Colonización materna por streptococcus agalactiae (Sag) en Córdoba: aspectos epidemiológicos y microbiológicos

Marco Teórico: Entre las principales causas que explican la mortalidad en el recién nacido está las infecciones invasivas por Streptococcus agalactiae (Sag). En la patogénesis de la infección neonatal por Sag interviene la colonización asintomática del tracto genito-rectal de su madre así como los factores de virulencia bacterianos. Entre estos se destacan los antígenos polisacáridos (PLS) capsulares, que además permiten clasificar a Sag en serotipos (la Ib, II,III,IV,V,VI,VII,VIII, y IX). Diferentes estrategias de prevención se han implementado desde los '90. En nuestro país en el año 2008, la Ley Nacional 26.369 incorporó la modalidad de búsqueda universal en mujeres embarazadas y la administración de profilaxis intraparto (PIP) en casos positivos. Modalidad que tiene sus limitaciones, ya que solamente controla las infecciones de aparición temprana

Summary: Background: Invasive infections caused by Streptococcus agalactiae (Sag) constitute on of the main causes of mortality in newborn babies. Asymptomatic colonization of maternal genital and rectal tracts, as well as bacterial virulence factors, participates in the pathogenesis of neonatal infections by Sag. Among these it is important to highlight the presence of capsule polysaccharide (CPS) antigens, which in addition, allow classification of Sag into different serotypes (la Ib, II,II,IV,V,VI,VII,VIII and IX). Various prevention strategies have been implemented since the '90's. In Argentina, National Law 26369/2008 incorporated universal prenatal screening as well as the administration of intrapartum antibiotic prophylaxis (IAP) in positive cases. However, this procedure has some limitations since it only alloes to control early-onset Sag infections

Morbimortality study of infection in patients undergoing different types of dialysis in a renal replacement therapy center

INTRODUCTION: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality. OBJECTIVES: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. METHODS: This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). RESULTS: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13-5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. CONCLUSIONS: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group. .

Brazilian experience in EU-CORE: daptomycin registry and treatment of serious Gram-positive infections

OBJECTIVES: To collect data about non-controlled prescribing use of daptomycin and its impact among Brazilian patients with serious Gram positive bacterial infection, as well as the efficacy and safety outcomes. MATERIALS AND METHODS: This is a multi-center, retrospective, non-interventional registry (August 01, 2009 to June 30, 2011) to collect data on 120 patients (44 patients in the first year and 76 patients in the second year) who had received at least one dose of commercial daptomycin in Brazil for the treatment of serious Gram-positive bacterial infection. RESULTS: Right-sided endocarditis (15.8%), complicated skin and soft tissue infections (cSSTI)wound (15.0%) and bacteremia-catheter-related (14.2%) were the most frequent primary infections; lung (21.7%) was the most common site for infection. Daptomycin was used empirically in 76 (63.3%) patients, and methicillin-resistant Staphylococcus aureus (MRSA) was the most common suspected pathogen (86.1%). 82.5% of the cultures were obtained prior to or shortly after initiation of daptomycin therapy. Staphylococcus spp. - coagulase negative, MRSA, and methicillin-susceptible S. aureus were the most frequently identified pathogens (23.8%, 23.8% and 12.5%, respectively). The most common daptomycin dose administered for bacteremia and cSSTI was 6 mg/kg (30.6%) and 4 mg/kg (51.7%), respectively. The median duration of inpatient daptomycin therapy was 14 days. Most patients (57.1%) did not receive daptomycin while in intensive care unit. Carbapenem (22.5%) was the most commonly used antibiotic concomitantly. The patients showed clinical improvement after two days (median) following the start of daptomycin therapy. The clinical success rate was 80.8% and the overall rate of treatment failure was 10.8%. The main reasons for daptomycin discontinuation were successful end of therapy (75.8%), switched therapy (11.7%), and treatment failure (4.2%). Daptomycin demonstrated a favorable safety and tolerability profile regardless of treatment duration. CONCLUSIONS: Daptomycin had a relevant role in the treatment of Gram-positive infections in the clinical practice setting in Brazil.

