Appraising epidemiology data and antimicrobial resistance of urinary tract infections in critically ill adult patients: a 7-year retrospective study in a referral Brazilian hospital

ABSTRACT BACKGROUND: Urinary tract infections (UTI) are highly preventable and have significant clinical and financial impact on the patient and the health care system. OBJECTIVE: To investigate UTIs in critically ill adult patients and the relationship of antimicrobial consumption and multidrug-resistant isolate. DESIGN AND SETTING: A cohort study performed in a Brazilian tertiary-care university hospital in the city of Uberlandia (MG), located at the Federal University of Uberlandia, southeast region of the country. METHODS: We analyzed a cohort of 363 patients with first episode of UTIs from the adult intensive care unit (ICU), from January 2012 to December 2018. The daily doses of antimicrobial administered were calculated. RESULTS: The incidence rate of UTI was 7.2/1000 patient days, with 3.5/1000 patient-days of bacteriuria, and 2.1/1000 patient-days of candiduria. Of 373 microorganisms identified, 69 (18.4%) were Gram-positive cocci, 190 (50.9%) Gram-negative bacilli, and 114 yeasts (30.7%). Escherichia coli and Candida spp. were the most common. Patients with candiduria had higher comorbidity score (Charlson Comorbidity Index ≥ 3), longer length of stay (P = 0.0066), higher mortality (P = < 0.0001) severe sepsis, septic shock, and were immunocompromised when compared with patients with bacteriuria. We observed correlation between antibiotics consumption and multidrug-resistant (MDR) microorganisms. CONCLUSION: The UTIs incidence was high and was mainly caused by Gram-negative bacteria that were resistant to common antibiotics. We observed increase in the consumption of broad-spectrum antibiotics in ICU correlating with MDR microorganisms. In general, ICU-acquired candiduria may be associated with critical illness and poor prognosis.

Inappropriate empirical antimicrobial treatment in bloodstream infections patients in the era of multidrug resistance / Terapia Empírica Inapropriada no Tratamento de Infecções de Corrente Sanguínea na Era da Multirresistência Antimicrobiana / Tratamiento antimicrobiano empírico inadecuado en pacientes con infecciones del torrente sanguíneo

Background and objectives: Bloodstream infection (BSI) by multidrug-resistant Pseudomonas aeruginosa is a severe infection. This study aimed to evaluate and identify the predictors of mortality in patients who had bloodstream infection by carbapenem-resistant P. aeruginosa. Methods: This is a retrospective cohort study, approved by Committee of Ethics in Research with Human Participants, which included 87 consecutive patients hospitalized in a referral hospital in Brazil. Clinical and demographic information about each patient were obtained from hospital records. The Student's T-test was used to compare continuous variables and x2 or Fisher's exact tests to compare categorical variables. To determine independent risk factors for 30-day mortality, a multiple logistic regression model was used. A survival curve was constructed using the Kaplan­Meier method. Results: Among the patients, 87.3% use antibiotics previously, 60.9% received inadequate empirical treatment, and the 30-day mortality rate was 57.5%. Inappropriate antibiotic empirical therapy was independently associated with a 30-days death and mortality rate. Conclusion: These findings can show some insights about the relationship between higher mortality and inappropriate empirical therapy for patients with BSI by P. aeruginosa. There is a need for better diagnostic tests and infection control programs should focus on de-escalation the antibiotic inappropriate therapy, mainly in BSI caused by carbapenem-resistant P. aeruginosa.(AU)

Justificativa e objetivos: Infecção da corrente sanguínea (ICS) por Pseudomonas aeruginosa multirresistente é grave. Este estudo teve como objetivo avaliar e identificar os preditores de mortalidade em pacientes admitidos em uma Unidade de Terapia Intensiva que apresentaram infecção da corrente sanguínea por P. aeruginosa resistente aos carbapenêmicos. Métodos: Trata-se de um estudo de coorte retrospectivo, aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos, que incluiu 87 pacientes consecutivos internados em um hospital de referência no Brasil. As informações clínicas e demográficas de cada paciente foram obtidas através de análise dos prontuários dos pacientes. O teste T de Student foi usado para comparar variáveis contínuas e o teste x2 ou exato de Fisher para comparar variáveis categóricas. Para determinar fatores de risco independentes para mortalidade em 30 dias, foi utilizado um modelo de regressão logística múltipla. Uma curva de sobrevida foi construída pelo método de Kaplan-Meier. Resultados: Do total de pacientes, 87,3% faziam uso prévio de antibióticos, 60,9% receberam tratamento empírico inadequado e a mortalidade em 30 dias foi de 57,5%. A terapia empírica inadequada foi fator de risco independente para mortalidade. Conclusão: Esses achados revelam alguns insights sobre a relação entre maior mortalidade e terapia empírica inadequada para pacientes com ICS por P. aeruginosa. Além disso, destacam a necessidade de melhores testes diagnósticos e os programas de controle de infecção devem se concentrar na redução da terapia inadequada com antibióticos, principalmente na ICS causada por P. aeruginosa resistente a carbapenêmicos.(AU)

Justificación y objetivos: La infección del torrente sanguíneo por Pseudomonas aeruginosa multirresistente es grave. Este estudio tuvo como objetivo evaluar e identificar predictores de mortalidad en pacientes ingresados en una Unidad de Cuidados Intensivos que presentaban infección del torrente sanguíneo por P. aeruginosa resistente a carbapenémicos. Métodos: Se trata de un estudio de cohorte retrospectivo, aprobado por el Comité de Ética en Investigación con Participantes Humanos, que incluyó 87 pacientes consecutivos ingresados en un hospital de referencia en Brasil. La información clínica y demográfica de cada paciente se obtuvo mediante el análisis de las historias clínicas de los pacientes. Se utilizó la prueba t de Student para comparar variables continuas y x2 o prueba exacta de Fisher para comparar variables categóricas. Para determinar los factores de riesgo independientes para la mortalidad a los 30 días, se utilizó un modelo de regresión logística múltiple. Se construyó una curva de supervivencia utilizando el método de Kaplan-Meier. Resultados: Del total de pacientes, el 87,3% utilizaba antibióticos previamente, el 60,9% recibió tratamiento empírico inadecuado y la tasa de mortalidad a los 30 días fue del 57,5%. La terapia empírica inadecuada fue un factor de riesgo independiente de mortalidad. Conclusión: Estos hallazgos revelan algunos conocimientos sobre la relación entre el aumento de la mortalidad y la terapia empírica inadecuada para los pacientes con infección del torrente sanguíneo por P. aeruginosa. Además, destacan la necesidad de mejores pruebas de diagnóstico y los programas de control de infecciones deben centrarse en reducir la terapia con antibióticos inapropiados, particularmente en infección del torrente sanguíneo causados por P. aeruginosa resistente a carbapenémicos.(AU)

Staphylococcus aureus and Enterococcus faecium isolated from pigeon droppings (Columba livia) in the external environment close to hospitals

ABSTRACT Background: Domestic pigeons carry pathogens in their droppings, posing a potential public health problem. Methods: The phenotypic and genotypic antimicrobial resistances of Staphylococcus aureus and Enterococcus faecium in the feces of urban pigeons near hospitals with intensive care units were measured. Results: Twenty-nine samples showed Enterococcus growth, whereas one was positive for S. aureus. The S. aureus isolate was sensitive to the antibiotics tested via antibiogram, however resistance genes were identified. E. faecium isolates showed phenotypic resistance to gentamicin, erythromycin, and ciprofloxacin. Conclusions: Antimicrobial profiles harmful to health were demonstrated in bacterial pathogens isolated from the external environment of hospitals.

Infections and antimicrobial resistance in an adult intensive care unit in a Brazilian hospital and the influence of drug resistance on the thirty-day mortality among patients with bloodstream infections

Abstract INTRODUCTION: The present study aimed to determine the incidence of health care-associated infections (HCAIs) and identify the main resistant microorganisms in intensive care unit (ICU) patients in a Brazilian university hospital. METHODS: A retrospective cohort study was conducted in a Brazilian teaching hospital between 2012 and 2014. RESULTS: Overall, 81.2% of the infections were acquired in the ICU. The most common resistant pathogenic phenotypes in all-site and bloodstream infections were oxacillin-resistant coagulase-negative staphylococci and carbapenem-resistant Acinetobacter spp. (89.9% and 87.4%; 80.6% and 70.0%), respectively. CONCLUSIONS: There is an urgent need to focus on HCAIs in ICUs in Brazil.

Carbapenem-resistant Pseudomonas aeruginosa: association with virulence genes and biofilm formation

Abstract Pseudomonas aeruginosa is an opportunistic pathogen that causes frequently nosocomial infections, currently becoming more difficult to treat due to the various resistance mechanisms and different virulence factors. The purpose of this study was to determine the risk factors independently associated with the development of bacteremia by carbapenem-resistant P. aeruginosa, the frequency of virulence genes in metallo-β-lactamases producers and to evaluate their ability to produce biofilm. We conducted a case–control study in the Uberlândia Federal University – Hospital Clinic, Brazil. Polymerase Chain Reaction was performed for metallo-β-lactamases and virulence genes. Adhesion and biofilm assays were done by quantitative tests. Among the 157 strains analyzed, 73.9% were multidrug-resistant, 43.9% were resistant to carbapenems, 16.1% were phenotypically positive for metallo-β-lactamases, and of these, 10.7% were positive for blaSPM gene and 5.3% positive for blaVIM. The multivariable analysis showed that mechanical ventilation, enteral/nasogastric tubes, primary bacteremia with unknown focus, and inappropriate therapy were independent risk factors associated with bacteremia. All tested strains were characterized as strongly biofilm producers. A higher mortality was found among patients with bacteremia by carbapenem-resistant P. aeruginosa strains, associated independently with extrinsic risk factors, however it was not evident the association with the presence of virulence and metallo-β-lactamases genes.

Spread of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clones in patients with ventilator-associated pneumonia in an adult intensive care unit at a university hospital

Background:In Brazil, ventilator-associated pneumonia (VAP) caused by carbapenem resis- tant Acinetobacter baumanniiand Pseudomonas aeruginosaisolates are associated with significant mortality, morbidity and costs. Studies on the clonal relatedness of these isolates could lay the foundation for effective infection prevention and control programs.Objectives: We sought to study the epidemiological and molecular characteristics of A. baumannii vs. P. aeruginosaVAP in an adult intensive care unit (ICU).Methods: It was conducted a cohort study of patients with VAP caused by carbapenem resistant A. baumanniiand P'. aeruginosaduring 14 months in an adult ICU. Genomic studies were used to investigate the clonal relatedness of carbapenem resistant OXA-23-producing A. baumanniiand P. aeruginosaclinical isolates. The risk factors for acquisition of VAP were also evaluated. Clinical isolates were collected for analysis as were samples from the environment and were typed using pulsed field gel electrophoresis.Results: Multivariate logistic regression analysis identified trauma diagnosed at admission and inappropriate antimicrobial therapy as independent variables associated with the development of A. baumanniiVAP and hemodialysis as independent variable associated with P. aeruginosaVAP. All carbapenem resistant clinical and environmental isolates of A. baumanniiwere OXA-23 producers. No MBL-producer P. aeruginosawas detected. Molecular typing revealed a polyclonal pattern; however, clone A (clinical) and H (surface) were the most frequent among isolates of A. baumanniitested, with a greater pattern of resistance than other isolates. In P. aeruginosathe most frequent clone I was multi-sensitive.Conclusion: These findings suggest the requirement of constant monitoring of these microor- ganisms in order to control the spread of these clones in the hospital environment.

Late onset sepsis in newborn babies: epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit

Aim: We assessed late onset sepsis (LOS) rates of neonates in a neonatal intensive care unit (NICU) before and after implementing an evidence-based bundle to prevent these infections in a country with poor resources. Methods: We evaluate trends of LOS between October 2010 and August 2012 in a large tertiary hospital in Brazil. We designed a protocol based of CDC guidelines for insertion of maintenance of central venous catheter targeted to reduction of bloodstream infections. During this period two major events occurred: a great increase of LOS rates in January months and relocation of the unit to a provisory place. Additionally we evaluated the risk factors and etiology of these infections. Results: A total of 112 (20.3%) cases defined as LOS were found. The overall incidence rate of LOS in the study was 16.1/1000 patient/days and 23.0/1000 CVC-days. Our monthly rates data of LOS/1000 patient-day reveal fluctuations over the studied period, with incidence rates of these infections in staff vacation period (January 2011 and 2012) significantly higher (59.6/1000 patients-days) than compared with the other months rates (16.6/1000 patients-days) (IRR = 3.59; p < 0.001). As opposite, the incidence rates of LOS during relocation period was lower (10.3/1000 patients-days) when compared with baseline period 26.7/1000 patients-days (IRR = 2.59; p = 0.007). After the intervention period, these rates decreased in the post intervention period, when compared with preintervention 14.7/1000 patients-days and 23.4/1000 patients-days, respectively (IRR = 1.59; p = 0.04). Conclusion: Through simple infection control measures, LOS can be successfully controlled especially in NICUs of limited resources countries such as ours. .

Genotypic study documents divergence in the pathogenesis of bloodstream infection related central venous catheters in neonates

OBJECTIVE: To investigate the pathogenesis of bloodstream infection by Staphylococcus epidermidis, using the molecular epidemiology, in high-risk neonates. METHODS: We conducted a prospective study of a cohort of neonates with bloodstream infection using central venous catheters for more than 24 h. "National Healthcare Safety Network" surveillance was conducted. Genotyping was performed by DNA fingerprinting and mecA genes and icaAD were detected by multiplex-PCR. RESULTS: From April 2006 to April 2008, the incidence of bloodstream infection and central venous catheter-associated bloodstream infection was 15.1 and 13.0/1000 catheter days, respectively, with S. epidermidis accounting for 42.9% of episodes. Molecular analysis was used to document the similarity among six isolates of bloodstream infection by S. epidermidis from cases with positive blood and central venous catheter tip cultures. Fifty percent of neonates had bloodstream infection not identified as definite or probable central venous catheter-related bloodstream infection. Only one case was considered as definite central venous catheter-related bloodstream infection and was extraluminally acquired; the remaining were considered probable central venous catheter-related bloodstream infections, with one probable extraluminally and another probable intraluminally acquired bloodstream infection. Additionally, among mecA+ and icaAD+ samples, one clone (A) was predominant (80%). A polyclonal profile was found among sensitive samples that were not carriers of the icaAD gene. CONCLUSIONS: The majority of infections caused by S. epidermidis in neonates had an unknown origin, although 33.3% appeared to have been acquired intraluminally and extraluminally. We observed a polyclonal profile between sensitive samples and a prevalent clone (A) between resistant samples. .

Active surveillance to determine the impact of methicillin resistance on mortality in patients with bacteremia and influences of the use of antibiotics on the development of MRSA infection

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. Methods We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. Results Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. Conclusions Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant. .

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance / Infecções hospitalares em unidade de terapia intensiva pediátrica de um país em desenvolvimento: vigilância NHSN

INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and children with NI (cases) were compared with a group (matched controls) in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.

INTRODUÇÃO: O objetivo deste estudo foi determinar a epidemiologia das três infecções hospitalares (IH) mais comuns - sepse, pneumonia e infecção do trato urinário (ITU) - em uma unidade de terapia intensiva pediátrica (UTIP) de um país em desenvolvimento e definir os fatores de risco associados com IH. MÉTODOS:Nós desenvolvemos um estudo prospectivo de incidência de IH em uma única UTIP, entre agosto/2009 e agosto/2010. Foi conduzida uma vigilância ativa pelo National Healthcare Safety Network (NHSN) na Unidade e as crianças com IH (casos) foram comparadas com um grupo (controles) em um estudo caso-controle. RESULTADOS: Nós analisamos 172 pacientes, 22,1% com IH, 71,1% adquirida na Unidade. A densidade de incidência de sepse, pneumonia e ITU por 1.000 pacientes/dia foram 17,9, 11,4, e 4,3, respectivamente. Os agentes mais comuns na sepse foram Enterococcus faecalis e Escherichia coli (18% cada), e Staphylococcus epidermidis foram isolados em 13% dos casos. Nas pneumonias Staphylococcus aureus foram os agentes mais comuns (3,2%), e nas ITUs os agentes mais frequentes foram os fungos (33,3%). A presença de IH foi associada com tempo de hospitalização prolongado, uso de procedimentos invasivos (CVC, sonda nasogástrica) e uso de antibióticos. Os dois últimos foram fatores independentes para o desenvolvimento de IH. CONCLUSÕES: A incidência de IH adquirida na Unidade foi alta, associada a fatores de risco extrínsecos.

Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients

Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1 percent) were found to be colonised with vanC VRE and only one patient (0.3 percent) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1 percent) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.

Sepse, sepse grave e choque séptico: aspectos clínicos, epidemiológicos e prognóstico em pacientes de Unidade de Terapia Intensiva de um Hospital Universitário / Sepsis, severe sepsis and septic shock: clinical, epidemiological and prognostic characteristics of patients in an intensive care unit in a university hospital

INTRODUÇÃO: Sepse é considerada doença grave com alta mortalidade. O objetivo desse estudo foi determinar a incidência e evolução da sepse em pacientes críticos. MÉTODOS: Foi realizada vigilância prospectiva de sepse na Unidade de Terapia Intensiva de Adultos, de abril-dezembro de 2007. RESULTADOS: A frequência de pacientes/dia foi 442. Setenta e cinco (18,6 por cento) pacientes tinham sepse; destes, 72 por cento hospitalar. As taxas de sepse grave e choque séptico por paciente/dia foram 5,0 e 3,1, respectivamente. A mortalidade total foi 34,6 por cento. Sessenta e um por cento dos casos tinham diagnóstico microbiológico. CONCLUSÕES: A sepse apresentou-se numa frequência maior, do que a usualmente descrita na literatura.

INTRODUCTION: Sepsis is considered to be a severe disease with high mortality. The objective of this study was to determine the incidence and evolution of sepsis among critically ill patients. METHODS: Prospective surveillance of sepsis was performed in the adult intensive care unit, between April and December 2007. RESULTS: The patient frequency/day was 442. Seventy-five patients (18.6 percent) had sepsis and 72 percent of these cases were hospital-acquired. The rates of severe sepsis and septic shock per patient/day were 5.0 and 3.1, respectively. The total mortality was 34.6 percent and 61 percent of the cases had microbiological diagnoses. CONCLUSIONS: Sepsis presented with higher frequency than is usually described in the literature.

Fatores de risco para colonização por bactérias hospitalares multiresistentes em pacientes críticos, cirúrgicos e clínicos em um hospital universitário brasileiro / Risk factors for colonization by multiresistant hospital bacterias in critical, surgical and clinical patients in aBrazilian university hospital

Objetivos: avaliar os fatores de risco intrínsecos e extrínsecos associados à colonização por microrganismos resistentes aos antibióticos em pacientes clínicos, cirúrgicos e críticos internados no Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU). Casuística: foi realizado um estudo em pacientes colonizados (n=78) e não-colonizados (n=155), incluindo pacientes clínicos (n=126), cirúrgicos (n=72) e críticos (n=35), com idade média de 56,5 anos e tempo de internação de 10,5 dias. A pesquisa de colonização foi realizada na narina e intestino a partir da coleta de material com auxílio de swab e o cultivo primário em meios de ágar MacConkey contendo 2 µg/mL de ceftazidima e ágar manitol salgado com 6 µg/mL de oxacilina. A multirresistência foi caracterizada pelo teste de difusão com disco. Foi preenchida uma ficha individual contendo dados demográficos, fatores de risco intrínsecos e extrínsecos e uso de antimicrobianos. Resultados: no total, aproximadamente 35,0% dos pacientes estavam colonizados; 39,7% estavam colonizados por estafilococos e 35,9% por bacilos gram-negativos (multirresistentes). Os pacientes críticos representaram 54,3% do total. Os fatores de risco associados à presença desses microrganismos incluíram: internação igual ou superior a sete dias (p<0,0001; OR=7,97; IC=3,54-18,47); uso de antibióticos(p=0,003; OR=2,38; IC=1,31-4,32), uso de ? 2 antibióticos (p=0,0004; OR=2,83; IC=1,54-5,21); e internação na Unidade de Terapia Intensiva (p=0,008; OR=2,80; IC=1,27-6,19). Conclusção: a taxa de colonização dos pacientes por Staphylococcus aureus e bacilos gram negativo resistentes foi alta e associada principalmente ao uso de antibióticos e internamento na UTI.

Objectives: to evaluate the intrinsic and extrinsic risk factors related to the colonization by antibiotics resistant microorganisms in clinical, surgical and critical patients in the Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU). Casuistic:"a study was carried out in colonized (n=78) and non-colonized (n=155) patients, included clinical (n=126), surgical (n=72) and critical (n=35) patients, with average age 56,5 years and hospital treatment for 10,5 days. The colonization research was carried out in the nostrils and intestine from material collection with the aid of a ?swab? and the primary cultivation in MacConkey agar environment containing 2 µg/mL of ceftazidime and Manitol agar salty with 6 µg/mL of oxaciline. The multirresistance was found by the diffusion test with disk. An individual card was filled in with demographic data, intrinsic and extrinsic risk factors and use of antimicrobials. Results: in the total, approximately 35,0% of the patients were colonized; 39,7% were colonizedby Staphylococcus and 35,9% by gram-negative bacilli (multirresistant). The critical patients represented 54,3% of the total. The risk factors related to the presence of thesemicroorganisms included: internment equal or over seven days (p<0,0001; OR=7,97; IC=3,54-18,47); use of antibiotics (p=0,003; OR=2,38; IC=1,31-4,32), use of ? 2 antibiotics (p=0,0004; OR=2,83; IC=1,54-5,21); and internment in theIntensive Therapy Unit (p=0,008; OR=2,80; IC=1,27-6,19). Conclusion: patients? colonization rate by resistant Staphylococcus aureus and gram negative bacilli was high and related mainly to the use of antibiotics and UTI internment.

Vancomycin-resistant van a phenotype Enterococcus faecalis: first case in Minas Gerais state and epidemiological considerations

We report the first case of vancomycin-resistant Enterococcus faecalis with VanA phenotype and vanA genotype isolated from a surgical patient in a general Hospital in Uberlândia, state of Minas Gerais, Brazil.

Spread of a methicillin-resistant staphylococcus aureus clone isolated from bacteremia in elderly patients in a Brazilian general hospital

A study of the genomic diversity of MRSA strains isolated from elderly patients with infection/colonization in three repeated prevalence, cross sectional studies was performed in the 1999-2000 period. In this study, 13 MRSA isolates from blood cultures and 5 from rectal and nare cultures were obtained from 18 patients (13 elderly and 5 adults). Most of the patients were being treated with two or more antimicrobials (83.3%), had insertion of invasive devices (88.9%) and were managed in ICU (Intensive Care Unit) and/or surgical units (66.7%). MIC (Minimum Inhibitory Concentration) data showed that 88.9% of the MRSA strains were resistant to high concentrations of oxacillin (MIC > 256 ìg/mL), 94.5% of the MRSA carried the mecA gene in their genome, and most (65.0%) of the isolates were indistinguishable according to their DNA finger­printing generated by PFGE (Pulsed-field gel electrophoresis). Although PFGE typing was performed with a few MRSA isolates, our results demonstrate that one MRSA clone was associated with infection/colonization in patients with an obvious connection among five out of eleven patients who stayed in the same clinic and ICU during the same period. Hospital acquired infection, a major “silent epidemy”, is associated with prolonged hospital stay and high mortality rate and its cause must be better evaluated.

Criptococose: estudo clínico-epidemiológico, laboratorial e das variedades do fungo em 96 pacientes / Cryptococosis: clinical epidemiologycal laboratorial study and fungi varieties in 96 patients

Estudo prospectivo foi realizado no Hospital de Clínicas da Universidade Federal de Uberlândia, entre março de 1998 e novembro de 2003, em 96 pacientes com diagnóstico clínico e laboratorial de criptococose, sendo 81,3 por cento portadores de Aids. Cepas de Cryptococcus neoformans foram obtidas de diferentes amostras, sendo 77 por cento em líquido cefalorraquidiano. A var neoformans foi isolada em 89 casos e a var gattii em 7. A meningoencefalite criptocócica (56,3 por cento dos casos), foi a manifestação clínica mais descrita, seguida da fungemia (13,5 por cento). Entre os fatores de risco, a AIDS (81,3 por cento) foi o mais comumente associado à micose. A pesquisa direta do fungo realizada em 121 amostras demonstrou o microrganismo em 98,3 por cento, com cultura (+) em todas. Dos pacientes, 59,4 por cento foram tratados com anfotericina B ou derivados triazólicos, sendo que 72,9 por cento evoluíram para óbito, em particular os portadores de AIDS (62,5 por cento). Atualmente, a criptococose tem sido diagnosticada com muita freqüência em nosso meio e constitui uma das doenças oportunísticas de maior morbidade e mortalidade nos pacientes com AIDS.

