hospitalarias por Staphylococcus aureus meticilino resistente. Resultados: en Uruguay no existen guías propias de tratamiento de las infecciones hospitalarias por Staphylococcus aureus meticilino resistente. Se utiliza como referencia la guía publicada por la Infectious Diseases Society of America. Discusión: algunos de los antibióticos recomendados en las guías analizadas no se encuentran disponibles en nuestro país, como es el caso de daptomicina, telavancina y cloxacilina. En particular, el no disponer de daptomicina podría llegar a dificultar el tratamiento de infecciones en las cuales la CIM de vancomicina sea mayor a 1.5 mg/L. Conclusiones: por lo tanto, se considera conveniente y necesario pautar el tratamiento de dichas infecciones, acorde a las posibilidades, a la epidemiología de nuestro país y a los patrones de resistencia a ésta bacteria, para unificar la práctica clínica y hacer un uso racional de los antibióticos de manera de evitar promover el fenómeno de resistencia microbiana.

Introduction: infection by methicillin-resistant Staphylococcus aureus, one of the main bacteria causing hospital infections, has become a worldwide concern due to the high morbidity and mortality rate it produces. Bacterial resistance is a factor that aggravates the problem of hospital infections and is mainly associated with the inappropriate use of antibiotics. The prudent use of antibiotics helps to control bacterial resistance; however, more and more strains resistant to different antibiotics are being detected. A review of available antibiotic treatments for hospital infections caused by methicillin-resistant Staphylococcus aureus in adult patients was carried out in order to provide a guide for a rational use of available antibiotics, thus avoiding further development of the phenomenon of bacterial resistance. Methodology: an observational, descriptive, literature review type study was carried out, restricting the search to clinical practice guidelines. In order to know the existing guidelines in Uruguay, the Department of Infectious Diseases of the School of Medicine, University of the Republic and the Ministry of Public Health were consulted. Guidelines from different countries were found and analyzed. There is agreement on the general guidelines for pharmacological treatment of hospital infections caused by methicillin-resistant Staphylococcus aureus. Results: in Uruguay there are no guidelines for the treatment of hospital infections caused by methicillin-resistant Staphylococcus aureus. The guidelines published by the Infectious Diseases Society of America are used as a reference. Discussion: some of the antibiotics recommended in the guidelines analyzed are not available in our country, as is the case of daptomycin, telavancin and cloxacillin. In particular, the unavailability of daptomycin could make the treatment of infections in which the MIC of vancomycin is higher than 1.5 mg/L more difficult. Conclusions: therefore, it is considered convenient and necessary to establish guidelines for the treatment of such infections, according to the possibilities, to the epidemiology of our country and to the resistance patterns to this bacterium, in order to unify clinical practice and make a rational use of antibiotics so as to avoid promoting the phenomenon of microbial resistance.

Introdução: a infecção por Staphylococcus aureus resistente à meticilina, uma das principais bactérias causadoras de infecções hospitalares, tornou-se uma preocupação mundial devido à alta taxa de morbidade e mortalidade que ela causa. A resistência bacteriana é um fator que agrava o problema das infecções adquiridas nos hospitais e está principalmente associada ao uso inadequado de antibióticos. O uso prudente de antibióticos ajuda a controlar a resistência bacteriana, entretanto, cada vez mais estirpes resistentes a vários antibióticos estão sendo detectadas. É realizada uma revisão dos tratamentos antibióticos disponíveis para infecções hospitalares causadas por Staphylococcus aureus resistente à meticilina em pacientes adultos, com o objetivo de fornecer um guia para o uso racional dos antibióticos disponíveis, evitando assim o desenvolvimento posterior do fenômeno de resistência bacteriana. Metodologia: foi realizado um estudo observacional, descritivo, do tipo revisão de literatura, restringindo a busca às diretrizes da prática clínica. O Departamento de Doenças Infecciosas da Faculdade de Medicina da Universidade da República e o Ministério da Saúde Pública foram consultados para as diretrizes existentes no Uruguai. Foram encontradas e analisadas diretrizes de diferentes países. Há acordo sobre as diretrizes gerais para o tratamento farmacológico de infecções hospitalares causadas por Staphylococcus aureus resistente à meticilina. Resultados: no Uruguai não há diretrizes para o tratamento de infecções por Staphylococcus aureus resistentes à meticilina adquiridas em hospitais. As diretrizes publicadas pela Sociedade de Doenças Infecciosas da América são usadas como referência. Discussão: alguns dos antibióticos recomendados nas diretrizes analisadas não estão disponíveis na Espanha, tais como daptomicina, telavancina e cloxacilina. Em particular, a indisponibilidade da daptomicina poderia dificultar o tratamento de infecções nas quais a MIC da vancomicina é maior que 1,5 mg/L. Conclusões: portanto, considera-se conveniente e necessário estabelecer diretrizes de tratamento para estas infecções, de acordo com as possibilidades, a epidemiologia de nosso país e os padrões de resistência a esta bactéria, a fim de unificar a prática clínica e fazer uso racional dos antibióticos, a fim de evitar a promoção do fenômeno da resistência microbiana.

Antimicrobial Susceptibility Testing for Enterococci.