Colangitis bacteriémica en adultos en un hospital general en Chile / Bacteremic colangitis in adults in a general hospital in Chile

Background: Some aspects of bacteremic cholangitis are unknown in Chile. Aim: To gather more information on clinical, microbiological aspects as well as risk factors for ICU admission, recurrence and antimicrobial resistance. Material and Methods: A retrospective research was performed using medical records of adult patients in a general hospital. Results: Between 2006-2012, 22 patients with 29 bacteremic events were identified. Previous cholangitis events were reported by 27.3%, 45.5% had recent admissions and, 50% had used antimicrobial compounds. Coledocholithiasis was the most common cause of obstruction (45.5%) followed by cancer (36.4%). One third developed shock (31%), the only factor associated with ICU admission (OR 30, p < 0.05). In 24 of the 29 bacteremic events, the biliary tract was intervened (82.8%) and in 80.8% during the first 72 hours. Gram negative bacilli were predominant (> 80%) and some infrequent agents such as Staphylococcus warneri, Shewanella spp. and, Aeromonas spp. were observed. Among enteric gram negative bacilli, 29.2% presented fluoroquinolone resistance and, 26.1% resistance to third generation cephalosporins, both associated with previous endoscopic retrograde cholangiography (OR 35 and 16.5, respectively p < 0.05). A favorable response was observed in 93.1% of bacte-remic events but in 31.8% of patients cholangitis recurred with or without bacteremia. Recurrence was associated to recent admission (OR 16.5, p = 0.01) and in all cases occurred before 81 days. In-hospital mortality was 9.1% (n = 2), but in only one case associated to sepsis. Average length of stay (LOS) was 17.8 days. Conclusions: Early intervention of the biliary tract allows a favorable response in patients affected by bacteremic cholangitis, but this condition use intensive care resources, had a prolonged LOS, a recurrent pattern, and is associated with several bacterial species, some of them resistant.

Introducción: La información sobre los cuadros de colangitis aguda bacteriémica es fragmentaria en Chile. Objetivo: Analizar las características clínicas, evolución, microbiología y factores de riesgo asociados a ingreso a UCI, recurrencia y resistencia antimicrobiana. Pacientes y Métodos: Estudio retrospectivo descriptivo con adultos atendidos entre el 2006 y el 2012 en un hospital general. Resultados: Se identificaron 22 pacientes con 29 episodios de bacteriemia. Un 27,3% tenía historia previa de colangitis aguda, 45,5% de hospitalizaciones en los últimos tres meses y 50% recibió previamente antimicrobianos. La coledocolitiasis fue la causa más frecuente de obstrucción (45,5%) y las neoplasias ocuparon el segundo lugar (36,4%). El 31% desarrolló shock hemodinámico y fue el factor determinante para ingresar a la UCI (OR 30, p < 0,01) En 24 de los 29 eventos de colangitis bacteriémica se efectuaron intervenciones sobre la vía biliar (VB) o complicaciones asociadas (82,8%), las que se realizaron predominantemente en las primeras 72 h de hospitalización (80,8%). Las especies bacterianas mayoritarias fueron bacilos gramnegativos entéricos o no fermentadores (> 80% del total) y se observaron agentes inusuales como Staphylococcus warneri, Shewanella spp y Aeromonas spp. Entre los bacilos gramnegativos entéricos, 29,2% presentó resistencia a fluoroquinolonas y 26,1 % a cefalosporinas de tercera generación, fenómenos asociados al antecedente de colangiografía endoscópica retrógrada (OR 35 y 16,5 respectivamente, p < 0,05). El 93,1% de los eventos de bacteriemia tuvo una respuesta favorable pero 31,8% de los pacientes presentó recu-rrencia de colangitis, con o sin bacteriemia, un hecho asociado a hospitalización reciente (OR 16,5, p = 0,01) y que se dio en todos los casos antes de 81 días. Dos pacientes con cáncer fallecieron en la misma hospitalización (9,1%), aunque uno solo de ellos en forma atribuible a la infección. La estadía hospitalaria promedio fue de 17,8 días. Conclusiones: Con la intervención precoz sobre la VB, los cuadros de colangitis bacteriémica han logrado una baja letalidad pero usan recursos intensivos, tienen una estadía prolongada, un patrón recurrente, pueden estar asociados a cáncer y a una diversidad de agentes bacterianos, algunos de ellos resistentes.

