Reutilização do detergente enzimático: avaliação do impacto da contaminação microbiana da solução na efetividade da limpeza de aparelhos endoscópicos gastrointestinais / Enzymatic detergent reuse: evaluation of the impact of the solution's microbial contamination on the cleaning effectiveness of gastrointestinal endoscopes

No Brasil, é recomendado que durante a limpeza dos Produtos para Saúde (PPS) o detergente utilizado possua ação enzimática. Embora a Resolução da Diretoria Colegiada nº 55 de 14 de novembro de 2012 da Agência Nacional de Vigilância Sanitária desaconselhe a reutilização desta solução de limpeza, sabe-se que na prática clínica elas são reaproveitadas por diversas vezes para imersão de PPS, como os aparelhos endoscópicos, o que pode comprometer a efetividade da ação do detergente enzimático e com isso a segurança no processamento do PPS. Esta pesquisa objetivou avaliar a carga microbiana presente na solução de detergente enzimático durante sua reutilização na limpeza manual de aparelhos endoscópicos gastrointestinais. Tratou-se de um estudo transversal realizado em um serviço de endoscopia digestiva de um hospital universitário de Belo Horizonte e no Laboratório de Microbiologia Oral e Anaeróbios do ICB/UFMG. A amostra foi composta por 57 aparelhos endoscópicos e 76 alíquotas de solução de detergente enzimáticos coletadas de diversos reusos de 19 diferentes soluções. O material coletado foi agitado em vórtex, acrescido a Caldo Letheem Modificado e submetido a filtração em membrana Millipore® 0,45µm. A membrana foi depositada em Tryptic Soy Ágar para crescimento microbiano. A identificação presuntiva dos micro-organismos foi realizada manualmente considerando-se aspectos morfotintoriais e reações bioquímico/fisiológicas. As variáveis foram descritas utilizando frequências, porcentagens e medidas de tendência central. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da Universidade Federal de Minas Gerais (CAAE ­ 67493417.1.0000.5149). As médias das cargas microbianas na solução de detergente enzimático variaram de 19,9 UFC/mL após primeiro uso, 51,1 UFC/mL após terceiro uso e 67,1UFC/mL após o quinto reuso. Nos canais de ar/água e biópsia houve aumento de micro-organismos Gram negativos ao longo das reutilizações do detergente. Foram recuperados, Enterobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas spp., Staphyloccocus aureus, Staphyloccocus coagulase negativa. Pseudomonas spp. foi o micro-organismo mais identificado em todas as alíquotas coletadas. Verificou-se a importância da escovação do canal de biópsia para correta remoção de micro-organismos. Conclui-se que a reutilização das soluções de detergente enzimático contribuiu para contaminação dos aparelhos endoscópicos com micro-organismos potencialmente patogênicos. Faz-se necessário a reavaliação de protocolos institucionais, no sentido de que seja cumprida a orientação da Anvisa por meio da RDC nº 55 de 14 de novembro de 2012 de que os detergentes enzimáticos não devem ser reutilizados sob perda da eficiência do produto. As características físico químicas dos detergentes enzimáticos devem ser respeitadas pelos serviços de saúde conforme parâmetros estabelecidos pelos fabricantes.(AU)

