Silvoflurano tópico en infección superficial por SARM tras artroplastia de rodilla: caso clínico / Topical sevoflurane for superficial MRSA infection after knee arthroplasty: case report

Intentar el tratamiento retentivo de material protésico ante heridas quirúrgicas infectadas por gérmenes resistentes es objeto de debate, especialmente cuando el agente causal es un Staphylococcus aureus resistente a meticilina (SARM). Una paciente diabética y con obesidad tipo I sufrió infección de la herida quirúrgica tras artroplastia de rodilla que no evolucionó bien con antibioterapia empírica y terapia hiperosmolar. Se planificó una reintervención que fue demorada por motivos extramédicos (falta de terapia de presión negativa para cubrir la herida postoperatoria, pues se preveía no poder realizar cierre primario). Mientras se conseguía este material, y tras obtener el consentimiento de la paciente, se iniciaron irrigaciones de la herida con sevoflurano tópico off-label, pues ese fármaco ha mostrado capacidad antimicrobiana. La evolución clínica fue excelente desde el inicio a pesar de que en el cultivo se aisló un SARM resistente a la antibioterapia empírica, por lo que se desestimó la reintervención y se continuó con sevoflurano tópico junto a la antibioterapia dirigida por antibiograma, lográndose la curación completa de la herida tras 6 semanas. Durante ese tiempo, la paciente no experimentó ningún efecto adverso atribuible al sevoflurano. El sevoflurano tópico aparece como una valiosa nueva opción terapéutica ante heridas postoperatorias infectadas, especialmente cuando los gérmenes causantes son resistentes a los antibióticos convencionales.

It is challenging to try a retentive treatment of prosthetic material superinfected by resistant microorganisms, especially when the causative agent is a methicillin-resistant Staphylococcus aureus (MRSA). A diabetic, obese female patient suffered from a postoperative wound infection after a knee arthroplasty. Initial treatment with antibiotics and hyperosmolar therapy failed and clinical evolution was no good. Surgery was scheduled, but it was delayed due to nonmedical reasons (lack of negative-pressure therapy to cover the wound since primary wound closure was anticipated to be very improbable to perform). While waiting for this therapy, off-label irrigations with topical sevoflurane were started after obtaining written consent, since this drug has exhibited antimicrobial properties. Clinical evolution turned out to be excellent since the very beginning, even though a MRSA resistant to the antibiotics empirically administered was isolated. Thus, surgery was discarded, and culture-guided antibiotic therapy was added to topical sevoflurane, which was followed by a complete healing of the wound after 6 weeks. Sevoflurane treatment was well tolerated as the patient reported no adverse effects. Therefore, treating postsurgical wounds with topical sevoflurane appears as a valuable new alternative, especially when infections are caused by microorganisms resistant to conventional antibiotics.

Spondylodiscitis with Extensive Spine Involvement ­ Case Report

Spondylodiscitis consists of an inflammatory process of infectious origin that affects primarily the intervertebral disc and spreads to the adjacent vertebral bodies, often evolving into osteomyelitis, with consequent associated neurological damage. The diagnosis is often delayed, with an average of 2 to 6 months between the appearance of the first symptoms and the confirmation of the disease. Therefore, the laboratorial and imaging exams play an important role in the diagnosis of spondylodiscitis, as well as in the orientation for the treatment to be followed (conservative or surgical). We report a case of extensive involvement of the spine and discuss about the epidemiology of the disease, its diagnosis, and therapeutic principles.

