Bacteriología de las exacerbaciones agudas de rinisonusitis crónica en pacientes operados por cirugía endoscópica de cavidades paranasales / Bacteriology of chronic rhinosinusitis in patients that had paranasal sinuses endoscopio surgery

Introducción: La rinosinusitis crónica (RSC) es un cuadro inflamatorio en el que las bacterias juegan un rol importante. Las exacerbaciones agudas de rinosinusitis crónica (EARSC) en pacientes posoperados no son infrecuentes. Sin embargo, su manejo es complejo debido a la aparición de nuevos agentes y el aumento de la resistencia a antibióticos. Objetivo: Desarrollar una técnica de toma de muestra en cavidades paranasales, que permita caracterizar a los agentes involucrados en EARSC en pacientes posoperados. Material y método: Se recluta ron 32 pacientes posoperados. Se realizó aspirado de seno maxilar bajo visión endoscópica. Las muestras fueron cultivadas para aerobios, anaerobios y hongos. Resultados: Se enviaron 50 muestras a cultivo, en 46 de ellas se aislaron gérmenes (92%), de los cuales 44 fueron aerobios. En 7 de las muestras se aislaron anaerobios, y en 2 se obtuvo cultivo positivo para hongos. La resistencia a betalactámicos fue de 48,2%, observándose 36% de resistencia a lo menos a dos familias de antibióticos. Discusión y conclusiones: Nuestro estudio es el primero a nivel nacional en caracterizar a los agentes involucrados en EARSC en pacientes poscirugía endoscópica nasal. Los resultados obtenidos, posicionan a los cultivos endoscópicos como una excelente herramienta clínica para estudiar las EARSC.

Introduction: Chronic rhinosinusitis (CRS) is an inflammatory condition where bacteria play an important role. Acute exacerbations of chronic sinusitis (AECS) in patients who underwent endoscopic sinus surgery (EES) are not infrequent. Treatment of these exacerbations is complex due to the emergence of new agents and to an increase in bacterial resistance. Therefore, it is important to develop methods to culture and identify these agents and their antimicrobial resistance and sensibilities. Aim: To develop a technique for recovery of pathogens in the paranasal sinuses of patients with AECS after EES. Material and Method: 32 patients that had undergone EES were recruited. Aspiration of the maxillary sinus under direct endoscopic vision was performed. Samples obtained were sent for aerobic, anaerobia and fungal cultures. Results: Of the 50 samples collected, 46 were positive. Of these, 44 cultured aerobes, 7 cultured anaerobes, and 2 cultured fungi. The resistance to betalactamic antibiotics was 48.2% with at least 36% resistance to two different types of antibiotics. Conclusion: This is the first report in Chile of the microorganisms involved in AECS after EES. The results suggest that the sampling method described here is a useful tool for the study of patients with AECS.

Oropharynx microbiota among alcoholics and non-alcoholics

Context: The oropharynx microbiota plays na important role in the origin infections, especially among alcoholics whose airway defenses are impaired. Objective: To compare the normal oropharingeal flora in heavy alcohol drinker and non-alcoholics. Patients; 117 persons, 58 heavy alcohol drinker and 59 non-alcoholics. Setting: Santa Casa de Sao Paulo Emergency Service. Design: A blind prospective study. Main outcomes measures: Prevalence of aerobic and anaerobic bacteria, and fungi. Results: The study of the oropharynx microbiota among heavy alcohol drinkers demonstrated the presence of anaerobic microorganisms in 84,5 per cent of them, including: Bacteroides sp, Prevotella melaninogenica, Fusobacterium sp, Veilonella sp, Peptostreptococcus sp, Propionibacterium sp, Bifidobacterium sp and Clostridium sp, versus 30.5 per cent (p<0.005) of non-alcoholics. Candida sp was present in 34.5 per cent of heavy alcohol drinkers and 5.1 per cent of non-alcoholics (p<0.005). Enterobacteria predominated among heavy alcohol drinkers (25 per cent) compared with non-alcoholics (5.5 per cent) only in the age group 14 to 34 years (p<0.05). Conclusion: Based upon these results, it was possible to conclude that the knowledge of the oropharynx microbiota among heavy drinkers and non-alcoholics has na important predictive value concerning probable etiologic agents of lower airway infections. Infections caused by anaerobic microorganisms and fungi should be taken into consideration during the choice of empirical therapy for heavy alcohol drinkers.

Otite média crônica: perfil de sensibilidade de espécies facultativas e anaeróbicas prevalentes: estudo de 40 casos / Chronic otitis media: sensitivity profile of prevalent facultative and anaerobic species: study of 40 cases

Este trabalho apresenta um traçado do perfil de sensibilidade a antimicrobianos das principais bactérias isoladas de exudatos purulentos de 40 pacientes com Otite Média Crônica. Oitenta e duas bactérias facultativas e aeróbias e sessenta e três bactérias anaeróbias estritas foram isoladas, tendo a infecçäo polimicrobiana predominado em 70 por cento dos casos estudados. Em ordem decrescente de freqüência, as bactérias mais comumente isoladas foram: Peptostreptococcus (13,1 por cento), Pseudomonas aeruginosa (12,4 por cento), Bacteroides sp (8,2 por cento), Proteus mirabilis (6,9 por cento), Staphylococcus aureus (6,9 por cento). Prevotella melaninogenica (6,9 por cento) e Bacteroides do grupo fragilis (6,9 por cento), onde a espécie fragilis foi prevalente. Múltipla resistência aos antimicrobianos testados foi uma constante entre as bactérias aeróbicas e facultativas a resistência à oxacilina em 20 por cento das cepas de S. aureus estudadas foi constatado. Resistência à penicilina (100 por cento), tetraciclina (80 por cento) e cefoxitina (20 por cento) foi observado entre as espécies de Bacteroides do grupo fragilis