In Brazil, it is recommended that during the cleaning of Health Products the detergent used has enzymatic action. Although Collegiate Board Resolution No. 55 of November 14, 2012 of the National Agency of Sanitary Surveillance advises against the reuse of this cleaning solution, it is known that in clinical practice they are reused several times for immersion of health products, such a gastrointestinal endoscope, which may compromise the effectiveness of the enzymatic detergent action and thus the safety in the processing. This research aimed to evaluate the microbial load present in the enzymatic detergent solution during its reuse in the manual cleaning of endoscopic gastrointestinal devices. This was a cross-sectional study performed at a gastrointestinal endoscopy service at a university hospital in Belo Horizonte and at the Oral Microbiology and Anaerobic Laboratory of ICB/UFMG. The sample consisted of 57 endoscopes and 76 aliquots of enzymatic detergent solution collected from several replicates of 19 different solutions. The collected material was vortexed, added to Modified Letheem Broth and subjected to Millipore® 0.45 µm membrane filtration. The membrane was deposited in Tryptic Soy Ágar for microbial growth. The identification of the microorganisms was performed manually considering morphotintorial aspects and biochemical/physiological reactions. The variables were described using frequencies, percentages and measures of central tendency. The project was approved by the Ethics and Research Committee of the Federal University of Minas Gerais (CAAE - 67493417.1.0000.5149). The mean values of the microbial loads in the enzymatic detergent solution varied from 19.9 UFC/mL after first use, 51.1 UFC/mL after third use and 67.1 UFC/mL after the fifth reuse. In the air/water and biopsy channels there was an increase of Gram negative microorganisms along the reuse of the detergent. Enterobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas spp., Staphylococcus aureus, Coagulase-negative Staphyloccocus were recovered. Pseudomonas spp. was the most identified microorganism in all aliquots collected. It was verified the importance of brushing the biopsy channel for correct removal of microorganisms. It was concluded that the reuse of enzyme detergent solutions contributed to the contamination of the endoscopes with potentially pathogenic microorganisms. It is necessary to re-evaluate institutional protocols, in order to comply with Anvisa's guidance through RDC nº. 55 of November 14, 2012 that enzymatic detergents should not be reused under loss of product efficiency. The physical characteristics of the enzymatic detergents must be observed by the health services according to the parameters established by the manufacturers.(AU)

Isolation, identification, and biocontrol of antagonistic bacterium against Botrytis cinerea after tomato harvest

ABSTRACT Tomato is one of the most important vegetables in the world. Decay after harvest is a major issue in the development of tomato industry. Currently, the most effective method for controlling decay after harvest is storage of tomato at low temperature combined with usage of chemical bactericide; however, long-term usage of chemical bactericide not only causes pathogen resistance but also is harmful for human health and environment. Biocontrol method for the management of disease after tomato harvest has great practical significance. In this study, antagonistic bacterium B-6-1 strain was isolated from the surface of tomato and identified as Enterobacter cowanii based on morphological characteristics and physiological and biochemical features combined with sequence analysis of 16SrDNA and ropB gene and construction of dendrogram. Effects of different concentrations of antagonistic bacterium E. cowanii suspension on antifungal activity after tomato harvest were analyzed by mycelium growth rate method. Results revealed that antifungal activity was also enhanced with increasing concentrations of antagonistic bacterium; inhibitory rates of 1 × 105 colony-forming units (cfu)/mL antagonistic bacterial solution on Fusarium verticillioides, Alternaria tenuissima, and Botrytis cinerea were 46.31%, 67.48%, and 75.67%, respectively. By using in vivo inoculation method, it was further confirmed that antagonistic bacterium could effectively inhibit the occurrence of B. cinerae after tomato harvest, biocontrol effect of 1 × 109 cfu/mL zymotic fluid reached up to 95.24%, and antagonistic bacterium E. cowanii has biocontrol potential against B. cinerea after harvest of fruits and vegetables.

Antimicrobial activity evaluation and comparison of methods of susceptibility for Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacter spp. isolates

Abstract The production of KPC (Klebsiella pneumoniae carbapenemase) is the major mechanism of resistance to carbapenem agents in enterobacterias. In this context, forty KPC-producing Enterobacter spp. clinical isolates were studied. It was evaluated the activity of antimicrobial agents: polymyxin B, tigecycline, ertapenem, imipenem and meropenem, and was performed a comparison of the methodologies used to determine the susceptibility: broth microdilution, Etest® (bioMérieux), Vitek 2® automated system (bioMérieux) and disc diffusion. It was calculated the minimum inhibitory concentration (MIC) for each antimicrobial and polymyxin B showed the lowest concentrations for broth microdilution. Errors also were calculated among the techniques, tigecycline and ertapenem were the antibiotics with the largest and the lower number of discrepancies, respectively. Moreover, Vitek 2® automated system was the method most similar compared to the broth microdilution. Therefore, is important to evaluate the performance of new methods in comparison to the reference method, broth microdilution.