Estudio de las infecciones por Staphylococcus aureus en un hospital general de agudos (2002-2013) / Study of Staphylococcus aureus infections in a general acute care hospital (2002-2013)

Se realizó una revisión retrospectiva durante 12 años de las infecciones por Staphylococcus aureus en pacientes adultos (PA) y pediátricos (PP) asistidos en el Hospital Interzonal General de Agudos Evita de Lanús, para conocer la incidencia, los focos y el origen de la infección, y analizar el perfil de resistencia antimicrobiana. Se documentaron 2125 casos de infección en PA y 361 en PP. La incidencia de casos en PA descendió significativamente en el último trienio (χ²; p < 0,05); en los PP aumentó significativamente durante los últimos 5 años (χ²; p < 0,0001). En ambas poblaciones se detectó un aumento significativo en las infecciones de piel y estructuras asociadas (PEA), de bacteriemias a punto de partida de un foco en PEA y de infecciones por S. aureus de inicio en el hospital (χ²; p < 0,005). La meticilino-resistencia (SAMR) aumentó del 28 al 78% en PP; en PA se mantuvo alrededor del 50%, con reducción significativa de la resistencia acompañante a antimicrobianos no betalactámicos en los SAMR de ambas poblaciones. En S. aureus documentados de infecciones de inicio en la comunidad (SAMR-CO) del último trienio, el porcentaje de meticilino-resistencia resultó del 57% en PP y 37% en PA; en infecciones con inicio en el hospital fue del 43 y el 63%, respectivamente. Si bien demostramos que S. aureus continúa siendo un patógeno asociado al ámbito nosocomial, hubo un aumento de infecciones por SAMR-CO, con compromiso en PEA en ambas poblaciones.

A twelve-year retrospective review of Staphylococcus aureus infections in adult and pediatric patients (AP and PP respectively) assisted in the Hospital Interzonal General de Agudos Evita in Lanús was performed to determine the incidence, foci of infection, the source of infection and to analyze the profile of antimicrobial resistance. An amount of 2125 cases of infection in AP and 361 in PP were documented. The incidence in AP decreased significantly in the last three years (χi²; p < 0.05); in PP it increased significantly during the last five years (χ²; p < 0.0001). In both populations was detected a notable increase in skin infections and associated structures (PEA) in bacteremia to the starting point of a focus on PEA, and in total S. aureus infections of hospital-onset (χ²; p < 0.005). Methicillin-resistance (MRSA) increased from 28 to 78% in PP; in AP it remained around 50%, with significant reduction in accompanying antimicrobial resistance to non-β-lactams in both groups of MRSA. In S. aureus documented from community onset infections (CO-MRSA) in the last three years, the percentage of methicillin-resistance was 57% in PP and 37% in AP; in hospital-onset infections it was 43% and 63% respectively. Although data showed that S. aureus remains a pathogen associated with the hospital-onset, there was an increase of CO-MRSA infections with predominance in PEA in both populations.

Agentes etiológicos más frecuentes en infecciones periprotésicas de artroplastía primaria de rodilla y cadera en adultos mayores / Etiological agents more common in primary hip and knee joint replacement infections in older adults

Resumen: Antecedentes: Los agentes etiológicos más frecuentes en las infecciones periprotésicas son Escherichia coli y Staphylococcus aureus. La frecuencia de estas infecciones se presenta en el reemplazo articular de rodilla de 0.68 a 1.60% en comparación con el de cadera de 0.67 a 2.4%. Objetivo: identificar cuáles son los agentes etiológicos más frecuentes en infecciones periprotésicas en adultos mayores y en pacientes con cirugía primaria de cadera y rodilla. Material y métodos: Se realizó un estudio observacional, transversal y retrospectivo, tipo serie de casos en un período comprendido de Junio de 2011 a Diciembre de 2014, se incluyeron pacientes mayores de 60 años con diagnóstico de infección periprotésica mediante dos cultivos positivos con antibiograma. Resultados: Se evaluaron 62 pacientes, 59.7% presentaron infecciones de rodilla y 40.3% de cadera, 59% fueron infecciones por Escherichia coli y 22% por Staphylococcus aureus. El antibiótico que mejor sensibilidad reportó fue trimetoprim-sulfametoxazol (40.3% )y el de mayor resistencia fue penicilina G (32.2%). Conclusión: Los agentes etiológicos más frecuentes fueron Escherichia coli y Staphylococcus aureus.