Enterococci are major, recalcitrant nosocomial pathogens with a wide repertoire of intrinsic and acquired resistance determinants and the potential of developing resistance to all clinically available antimicrobials. As such, multidrug-resistant enterococci are considered a serious public health threat. Due to limited treatment options and rapid emergence of resistance to all novel agents, the clinical microbiology laboratory plays a critical role in deploying accurate, reproducible, and feasible antimicrobial susceptibility testing methods to guide appropriate treatment of patients with deep-seated enterococcal infections. In this review, we provide an overview of the advantages and disadvantages of existing manual and automated methods that test susceptibility of Enterococcus faecium and Enterococcus faecalis to ß-lactams, aminoglycosides, vancomycin, lipoglycopeptides, oxazolidinones, novel tetracycline-derivatives, and daptomycin. We also identify unique problems and gaps with the performance and clinical utility of antimicrobial susceptibility testing for enterococci, provide recommendations for clinical laboratories to circumvent select problems, and address potential future innovations that can bridge major gaps in susceptibility testing.

Occurrence of blaKPC gene in clinical isolates of Pseudomonas aeruginosa from Brazil

Pseudomonas aeruginosa is one of the main microorganisms causing healthcarerelated infections. The rise of carbapenem-resistant P. aeruginosa (CRPA) strains has become a serious public health problem. Dissemination of the enzyme Klebsiella pneumoniae carbapenemase (KPC) encoded by the blaKPC gene cause the inactivation of ß-lactam antibiotics being one of the mechanisms involved in this resistance. Given the above, the objective of this review was to evaluate the occurrence of the blaKPC gene in clinical isolates of P. aeruginosa in Brazil. For this, the online databases used were: Lilacs, SciELO and PubMed. The search for articles included articles published from 2012 to 2020, using the following keywords: blaKPC (KPC), Pseudomonas aeruginosa, and Brazil (in Portuguese and English). Initially, 30 publications eligible for inclusion in this review were identified. After the first analysis, two articles were excluded due to duplication. Subsequently, titles and abstracts were evaluated, 15 articles were excluded because they did not fit the theme, and 13 articles that met the inclusion criteria were read in full. In these studies, the presence of the blaKPC gene was investigated in 566 clinical isolates of P. aeruginosa in Brazil, with 86 (15.2%) positive samples found. Pernambuco was the state with the highest number of articles and positive samples, respectively, 38.5% (5/13), and 65.1% (56/86). This study reinforces the need to investigate the occurrence of this gene in all regions of the country in CRPA, aiming to understand how its dissemination occurs and to promote prevention and therapeutic strategies.

Infección urinaria nosocomial y microorganismos implicados / Nosocomial urinary infection and implicated microorganisms

Introducción: Las infecciones urinarias nosocomiales constituyen una complicación frecuente e importante problema de salud debido complicaciones y recidivas frecuentes. Se pretende identificar los microorganismos implicados en las infecciones urinarias nosocomiales, su relación con el uso de sonda y estancia hospitalaria. Materiales y métodos: Estudio descriptivo­retrospectivo. Se revisaron bases de vigilancia epidemiológica restringiendo a infección de vías urinarias de origen hospitalario; se describieron las características generales y se exploraron diferencias entre los tiempos de estancia por microorganismo por Kluskal Wallis para un nivel de significancia del 95%. Resultados: Se encontraron 167 de infección de vías urinarias de origen hospitalario, la mediana de edad fue de 75 años; la mayoría de género femenino (58%), 34,1% asociadas al uso de sonda; 10% fallecieron en la hospitalización, la mayoría provenían de la unidad de cuidados intensivos adultos. El microorganismo más frecuentemente aislado fue Escherichia coli (46,1%); los pacientes aportaron una mediana de estancia de 20 días. Se encontraron diferencias significativas en los tiempos de estancia por microorganismo aislado en infección urinaria asociada a sonda, el microorganismo relacionado con los mayores tiempos de estancia fue Proteus mirabillis; el resto de diferencias no fueron significativas. Conclusiones: El microorganismo más frecuentemente aislado fue Escherichia coli, el Proteus mirabillis se encontró fue el más relacionado con uso sonda y tiempo de estancia, se requieren estudios adicionales para determinar asociaciones entre la estancia hospitalaria y fenotipos de resistencia, los protocolos de tratamiento empírico disponibles a la fecha, concuerdan los microorganismos aislados.

Introduction: The nosocomial urinary tract infections are a common complication and a major health problem due to complications and frequent recurrences. It aims to identify microorganisms involved in nosocomial urinary infections, their relationship with the use of probe and hospital stay. Materials & methods: A descriptive retrospective study. Surveillance bases restricting urinary tract infections hospital origins were reviewed; general characteristics were described and differences between the lengths of time of stay were screened by microorganism Kluskal Wallis for a significance level of 95%. Results: 167 urinary tract infections were found of hospital origin, the median age was found to be of 75; most females (58%), 34.1% associated with the use of probe; 10% died in the hospital, most came from the adult intensive care unit. The most frequently isolated microorganism was Escherichia coli (46.1%); patients contributed a median stay of 20 days. Significant differences in length of stay by microorganism isolated in catheter-associated urinary tract infection was found, the microorganism related to the greatest length of stay was Proteus mirabilis; the remaining differences were not significant. Conclusions: The most frequently isolated microorganism was Escherichia coli, Proteus mirabilis was found to be related to probe the use and length of stay, additional studies are required to determine associations between hospital stay and resistance phenotypes empirical treatment protocols available to the date, consistent microorganisms isolated.