Molecular identification of multidrug resistant Enterobacter hormaechei in Venezuela / Identificación molecular de Enterobacter hormaechei multidrogoresistente en Venezuela

Besides the importance of Enterobacter cloacae species complex as a nosocomial pathogen, little is known about the frequency of each species/genotype. Here, we describe a strain of E. hormaechei subsp. hormaechei isolated from a bronchial secretion of a patient, in the Intensive Care Unit at the General Hospital of Cumaná, Venezuela, who died due to complications of his infection. The molecular identification was done by sequencing the 16S rRNA gene and comparing it to sequences from the GenBank. This strain showed resistance to multiple families of antibiotics (MDR), and the genes blaKPC and blaVIM were detected by PCR. This is the first time E. hormaechei has been identified in Venezuela.

A pesar de la importancia de las especies del complejo Enterobacter cloacae como patógeno nosocomial, poco se conoce sobre la frecuencia de cada especie/genotipo. Aquí se describe una cepa de E. hormaechei subsp. hormaechei aislada de una secreción bronquial de un paciente internado en la Unidad de Cuidados Intensivos del Hospital General de Cumaná, Venezuela, quien murió producto de complicaciones de su infección. La identificación molecular fue hecha por secuenciación del gen ARNr 16S y porcomparación con las secuencias del GenBank. Esta cepa mostró resistencia a múltiples familias de antibióticos (MDR) y se detectaron los genes blaKPCyblaVIMpor PCR. Este es el primer reporte de E. hormaechei en Venezuela.

Isolation and characterization of arsenic resistant bacteria from wastewater

The present study proposed the isolation of arsenic resistant bacteria from wastewater. Only three bacterial isolates (MNZ1, MNZ4 and MNZ6) were able to grow in high concentrations of arsenic. The minimum inhibitory concentrations of arsenic against MNZ1, MNZ4 and MNZ6 were 300 mg/L, 300 mg/L and 370 mg/L respectively. The isolated strains showed maximum growth at 37 ºC and at 7.0 pH in control but in arsenite stress Luria Bertani broth the bacterial growth is lower than control. All strains were arsenite oxidizing. All strains were biochemically characterized and ribotyping (16S rRNA) was done for the purpose of identification which confirmed that MNZ1 was homologous to Enterobacter sp. while MNZ4 and MNZ6 showed their maximum homology with Klebsiella pneumoniae. The protein profiling of these strains showed in arsenic stressed and non stressed conditions, so no bands of induced proteins appeared in stressed conditions. The bacterial isolates can be exploited for bioremediation of arsenic containing wastes, since they seem to have the potential to oxidize the arsenite (more toxic) into arsenate (less toxic) form.

Optimization of biodegradable plastic production on sugar cane molasses in Enterobacter sp. SEL2

Contaminated environments have a large number of bacteria which can accumulate PHA as their energy reserves. Out of 54 isolated bacterial strains from three groups of contaminated sites 48 were found PHA positive. The sites were grouped on the basis of the type of carbon sources i.e. sugars, fatty acids and much diverse type. Strains MFD5, MFD11, UML3, USL2, SEL2, SEL3, SEL10 and PFW1 produced 69.9 ± 0.29, 75.27 ± 0.45, 65.43 ± 0.1, 72.54 ± 0.27, 76.61 ± 0.28, 61.81 ± 0.05, 71.16 ± 0.09 and 74.92 ± 0.5 percent of PHA to their constant cell weight (CCW) respectively in PHA detection media supplemented with 2% glucose. Molasses, whey, crumbs hydrolysate and palm oil were checked as inexpensive carbon sources. Molasses alone could supply the required nutrients for growth and PHA production. Strain SEL2 produced 47.36 ± 0.45% PHA using 2% molasses at 37 °C and pH 7.0. Upon production optimization the best accumulation (80.95 ± 0.01%) was observed in PHA detection media with 0.2% nitrogen source, 3% molasses, pH 5.0 and 37 °C by the strain SEL2. The overall effect of the presence of increased molasses concentration in the media was positive it increased the accumulation period till 72 h. Enterobacter sp. SEL2 (JF901810) is first time being reported for PHA production.

