Microbiologia do meato médio em indivíduos sadios / Microbiology of middle meatus in healthy individuals

Introdução: A microbiologia nasossinusal de indivíduos sadios é pouco documentada. Seu conhecimento permite a determinação dos agentes colonizantes nasossinusais e a monitoração dos padrões de resistência bacteriana. Objetivos: Determinar a microbiologia do meato médio em indivíduos sadios e compará-la com a de pacientes com rinossinusite crônica. Método: Foram incluídos 61 indivíduos sadios. As amostras foram coletadas sob visão endoscópica e submetidas a exame de Gram com contagem leucocitária e cultura para aeróbios, anaeróbios e fungos. 114 pacientes com rinossinusite crônica constituíram o grupo controle. Resultados: Nos indivíduos sadios foram isolados 58 microorganismos, sendo os mais prevalentes Staphylococcus coagulase-negativos, Staphylococcus e Corynebacterium. Fungos foram cultivados em 10%.Todas as amostras apresentaram leucócitos raros ou ausentes. Identificou-se resistência à penicilina em 75% dos Staphylococcus aureus e 69% dos Staphylococcus coagulase-negativos. Quanto à oxacilina, 100% dos Staphylococcus aureus e 92% dos Staphylococcus coagulase-negativos foram sensíveis. No grupo controle foram cultivados 158 microorganismos. Os mais freqüentes foram Staphylococcus aureus e coagulase-negativos. Os Gram-negativos representaram 26% dos aeróbios. Entre as amostras com cultura positiva, 73% apresentavam alguns ou numerosos leucócitos. Conclusão: Ausência ou raridade de leucócitos, Staphylococcus coagulase-negativos e Corynebacterium foram mais freqüentes em sadios, e Streptococcus pneumoniae, anaeróbios, Staphylococcus coagulase-negativos oxacilino-resistentes e Gram-negativos mais freqüentes no grupo controle.

Introduction: The nasosinusal microbiology of healthy individuals is not much documented. Its knowledge allows to determine the nasosinusal colonizing agents and to monitor the patterns of bacterial resistance. Objective: To evaluate the microbiology of the middle meatus in healthy individuals and to compare it with that of patients with chronic rhinosinusitis. Method: 61 healthy individuals were included. The samples were collected under endoscopic view and Gram stained with leucocytes count and aerobic, anaerobic and fungus cultures. 114 patients with chronic rhinosinusitis formed the control group. Results: In healthy individuals 58 microorganisms were isolated. The most frequent ones were coagulase-negative Staphylococcus, Staphylococcus and Corynebacterium. Fungi were cultivated in 10%. There were rare or no white blood cells in all samples. There was penicillin resistance in 75% of the Staphylococcus aureus and 69% of the coagulase-negative Staphylococcus. As for oxacillin, 100% of Staphylococcus aureus and 92% of coagulase-negative Staphylococcus were sensitive. In the control group 158 microorganisms were cultivated. The most common ones were Staphylococcus aureus and coagulase-negative Staphylococcus. Gram-negatives represented 26% of the aerobics. 73% of the samples with positive cultures presented a few or many white blood cells. Conclusion: Rare or no white blood cell, coagulase-negative Staphylococcus and Corynebacterium were more frequent in healthy individuals and Streptococcus pneumoniae, anaerobics and oxacillin resistant coagulase-negative Staphylococcus and Gram-negative were more frequent in the control group.

Microbiologia do meato médio na rinossinusite crônica / Microbiology of middle meatus in chronic rhinosinusitis

Este foi um estudo prospectivo que visou identificar a microbiologia do meato médio em pacientes com rinossinusite crônica (RSC) e compará-la com a de indivíduos sadios. MATERIAL E MÉTODOS: Foram incluídos 134 pacientes RSC e 50 voluntários sadios, que constituíram o grupo controle. As amostras foram coletadas endoscopicamente e submetidas a exames pelo método de Gram com contagem leucocitária e culturas para aeróbios, anaeróbios e fungos. RESULTADOS: Nos pacientes com RSC foram cultivados 220 microorganismos, dentre os quais os mais freqüentes foram o Staphylococcus aureus, presente em 31 por cento das amostras, e o Staphylococcus coagulase-negativo (SCN) em 23 por cento. Gram-negativos ou facultativos foram isolados em 37 por cento das amostras, anaeróbios em 12 por cento, e fungos em 14 por cento. Ao exame bacterioscópico evidenciou-se alguns ou numerosos leucócitos em 74 por cento das amostras com culturas positivas. Nos indivíduos sadios o SCN foi isolado em 40 por cento das amostras e o Staphylococcus aureus em 18 por cento. Em 12 por cento dos indivíduos a cultura para fungos foi positiva, e o exame direto negativo. Todas as culturas anaeróbias foram estéreis. Quanto à contagem leucocitária todos apresentaram nenhum ou raros leucócitos. CONCLUSÃO: Os grupos apresentaram resultados semelhantes quanto à microbiologia, entretanto, diferiram em relação à contagem leucocitária, o que auxilia na diferenciação um microorganismo infectante de um colonizante.

This was a prospective study which assessed endoscopically collected middle meatus secretions in patients with chronic rhinosinusitis (CRS) and compared those findings with microbiological data of healthy individuals. METHODS: Middle meatus samples were collected from 134 CRS patients. In the laboratory, samples were Gram stained for microscopic examination with white blood cels (WBCs) count and also send for aerobic, anaerobic and fungal cultures. Fifty volunteers served as control. RESULTS: In CRS patients a total of 220 microorganisms were isolated. The most frequent microorganisms were Staphylococcus aureus (31 percent), coagulase-negative Staphylococcus (CNS) (23 percent). Gram-negative or facultative microorganisms were isolated in 37 percent of the samples, anaerobes in 12 percent and fungi in 14 percent. Seventy four percent of the samples with positive cultures presented many or few WBC. In the control group, 76 percent of cultures were positive for aerobes and 12 percent for fungi. No anaerobes were isolated. There were rare or no WBC in the fifty samples. The most frequent microorganisms were CNS (40 percent), Staphylococcus aureus (18 percent). CONCLUSION: The microbiology of the middle meatus is similar in CRS patients and healthy individuals. Despite this, there was an important difference between the WBC count in these two groups, which helps to distinguish an infective from a saprophitic microorganism.

Impacto das manobras de reanimação cardiorespiratória cerebral em um hospital geral: fatores prognósticos e desfechos / Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58 percent) patients, and 42 (28 percent) were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT) as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP) prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95 percent confidence interval [CI] = 2.7-13.6), when the initial rhythm was VF/VT; 9.4 (95 percent CI = 4.1-21.3), when the time of cerebral cardiopulmonary resuscitation was < 15 min; 9.2 (95 percent CI = 3.9-21.3), when the time of cardiopulmonary arrest was < 20 min; and 5.7 (95 percent CI = 2.4-13.7), when BP was > 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis