Temporal evolution of the prevalence of methicillin-resistant Staphylococcus aureus in a tertiary hospital in Bahia, Brazil: a nine-year evaluation study

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have become an increasing problem in Brazilian hospitals within the last years. In Bahia, there is scarce information on the epidemiological characteristics of MRSA infections and their determinants. The objective of this study was to evaluate the temporal evolution of MRSA infections in a private, tertiary hospital, in Salvador, the capital of the state of Bahia. We reviewed the microbiological records of bacterial isolates from the Hospital Espanhol, a 300 bed, general hospital, in Salvador. We analyzed the frequency of positive cultures for S. aureus during the last nine years, the prevalence of MRSA, and the spatial distribution of the isolates in the hospital. We also evaluated the temporal evolution of MRSA during the study period. Seven-hundred-ten cultures were positive for S. aureus from 1996 through 2004. The prevalence of MRSA was 28 percent. The intensive care unit (59 percent), the hemodyalisis unit (43 percent), and the infectious diseases unit (34 percent) presented with significantly higher prevalence of MRSA, when compared to the remaining clinics of the hospital. We detected a significant increase of MRSA isolation among patients with nosocomial infections, over time (P<0.0001). MRSA isolates were highly resistant to alternative drugs (clyndamicin, erythromycin, co-trimexazole, levofloxacin), reinforcing the likelihood of nosocomial acquisition of the pathogen. The overall prevalence of MRSA in the hospital has remained relatively stable within the last nine years, but there was a significant trend forincreasing nosocomial acquisition of MRSA over time, which is even higher for patients attended in intensive care units, HDU, or IDU.

Risk factors for infection by extended-spectrum beta-lactamase producing Klebsiella pneumoniae in a tertiary hospital in Salvador, Brazil

Nosocomial infection caused by extended-spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-Kp) have been frequently reported worldwide. We have no information on such problems in Bahia, Brazil. OBJECTIVES: Evaluate the risk factors for nosocomial infections caused by ESBL-Kp, in a tertiary hospital, in Bahia, Brazil. MATERIAL AND METHODS: We evaluated all reported cases of nosocomial infections caused by ESBL-Kp in a private, tertiary hospital, in Salvador, Brazil, from 2000 through 2004. We compared patients with a diagnosis of ESBL-Kp (cases) and patients infected by non-ESBL producing K. pneumoniae (controls). Mean age, underlying disease, and frequency of invasive procedures were compared between the two groups. History of previous use of antibiotics was also analyzed. RESULTS: Based on multivariate analysis, previous use of antibiotics, diagnosis of malignant diseases, and diabetes mellitus were independent risk factors for acquisition of ESBL-Kp infection. No correlation was found for age, use of corticosteroids, diagnosis of chronic renal failure or AIDS, and infection by ESBL-Kp. CONCLUSION: Our findings suggest that the use of antibiotics or underlying disease that increases the chance of antibiotic are the main risk factors for ESBL-Kp infections. Programs focusing on rational use of antibiotics are mandatory for prevention and control of such infections.

Antibiotics for the empirical treatment of acute infectious diarrhea in children

While the routine use of antibiotics for infectious diarrhea in children must be avoided, because it brings little benefit in most cases and is associated with the risk of increasing antimicrobial resistance, selected cases may require antimicrobial therapy, and the choice of the antimicrobial agent often has to be made empirically. Physicians prescribing antimicrobials in such a setting have not only to be aware of the most likely pathogens, but also of their characteristic antimicrobial susceptibility pattern and the safety profile of the various drugs. We reviewed the literature on the use of ampicillin, beta-lactamase inhibitors, trimethoprim-sulfamethoxazole, chloramphenicol, tetracyclines, nalidixic acid, fluoroquinolones, third-generation cephalosporins, macrolides, metronidazole and malabsorbed agents in the setting of acute infectious diarrhea, and we evaluated the available information, seeking to apply it to empirical use, highlighting clinically-useful pharmacological information and patients' and pathogens' characteristics that must be taken into account for decisions about antimicrobial therapy.

Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: a case-control study

Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (± 30 days) of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases), C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each). The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC), use of parenteral nutrition support (PNS), previous exposure to antibiotics, and chronic renal failure (CRF). No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity of the underlying diseases, than as a direct consequence of Candidemia.

Evaluation of efficacy and safety of itraconazole oral solution for the treatment of oropharyngeal candidiasis in aids patients

This study was a non-comparative multicenter clinical trial to evaluate the efficacy and tolerability of itraconazole oral solution 200 mg/day (100 mg twice a day in the fasting state) for the treatment of oropharyngeal candidiasis in AIDS patients. We included 50 patients who were treated and followed for up 3 weeks after ending therapy in the analysis. Mycological cures at the end of therapy occurred in 20/50 patient (40 percent), but colonization by Candida sp. was recorded in 42/50 (84 percent) by the end of follow-up. A high rate of clinical response was observed in 46/50(92 percent), and the response was sustained for up to 21 days after stopping therapy in 24/46 patients (52 percent). Clinical relapse were documented among 22 patients, but all causative fungal organisms associated with a relapse were susceptible to itraconazole. There were many patients with persistence or recorrence of Candida, but without mucositis. Relapse of Candida mucositis was significantly related low levels of CD4 lymphocytes exhibited by symptomatic patients. The drug was well tolerated bt all but 1 patient. We conclude that itraconazole oral solution (100 mg bid for 7-14 days) is a well tolerated and effective treatment for suppressing the symptoms of oropharyngeal candidiasis in AIDS patients. Patients with severe immunosupression may relapse and require frequent cycles of treatment or longterm supressive therapy.