Abstract: Background: The most common etiological agents in periprosthetic infections are Escherichia coli and Staphylococcus aureus. The frequency of these infections are found in knee replacement with 0.68 to 1.60% compared to the hip with 0.67 to 2.4%. Objective: To identify what are the most common etiologic agents in periprosthetic infections in elderly patients with primary hip and knee surgery. Material and methods: An observational study, transverse and retrospective case series was performed in a period from June 2011 to December 2014, patients over 60 years with a diagnosis of periprosthetic infection by two positive cultures with antibiograma. Results: 62 patients were evaluated 59.7% were infections of knee and hip 40.3%, 59% were infections by Escherichia coli and Staphylococcus aureus 22%. The best sensitivity reported antibiotic trimethoprim-sulfamethoxazole was 40.3%. The largest penicillin G resistance 32.2%. Conclusion: The most common causative agents were Escherichia coli and Staphylococcus aureus.

Prevalencia y frecuencia de factores asociados a infección en pacientes mayores de 18 años con fracturas cerradas / Prevalence and frequency of factors associated with infection in patients older than 18 years with closed fractures

Resumen: Introducción: La infección de sitio operatorio (ISO) es la infección nosocomial más común y es un proceso asociado a múltiples factores, los cuales en conjunto generan una alteración que afecta directamente el bienestar del paciente. Material y métodos: Estudio de corte transversal realizado en un período de un año, el tamaño de la muestra se estableció por el total de pacientes que cumplían los criterios de inclusión; se efectuó doble tabulación de los pacientes en el programa de Excel 2013 y se analizaron los datos en Stata versión 11. Resultados: La edad promedio fue de 44.3 ± 18.8 años y la relación hombre:mujer fue 1.7:1. De las características clínicas, los miembros inferiores fueron los más afectados y 21.9% de los casos afectó el fémur. Se halló una prevalencia de 6.6%, siendo la infección profunda la más frecuente; Staphylococcus aureus se cultivó en 38.5%, de los cuales 40% fue meticilino sensible. Conclusión: La prevalencia de ISO en pacientes con fracturas cerradas en el HUS fue de 6.6%, dato elevado comparado con la literatura. Los hallazgos de este estudio permitieron establecer que la hemoglobina por debajo de 10 g/dl, la realización de transfusión, la reintervención y el riesgo quirúrgico ASA se asociaron de manera estadística a la ISO.

Abstract: Introduction: Surgical site infection (ISO) is the most common nosocomial infection and is a process associated with multiple factors, which together generate a condition that directly affects the welfare of the patient. Material and methods: Cross-sectional study, conducted over 1 year period, the sample size was established for all patients who met the inclusion criteria. An instrument takes the variables; double tabulation of patients is performed in Excel 2013 and data are analyzed in Stata version 11. Results: The average age was 44.3 ± 18.8 years and the male: female ratio is 1.7:1. Clinical features, lower limbs are the most affected and 21.9 % of cases affect the femur. A prevalence of 6.6 % was found, being the most common deep infection classification. Staphylococcus aureus was cultured in 38.5% of which 40% were methicillin sensible. Conclusion: ISO prevalence in patients with closed fractures in HUS is 6.6% higher compared with literature data. The findings of this study it was established that hemoglobin below 10 g/dl, transfusion, reoperation and surgical risk ASA were associated statistically with ISO.

