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Pesqui. vet. bras ; 40(2): 129-133, Feb. 2020. tab
Article in English | LILACS, VETINDEX | ID: biblio-1098445


Enterococcus are recognized worldwide as significant nosocomial agents that have been continuously envolving to adapt to different niches and acquire resistance to several antibiotic classes. Vancomycin and gentamicin-resistant strains of E. faecalis and E. faecium have been associated with nosocomial human infections. Some epidemiological studies suggest the participation of pets as reservoirs of vancomycin and gentamicin-resistant Enterococcus strains. However, the role of companion birds as reservoirs of these strains has been poorly studied. In this study, 126 psittacine birds were evaluated and 26.9% carried Enterococcus spp., including the species E. faecalis, E. faecium, E. hirae, E. phoeniculicola, E. gallinarum and E. casseliflavus. The antibiotic resistance profile showed four high-level gentamicin-resistance (HLGR) strains. In addition, two strains presented intermediate levels of vancomycin resistance. Resistant strains were isolated from fecal and oropharynx samples of sick and clinically healthy birds, suggesting that psittacine birds may act as reservoirs of HLGR Enterococcus spp. However, sick birds appear to be more implicated in the enterococci transmission than healthy birds.(AU)

Enterococcus são reconhecidos mundialmente como significantes agentes nosocomiais, que têm continuamente se adaptado a diferentes nichos e adquirido resistência a várias classes de antibióticos. Cepas de E. faecalis e E. faecium vancomicina e gantamicina-resistentes têm sido associadas a infecções nosocomiais em humanos. Alguns estudos epidemiológicos sugerem a participação de aves como reservatórios de cepas de Enterococcus vancomicina e gentamicina-resistentes. Entretanto, a relação das aves de companhia como reservatórios destas cepas tem sido pouco estudada. Neste estudo, 126 psitacídeos foram avaliados, e 26,9% destes eram portadores de Enterococcus spp., incluindo as espécies E. faecalis, E. faecium, E. hirae, E. phoeniculicola, E. gallinarum e E. casseliflavus. O perfil de resistência antibiótica mostrou quatro cepas com alto nível de resistência a gentamicina (ANRG). Além de duas cepas com nível intermediário de resistência a vancomicina. As cepas resistentes foram isoladas de amostras fecais e de orofaringe de aves doentes e clinicamente saudáveis, sugerindo que psitacídeos podem estar atuando como reservatórios para Enterococcus spp. com ANRG. Contudo, Aves doentes parecem estar mais relacionadas à transmissão de enterococcus, do que aves saudáveis.(AU)

Animals , Parrots/microbiology , Disease Reservoirs/veterinary , Gentamicins , Vancomycin Resistance , Drug Resistance, Bacterial , Pets/microbiology , Enterococcus/isolation & purification
Rev. Soc. Bras. Med. Trop ; 51(3): 304-309, Apr.-June 2018. tab
Article in English | LILACS | ID: biblio-957419


Abstract INTRODUCTION: The increasing reports of vancomycin-resistant Staphylococcus strains (VRS) haves caused concern worldwide, from the laboratory detection to patient management. This study aimed to identify the occurrence of VRS strains among healthcare professionals from a university hospital. METHODS: A total of 102 Staphylococcus sp. isolates from healthcare professionals, obtained in a previous study were evaluated according to standard techniques for VRS detection. RESULTS: After screening inoculation of plates containing 6µg/ml of vancomycin, 19 resistant isolates were identified. The susceptibility profile to other antimicrobials revealed 18 multidrug resistant isolates. The minimum inhibitory concentration (MIC) was determined by E-test and broth microdilution. According to E-tests, of 19 isolates grown in BHI-V6, four isolates presented MIC ≥ 128 µg/ml, seven with MIC ranging from 4 to 8 µg/ml, and eight with MIC ≤ 2µg/ml. By broth microdilution, 14 isolates presented MIC ≤ 2 µg/ml and five with MIC ≥ 16µg/ml. The presence of the gene vanA was determined by PCR in the five resistant isolates, and this gene was detected in one of the strains. Furthermore, among the 19 strains, the gene mecA was found in 13 (39,4%) isolates, including the strain carrying the gene vanA. CONCLUSIONS: Based on these results, we highlight the presence of one strain carrying both vanA and the mecA genes, as well as multidrug-resistant strains colonizing healthcare professionals, and their importance as potential vectors to spread strains carrying resistance genes in the hospital environment.