Empiemas pleurales por Gemella spp: una etiología no tan infrecuente / Pleural empyema due to Gemella spp: Report of 12 cases

Background: Gemella genus bacteria can produce localized or generalized severe infections, but very rarely they have been described as causingpulmonary infections or pleural empyemas. Aim: To characterize patients with empyema caused by Gemella genus bacteria. Material and Methods: The database of a Microbiology laboratory of a Spanish hospital was reviewed, searchingfor Gemella positive cultures ofpleural effusions in a period offive years. Results: We identified 12 patients (11 males) with Gemella spp pleural empyema. Eight were infected with G. haemolysans and four with G. morbillorum. All patients had predisposingfactors such as poor oral hygiene, smoking, chronic cardiovascular or respiratory disease, alcoholism or malignancies. In ten cases, a thoracic drainage tube was placed with fibrinolysis in seven. One patient needed surgery because of a relapse of the empyema. Two patients died because of an advanced neoplasm, and the empyema was resolved in the rest. Conclusions: Gemella pleural empyema can occur and its isolation must not be seen as a contamination.

Bacteriemia en daño hepático crónico / Bacteremia in patients with liver cirrhosis

Las infecciones bacteriémicas son más frecuentes en el paciente cirrótico que en la población general. Se identificaron retrospectivamente 59 pacientes cirróticos con bacteriemia, hospitalizados entre los años 2005 y 2008. La bacteriemia sin foco fue la más frecuente (29 por ciento), seguida de aquellas de origen pulmonar (22 por ciento). Cincuenta y dos por ciento de los agentes aislados correspondieron a cocáceas grampositivas y 48 por ciento a bacilos gramnegativos, siendo estos últimos los agentes predominantes en las bacteriemias nosocomiales. Los principales agentes aislados fueron Staphylococcns aureus (24 por ciento) y Escherichia col i (22 por ciento). La mortalidad de los pacientes cirróticos bacteriémicos fue mayor que la del total de cirróticos hospitalizados (37 vs 9,4 por ciento; p < 0,001) y la medición del puntaje de MELD a las 72 horas se correlacionó significativamente con la mortalidad. Conclusión: La bacteriemia es una complicación grave del paciente cirrótico y el MELD podría ser útil en su categorización de riesgo.

Bacteremic infections are more frequent in patients with cirrhosis, as their immune system is compromised. Series of cirrhotic patients with bacteremia has seldom been reported in Chile. We retrospectively collected, from 2005 to 2008, 59 episodes of bacteremia in cirrhotics representing 9 percent of the overall number of bacteremic episodes seen in our center in the period. Spontaneous bacteremia accounted for 29 percent followed by those of pulmonary origin (22 percent). Grampositive cocci and gramnegative bacilli were responsible in 52 percent and 48 percent respectively, however gramnegative rods predominated in nosocomial bacteremias. Overall, the most frequent organisms were Staphylococcus aureus (24 percent) and Escherichia col i (22 percent). Mortality in bacteremic patients was significantly higher compared with all cirrhotic patients hospitalized in the period (37.0 vs 9.4 percent; p < 0.001) and MELD score was significantly correlated with mortality. Conclusion: bacteremia is a severe complication of cirrhosis and MELD score could be a useful tool to stratify risk in these patients.

Analysis of Enterococcus faecalis in samples from Turkish patients with primary endodontic infections and failed endodontic treatment by real-time PCR SYBR green method

OBJECTIVE: The aims of this study were to investigate the presence of Enterococcus faecalis in primary endodontic infections and failed endodontic treatments using real-time PCR and to determine the statistical importance of the presence of E. faecalis in a Turkish population with endodontic infections. MATERIAL AND METHODS: E. faecalis was investigated from 79 microbial samples collected from patients who were treated at the Endodontic Clinic of the Dental School of Atatürk University (Erzurum, Turkey). Microbial samples were taken from 43 patients (Group 1) with failed endodontic treatments and 36 patients (Group 2) with chronic apical periodontitis (primary endodontic infections). DNA was extracted from the samples by using a QIAamp® DNA mini-kit and analyzed with real-time PCR SYBR Green. RESULTS: E. faecalis was detected in 41 out of 79 patients, suggesting that it exists in not less than 61 percent of all endodontic infections when the proportion test (z= -1.645,