Tratamiento endovascular exitoso de aneurisma de aorta torácica secundario a infección de catéter de arteria umbilical en un recién nacido pretérmino / Successful endovascular treatment of thoracic aortic aneurysm secondary to infection of the umbilical artery catheter in preterm infants

Los aneurismas aórticos en la población pediátrica son poco frecuentes. El uso de catéteres de arteria umbilical en neonatos se ha asociado a infección y en algunas oportunidades a formación de aneurismas aórticos. La reparación quirúrgica de estos aneurismas es una forma de terapia; sin embargo, la intervención percutánea con stents pudiese proveer una vía alternativa de tratamiento con menores complicaciones. El objetivo de este reporte es dar a conocer el alcance terapéutico de un procedimiento híbrido, en el que el desarrollo de la técnica quirúrgica y percutánea en conjunto ofrece otra alternativa terapéutica menos invasiva que la cirugía vascular abierta, para la reparación de aneurismas aórticos o de sus ramas principales. Caso clínico: Recién nacido de pretérmino, 30 semanas, peso 1.335 g. Se instaló catéter en arteria umbilicar que se retiró a los 14 días por infección. Evolucionó con sepsis a Staphylococcus aureus. Ecocardiograma y angiotac confirman AAT, se manejó mediante procedimiento híbrido, cirugía e instalación endovascular de 2 stents recubiertos (Atrium V12 XR Medical Corp, Hudson, NH). Los controles clínicos post procedimiento como la ecotomografía abdominal confirmaron el éxito del tratamiento. Conclusión: El procedimiento endovascular de reparación de aneurisma de la aorta en recién nacidos prematuros puede ser considerado en el momento de decir la terapéutica de esta enfermedad y podría evitar los riesgos asociados a cirugía abierta. Sin embargo, obliga a un seguimiento y control durante el crecimiento del paciente por la eventual necesidad de redilatar los stents implantados. Se desconoce cómo será la evolución de los procedimientos endovasculares neonatales en el futuro.

Aortic aneurysms (AA) in the paediatric population are uncommon. The use of umbilical catheters in neonates has been associated with infections and, on some occasions, the formation of aortic aneurysms. The surgical repair of these aneurysms is one type of treatment; however, percutaneous intervention with stents could provide an alternative treatment route, with fewer complications. The aim of this report is to present the therapeutic scope of a hybrid procedure, in which the combined surgical and percutaneous technique offers a less invasive alternative to open surgery for the repair of aortic aneurysms or their main branches. Clinical case: The case concerns a pre-term newborn of 30 weeks weighing 1,335 g. An umbilical catheter was introduced, which was withdrawn at 14 days due to an infection. It developed as Staphylococcus aureus with sepsis. The echocardiogram and Angio-CT confirmed AA, which were managed using a hybrid procedure of surgery and the endovascular implantation of 2 coated stents (Atrium V12 XR Medical Corp, Hudson, NH). The post-procedure clinical follow-ups, including abdominal echo-tomography, confirmed the success of the treatment. Conclusion: The endovascular aortic aneurysm repair procedure in premature newborns may be considered when deciding treatment of this disease, and could avoid the risks associated with open surgery. However, follow-up and monitoring is required while the patient grows up, due to the possibility that the implanted stents require re-dilating. The outcomes of neonatal endovascular procedures in the future are unknown.

Histoplasmosis del sistema nervioso central en un paciente inmunocompetente / Histoplasmosis of the central nervous system in an immunocompetent patient

La histoplasmosis es una afección polifacética producida por el hongo dimorfo Histoplasma capsulatum , cuyas esporas son inhaladas y llegan al pulmón, órgano primario de infección. La forma meníngea, considerada como una de las manifestaciones más graves de esta micosis, suele presentarse en individuos con alteraciones en la inmunidad celular: pacientes con síndrome de inmunodeficiencia humana adquirida, con lupus eritematoso sistémico o con trasplante de órgano sólido, así como en lactantes, debido a su inmadurez inmunológica. La forma de presentación más usual es de resolución espontánea y se observa en individuos inmunocompetentes que se han expuesto a altas concentraciones de conidias y fragmentos miceliares del hongo. En estas personas, la afección se manifiesta por trastornos pulmonares y por la posterior diseminación a otros órganos y sistemas. Se presenta un caso de histoplasmosis del sistema nervioso central en un niño inmunocompetente.