Bacteria with a Potential for Multidrug Resistance in Hospital Material.

The objective of this research was to determine the antimicrobial resistance of bacteria isolated from items related to hygiene and antisepsis, equipment, and instruments used in different hospital wards. Bacterial isolation and identification, phenotypic antimicrobial susceptibility assays, mecA gene detection, and multiple antimicrobial resistance index analysis were performed. In total, 105 bacteria were isolated from 138 items. Of these, 49.52% bacteria were collected from instruments, 43.80% from equipment, and 6.66% from items related to hygiene and antisepsis. All gram-positive bacteria (88 isolates) were identified as coagulase-negative Staphylococcus. Five species of gram-negative bacilli (17 isolates) were isolated, and the prevalence of Enterobacter agglomerans (29.41%), Escherichia coli (11.76%), and Serratia liquefaciens (11.76%) was high. Antimicrobial resistance was reported for 93.33% of the isolates. Gram-positive bacteria were resistant to sulfazotrim (88.64%) and penicillin (82.95%), while gram-negative bacteria showed resistance to sulfazotrim (70.59%) and ampicillin (64.71%). Analysis of multiple antibiotic resistance index showed that 73.33% of the isolates were a high risk to public health. The mecA gene was detected in 23 (71.88%) isolates. The evaluation of microorganisms isolated in the hospital environment revealed their high multidrug resistance index. Thus our study presses the need to pay more attention to the cleanliness of frequently used instruments, which may be potential sources of infections.

Cumplimiento del Protocolo de Lavado de Manos por profesionales de enfermería en un servicio de salud de la ciudad de Encarnación, marzo-julio del 2019 / Compliance with the handwashing protocol by nursing professionals in a health service of the city of Encarnacion, March-July 2019

El cumplimiento del protocolo de lavado de manos evita las infecciones nosocomiales, mientras que el incumplimiento ocasiona consecuencias como el aumento de la morbimortalidad, la estancia hospitalaria, así como gastos adicionales al sistema sanitario y al usuario. Esto se puede prevenir con el lavado de manos que surgió como teoría desde la antigüedad. El trabajo de investigación fue de tipo observacional descriptivo con enfoque cuantitativo y fue realizado en 24 enfermeros de un servicio de salud de la ciudad de Encarnación con el objetivo de evaluar el cumplimiento del protocolo del lavado de manos establecido en el Manual de Prevención y Control de Infecciones asociado a la Atención de la Salud del año 2017 del Ministerio de Salud Pública y Bienestar Social. Los resultados evidenciaron un 54% de incumplimiento en la técnica de lavado de manos, un 44% de incumplimiento parcial y solamente un 2% de cumplimiento. En cuanto a los cinco momentos del lavado de manos, el 85% no cumplió con todos los momentos y un 70% no ha recibido capacitación referente al lavado de manos en los últimos 2 años. Se evidenció un alto porcentaje de incumplimiento del protocolo de lavado de manos, lo que representa un riesgo para la salud que podría subsanarse con la realización de cursos de capacitaciones o retroalimentación a los profesionales de enfermería

Compliance of handwashing protocol avoid nosocomial infections, while non-compliance causes consequences such as increased morbidity and mortality, hospital stay, additional cost to the health system and the patient. This can be prevented with handwashing which emerged as a theory in ancient times. This study was descriptive observational with quantitative approach and was carried out in 24 nurses at a health service in the city of Encarnacion in order to evaluate the compliance of handwashing protocol, established in the Infection Prevention and Control Manual associated to Health Care of 2017 of the Ministry of Health Care and Social Welfare. The results showed 54% of non-compliance in the handwashing technique, 44% of partial non-compliance and just 2% of compliance. In relation to the five moments of handwashing technique, 85% did not follow all the steps and 70% did not receive training regarding to the hand washing technique in the last 2 years. A high percentage of non-compliance with the hand washing technique protocol was evidenced, which represents a health risk, which can be corrected with training or feedback workshops for nursing professionals

Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis.

We conducted a systematic review and meta-analysis to determine the rate of polymyxin resistance among Acinetobacter baumannii isolates causing infection in hospitalized patients around the world during the period of 2010-2019. The systematic review was performed on September 1, 2019, using PubMed/MEDLINE, Scopus, and Web of Science; studies published after January 1, 2010, were selected. The data were summarized in tables, critically analyzed, and treated statistically using the RStudio® Software with Meta package and Metaprop Command. After applying exclusion factors, 41 relevant studies were selected from 969 articles identified on literature search. The overall rate of polymyxin-resistant A. baumannii (PRAB) related to hospitalized patients was estimated to be 13% (95% CI, 0.06-0.27), where a higher rate was observed in America (29%; 95% CI, 0.12-0.55), followed by Europe (13%; 95% CI, 0.02-0.52), and Asia (10%; 95% CI, 0.02-0.32). The extensive use of polymyxins on veterinary to control bacterial infection and growth promotion, as well as the resurgence in prescription and use of polymyxins in the clinics against carbapenem-resistant gram-negative bacteria, may have contributed to the increased incidence of PRAB. The findings of this meta-analysis revealed that the rate of PRAB recovered from hospitalized patients is distinctively high. Thus, action needs to be taken to develop strategies to combat the clinical incidence of PRAB-induced hospital infections.