Estudio de factores de riesgo para colonización por enterococo resistente a vancomicina en el Hospital Militar de Santiago / Risk factors associated to vancomycin-resistant enterococccus colonization in the Army Hospital in Santiago

Since the appearance of Vancomicin-resistant enterococci (VRE) in our country, the Chilean Ministry of Health recommended the surveillance of intestinal colonization in patients in critical wards. We report the results of surveillance in ICU and onco-hematological wards from 2002 to 2008, with analysis of possible risk factors: demographical data, use and type of antibiotic, days of hospitalization prior to sampling, and year of hospitaliza-tion. Colonization rate increased from 0.03 cases per lOOObed-days in2003 to 0.18 cases during2008. Univariate analysis identified 7 risk factors associated with ERV colonization: hospitalization in ICU, use of antibiotics, use of 3 or more compounds, use of imipenem or colistin, > 10 days of hospitalization prior to the study and year of hospitalization ( before 2007 or after). Multivariate analysis by logistic binary regression showed that only the last two: >10 days of hospitalization prior to the study and year of hospitalization (before 2007 or after), were significantly associated to colonization by ERV.

Desde la emergencia de Enterococcus resistente a vancomicina (ERV) en Chile, el Ministerio de Salud recomendó la vigilancia de colonización intestinal por ERV en pacientes hospitalizados en unidades de pacientes críticos. Describimos los resultados de vigilancia en UCI y Unidad de Aislamiento de Pacientes Hemato-oncológicos desde 2002 a 2008, analizando probables factores de riesgo: datos demográficos, uso y tipo de antimicrobiano, días de hospitalización previo a la toma de muestra y año de hospitalización. La tasa de colonización aumentó de 0,03 casos por 1000 días cama en 2003 a 0,18 durante 2008. El análisis univariado permitió identificar siete factores asociados al riesgo de colonización por ERV: hospitalización en UCI, uso previo o actual de antimicrobianos, haber recibido tres o más antibióticos, terapia con imipenem o colistin, más de 10 días de hospitalización y el año de hospitalización. El análisis multivariado mediante regresión logística binaria, señaló la duración de la hospitalización hasta el momento del estudio (> 10 días) y el año de hospitalización (2007 o después) como factores significativamente asociados al riesgo de colonización por ERV.

Emergencia de infecciones por Enterococcus sp resistente a vancomicina en un hospital universitario en Chile / Emergency of vancomycm-vesistant Enterococcus infections in a teaching hospital in Chile

Introducción. En Chile, se desarrolla una vigilancia activa de portación intestinal de Enterococcus resistente a vancomicina (ERV) desde el año 2000. Sin embargo, no hay publicaciones sobre casos clínicos. Objetivo: Describir casos de infección por ERV en un hospital de nivel terciario. Pacientes y Método: Se obtuvieron de los registros del laboratorio las muestras clínicas o intestinales positivas para ERV (2001 al 2006) y se analizaron en los pacientes afectados los factores de riesgo potenciales, manifestaciones clínicas, tratamiento y evolución. Resultados: Se identificaron 23 casos (tasa de incidencia año 2005 de 0,07 y año 2006 de 0,09/1.000 días camas ocupadas). El promedio de edad fue 62,0 ± 17 años. Antecedentes: cáncer (39,l por cientoo), procedimientos quirúrgicos recientes (54,1 por ciento), hemodiálisis (26,1 por ciento), corticoterapia (26,1 por ciento). El 87 por cientoo había recibido dos o más antimicrobianos, casi un tercio fue transferido desde otros hospitales y 22 por ciento había reingresado antes de 30 días. Los pacientes habían estado principalmente en UCI (60,9 por ciento), el resto en salas nefrológicas u onco-hematológicas. Los cuadros clínicos incluyeron bacteriemias (30,4 por ciento), infecciones del sitio quirúrgico o abscesos (26,1 por ciento), infecciones urinarias (26,1 por ciento) u otros. Tres pacientes fueron asintomáticos (13 por ciento). Los aislados fueron identificados como E. faecium en 82,6 por cientoo del total, el resto como Enterococcus sp. El 66,7 por cientoo de las cepas mostró susceptibilidad intermedia a vancomicina. En 14 cepas con estudio completo para vancomicina y teicoplanina, predominó el fenotipo VanB (85,7 por ciento), seguido de los fenotipos VanA (7,1 por ciento) y VanB/VanD (7,1 por ciento). Quince pacientes fueron tratados en forma médica o médico-quirúrgica, hubo respuesta favorable en 80 por cientoo de ellos. Ocho pacientes no recibieron tratamiento (34,8 por ciento), en dos...