Humans , Staphylococcus epidermidis/genetics , Bacterial Proteins/genetics , Nasopharynx/microbiology , Methicillin Resistance/genetics , Health Personnel , Carbon-Oxygen Ligases/genetics , Vancomycin Resistance , Anti-Bacterial Agents/pharmacology , Staphylococcus epidermidis/isolation & purification , Staphylococcus epidermidis/drug effects , Microbial Sensitivity Tests , Polymerase Chain Reaction
Article in English | WPRIM | ID: wpr-714434


BACKGROUND: Enterococcus faecium, especially vancomycin-resistant E. faecium (VREfm), is a major concern for patients with hematologic diseases. Exposure to antibiotics including fluoroquinolone, which is used as a routine prophylaxis for patients with hematologic (MH) diseases, has been reported to be a risk factor for infection with vancomycin-resistant eneterocci. We compared the characteristics of E. faecium isolates according to their vancomycin susceptibility and patient group (MH vs non-MH patients). METHODS: A total of 120 E. faecium bacteremic isolates (84 from MH and 36 from non-MH patients) were collected consecutively, and their characteristics (susceptibility, multilocus sequence type [MLST], Tn1546 type, and the presence of virulence genes and plasmids) were determined. RESULTS: Among the vancomycin-susceptible E. faecium (VSEfm) isolates, resistance to ampicillin (97.6% vs 61.1%) and high-level gentamicin (71.4% vs 38.9%) was significantly higher in isolates from MH patients than in those from non-MH patients. Notably, hyl, esp, and pEF1071 were present only in isolates with ampicillin resistance. Among the VREfm isolates, ST230 (33.3%) and ST17 (26.2%) were predominant in MH patients, while ST17 (61.1%) was predominant in non-MH patients. Plasmid pLG1 was more prevalent in E. faecium isolates from MH patients than in those from non-MH patients, regardless of vancomycin resistance. Transposon analysis revealed five types across all VREfm isolates. CONCLUSIONS: The antimicrobial resistance profiles and molecular characteristics of E. faecium isolates differed according to the underlying diseases of patients within the same hospital. We hypothesize that the prophylactic use of fluoroquinolone might have an effect on these differences.

Ampicillin , Ampicillin Resistance , Anti-Bacterial Agents , Enterococcus faecium , Enterococcus , Gentamicins , Hematologic Diseases , Humans , Multilocus Sequence Typing , Plasmids , Risk Factors , Vancomycin , Vancomycin Resistance , Virulence
Article in English | WPRIM | ID: wpr-718073


BACKGROUND: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. METHODS: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. RESULTS: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378–46.651), hospital days (4–7 days; aOR: 7.246; 95% CI: 3.229–16.261), duration of antimicrobial exposure (1–3 days; aOR: 1.976; 95% CI: 1.137–3.436), and age (aOR: 1.025; 95% CI: 1.007–1.043). CONCLUSION: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.

Bacterial Infections , Colon , Cross-Sectional Studies , Delivery of Health Care , Emergencies , Emergency Service, Hospital , Enterococcus , Humans , Infection Control , Korea , Logistic Models , Long-Term Care , Mass Screening , Vancomycin Resistance , Vancomycin-Resistant Enterococci
Kosin Medical Journal ; : 422-430, 2018.
Article in English | WPRIM | ID: wpr-739007


Leuconostoc species are Gram-positive coccobacilli and are used in dairy products and are intrinsically resistant to vancomycin. Leuconostoc infections are rare in humans, usually occurring in immune-compromised patients. We describe 6 patients with Leuconostoc bacteremia at Dong-A university hospital between 1990 and 2015. One isolate (L. lactis) was identified to species level using 16S rRNA gene sequencing analysis. All patients had underlying diseases and 5 patients underwent procedures that interrupted the normal integumentary defense. Four patients died within 30 days after being identified as carrying Leuconostoc species.

