RESUMO
Nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus (MRSA) often precedes the development of nosocomial infections. In order to identify risk factors for MRSA colonization, we conducted a case-case-control study, enrolling 122 patients admitted to a medical-surgical intensive care unit (ICU). All patients had been screened for nasopharyngeal colonization with S. aureus upon admission and weekly thereafter. Two case-control studies were performed, using as cases patients who acquired colonization with MRSA and methicillin-susceptible S. aureus (MSSA), respectively. For both studies, patients in whom colonization was not detected during ICU stay were selected as control subjects. Several potential risk factors were assessed in univariate and multivariable (logistic regression) analysis. MRSA and MSSA were recovered from nasopharyngeal samples from 27 and 10 patients, respectively. Independent risk factors for MRSA colonization were: length-of-stay in the ICU (Odds Ratio [OR]=1.12, 95 percentConfidence Interval[CI]=1.06-1.19, p<0.001) and use of ciprofloxacin (OR=5.05, 95 percentCI=1.38-21.90, p=0.015). The use of levofloxacin had a protective effect (OR=0.08, 95 percentCI=0.01-0.55, p=0.01). Colonization with MSSA was positively associated with central nervous system disease (OR=7.45, 95 percentCI=1.33-41.74, p=0.02) and negatively associated with age (OR=0.94, 95 percentCI=0.90-0.99, p=0.01). In conclusion, our study suggests a role for both cross-transmission and selective pressure of antimicrobials in the spread of MRSA.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Unidades de Terapia Intensiva , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Nasofaringe/microbiologia , Infecções Estafilocócicas/microbiologia , Antibacterianos/farmacologia , Estudos de Casos e Controles , Testes de Sensibilidade Microbiana , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Estudos Retrospectivos , Fatores de RiscoRESUMO
OBJECTIVE: To determine the prevalence of pneumococcus colonization among HIV-infected outpatients aged 0 to 18 years. To determine the resistance to penicillin of the microorganisms observed, to identify their serotypes, and to determine whether there are associations between known risk factors and colonization in this group. MATERIAL AND METHOD: This was an observational and cross-sectional study in which nasopharynx swabs were collected from 112 children on the occasion of their monthly appointments and a questionnaire applied to the mothers. The material collected was processed at the microbiology laboratory of the hospital in accordance with National Committee for Clinical Laboratory Standards (NCCLS) regulations and serotyping was performed at the Centers for Diseases Control and Prevention (CDC). Data were analyzed statistically using the chi-square test and with univariate and multivariate analysis with multiple logistic regression. RESULTS: The prevalence rate of nasopharyngeal colonization by pneumococci was 28.6%, with a 15.6% rate of resistance to penicillin (6.2% intermediate resistance and 9.4% full resistance). The serotypes identified were 6A, 6B, 7C, 9V, 11A, 13, 14, 15A, 16F, 18C, 19B, 19F, 23B, 23F, and 34. In this population there were no associations between pneumococcal colonization and the risk factors studied. CONCLUSIONS: The prevalence of pneumococcal colonization among HIV-infected children at our service was not higher than prevalence rates observed in healthy children and reported in the literature.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Infecções por HIV/microbiologia , HIV-1 , HIV-2 , Nasofaringe/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Resistência às Penicilinas , Reação em Cadeia da Polimerase , Fatores de Risco , Fatores SocioeconômicosRESUMO
La otitis media aguda constituye una patología frecuente en el niño. La calidad de su tratamiento influirá no sólo en la curación de la infección, sino también en el buen estado futuro del oído medio, en la tendencia o no a recidivar y en la predisposición a evolucionar a otitis crónica, eventualmente colesteatomatosa. El autor analiza la incidencia y gérmenes implicados, importancia del estado de la rinofaringe, senos paranasales y mastoides y su relación con episodios de otitis media aguda. Se revisan conceptos y se proponen medidas terapéuticas, de acuerdo a diversos estudios realizados estos últimos años