Infection and colonization by Gram-negative bacilli in neonates hospitalized in High Risk Nursery at Uberlandia Federal University Hospital: etiology, resistant phenotypes and risk factors

Os objetivos deste estudo foram determinar infecções endêmicas e epidêmicas por bacilos Gram-negativos, fatores de risco associados a colonização e infecção e a presença dos fenótipos de resistência ESBL e AmpC em neonatos admitidos em Berçário de Alto Risco. Durante um período de 21 meses, foi realizado um estudo prospectivo para avaliar os casos de infecções hospitalares e o uso de cefalosporinas de terceira geração; e um estudo caso-controle para determinar os fatores de risco associados a colonização/infecção. Quatro inquéritos de colonização da orofaringe e intestino dos neonatos (Setembro e Novembro/2001, Fevereiro e Agosto/2002). Amostras com resistência a 2 mg/mL de ceftazidima foram isoladas devido a suspeita de produção de b-lactamases (ESBL/ AmpC). A incidência de pacientes infectados por bacilos Gram-negativos foi de 2,4% (89/3.709 neonatos), sendo sepse (35,9%) e conjuntivite (31,4%) as síndromes mais frequentes. A maioria das infecções foram endêmicas (73,9%) e associadas a Enterobacteriaceae (95,5%), estes também foram relacionados à colonização, correspondendo principalmente as amostras de Enterobacter spp e Klebsiella spp.. Foram identificados dois surtos, durante o estudo, associados a Pseudomonas aeruginosa (N=10) e Acinetobacter baumannii (N=11). Os fatores de risco incluindo: tempo de internação, uso de antimicrobianos, ventilação mecânica, cateter vascular central, cirurgia e nutrição parenteral foram significativos em uma análise univariada e considerados um risco para infecção por bacilos Gram-negativos. A maioria das amostras de Enterobacteriaceae (80,9%) com resistência a 2 mg/mL de ceftazidima foram do fenótipo ESBL. O uso de cefalosporinas de terceira geração (ceftriaxona) na unidade neonatal favoreceu a emergência de bacilos Gram-negativos multiresistentes.

Conventional versus molecular tests (Multiplex PCR and PCR mecA gene) for detection of methicillin resistant Staphylococcus aureus

Nesse estudo, para detecção de S. aureus resistente à meticilina (MRSA), a amplificação do gene mecA baseada no multiplex PCR foi comparada com os testes de difusão com disco para 1 µg/mL de oxacilina, detecção da concentração inibitória mínima (CIM), meio de triagem com 4% de NaCl e 6 µg/mL de oxacilina. Na investigação de 24 isolados obtidos de sangue, o genótipo mecA foi detectado em apenas 16 (66,7%) dos isolados pelo multiplex PCR. A CIM apresentou valores variando de 0,19 a 512 µg/mL entre os isolados de MRSA. Os dados obtidos pelos testes de triagem e diluição em ágar apresentaram sensibilidades de 80,0% e 72,8% respectivamente, quando comparados com a presença do gene mecA (multiplex). Todos os isolados, incluindo os negativos, quando reavaliados com a técnica de PCR exclusivo para este gene, o resultado foi positivo. A produção de b-lactamase foi positiva em 20/25 (80,0%) dos isolados. Cerca de » dos pacientes evoluiu para óbito apesar da maioria (83,3%) ter sido tratada adequadamente. A identificação simultânea da bactéria e sua susceptibilidade aos antibióticos é necessária para a escolha de uma terapia adequada para casos de sepse estafilocócica, mas é importante considerar a sensibilidade, especificidade e validação dos kits disponíveis.