Bacteremia , Dairy Products , Genes, rRNA , Humans , Leuconostoc , Vancomycin , Vancomycin Resistance
Braz. j. microbiol ; 48(3): 489-492, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-889140


Abstract The aim of this study was to determine the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and efficacy of screening stools submitted for C. difficile toxin assay for prevalence of VRE. Between April 2012 and February 2014, 158 stool samples submitted for C. difficile toxin to the Marmara University Microbiology Laboratory, were included in the study. Stool samples were analyzed by enzyme immuno assay test; VIDAS (bioMerieux, France) for Toxin A&B. Samples were inoculated on chromID VRE (bioMerieux, France) and incubated 24 h at 37 °C. Manuel tests and API20 STREP (bioMerieux, France) test were used to identify the Enterococci species. After the species identification, vancomycin and teicoplanin MIC's were performed by E test and molecular resistance genes for vanA vs vanB were detected by polymerase chain reaction (PCR). Of the 158 stool samples, 88 were toxin positive. The prevalence of VRE was 17%(n:19) in toxin positives however, 11.4% in toxin negatives(n:70). All VRE isolates were identified as Enterococcus faecium. These results were evaluated according to Fischer's exact chi-square test and p value between VRE colonization and C. difficile toxin positivity was detected 0.047 (p < 0.05). PPV and NPV were 79% and 47% respectively. In our study, the presence of VRE in C. difficile toxin positives is statistically significant compared with toxin negatives (p < 0.05). Screening for VRE is both additional cost and work load for the laboratories. Therefore VRE screening among C. difficile toxin positive samples, will be cost effective for determination of high risk patients in the hospitals especially for developing countries.

Humans , Bacterial Toxins/analysis , Clostridioides difficile/metabolism , Clostridium Infections/microbiology , Vancomycin Resistance , Feces/microbiology , Vancomycin-Resistant Enterococci/isolation & purification , Bacterial Toxins/metabolism , Vancomycin/pharmacology , Microbial Sensitivity Tests , Clostridioides difficile/isolation & purification , Clostridioides difficile/drug effects , Clostridioides difficile/genetics , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Clostridium Infections/diagnosis , Vancomycin-Resistant Enterococci/classification , Vancomycin-Resistant Enterococci/drug effects , Vancomycin-Resistant Enterococci/genetics , Anti-Bacterial Agents/pharmacology
Article in English | WPRIM | ID: wpr-81403


BACKGROUND: Over the past two decades, enterococci have emerged as an important agent responsible for hospital acquired infection. Several virulence factors contribute to the adherence, colonization, evasion of the host immune response, and pathogenicity and severity of the infection. Enterococcus faecalis is the most common and virulent species causing infections in hospitalized patients. The aim of the present study was to examine the prevalence of genes encoding virulence factors and antimicrobial resistance patterns of E. faecalis strains isolated from hospitalized patients in Shiraz, south west of Iran. MATERIALS AND METHODS: A total of 51 E. faecalis isolates from the urine, blood, pleural fluid, peritoneal fluid, eye discharge, endotracheal tube (ETT) and transjugular intrahepatic portosystemic shunt (TIPS) specimens of patients were identified by phenotypic and genotypic methods. Antimicrobial sensitivity tests and detection of virulence factors were performed using standard methods. RESULTS: The efa and asa1 were the most frequently detected gene (100%) among the isolates, followed by esp (94.1%), ace (90.2%), gelE (80.4%), cylA (64.7%), and hyl (51%). More than half of the isolates (52.9%) were high level gentamicin resistant (HLGR). Vancomycin resistance was observed among 23 (45.1%) isolates. The lowest antimicrobial activity was related to erythromycin (3.9%), tetracycline (5.9%) and ciprofloxacin (9.8%). No isolate was found resistant to fosfomycin and linezolid. CONCLUSION: Our data indicated a high incidence of virulence factors among E. faecalis strains isolated from clinical samples. Colonization of drug resistant virulent isolates in hospital environment may lead to life threatening infection in hospitalized patients. Therefore, infection control procedures should be performed.