Cloning and characterization of newly isolated lipase from Enterobacter sp. Bn12

A mesophilic Enterobacter sp. Bn12 producing an alkaline thermostable lipase was isolated from soil in Tehran, Iran. The lipase gene (ELBn12) was identified from a genomic library. Sequence analysis of the DNA fragment revealed an open reading frame of 879 bp encoding a lipase with a molecular mass of 31.3 kDa. The deduced amino acid sequence showed 96% identity with a lipase of Enterobacter sp. Ag1 and the identity of their DNA sequences was 88.9%. ELBn12 belongs to the lipase subfamily I.1 and its catalytic triad consists of Ser82, Asp237 and His259. The lipase was expressed in Escherichia coli (BL21) pLysS and partially purified by anion exchange chromatography. The maximum activity of ELBn12 was obtained at temperature of 60 °C and pH 8.0 towards tricaprylin (C8) and its specific activity was around 2900 U/mg. ELBn12 was stable within a broad pH range from 6.0 to 11.0. The enzyme showed high stability in both polar and nonpolar organic solvents at 50% (v/v). The lipase activity was enhanced in the presence of 10 mM of Ca2+, Mg2+ and K+, while heavy metals (Fe3+ and Zn2+) had strong inhibitory effect. ELBn12 showed high activity in the presence of 1% (w/v) nonionic surfactants, however ionic surfactants inhibited the lipolytic activity. ELBn12 characteristics show that it has a potential to be used in various industrial processes.

Infecções de corrente sanguínea por bactérias multirresistentes em UTI de tratamento de queimados: experiência de 4 anos / Bloodstream infections by multidrug-resistant bacteria in patients in an intensive care unit for the treatment of burns: a 4-year-experience

INTRODUÇÃO: O conhecimento do perfil de resistência aos antibióticos das bactérias de um nosocômio é essencial para orientar tratamento adequado dos pacientes. Isso é especialmente importante para os pacientes mais graves, já que o tratamento deve ser instituído antes do resultado das culturas. O objetivo deste estudo foi analisar o perfil das bactérias multirresistentes encontradas nas hemoculturas de pacientes admitidos na Unidade de Tratamento Intensivo (UTI) da Unidade de Queimados do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. MÉTODO: Foram analisados 178 pacientes internados na UTI para tratamento de queimados, no período de 2009 a 2011, sendo 131 do sexo masculino, com média de idade de 29,2 anos. RESULTADOS: Entre os pacientes analisados, 80 (44,9%) apresentaram hemocultura periférica positiva, sendo 66 (82,5%) casos com bactérias multirresistentes. Em 48 pacientes, foram isoladas Staphylococcus sp., que se apresentaram resistentes à oxacilina em 33 deles. Em 11 pacientes, foram isoladas Acinetobacter baumanii, que se apresentaram resistentes a imipenem em 8 casos. Em 19 pacientes, foram isoladas Pseudomonas sp., resistentes a imipenem em 16 casos. Em 10 pacientes foram isoladas Enterobacter sp., resistentes a amicacina e ciprofloxacina em 2 casos. A presença de bactérias multirresistentes não foi associada a maior ocorrência de óbitos, porém foi verificado maior tempo de internação (52,6 dias vs. 36,3 dias para os grupos com e sem bactérias multirresistentes, respectivamente; P = 0,0306). Não foi encontrada interação significante entre superfície corpórea queimada e presença de bactérias MR. CONCLUSÕES: A presença de bactérias multirresistentes é um problema grave, tanto pela prevalência como pela morbidade e mortalidade associadas.