Ozono como método de desinfección del ambiente hospitalario / Ozone a method of disinfection of the environment of hospitals

Resumen Justificación y objetivo: Las infecciones asociadas a la asistencia sanitaria elevan los costos, prolongan la estadía hospitalaria e incrementan la mortalidad, por lo que se hace necesaria la desinfección ambiental como método de disminuir este problema. El objetivo del estudio fue evaluar el impacto del uso del ozono para la desinfección ambiental, en áreas de alto riesgo hospitalario. Métodos: Se realizó una intervención para la desinfección de ambiente con el empleo de equipos de ozono en áreas de alto riesgo del Instituto de Neurología y Neurocirugía de Cuba, y se evaluó el resultado mediante las siguientes variables: estado microbiológico ambiental, número de fallecidos en general, por sepsis, y consumo de antibióticos durante enero - junio de 2019. Resultados: De las 12 áreas evaluadas, previo a la aplicación de ozono ambiente, teniendo en cuenta la cantidad de unidades formadoras de colonias por m3, 2 se clasificaron como ambiente no aceptable, 3 como ambiente aceptable, 7 como ambiente limpio. Posterior a la aplicación de ozono, se obtuvo en las 12, resultados correspondientes a ambiente muy limpio. El consumo de antibióticos disminuyó a un tercio en las áreas expuestas evaluadas y se elevó en las no expuestas. Hubo menor número de fallecidos que en similar periodo del año anterior a la intervención. Conclusiones: La desinfección ambiental con ozono en áreas hospitalarias de alto riesgo fue útil para generar ambientes limpios, y favorecer la disminución del consumo de antibióticos, la estadía hospitalaria y la mortalidad por infecciones asociadas a la asistencia sanitaria.

Summary Background and aim: Health care-associated infections raise costs, prolong hospital stays and increase mortality, making environmental disinfection necessary as a method of reducing this problem. The aim of this study was to evaluate the impact of the use of ozone for environmental disinfection in areas of high hospital risk. Methods: An intervention was carried out to disinfect the environment with the use of ozone equipment in high-risk areas of the Cuban Institute of Neurology an Neurosurgery and the result was evaluated using the following variables: environmental microbiological status, number of deaths in general and for sepsis, and consumption of antibiotics from January to June 2019. Results: Of the 12 areas evaluated, prior to the application of ozone, taking into account the number of colony forming units per m3, 2 were classified as unacceptable, 3 as an acceptable environment and 7 as a clean environment . After the ozone application, the results of the 12 areas showed a very clean environment. Antibiotic use decreased to a third in the exposed areas evaluated and rose in the unexposed areas. There were fewer deaths than in a similar period of the year prior to the intervention. Conclusions: Environmental disinfection with ozone in high-risk hospital areas is useful to generate clean environments, and favor the decrease in antibiotic consumption and mortality due to infections associated with healthcare.

Risks associated with pathogenic fungi isolated from surgical centers, intensive care units, and materials sterilization center in hospitals. Risks associated with pathogenic fungi isolated from critical hospital areas.

The hospital environment requires special attention to air quality, since it needs to be healthy for the protection of patients and health professionals in order to prevent them against hospital infections. The objective of this study was to isolate, identify and evaluate the susceptibility profile of isolated fungi from two hospitals. For air sampling the impaction (Spin Air, IUL®) and passive sedimentation methods were used. For the isolation of fungi from surfaces, contact plates (RODAC®) were used. The identification of the fungi was performed by observing the macroscopic and microscopic aspects of the colonies, whereas for better visualization of fruiting structures, the microculture technique was performed on slides. To evaluate the susceptibility profile, the broth microdilution test recommended by CLSI was performed. Thirty-five isolates were identified: Aspergillus flavus (12), Aspergillus fumigatus (11), Aspergillus niger (1), Aspergillus terreus (2), Penicillium spp. (7), and Fusarium spp. (2) in the hospitals evaluated. All isolates had a minimum inhibitory concentration (MIC) more than 128 µg/ml for fluconazole; 0.5 to 4.0 µg/ml for amphotericin B (hospital 1), and all isolates from haospital 2 had MIC ≥2.0 µg/ml. In hospital 1, MIC for posaconazole ranged from 0.25 µg/ml to ≥32 µg/ml, and hospital 2 ranged from 0.5 to 1.0 µg/ml. The monitoring and evaluation of air quality and surfaces are essential measures for prevention and control of hospital infections, as these microorganisms are becoming increasingly resistant to antimicrobial agents, thus making treatment difficult, especially in immunocompromised individuals.

Characterization of a Kunitz trypsin inhibitor from Enterolobium timbouva with activity against Candida species.