Ascitic Fluid , Ciprofloxacin , Colon , Enterococcus faecalis , Enterococcus , Erythromycin , Fosfomycin , Gentamicins , Humans , Incidence , Infection Control , Iran , Linezolid , Portasystemic Shunt, Surgical , Prevalence , Tetracycline , Vancomycin Resistance , Virulence Factors , Virulence
Med. infant ; 23(4): 303-307, diciembre 2016. tab
Article in Spanish | LILACS | ID: biblio-885129


La vancomicina (VAN) es un glucopéptido que inhibe la síntesis de la pared celular y con el tiempo se había transformado en la droga de elección para el tratamiento de infecciones graves por gram positivos. La resistencia observada en enterococos y la sensibilidad disminuida registrada en estafilococos hasta cierto punto han limitado su uso. La aparición de estreptococos del grupo viridans y del grupo B con marcadores de resistencia a vancomicina enciende un alerta en función de su posible pasaje a neumococos y Streptococcus pyogenes (AU)

Vancomycin (VAN) is a glycopeptide inhibiting cell-wall synthesis and has become the drug of choice for the treatment of severe gram-positive infections. Resistance observed in enterococci and decreased sensitivity in staphylococci have to a certain point limited its use. The appearance of the viridans group and group B streptococci showing markers for resistance to vancomycin have caused an alert regarding the possible passage to pneumococci and Streptococcus pyogenes (AU)

Humans , Gram-Positive Bacterial Infections/drug therapy , Streptococcus/drug effects , Vancomycin Resistance , Vancomycin-Resistant Enterococci , Vancomycin/therapeutic use , Methicillin-Resistant Staphylococcus aureus
Rev. chil. infectol ; 33(4): 395-402, ago. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-830110


Background: Bloodstream infections (BSIs) due to Enterococcus faecium (E. faecium), particularly those due to vancomycin-resistant enterococcus (VRE), are still a therapeutic challenge. Aim: To evaluate mortality from BSI due to E. faecium and VRE in central Taiwan. Materials and Methods: We retrospectively analyzed cases of significant E. faecium BSI in the Changhua Christian Hospital System between January 1, 2010 and December 31, 2013. Results: Of the 76 cases, 28 patients (36.8%) were admitted to intensive care units (ICUs) at the onset of BSI, 10 (13.2%) cases were associated with polymicrobial bacteremia, and 29 (38.2%) cases were associated with entry via the biliary tract. VRE was observed in 18 (23.7%) cases. The 30-day mortality rate was 13.1% (10/76). Multivariate logistic regression analysis showed that bacteremia of non-biliary tract origin (OR = 8.43, 95% confidence interval (95% CI) = 1.32-54.00, p = 0.002) and ICU admission (OR = 4.2, 95% CI = 1.7-10.0, p = 0.002) were significant risk factors for 30-day mortality, whereas appropriate antimicrobial therapy was a protective factor for 30-day mortality (OR = 0.33, 95% CI = 0.14-0.79, p = 0.013). Conclusions: Our results underscore the need to assist patients admitted to ICUs with E. faecium BSIs with a non-biliary tract origin. We emphasize the use of appropriate antimicrobial therapy for E. faecium BSI with the aim to rescue more patients with these infections.