BACKGROUND: Knowledge of the profile of antibiotic resistance in bacteria in a hospital is essential for guiding appropriate patient treatment. This is especially important for the severely ill patients, because treatment must be initiated before the results of cultures can be obtained. In this study, we aimed to analyze the profile of multidrug-resistant bacteria (MR) found in blood cultures from patients admitted to the intensive care unit (ICU) of the Burns Unit of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. METHODS: We evaluated 178 patients (131 men) admitted to the ICU for the treatment of burns from 2009 to 2011, with a mean age of 29.2 years. RESULTS: Eighty (44.9%) patients indicated positive results in peripheral blood cultures, and there were 66 (82.5%) cases with MR bacteria. Staphylococcus sp. was isolated in 48 cases, of which 33 cases showed resistance to oxacillin. Acinetobacter baumannii was isolated in 11 cases, and 8 of these cases were resistant to imipenem. Pseudomonas sp. was isolated in 19 cases, and 16 of these cases were resistant to imipenem. Enterobacter sp. was isolated in 10 cases, and 2 of these cases were resistant to ciprofloxacin and amikacin. The presence of MR bacteria was not associated with a higher incidence of deaths but was associated with longer hospital stay (52.6 vs. 36.3 days for those with and without MR bacteria, respectively, P = 0.0306). There was no significant association between burned body surface and the presence of MR bacteria. CONCLUSIONS: The presence of MR bacteria is an important problem, because of the prevalence and associated morbidity and mortality.

Phenotypic & molecular characterization of AmpC β-lactamases among Escherichia coli, Klebsiella spp. & Enterobacter spp. from five Indian Medical Centers.

Background & objectives: AmpC β-lactamases which are often plasmid mediated hydrolyze all β-lactam antibiotics except cefepime and carbapenems. We evaluated the presence of AmpC β-lactamases among Enterobacteriaceae strains recovered prospectively from patients at five Indian tertiary care centres. Methods: The study included 909 consecutive Gram-negative isolates recovered from clinically significant specimens during June 2007 - May 2008 as part of an ICMR-ESBL study. Among the study isolates, 312 were found to be cefoxitin resistant by disc diffusion test (DDT). Minimum inhibitory concentration (MIC) determination by E test was done against amikacin, levofloxacin, impinem, meropenem, ertapenem, tigecycline and piperacillin-tazobactam. Combined DDT using phenyl boronic acid as inhibitor with cefoxitin was used for phenotypic confirmation of AmpC phenotype. The common Amp C genotypes ACC, FOX, MOX, DHA, CIT and EBC were detected by multiplex PCR. Results: Plasmid mediated Amp C phenotype was confirmed in 114 of the 312 (36.5%) cefoxitin resistant isolates with 255 (81.7%) showing multidrug resistance. Susceptibility to tigecycline was highest (99%) followed by imipenem, meropenem (97%), ertapenem (89%), amikacin (85%), and piperacillin-tazobactam (74.6%). Levofloxacin resistance was 82 per cent. ESBL co carriage was observed among 92 per cent of Amp C producers. Among 114 Amp C producers, 48 could be assigned a genotype, this included CIT- FOX (n=25), EBC (n=10), FOX (n = 4), CIT (n=3), EBC-ACC (n=2) and one each of DHA, EBC-DHA, FOX -DHA and FOX-EBC-DHA. Interpretation & Conclusions: Overall, AmpC phenotypes were found in 12.5 per cent isolates, multidrug resistance and ESBL co-carriage among them was high suggesting plasmid mediated spread. The study results have implications in rational antimicrobial therapy and continued surveillance of mechanisms of resistance among nosocomial pathogens.

Growth response of maize plantlets inoculated with Enterobacter spp., as a model for alternative agriculture / Respuesta de plántulas de maíz inoculadas con Enterobacter spp. como un modelo de agricultura alternativa

A maize rhizosphere isolate was phenotypically and genotypically characterized and identifed as Enterobacter spp. bacterium. Germinated seeds were inoculated, the plantlets were sown in vermiculite and in soil and grown under laboratory and feld conditions, respectively. The adherence, colonization and plant growth promotion capability of Enterobacter sp. UAPS03001 was evaluated in "Rojo-Criollo" maize under laboratory conditions. Twenty days after inoculation, the treated plantlets showed larger biomass than non-inoculated ones. In feld grown plants, the kernel biomass was also greater in inoculated than in non-inoculated plants. The inoculation of maize sprouts with plant growth- promoting bacteria before their sowing in the feld would be an alternative practice for achieving successful yield in temporal agriculture.