Scientific advances have not been sufficient to accompany the growing resistance to antimicrobial medicines. High mortality rates due to opportunistic infections have threated human health. The development of new drugs, such as those obtained from plant sources, is a world priority. Herein, we report the purification of a trypsin inhibitor from Enterolobium timbouva seeds (EtTI) with regard to its homology, physico-chemical and inhibitory properties. Furthermore, we evaluated its activity against Candida strains, opportunistic pathogens regularly found in hospital infections. EtTI belongs to the Kunitz family and inhibits two trypsin molecules simultaneously; a feature shared among double-headed Kunitz inhibitors. A high inhibitory activity against trypsin was determined (Ki = 0.5 nM), and refractory to digestion by pepsin. EtTI was candidicidal against C. albicans, C. buinensis and C. tropicalis, triggering disturbances on integrity of the plasma membrane and morphological alterations, presumably mediated via apoptosis. The presence of two reactive sites is an unusual feature detected in EtTI. Numerous diseases and pathologies involve changes in peptidase activities, encouraging studies with multifunctional inhibitors. Accordingly, the further exploration of EtTI could provide new insights into the Kunitz inhibitors and their applications in disease control.

Prevalência e perfil de suscetibilidade a antimicrobianos de microrganismos isolados em culturas de cateter / Prevalence and antimicrobial susceptibility profile of isolated microorganisms in catheter cultures

Introdução: os cateteres intravenosos são de uso amplamente difundido em hospitais e por estarem em contato direto com a circulação sanguínea, tornam­se um potencial risco para a ocorrência de contaminação e infecção local e sistêmica, aumentando a mortalidade, o tempo de internação e consequentemente custos hospitalares. Objetivo: o presente estudo teve como objetivo realizar levantamento epidemiológico da prevalência de bactérias e fungos em pontas de cateteres provenientes de sete hospitais do município de Cascavel ­ Paraná. Metodologia: foi realizado um estudo transversal por meio da coleta de dados em laudos emitidos por um laboratório clínico privado do mesmo município, entre os anos de 2011 a 2014. Resultados: verificou­se positividade em 21,7% dos laudos analisados (248). O grupo dos bacilos Gram negativos fermentadores (BGN) foi o mais prevalente, sendo as principais bactérias encontradas Escherichia coli e Klebsiella pneumoniae (84 laudos), seguidos de BGN não­fermentadores (79 laudos) e cocos Gram positivos (67 laudos). Leveduras foram encontradas em 18 laudos. Staphylococcus aureus apresentaram uma resistência de 31,8% para oxacilina, sendo para Staphylococcus coagulase­negativa resistência de 86,9%. Klebsiella pnemoniae apresentou discreta resistência para ertapenem (9,5%), imipenem (7,1%) e meropenem (7,1%), sugerindo presença de carbapenemase. Espécies de Enterobacter foram resistentes a diversos antimicrobianos, não constatado resistência aos carbapenêmicos ertapenem, imipenem e meropenem. Acinetobacter baumanii e Pseudomonas aeruginosa apresentaram elevada resistência para imipenem e meropenem (77,1% e 45,2%; 80% e 51,6%, respectivamente). Candida albicans apresentou 100% de suscetibilidade aos antifúngicos utilizados. Conclusão: esses resultados demonstram a grande importância no manejo eficiente do controle de infecção hospitalar e uso responsável de antimicrobianos por hospitais.

Introduction: intravenous catheters are widely used in hospitals, and they become a potential risk for local and systemic contamination due to direct contact with blood circulation, increasing mortality, length of hospital stay and consequently hospital costs. Objectives: the present study aimed to conduct an epidemiological survey of bacteria and fungi prevalence in catheter tips from seven hospitals in Cascavel county ­ Paraná. Methodology: a cross­sectional study was performed by data collection in reports issued by a private clinical laboratory in the same municipality from 2011 to 2014. Results: positive results were found in 21.7% of analyzed reports (248). The Gram negative bacilli fermenting (BGN) group was the most prevalent, being main bacterias Escherichia coli and Klebsiella pneumoniae (84 reports), followed by non­fermenting BGN (79 reports) and Gram positive cocci (67 reports). Yeasts were found in 18 reports. Staphylococcus aureus showed a resistance of 31.8% for oxacillin, and resistance for Staphylococcus coagulase­negative of 86.9%. Klebsiella penmoniae presented a mild resistance to ertapenem (9.5%), imipenem (7.1%) and meropenem (7.1%), suggesting presence of carbapenemase. Enterobacter species were resistant to several antimicrobials, no resistance to carbapenems ertapenem, imipenem and meropenem. Acinetobacter baumanii and Pseudomonas aeruginosa presented high resistance to imipenem and meropenem (77.1% and 45.2%, 80% and 51.6%, respectively). Candida albicans showed 100% susceptibility to antifungals used. Conclusion: these results demonstrate great importance in the efficient management of hospital infection control and responsible use of antimicrobials by hospitals

Probióticos en diarrea aguda, asociada a antibióticos y nosocomial: evidencia en pediatría / Probiotics in Acute, Antibiotic-associated and Nosocomial Diarrhea: Evidence in Pediatrics