Antecedentes: Las infecciones del torrente sanguíneo por Enterococcus faecium, particularmente aquellas causadas por enterococos resistentes a vancomicina (ERV), representan aún un desafío para los tratamientos. Este estudio está orientado a la evaluación de la mortalidad debido a la infección del torrente sanguíneo (ITS) por E. faecium y por enterococos resistentes a vancomicina (ERV) en Taiwán central. Materiales y Métodos: Analizamos de forma retrospectiva casos de ITS causadas por E. faecium genuinas en el Sistema del Hospital Changhua Christian, entre los días 1 de enero de 2010 y 31 de diciembre de 2013. Resultados: De los 76 casos analizados, 28 pacientes fueron ingresados a las Unidades de Cuidados Intensivos (UCI) al comienzo de una ITS (36,8%), 10 casos fueron asociados a bacteriemia polimicrobiana (13,2%), y 29 casos tuvieron como puerta de entrada la vía biliar. En 18 casos se pudieron observar ERV (23,7%). La mortalidad a 30 días fue de 13,1% (10/76). El análisis multivariado mediante regresión logística mostró que la bacteriemia de origen no biliar (OR = 8,43, 95% intervalo de confianza (95% CI) = 1,32-54,00; p = 0,002), y el ingreso a la UCI (OR = 4,2; 95% CI = 1,7-10,0; p = 0,002), fueron factores de riesgo significativos para el rango de mortalidad de 30 días, así como un tratamiento de antimicrobiano apropiado constituye un factor protector en contra la mortalidad (OR = 0,33; 95% CI = 0,14-0,79; p = 0,013). Conclusiones: Nuestros resultados destacan la necesidad de asistir a los pacientes ingresados a la UCI con ITS por E. faecium con origen no biliar. Hacemos énfasis a la aplicación de una antibioterapia adecuada para sacar adelante a un mayor número de pacientes con este tipo de infecciones.

Humans , Male , Female , Middle Aged , Bacteremia/microbiology , Bacteremia/mortality , Vancomycin-Resistant Enterococci/isolation & purification , Taiwan/epidemiology , Microbial Sensitivity Tests , Incidence , Retrospective Studies , Risk Factors , Bacteremia/drug therapy , Vancomycin Resistance
Braz. j. microbiol ; 46(3): 777-783, July-Sept. 2015. tab, ilus
Article in English | LILACS | ID: lil-755813


Vancomycin resistant Enterococcus faecium (VREF) ia an emerging and challenging nosocomial pathogen. This study aimed to determine the prevalence, risk factors and clonal relationships between different VREF isolates in the intensive care units (ICUs) of the university hospitals in our geographic location. This prospective study was conducted from July, 2012 until September, 2013 on 781 patients who were admitted to the ICUs of the Mansoura University Hospitals (MUHs), and fulfilled the healthcare-associated infection (HAI) criteria. Susceptibility testing was determined using the disk diffusion method. The clonal relationships were evaluated with pulsed field gel electrophoresis (PFGE). Out of 52 E. faecium isolates, 12 (23.1%) were vancomycin resistant. The significant risk factors for the VREF infections were: transfer to the ICU from a ward, renal failure, an extended ICU stay and use of third-generation cephalosporins, gentamicin, or ciprofloxacin. PFGE with the 12 isolates showed 9 different patterns; 3 belonged to the same pulsotype and another 2 carried a second pulsotypes. The similar pulsotypes isolates were isolated from ICUs of one hospital (EICUs); however, all of the isolates from the other ICUs had different patterns. Infection control policy, in conjunction with antibiotic stewardship, is important to combat VREF transmission in these high-risk patients.


Humans , Anti-Bacterial Agents/therapeutic use , Cross Infection/epidemiology , Enterococcus faecium/drug effects , Gram-Positive Bacterial Infections/epidemiology , Vancomycin Resistance/physiology , Vancomycin-Resistant Enterococci/isolation & purification , Vancomycin/therapeutic use , Cephalosporins/therapeutic use , Ciprofloxacin/therapeutic use , Cross Infection/microbiology , DNA, Bacterial/genetics , Egypt/epidemiology , Enterococcus faecium/isolation & purification , Gentamicins/therapeutic use , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiology , Intensive Care Units , Infection Control/methods , Microbial Sensitivity Tests , Prospective Studies , Renal Insufficiency , Risk Factors , Vancomycin-Resistant Enterococci/drug effects
Rev. chil. infectol ; 32(4): 393-398, ago. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-762636