En este trabajo se aisló una bacteria de la rizósfera de maíz, que fue caracterizada mediante métodos fenotípicos y genotípicos e identifcada como Enterobacter sp. UAPS03001. La bacteria fue inoculada en semillas de maíz "Rojo-Criollo" germinadas en forma axénica. Las semillas germinadas e inoculadas se plantaron en vermiculita y posteriormente las plántulas fueron cultivadas en vermiculita o en suelo, para evaluar el efecto promotor del crecimiento vegetal de dicha bacteria, bajo condiciones de laboratorio y de campo. Bajo condiciones de laboratorio, también se evaluó la capacidad de esta cepa para adherirse a las plantas de maíz y colonizarlas. Veinte días después de la inoculación, las plántulas inoculadas mostraron una biomasa mayor con referencia a las no inoculadas. En campo, la biomasa de la mazorca fue también mayor en las plantas inoculadas respecto de las plantas no inoculadas. La inoculación de germinados de maíz con una bacteria promotora del crecimiento vegetal y su posterior transferencia a campo podría ser una práctica alternativa para llevar a cabo una producción exitosa en agricultura de temporal.

Isolation and molecular characterization of some copper biosorped strains

TThe biosorption of copper [II] from aqueous solution using different bacterial strains was studied. Copper-biosorbing bacteria were isolated from tannery effluent collected from Borg Al-Arab, Alexandria, Egypt. These isolates displayed different degrees of copper biosorption under aerobic conditions. Based on 16S rDNA gene sequence analysis, three of them [S2, S5 and S7] were identified as Chryseobacterium sp., Enterobacter sp. and Stenotrophomonas sp., respectively. Initial copper [II] ion concentrations from 25-250 mg/L at constant temperature 30°C were studied. The residual copper [II] concentration and its toxicity effect in solution were determined using atomic absorption spectrophotometer and bioluminescent bioreporter. The bioluminescence inhibition of strain [S5] reached to 91.4% as compared with the strain [S7] reached to 83.3% at 225 mg/L of copper ion where the maximum biosorption efficiency for S5 and S7 were 71% and 70.1% correspondingly using atomic absorption. The biolumi-nescent bioreporter was proved to be fast and accurate technique for measurement the toxicity effect of residual copper [II] in solution

An "epidemic" of post cataract surgery endophthalmitis by a new organism.

We report a case series of endophthalmitis by an organism hitherto not reported in the eye. Nineteen of 63 cataract patients operated in a high-volume setup were urgently referred to us with acute onset of decreased vision one to two days following cataract surgery. All patients had clinical evidence of acute endophthalmitis with severe anterior chamber exudative reaction. Vitreous tap was done in three representative patients and repeated intravitreal injections were given as per established protocol. The vitreous sample from all three patients grew Enterobacter amnigenus Biogroup II, a gram-negative bacillus which, to the best of our knowledge, has never been reported in the eye. With prompt and accurate microbiological support, it was possible to salvage 17 of these eyes without performing vitrectomy. Six eyes regained 6/200 or better vision.