An active surveillance of vancomycin-resistant enterococci (VRE) intestinal colonization in selected group of patients has been developed in Chile since year 2000. Nevertheless, no reports of clinical cases have been published. Aim. To describe main clinical and microbiological features of patients infected by VRE in a tertiary-level teaching Hospital. Patients and methods. Intestinal and clinical samples positive to VRE were provided by laboratory, and a retrospective analysis of potential risk factors, clinical features, treatment and outcomes was performed. Study encompassed years 2001 to 2006. Main results. 23 cases of infections were identified, all cases occurring during 2005 and 2006. Incidence rate was 0.07 and 0.09 cases per 1000 occupied bed-days, respectively. The mean age was 62.0 ± 17 years. A significant proportion of patients had cancer (39.1 percent), recent surgical procedures (54.1 percent), were on dialysis (26.1 percent), or were using steroids (26.1 percent). Most patients had received 2 or more antimicrobial (87 percent), almost a third represented transfers from other hospitals and an additional 22 percent readmissions before 30 days of latest discharge. Patients were mainly hospitalized in the ICU (60.9 percent) but nearly 30 percent were associated exclusively to nephrological or onco-hematological wards. Clinical manifestations included bacteremia (30.4 percent), surgical site infections or abscesses (26.1 percent), urinary tract infections (26.1 percent) and others. . Three patients (13 percent) did not have symptoms. After identification was possible, all isolates were identified as E. faecium (82.6 percent of total), the rest as Enterococcus sp. Most strains showed intermediate susceptibility to vancomycin (66.7 percent). For 14 strains studied both with vancomycin and teicoplanin, , phenotype Van B was predominant (85.7 percent), followed by VanA (7.1 percent) and VanB/VanD type (7.1 percent). No molecular...

Prevalência de bactérias em crianças com otite média com efusão / Prevalence of bacteria in children with otitis media with effusion

OBJETIVOS: 1) Determinar a prevalência do Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis nas efusões de orelha média de crianças com otite média com efusão que foram submetidas à miringotomia; 2) comparar os resultados obtidos por cultura e PCR; e 3) determinar o perfil de resistência à penicilina dos germes isolados. MÉTODOS: Analisaram-se 128 amostras de efusões de orelha média de 75 crianças entre 11 meses e 10 anos de idade (média = 34,7 meses). Pacientes com otite média recorrente tinham efusão documentada por > 6 semanas e aqueles com otite média com efusão crônica, por > 3 meses. Os pacientes não tinham sinais de otite média aguda ou infecção do trato respiratório e não estavam sob antibioticoterapia no momento do procedimento. A aspiração do material foi realizada por timpanocentese, utilizando-se um coletor de Alden-Senturia. Os estudos bacteriológicos foram iniciados menos de 15 minutos após a obtenção da efusão, e uma parte da amostra foi armazenada a -20 ºC para análise posterior pela PCR. Utilizou-se um método de PCR simultânea para a detecção de três patógenos. A análise estatística foi efetivada com o teste c² de McNemar. RESULTADOS: Cultivaram-se bactérias em 32 (25,1 por cento) das 128 amostras e os patógenos principais foram encontrados em 25 (19,6 por cento). A PCR identificou bactérias em 73 (57,0 por cento) das amostras, e os resultados positivos foram: 50 (39,1 por cento) para H. influenzae, 16 (12,5 por cento) para S. pneumoniae e 13 (10,2 por cento) para M. catarrhalis. Todas as amostras positivas por cultura foram positivas pela PCR, mas 48 (65,7 por cento) das efusões com resultado positivo pela PCR foram negativas por cultura para os germes estudados. A PCR foi significativamente mais sensível que a cultura (p < 0,001). Quanto ao perfil de resistência, 100 por cento das M. catarrhalis, 62,5 por cento dos S. pneumoniae e 23 por cento dos H. influenzae eram resistentes à penicilina. A prevalência das bactérias na otite média com efusão em um grupo de crianças brasileiras é semelhante àquelas relatadas em outros países, sendo o H. influenzae o mais encontrado dentre os patógenos principais da orelha média. Essa prevalência sugere que bactérias podem desempenhar um papel na patogênese da otite média com efusão. Os resultados mostram que a PCR é mais sensível na detecção de bactérias na efusão da orelha média quando comparada com cultura. A resistência à penicilina por parte do pneumococo e da moraxela...