Avaliaçäo da qualidade da "porta de entrada" do sistema assistencial em Saúde Mental de Niterói - RJ / Evaluation of the admission-interview's quality for the public mental health system of care of the city of Niterói - Brasil

A pesquisa avalia o trabalho do serviço "Porta de Entrada" (PE) do Hospital Psiquiátrico de Jurujuba em Niterói-RJ. Após a descriçäo do serviço, desenvolveu-se uma estratégia de avaliaçäo a partir de questöes levantadas pela equipe clínica e discutidas com a equipe de pesquisa nas reuniöes semanais do serviço. Foram estudadas questöes relativas a pacientes com "permanência prolongada" (maior ou igual a 7 dias) na PE e a pacientes com sucessivas reinternaçöes (maior ou igual a 3). Verificou-se que a permanência prolongada justificou-se nos casos de risco ou tentativa de suicídio, Intercorrências clínicas e dúvidas diagnósticas. 54,8 por cento das reinternaçöes frequentes (maior ou igual a 3) foram de alcoolistas, 28,6 por cento de psicóticos e 16,6 por cento dos pacientes com outros diagnósticos. Em relaçäo ao prosseguimento do tratamento ambulatorial após a alta, verificou-se que o grupo de pacientes psicóticos aderiu ao tratamento, enquanto o de alcoolistas näo o fez. O objetivo de motivar a equipe para o trabalho avaliativo foi plenamente atingido. Partindo da caracterizaçäo do serviço, levantou-se uma grade de inteligibilidade do trabalho realizado, extremamente útil para a equipe de PE e para sua inserçäo na rede de saúde mental em Niterói

Once daily fleroxacin and twice daily ciprofloxacin are both effective in the treatment of complicated urinary tract infections

In a multicenter randomized double-blind, trial, 90 patients received either fleroxacin 400mg po once/day or ciprofloxacin 500mg po twice/day for treatment of complicated urinary tract infections (UTI). Treatment was administered orally and presumptively. Bacteriological efficacy was assessed 7 days post-treatment. In total, 78 patients were available for efficacy testing: 40 in the fleroxacin group and 38 in the ciprofloxacin group. The bacteriological cure rate was 92.5 percent and 94.7 and in the fleroxacin and ciprofloxacin groups, respectively. The most commonly isolated pathogen (E. coli) was erradicated in 94.1 percent and 95.8 percent of the cases in fleroxacin and ciprofloxacin groups, respectively. Eight patients in the fleroxacin group had some adverse events, two of them severe (insomnia and photodermatitis). In the ciprofloxacin group, 11 patients had adverse events of mild to moderate intensity, mainly affecting the digestive system. In conclusion, fleroxacin 400mg po once/day and ciprofloraxin 500mg po twice/day were both effective in the treatment of complicated urinary tract infections.

Blastocystis hominis as a potential causa of diarrhea in AIDS patients: a report of six cases in Bahia, Brazil

The role of Blastocystis hominis as a human pathogens is controversial, although there is some evidence suggesting that it is agent implicated in causing diarrhea in immunocompromised patients. We report 6 cases of AIDS patients presenting with diarrhea with no agents identified in their stools except B. hominis. In all cases, treatment was followed by complete recovery from symptoms and clareance of B. hominis from the patients' stools. In 2 cases, relapse of diarrhea was followed by a positive stool examination for B. hominis oocysts, which again disappeared after treatment. These findings provide additional evidence for considering B. hominis a potential intestinal pathogen in AIDS patients.

Leprosy and AIDS: report of a fatal case and literature review

We report a severe fatal lepromatous leprosy case in an adult homosexual male 2 years after AIDS class IV was diagnosed. Multidrug therapy including thalidomide for erythema nodosum leprosum (ENL) was ineffective. The patient died with multiple large skin ulcerations due to multibacillary leprosy. Leprosy in AIDS patients may present as a severe uncontrolled disease, with extensive ENL unresponsive to therapy.

Tratamento da criptosporidíase em pacientes com AIDS, por meio da paromomicina / Treatment of cryptosporidiasis with paramomycin in AIDS patients

The authors treated with paromomycin 25 patients, with AIDS and cryptosporidiosis. The drug was given orally in a doses of 500 mg qid, for a period of 14 days. Tolerance was good, with just two cases of mild side-effects. Clinical improvement was obtained in 19 (76 per cent) patients. Parasitological cure, however, occurred only in a low percentage (25 per cent). In some cases where initial success was observed, recrudescence occurred after some weeks or few months, but with retreatment again clinical improvement was obtained. Even if it does not lead to frequent parasite eradication, the good clinical results and tolerance permit us to consider paromomycin one of the few drugs effective for the treatment of cryptosporidial diarrhea in AIDS patients. Studies with maintainance therapy are indicated.

The influence of CD4+ T cells, HIV disease stage and zidovudine on HIV isolation in Bahia, Brazil

HIV-1 isolation was attempted on 72 individuals, including persons with known HIV infection and five without proven HIV infection but with indeterminate Western blot patterns, as well as on low-risk HIV seronegative persons. The ability to detect HIV-1 from culture supernatant by p24 antigen capture assay was evaluated by segregating patients by absolute CD4+ cell counts, clinical stage of disease, p24 antigenemia and zidovudine use. The likelihood of a p24 positive HIV culture was highest among patients with CD4+ T-cell counts below 200/ul and patients with advanced clinical disease. Use of zidovudine did not affect the rate of HIV positivity in cultures.