Avaliação do desenvolvimento microbiano em superfície de manipulação de alimentos / Evaluation of microbial development in the area of food handling

O objetivo deste trabalho foi avaliar a contaminação microbiológica de tábuas de corte utilizadas no preparo de alimentos, em restaurantes e churrascarias comerciais do município de Santo André – SP. Para a análise microbiológica, foram colhidas amostras na superfície lisa (frente e verso) das tábuas de corte de alimentos, feitas com materiais de madeira e de polietileno. Foi elaborado um questionário para analisar se os proprietários dos estabelecimentos conheciam o programa de Análise de Perigos e Pontos Críticos de Controle (APPCC). Os resultados (tábua de carne) mostraram contaminações pelos seguintes microrganismos: Enterobacter, Proteus sp., Klebsiella, Yersinia, Citrobacter e Escherichia coli. Com esse resultado, conclui-se que nos estabelecimentos de alimentação coletiva, devem ser ministrados programas de educação em saúde, tanto aos proprietários quanto aos funcionários. Não se deve esquecer a importância da boa qualidade da matéria-prima, da higiene das instalações e utensílios e, principalmente, dos métodos de preparo e conservação dos alimentos. Se os estabelecimentos de refeições coletivas pesquisadas estivessem inseridos dentro desse contexto, não ocorreriam as contaminações pelos microorganismos encontrados na pesquisa.

Peritonitis due to Penicillium and Enterobacter in a patient receiving continuous ambulatory peritoneal dialysis

Infectious peritonitis is a common complication of continuous ambulatory peritoneal dialysis (CAPD). Polymicrobial peritonitis accounts for about 8 percent of the peritonitis episodes and involves fungi in 9 percent to 33 percent of cases. We report the known first case of polymicrobial peritonitis in which Penicillium sp. was one of the organisms cultured and the ninth case of Penicillium peritonitis in CAPD.

Ulcerative keratitis associated with contact lens wear.

To review the microbiological profile of ulcerative keratitis associated with contact lens (CL)-wear, 35 patients with culture-proven CL-associated microbial keratitis were studied between September 1999 and September 2002. Corneal scrapes and CL-care products were collected and were subjected to microbiological evaluation. Gram-negative bacilli alone were recovered from the corneal scrapes of all 35 (100%) patients, all 70 (100%) CL storage case wells and also from CL-care solution of six (17.14%) of the 35 patients. There was a significantly higher number of Pseudomonas aeruginosa (71.43%) isolated from eyes with CL-related keratitis than other bacterial isolates (28.57%) (P<0.001). Microbial contamination of CL storage cases was a great risk for gram-negative bacterial infection among soft CL-wearers.

Risk factors for central venous catheter-related infections in pediatric intensive care

OBJECTIVES: To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection. METHOD: After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve. RESULTS: Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular) was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014) and duration of catheter use (p=0.0013), and protective factors included concomitant antibiotic use (p=0.0005) and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002). Pediatric Risk of Mortality did not discriminate the risk of infection. CONCLUSIONS: Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.

OBJETIVOS: Identificar fatores de risco para as infecções relacionadas a cateter venoso central de curta permanência, inserido por punção, em crianças e avaliar a eficiência de um escore de mortalidade pediátrica em prever o risco de infecção. MÉTODOS: Revisão dos casos de infecção relacionada a cateter ocorridos na unidade de terapia intensiva pediátrica de um hospital universitário seguida de estudo caso-controle com 51 pares. Foram analisadas variáveis relacionadas aos pacientes e à inserção e utilização dos cateteres, sendo definidos fatores de risco por análise de regressão logística. A eficiência de Pediatric Risk of Mortality em discriminar o risco de infecção foi testada pela curva receiver operating characteristic. RESULTADOS: Foram variáveis associadas à infecção: insuficiência respiratória, duração da internação, tempo de intubação, inserção do cateter na unidade de terapia intensiva e nutrição parentérica. O sítio de inserção foi indiferente quando comparadas as veias jugular interna e femoral. Foram fatores de risco: inserção de mais de um cateter (p=0,014) e tempo de permanência do cateter (p=0,0013). Foram fatores de proteção: uso concomitante de antibióticos (p=0,0005) e infusão intermitente seguida de heparinização quando comparada à infusão contínua sem heparinização (p=0,0002). Pediatric Risk of Mortality não discriminou o risco de infecção. CONCLUSÕES: Deve-se suspender a nutrição parentérica e retirar o cateter venoso central assim que possível. A cateterização da veia femoral implica em risco de infecção semelhante ao da veia jugular interna. O escore Pediatric Risk of Mortality não deve ser utilizado para estimar o risco de infecção relacionada ao cateter venoso central.