Revisión de infección pelviana por actinomices: presentación de un caso clínico / Pelvic actinomycosis review: presentation of a clinical case

La infección por actinomices ha sido llamada "la gran imitadora" en la práctica clínica. La actinomicosis es una infección crónica supurativa debido a gérmenes gram positivos, anaerobios, no esporulados. Habita normalmente en las mucosa oral, gastrointestinal, genitales. Las infecciones oportunistas ocurren cuando se rompen las barreras mucosas, ocasionando la formación de abscesos, fístulas o masas. La actinomicosis tiene tres grandes presentaciones clínicas: cervicofacial, torácica y abdomino-pélvica. Se presenta un caso de actinomices abdomino-pélvica.

Bacteremia após a colangiopancreatografia retrógrada endoscópica, com e sem procedimento terapêutico: frequência, fatores associados e significado clínico / Bacteremia after endoscopic retrograde cholangiopancreatography with or without therapeutic procedure: frequency, associated factors and clinical manifestations

Objetivo. O objetivo do presente estudo foi avaliar a freqüência, os fatores associados e a manifestaçöes clínica de bacteremia em pacientes submetidos à colangiopancreatografia retrógrada endoscópica (CPRE), associada ou näo Ó realizaçäo de procedimento terapêutico. Casuística. Foram analisadas prospectivamente 46 colangiopancreatografias retrógradas endoscópicas (CPREs) realizadas em 42 pacientes. Os pacientes foram divididos em três subgrupos na dependência da utilizaçäo de antibióticos, da presença de obstruçäo do ducto biliar e/ou pancreático e da realizaçäo de procedimentos terapêuticos. Método. A pesquisa de bacteremia foi realizada mediante coleta de hemoculturas seriadas antes e após a CPRE. Foram utilizados, como meio para as hemoculturas, frascos tipo Bactec, capazes de receber maiores volumes de sangue e com resinas para adsorçäo de antibioóticos. A análise de positividade das hemoculturas foi realizada no sistema Bactec 9240Ô, e a identificaçäo das bactrérias, por meio de rotina do Laboratório Central da instituiçäo e com o sistema autoScan/Microscan. Resultados. Foi detectada bacteremia após sete exames; entretanto, em dois os microrganismos isolados foram considerados contaminantes. Em cinco exames ocorreu bacteremia verdadeira (freqüência, 10,9 por cento). Foram identificados os microrganismos: Streptococcus viridans, Corynebacterium sp., Enterobacter cloacae, Klebsiella oxytoca e Enterobacter aerogenes. Os episódios de bacteremia foram detectados com maior freqüência nas hemoculturas realizadas imediatamente após os exames (p<0,05), e foram restrito aos pacientes que näo estavan utilizando antibióticos (p=0,0192). Näo houve manifestaçäo clínica dos episódios de bacteremia. Conclusöes. Concluiu-se que os episódios de bacteremia ocorreram exclusivamente nos pacientes que näo estavam utilizando antibiótico e foram transitórios e completamente assintomáticos.