Resumen Introducción: los probióticos son microorganismos vivos que, administrados en cantidades adecuadas, proveen una acción benéfica en el ser humano. Existen numerosos estudios acerca de su uso en enfermedad diarreica en pediatría, por lo que se hace necesario evaluar la evidencia. Métodos: se realizó una revisión de la literatura incluyendo solo metaanálisis y revisiones sistemáticas en los últimos 10 años acerca del uso de probióticos en diarrea aguda, diarrea asociada a antibióticos y Clostridium difficile, y diarrea nosocomial. Resultados: en diarrea aguda, los metaanálisis muestran disminución de la duración en un día (intervalo de confianza [IC] 95%; 15,9 a 33,6 horas) y disminución del riesgo de prolongación en los siguientes 4 y 7 días, con recomendaciones fuertes y evidencia moderada para Lactobacillus rhamnosus GG y Saccharomyces boulardii. En diarrea asociada a antibióticos y a C. difficile, los metaanálisis mostraron reducción del riesgo entre el 50% y 60%, con recomendación fuerte para L. rhamnosus GG y S. boulardii con un número necesario a tratar (NNT) de 10 (IC 95%; 7-12). En diarrea nosocomial, se encontró evidencia moderada con el uso de L. rhamnosus GG, principalmente en reducción del riesgo de gastroenteritis sintomática por rotavirus. Sin evidencia suficiente para dar recomendación para las cepas Streptococcus thermophilus y Bifidobacterium bifidum. Conclusión: solo existe evidencia con los probióticos L. rhamnosus GG y S. boulardii en reducción de la duración y disminución del riesgo de prolongación de diarrea aguda, así como reducción del riesgo entre 50% y 60% de diarrea asociada a antibióticos. Existe evidencia moderada con L. rhamnosus GG, en la reducción de riesgo de diarrea nosocomial.

Abstract Introduction: Probiotics are live microorganisms which, when administered in adequate amounts, provide beneficial action in humans. There are numerous studies about their use to treat diarrhea in pediatrics, so it is necessary to evaluate the evidence. Methods: We reviewed metaanalyses and systematic reviews in the last ten years about the use of probiotics to treat acute diarrhea, diarrhea associated with antibiotics and Clostridium difficile and nosocomial diarrhea. Results: Metaanalyses show that treatment of acute diarrhea with probiotics decreases duration by one day (95% CI: 15.9 to 33.6 hours) and reduces a risk of prolongation in the following four to seven days. They provide strong recommendations with moderate evidence for Lactobacillus rhamnosus GG and Saccharomyces boulardii. For diarrhea associated with antibiotics and Clostridium difficile, meta-analyses show risk reduction of between 50% and 60%, with strong recommendations for Lactobacillus rhamnosus GG and Saccharomyces boulardii with an NNT of 10 (95% CI: 7 to 12). For nosocomial diarrhea, moderate evidence was found for the use of Lactobacillus rhamnosus GG, mainly in reducing the risk of symptomatic gastroenteritis due to rotavirus. Currently, sufficient evidence does not exist to give recommendation for strains S. thermophiles and B. bifidum. Conclusion: For reducing the duration and reducing the risk of prolongation of acute diarrhea, evidence exists only for Lactobacillus rhamnosus GG and Saccharomyces boulardii. In addition, they reduce the risk of diarrhea associated with antibiotics by 50% to 60%. There is moderate evidence that Lactobacillus rhamnosus GG reduces the risk of nosocomial diarrhea.

What are the risk factors and agents responsible for bacterial infections in ICUS? / Quais os fatores de risco e agentes responsáveis por infecções bacterianas em UTI?

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult andneonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted inadult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU,58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulasenegative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantlypresented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) andEnterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but withinfections caused by Gram positive cocci, mainly CNS

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult andneonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted inadult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU,58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulasenegative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantlypresented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) andEnterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but withinfections caused by Gram positive cocci, mainly CNS

Este estudo objetivou analisar os principais fatores de risco e a prevalência de microrganismos em infecções bacterianas de pacientes internados em UTIs Adulto e Neonatal. Estudo retrospectivo onde foram incluídos dados de culturas dos microrganismos e dos respectivos pacientes internados nas UTIs Adulto e Neonatal de um hospital escola do Vale do Rio Pardo, localizado na região central do RS. Na UTI Adulto 58,8% dos pacientes apresentaram problemas cardíacos,foram encontradas 60 culturas positivas com a prevalência de Staphylococcus coagulase negativa (SCN) (30%) eStaphylococcus aureus (13,3%). Na UTI Neonatal os pacientes apresentaram predomínio de doenças pulmonares(52,6%), foram 31 culturas positivas neste período com maior prevalência de SCN (35,5%) e Enterococcus spp. (16,1%).Desta forma, conclui-se que as duas unidades analisadas possuem pacientes diferentes com fatores de risco distintos,mas com o predomínio de infecções por cocos Gram positivos, principalmente SCN

Prescripción de antibioticoterapia por vía parenteral en un servicio de cirugía general de Santiago de Cuba / Parenteral antibiotic therapy prescription in a general surgery service of Santiago de Cuba