Histoplasmosis is a multifaceted condition caused by the dimorphic fungi Histoplasma capsulatum whose infective spores are inhaled and reach the lungs, the primary organ of infection. The meningeal form, considered one of the most serious manifestations of this mycosis, is usually seen in individuals with impaired cellular immunity such as patients with acquired immunodeficiency syndrome, systemic lupus erythematous or solid organ transplantation, and infants given their immunological immaturity. The most common presentation is self-limited and occurs in immunocompetent individuals who have been exposed to high concentrations of conidia and mycelia fragments of the fungi. In those people, the condition is manifested by pulmonary disorders and late dissemination to other organs and systems. We report a case of central nervous system histoplasmosis in an immunocompetent child.

Aislamientos bacterianos de muestras respiratorias de pacientes pediátricos con fibrosis quística y su distribución por edades / [Bacterial isolates from respiratory samples of pediatric patients with cystic fibrosis and their distribution by ages].

The bacterial isolates from respiratory samples of 50 pediatric patients with cystic fibrosis, their distribution by ages and antimicrobial resistance pattern as well as the intermittence of isolations and coinfections, were investigated. Staphylococcus aureus was isolated in 72

of patients, followed by Pseudomonas aeruginosa (58

), and the Burkholderia cepacia complex (12

). The frequency of resistance of P. aeruginosa isolates to ß-lactam antibiotics was low (13.8

). Fifty percent of S. aureus isolates was methicillin-resistant, and 57.1

of H. influenza was ampicillin resistant due to ß-lactamase production. In children under 4 years-old, S. aureus was predominant, followed by P. aeruginosa and H. influenzae. This order of predominance was observed in all the groups studied, except in that of children between 10 and 14 years-old. Stenotrophomonas maltophilia and Achromobacter xylosoxidans isolates were intermittent and accompanied by other microorganisms. Finally, we observed a great variety of bacterial species, which imposes stringent performance requirements for microbiological studies in all respiratory samples of these patients.

Acute bilateral endophthalmitis following bilateral intravitreal bevacizumab [avastin] injection

The clinical presentation and management of two patients who presented with acute bilateral endophthalmitis following bilateral intravitreal bevacizumab injection. Both cases were diagnosed clinically and subsequent to a vitreous sample, intravitreal ceftazidime [2.25 mg/0.lml] and vancomycin [l mg/0.lml] were injected. One patient had a significant improvement in signs and symptoms after intravitreal antibiotics. However, there were was no improvement in the other patient and pars plana vitrectomy was performed bilaterally. Vitreous cultures were positive in both cases for Staphylococcus epidermidis

Discitis hematógena aguda en un adulto / Discite hématogène aiguë chez un adulte / Acute hematogenous discitis in an adult patient

Introducción: la discitis es una de las formas de presentación de los procesos infecciosos en el raquis. La de origen hematógeno es más frecuente en los niños y de modo raro aparece en el adulto asociada a una inmunodepresión, porque en esta edad ocurre generalmente como complicación de un proceder quirúrgico sobre el disco intervertebral. Objetivo: establecer las características clínicas e imaginológicas y el tratamiento de esta afección en el adulto. Descripción: se presentó un paciente masculino de 35 años de edad con antecedentes de salud anterior, que comenzó a presentar dolor en columna lumbar e impotencia funcional absoluta. Se realizaron estudios de laboratorio y de imágenes. Los parámetros hematológicos inclinaban al diagnóstico de un proceso infeccioso y la resonancia magnética nuclear evidenció una discitis. El tratamiento consistió en la administración de antibióticos e inmovilización. Conclusiones: el paciente presentó mejoría de los síntomas a las 72 h, con alivio total del dolor a las 2 semanas. Los resultados hematológicos mejoraron paulatinamente hasta alcanzar la normalidad a los 3 meses. Los estudios de imágenes fueron normales a los 6 meses y el paciente se incorporó a sus actividades habituales. la discitis hematógena en el adulto, aunque infrecuente, debe ser sospechada en todo paciente con síntomas dolorosos del raquis de posible origen infeccioso, que no responde a tratamiento médico y mucho más si concomita con algún grado de inmunodepresión(AU)