Uso de antibióticos en infección de vías urinarias en una unidad de primer nivel de atención en salud, Bogotá, Colombia / Using antibiotics in urinary tract infection in a first level of attention health care unit in Bogotá, Colombia

OBJETIVOS: Describir el uso de antibióticos en infección de vías urinarias, en una unidad de primer nivel de atención en salud. MÉTODOS: Estudio observacional, descriptivo, de una cohorte histórica, basada en registros, de usuarios consultantes en la Unidad de Servicios de Salud-UNISALUD, de la Universidad Nacional de Colombia, sede Bogotá, con diagnóstico de infección de vías urinarias, entre julio de 2002 y junio de 2003. RESULTADOS: La incidencia de infección de vías urinarias fue de 6,3 por ciento, afectando especialmente a las mujeres con 84,4 por ciento. Los signos y síntomas son los típicamente encontrados en esta entidad: 58 por ciento de los casos corresponde a infecciones bajas, 36 por ciento a inespecíficas, 4 por ciento a infecciones durante el embarazo y 2 por ciento a infecciones altas. Los uropatógenos aislados fueron: E. coli (88,9 por ciento), Proteus spp. (5,1 por ciento), Klebsiella spp. (3,7 por ciento), Enterobacter spp. (1 por ciento), Citrobacter spp. (1 por ciento) y Staphylococcus saprophyticus (0,3 por ciento). Hubo una gran variabilidad en la prescripción de esquemas antibióticos. Los de mayor consumo, en dosis diaria definida, fueron: Nitrofurantoína, Trimetoprim-sulfa y Fluoroquinolonas, frente a los cuales, los uropatógenos aislados presentaron perfiles de susceptibilidad bajos. La proporción de tratamientos empíricos con respecto a los confirmados fue de 4:1. El 98 por ciento de los casos correspondió a pacientes con un único evento, o con una o dos recurrencias. DISCUSION: La infección de vías urinarias presentó un comportamiento acorde al perfil epidemiológico de esta entidad patológica en la población general. La baja susceptibilidad de los microorganismos a los antibióticos prescritos, podría reflejar un uso inadecuado, a nivel de la comunidad institucional, induciendo presión selectiva sobre la resistencia bacteriana.

Prevalencia nacional de infecciones nosocomiales Cuba 1997 (PNIN Cuba 1997) / National prevalence of nosocomial infections Cuba 1997

Con el objetivo de determinar la magnitud de la prevalencia de infecciones nosocomiales (IN) en el sistema de hospitales cubanos, se realizó un estudio multicéntrico en 28 hospitales seleccionados aleatoriamente de un total de 119 hospitales de más de 50 camas, en el periodo comprendido del 5 de mayo al 11 del mismo mes del año 1997. La prevalencia general fue de 8,2%. De los 6152 pacientes evaluados, a 418 se le diagnosticó un total de 504 infecciones nosocomiales. Las tasas más altas de infección nosocomial fueron encontradas en las unidades de cuidados intensivos (24,6%), las unidades quirúrgicas (10,3%), unidades de quemados y unidades de Cirugía Cardiovascular. La herida quirúrgica fue la localización de la infección más prevalente (23%), seguida del tracto respiratorio bajo y alto, la piel y el tracto urinario. Los patógenos más frecuentemente aislados fueron E. coli, Staphylococcus spp., Enterobacter spp., Proteus y Pseudomonas. Nuestros resultados son comparables con estudios internacionales a excepción de las infecciones del tracto urinario. Se propone la realización de estudios en busca de factores de riesgo en los servicios más prevalentes, los grupos de pacientes más afectados, las operaciones de mayor riesgo y la frecuencia relativa de cada localización; así como de estudios cualitativos que pudieran ofrecer datos sobre el conocimiento, las actitudes y el comportamiento del personal hospitalario frente a las IN