Se realizó un estudio analítico y transversal, del tipo indicación-prescripción de medicamentos, de 254 pacientes atendidos en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero a mayo de 2016, con vistas a analizar la prescripción de antibióticos de administración parenteral por parte del personal médico de esta área. En la serie las infecciones resultaron más frecuentes en el sexo masculino (53,1 por ciento y en los grupos etarios de 45 a 64 años (42,1 por ciento). Asímismo, predominó el criterio de aplicar terapia antimicrobiana empírica (71,7 por ciento) y en general, las indicaciones correspondieron a la amikacina 144 (25,2 por ciento), 121 al metronidazol (21,2 por ciento) y 118 a la penicilina cristalina (20,7 por ciento); por otra parte, los gérmenes patógenos más aislados en el Servicio fueron la Escherichia coli, la Klebsiella, el enterobacter y el estafilococo coagulasa positivo.

An analytic and cross-sectional study, of the indication-prescription medications type, of 315 patients assisted in the General Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January to May, 2016, aimed at analyzing the prescription of parenteral antibiotics on the part of the medical staff of this area. In the series the infections were most frequent in the male sex (53,1 percent) and in the 45 to 64 years group (42,1 percent). Also, the criterion of applying antimicrobians empirically prevailed (71,7 percent) and in general, indications corresponded to amikacin 144 (25,2 percent), 121 to metronidazole (21,2 percent), and 118 to crystalline penicillin (20,7 percent); on the other hand, the most isolated pathogens in the Service were Escherichia coli, Klebsiella, enterobacter and positive coagulase staphylococcus.

Carbapenem-resistant Acinetobacter baumannii contamination in an intensive care unit

Abstract INTRODUCTION: Acinetobacter baumannii is a major pathogen causing infections in intensive care units (ICUs). In this study, we aimed to evaluate the presence of A. baumannii in an ICU environment and gloves from ICU workers and to characterize the antimicrobial resistance of the isolates in comparison with those isolated from ICU patients at the same hospital. METHODS: ICU samples were collected from March to November 2010. Isolates biochemically characterized as Acinetobacter calcoaceticus-Acinetobacter baumannii complex were evaluated by PCR targeting the 16S rDNA and bla OXA-51 genes. Antimicrobial susceptibility was determined using the disk diffusion method, and carbapenem-resistant isolates were also evaluated for the minimum inhibitory concentration of imipenem using broth microdilution. The presence of the bla OXA-23 gene was evaluated in isolates with reduced susceptibility to carbapenems. RESULTS: A. baumannii was detected in 9.5% (84) of the 886 samples collected from the ICU environment, including from furniture, medical devices, and gloves, with bed rails being the most contaminated location (23.8%; 20/84). Multidrug-resistant (MDR) A. baumannii was found in 98.8% (83/84) of non-clinical and 97.8% (45/46) of clinical isolates. Reduced susceptibility to carbapenems was detected in 83.3% (70/84) of non-clinical and 80.4% (37/46) of clinical isolates. All isolates resistant to carbapenems harbored bla OXA-23. CONCLUSIONS: We found a strong similarity between the antimicrobial susceptibility profiles of non-clinical and clinical A. baumannii isolates. Such data highlight the ICU environment as a potential origin for the persistence of MDR A. baumannii, and hence the ICU may be a source of hospital-acquired infections caused by this microorganism.

Vigilancia de infecciones asociadas al cuidado de la salud en áreas no críticas del Hospital Dr. Julio C. Perrando, Año 2016 / Surveillance of infections associated with health care in non-critical areas of the Hospital Dr. Julio C. Perrando, Year 2016

Las infecciones asociadas a la atención de la salud son un problema de salud pública importante, debido a la frecuencia con que se producen, la morbilidad y mortalidad que provocan y la carga que imponen a los pacientes, al personal sanitario y a los sistemas de salud. El objetivo fue determinar la frecuencia y la tendencia de las infecciones asociadas al cuidado de la salud en áreas no críticas, durante el año 2016 en el Hospital Julio CPerrando. Se consideró infecciones asociadas al cuidado de la salud (IACS) a: "Toda infección que se inicia transcurridas las 48 hs de la admisión al hospital o dentro de los 30 días posteriores al alta"; y como infección del sitio quirúrgico a: "toda infección localizada en el sitio incisional que ocurre dentro de los 30 días posteriores a un procedimiento quirúrgico o hasta un año si hubiera implante de prótesis". Se realizó un estudio descriptivo, transversal, prospectivo. Se incluyó a todos los pacientes mayores de 14 años internados en este nosocomio que cumplan con la definición de caso. La recolección de datos se realizó diariamente y la información obtenida se registró en un formulario de confección propia. Se registraron un total de 429 infecciones, con una tasa de incidencia de 8,14 por 1000 pacientes internados por día en el año, con tendencia al descenso, siendo los servicios con mayor tasa los de Cirugía y Clínica