Introduction: Discitis is one of the forms of presentation of infectious processes of the spine. Discitis of hematogenous origin is more common in children. In adults it is a rare condition associated to immunosuppression, since it generally occurs as a complication of intervertebral disk surgery. Objective: Determine the clinical and imaging characteristics as well as the treatment of this condition in adults. Description: A male 35-year-old patient with a disease history presents with lumbar pain and total functional impotence. Laboratory and imaging studies were conducted. Hematological parameters pointed to an infectious process, and nuclear magnetic resonance imaging revealed a discitis. Treatment consisted of antibiotics and immobilization. Conclusions: The patient showed symptom improvement at 72 hours, with total pain relief at 2 weeks. There was gradual improvement in hematological results, which reached normal levels at 3 months. Imaging studies were normal at 6 months, and the patient resumed his daily routine. Adult hematogenous discitis, though infrequent, should be suspected in any patient with spinal pain symptoms of possible infectious origin not responding to clinical treatment, particularly when it is concomitant with some degree of immunosuppression(AU)

Introduction: la discite est l'une des formes de présentation caractérisant les processus infectieux au niveau du rachis. L'infection hématogène est la plus fréquente chez les enfants, mais rare chez les adultes si associée à une immunodépression, car à l'âge adulte, elle survient généralement comme une complication d'un geste chirurgical sur un disque intervertébral. Objectif: établir les caractéristiques cliniques et par image, et le traitement de cette affection chez l'adulte. Description: un patient du sexe masculin, âgé de 35 ans, avec une histoire médicale connue, ayant une douleur lombaire et un dysfonctionnement absolu, s'est présenté en consultation. Des examens de laboratoire et d'imagerie ont été réalisés. Les résultats hématologiques ont évoqué une infection, et la résonance magnétique nucléaire a mis en évidence une discite. Le traitement a consisté à l'administration des antibiotiques et à l'immobilisation. Conclusion: les symptômes du patient ont résolu à 72 h, la douleur s'est atténuée à 2 semaines. Les résultats hématologiques ont amélioré peu à peu lors de 3 semaines. Les examens d'imagerie sont revenus à la normale à 6 mois, et le patient s'est réincorporé à sa vie quotidienne. La discite hématogène chez l'adulte, quoique rare, doit être soupçonnée chez tout patient ayant une douleur de possible origine infectieuse au niveau du rachis et ne répondant pas au traitement médical, nettement plus si une certaine immunodépression est concomitante(AU)

Epidemiological and microbiological profile of infective keratitis in Ahmedabad.

Context: Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims: To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design: A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods: Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results: Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion: Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.

Post-influenza Pneumonia Caused by the USA300 Community-Associated Methicillin-Resistant Staphylococcus aureus in Korea

Panton-Valentine leukocidin (PVL)-positive USA300 clone has been the most successful community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clone spreading in North America. In contrast, PVL-negative ST72-CA-MRSA has been predominant in Korea, and there has been no report of infections by the USA300 strain except only one case report of perianal infection. Here, we describe the first case of pneumonia caused by the USA300 strain following pandemic influenza A (H1N1) in Korea. A 50-year-old man was admitted with fever and cough and chest radiograph showed pneumonic consolidation at the right lower lung zone. He received a ventilator support because of respiratory failure. PCR for pandemic influenza A (H1N1) in nasopharyngeal swab was positive, and culture of sputum and endotracheal aspirate grew MRSA. Typing of the isolate revealed that it was PVL-positive, ST 8-MRSA-SCCmec type IV. The analysis of the PFGE patterns showed that this isolate was the same pulsotype as the USA300 strain.