Summary: The infections asocciated with health care (HAI) are a major public health problem, due to the frecuency of they ocurrence, the morbidity and morbility they cause, and the burden they impose on patients, health personnel, and health systems. The aim was to determine the frecuency and trend of de infections asocciated with health care in non-critical areas of the Hospital Julio C Perrando during the year 2016. As infections associated with health care (HAI) were considered any infections that begin 48 hours from admission to the hospital or within 30 days afer discharge; and asa surgical site infection to: any infections localizated at the incisional site that's ocurrs within 30 days after a surgical procedure or up to year if the protesis was implanted. A cross-sectional descriptive study was designed. Included al patients older than 14 years of age who met the definition of a case. Data collection was performed daily and the information obtained was recorded on a self-made form. A total of 429 infections were registered, with an incidence rate of 8.14 per 1000 hospitalized patients/ day in the year, with a tendency to decline. Surgery and Clinic were the services with the highest rate. Palabras clave: infección hospitalaria; incidencia; tendencia

Structure for prevention of health care-associated infections in Brazilian hospitals: A countrywide study.

BACKGROUND: Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. METHODS: This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. RESULTS: The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P < .001). Regarding alcoholic product for handrubbing, the worst ratio of beds to dispensers was found in hospitals with <50 beds (6.4) compared with reference hospitals (3.3; P < .001). The CI for sterilization services showed huge variation ranging from 0.0-1.00. Reference hospitals were more likely to have their own laboratory of microbiology than other hospitals. CONCLUSION: This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals.

Perfil de Sensibilidad y Resistencia Antimicrobiana de Acinetobacter spp. en el Hospital Municipal Boliviano Holandés / Sensitivity profile and antimicrobial resistance of Acinetobacter spp. in the Bolivian Dutch Municipal Hospital

Objetivo: Observar el perfil de sensibilidad y resistencia antimicrobiana de Acinetobacter spp., aislado en pacientes hospitalizados en el Hospital Municipal Boliviano Holandés durante el año 2010 al 2014. Material y métodos: Se revisaron un total de 167 cultivos positivos de Acinetobacter spp. Se realizó un estudio observacional no experimental, descriptivo, retrospectivo, de corte transversal. Resultados: En el antibiograma de los cultivos positivos de Acinetobacter spp. se utilizaron ocho antimicrobianos y se identificó la siguiente sensibilidad y resistencia: a) amikacina, sensibilidad de 25%, sensibilidad intermedia de 2% y resistencia 73%; b) ampicilina más sulbactam, sensibilidad de 22%, intermedia de 8% y resistencia 70%; c) ceftazidime, sensibilidad de 9%, intermedia de 4% y resistencia 87%; d) ciprofloxacina sensibilidad 19%, intermedia 1% y resistencia 80%; e) gentamicina, sensibilidad de 21%, intermedia 0% y resistencia 79%; f) SMX-TMP, sensibilidad de 14%, intermedia de 1% y resistencia 85%; g) imipenem sensibilidad de 61%, intermedia de 1% y resistencia 38%; h) meropenem con sensibilidad de 57%, intermedia 4% y resistencia 39%. Se observó una resistencia absoluta a 6 antimicrobianos. La multidrogoresistencia se identificó en el 41%, la misma que se incrementó progresivamente en los últimos años. Así, en el 2010 se encontró solo 3% de multidrogoresistencia, el 2011 6%, el 2012 y 2013 19% y en el año 2014 53%. Conclusiones: La incidencia de infecciones por Acinetobacter spp., un agente nosocomial de gran importancia clínica, se incrementó de manera progresiva en los últimos años en nuestro hospital al igual que su resistencia. Por ello, se aconseja un uso racional de antimicrobianos y mejorar las medidas de bioseguridad en nuestro nosocomio y en el personal de salud.

Objective: To observe the sensitivity profile and antimicrobial resistance of Acinetobacter spp, isolated from patients hospitalized in the Bolivian Dutch Municipal Hospital during 2010 to 2014. Material and Methods: A total of 167 positive cultures of Acinetobacter spp were reviewed a non-experimental, descriptive, retrospective, observational cross-sectional study was conducted. Results: In the susceptibility testing of positive cultures of Acinetobacter spp. eight antimicrobials were used and the following sensitivity and resistance was identified: a) amikacin, sensitivity of 25%, 2% intermediate sensitivity and resistance 73%; b) ampicillin-sulbactam, sensitivity of 22%, 8% and intermediate resistance 70%; c) ceftazidime, sensitivity of 9%, 4% and intermediate resistance 87%; d) Ciprofloxacin sensitivity 19%, 1% and intermediate resistance 80%; e) gentamicin, sensitivity of 21%, intermediate resistance 0% and resistance 79%; f) TMP-SMX, sensitivity of 14%, intermediate 1% and resistance 85%; g) 61% sensitivity imipenem, intermediate 1% and resistance 38%; h) meropenem with sensitivity of 57%, intermediate resistance and 4% resistance 39%, absolute resistance to 6 antimicrobials was observed. multidrug resistense identified in 41%, the same as it was progressively increased in recentyears. Thus, in 2010 he found only 3% of multidrug, 6% in 2011,2012 and 2013 19% and in 2014 53%. Conclusions. The incidence of infections Acinetobacter spp, a nosocomial agent of great clinical importance, gradually increased in recent years in our hospital as their resistance. Therefore, it is advisable rational use of antimicrobials and improves bio-security measures in our hospital and health personnel.