Contaminação bacteriana em concentrados plaquetários: identificação, perfil de sensibilidade aos antimicrobianos e sepse associada à transfusão / Bacterial contamination on platelet concentrates: identification, antimicrobial susceptibility profile and transfusion-related sepsis

INTRODUÇÃO: Devido à sepse bacteriana associada à transfusão de concentrados plaquetários (CPs) ter sérias consequências clínicas para os pacientes, alguns procedimentos têm sido incorporados na preparação e no controle de qualidade dos componentes sanguíneos para reduzir o risco da contaminação bacteriana. Este artigo descreve a prevalência da contaminação bacteriana dos CPs que foram transfundidos, o espectro bacteriano detectado com seu perfil de sensibilidade aos antimicrobianos e as reações transfusionais nos receptores. MÉTODOS: Um total de 292 CPs (278 randômicos e 14 por aférese), proveniente do Hemocentro do Estado do Rio Grande do Sul (HEMORGS) de Santa Maria foi testado. As quantidades de 100μL e 200μL foram coletadas da porção tubular da bolsa de plaquetas e semeadas utilizando dois tipos de metodologias. RESULTADOS: Em cinco unidades(1,7 por cento; 5/292) foram isoladas bactérias pela metodologia qualitativa e apenas uma pela quantitativa. Staphylococcus epidermidis foi o microrganismo identificado em todas as amostras. Dois pacientes apresentaram sepse associada à transfusão com desfecho fatal. CONCLUSÕES: A contaminação bacteriana pelas transfusões de CPs constitui-se num importante problema de saúde pública devido a sua associação com altas taxas de morbidade e mortalidade. Neste estudo, somente microrganismos gram-positivos foram isolados sendo que nenhuma amostra obtida por aférese apresentou contaminação.

INTRODUCTION: Bacterial sepsis associated with the transfusion of platelet concentrates (PCs) results in serious clinical implications for patients. Given these implications, certain procedures have been integrated into the preparation and quality control of blood components to reduce the risk of bacterial contamination. This article describes the prevalence of bacterial contamination on transfused PCs, the bacterial spectrum detected and their antimicrobial susceptibility profile and transfusion reactions in receptors. METHODS: A total of 292 PCs (278 random and 14 per apheresis) from the Blood Center of the State of Rio Grande do Sul (HEMORGS), located in the city of Santa Maria, were tested. Quantities of 100μL and 200μL were collected from platelet bag tubing and seeded using two methodologies. RESULTS: Using the qualitative methodology, bacteria were isolated in five units (1.7 percent; 5/292), while only one was isolated using the quantitative methodology. Staphylococcus epidermidis was the microorganism identified in all samples. Two patients died of transfusion-related sepsis. CONCLUSIONS: Bacterial contamination due to PC transfusion is considered a major public health problem due to its association with high rates of morbidity and mortality. In this study only gram-positive microorganisms were isolated and none of the samples obtained by apheresis presented contamination.

Coagulase-Positive Staphylococcal Necrotizing Fasciitis Subsequent to Shoulder Sprain in a Healthy Woman

Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.

[Infective endocarditis on probe of pacemaker]

Infective endocarditis is an uncommon but potentially lethal complication of permanent cardiac pacing. Infection is mainly caused by local contamination during the implantation procedure. The most frequently detected causative microorganisms were staphylococci. The clinical presentation is often atypical causing prolonged diagnostic delay. Bacteriological data and visualisation of neostructures consistent with vegetations on transoesophageal echocardiography, strongly suggest pacemaker lead infection. Management is based on a combined approach using both prolonged antibiotic treatment and early complete device explantation. Percutaneous techniques are currently the method of choice for lead extraction but it is not without possible complications. Antibiotic prophylaxis in order to reduce infection risk related to pacemaker implantation is widely recommended

Vascular access-related infections in HIV patients undergoing hemodialysis: case description and literature review

Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU) may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.

[Colonization rate of intravascular catheters and catheter related bacteremia in neonatal intensive care unit of Qods hospital, Qazvin [2005]

Peripheral intravenous catheters are increasingly used in neonatal intensive care unit [NICU] to administer intravenous fluids, blood products, drugs and nutrition. Catheter infection is associated with increased morbidity, mortality, and duration of hospital stay. To determine colonization rate of intravascular [IV] catheters and catheter related bactermia in NICU of Qods hospital. This was a descriptive study carried out on 100 infants who catheters were removed for any reason. A length of 3 cm from the catheter tip was cut aseptically and placed in thioglycolate media. In case of any growth within the next 7 days, subcultures on blood agar and MC agar media were performed followed by bacterial identification. Drug susceptibility profiles of isolated bacteria were detected according to standard methods. Before catheter removal, blood sample from each infant, was taken for culture, microbiological identification and susceptibility assay. Of 100 catheter tips, 35 [35%] samples produced positive cultures among those 19 cases [52%] identified as coagulase negative staphylococci [CNS]. Positive blood cultures were found in samples of 7 patients [7%], all from catheters colonized with bacteria, and identified as CNS [4 samples] and coagulase positive staphylococcus [3 samples]. Among the CNS isolated from catheters, the highest resistance [100%] was related to ampicillin and Oxicillin and the lowest [18%] resistance associated with vancomycin. Application of intravascular catheters in neonates should be accompanied with great attention in making a balance between the need for vascular access and the risk of bacteremia and thus, adequate control and rigorous preventive measures must be established when a vascular access is a necessity

Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

Although central vascular catheters (CVC) are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI) caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU) from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU)/20 cm² (p=0.03; odds ratio (OR) =6.89) and catheter tip (p=0.01; OR=7.95). The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

Microorganismos patógenos aislados en muestras respiratorias de niños con fibrosis quística / Isolated pathogen microorganisms in respiratory samples from children with cystic fibrosis

La fibrosis quística (FQ) se caracteriza por disfunciones en las glándulas de secreción exocrina del organismo. Las primeras manifestaciones suelen observarse en el sistema respiratorio, constituyendo una de las causas más importantes de morbimortalidad en los pacientes afectados. Los microorganismos patógenos que colonizan frecuentemente el tracto respiratorio de estos pacientes son Staphylococcus aureus, Haemophilus spp., y Pseudomonas aeruginosa. Entre noviembre de 2001 y agosto de 2004 se estudiaron 222 muestras respiratorias de pacientes con FQ de entre 4 meses y 11 años de edad. Se aislaron S. aureus (38,7%), P. aeruginosa (37,4%) y Haemophilus spp., (15,3%). En S. aureus la meticilina-resistencia fue del 25,9% y se asoció con altas resistencias a eritromicina (35,0%) y clindamicina (29,4%). El mayor porcentaje de resistencia observado en las cepas de P. aeruginosa fue frente a gentamicina (31,0%). Los aislamientos de Haemophilus spp. fueron resistentes a ampicilina (23,0%) debido a la presencia de beta-lactamasas, y a trimetoprima/sulfametoxazol (59,0%).

Cystic Fibrosis (CF) is characterized by a dysfunction of the exocrine secretion glands. The first symptoms often appear in the respiratory system which constitutes one of the most important morbimortality causes in these patients. Chronic respiratory tract colonization is caused mainly by bacteria such as Staphylococcus aureus, Haemophilus spp. and Pseudomonas aeruginosa. Respiratory samples from patients with CF (age group: 4 months to 11 years) were analyzed from November 2001 to August 2004. The most frequently isolated microorganisms were S. aureus (38.7%), P. aeruginosa (37.4%) and Haemophilus spp (15.3%). A high resistance to erithromycine (35.0%) and clindamicine (29.4%) was observed in S. aureus strains and 25.9% of them were methicillin-resistant. P. aeruginosa strains were mainly gentamicin-resistant (31.0%). The rate of ampicillin-resistant Haemophilus spp. was 23.0% and it was due to the presence of beta-lactamases, but a high trimethoprim-sulfamethoxazole resistance was observed in this microorganism (59.0%).