Background: The isolation of vancomycin-resistant Enterococcus spp (ERV) has increased significantly within the last few years, along with the risk of infection and dissemination of these bacteria. Our aim was to determine risk factors (RF) for intestinal colonization in hospitalized pediatric patients with oncological disease at Hospital de Niños Roberto del Río. Methods: Between January 2012 and December 2013 a transversal study was performed with 107 rectal swabs and processed with a PCR for ERV. The patients were classified as "colonized with ERV" and "not colonized with ERV" and we evaluated possible RF for intestinal colonization in both groups. Results: VRE colonization was found in 51 patients (52%). The median of time elapsed between oncological diagnosis and VRE colonization was 35 days. The significant RF associated with VRE colonization were days of hospitalization prior to study, neutropenia and treatment with antibiotics within 30 days prior to study and mucositis. Conclusions: According to the RF revealed in this study we may suggest prevention standards to avoid ERV colonization. This is the first investigation in our country in hospitalized pediatric patients with oncological disease and processed with a multiplex PCR for ERV, therefore it is a great contribution about this subject in Chile.

Introducción: El aislamiento de Enterococcus spp resistentes a vancomicina (ERV) ha presentado un incremento significativo en los últimos años, aumentando el riesgo de infección por esta bacteria y favoreciendo su diseminación. Nuestro objetivo es determinar los factores de riesgo (FR) de colonización intestinal de ERV en pacientes oncológicos internados en el Hospital de Niños Roberto del Río. Método: Entre enero de 2012 y diciembre de 2013 se realizó un estudio transversal de colonización rectal por ERV mediante muestras de hisopado rectal obtenidas en 107 pacientes efectuando RPC múltiple para ERV. Se dividió en grupo "portador" y "no portador" y se evaluó los posibles FR para colonización por ERV. Resultados: Se encontró colonización por ERV en 51 pacientes (52%). El tiempo transcurrido desde el diagnóstico oncológico y la colonización presentó una mediana de 35 días. Los FR encontrados con asociación significativa fueron el número de días de hospitalización previa, neutropenia, uso de antimicrobianos 30 días previos y mucositis. Conclusión: De acuerdo a los FR encontrados podemos sugerir medidas de prevención para colonización por ERV. Esta es la primera investigación realizada en nuestro país en pacientes oncológicos pediátricos y que utiliza la técnica de RPC múltiple para ERV, lo que permite un aporte significativo sobre este tema en Chile.

Child , Child, Preschool , Female , Humans , Male , Hospitalization , Intestines/microbiology , Leukemia, Myeloid, Acute/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Rectum/microbiology , Vancomycin-Resistant Enterococci/isolation & purification , Case-Control Studies , Cross-Sectional Studies , Cross Infection/microbiology , Length of Stay , Leukemia, Myeloid, Acute/complications , Multiplex Polymerase Chain Reaction , Mucositis/complications , Mucositis/microbiology , Neutropenia/complications , Neutropenia/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Risk Factors , Vancomycin Resistance , Vancomycin-Resistant Enterococci/classification
Ciênc. saúde coletiva ; 20(7): 2211-2220, 07/2015.
Article in Portuguese | LILACS | ID: lil-749930


Resumo Este artigo pretende compreender a visão das pacientes com câncer sobre o processo de adoecimento e os procedimentos terapêuticos que experimentam. Os tratamentos de câncer provocam uma série de consequências físicas e emocionais nas pacientes, assim, estas passam por uma reestruturação e elaboram mecanismos para “cuidarem de si”. A metodologia utilizada foi a etnográfica, desencadeada por meio de entrevistas, anotações em diário de campo e observação participante. A etnografia revelou como essas mulheres, submetidas ao tratamento convencional em determinado hospital, criam tecnologias de cuidado compartilhadas baseadas na sociabilidade.

Abstract This article seeks to understand the viewpoint of cancer patients about the disease process and the therapeutic procedures that they experience. Cancer treatments provoke a series of physical and emotional consequences in patients. Thus, patients undergo a restructuring of life and establish mechanisms to “take care of themselves.” The methodology used was an ethnographic approach through interviews, field notes and participant observation. The ethnographic approach revealed how these women being given conventional treatment in a given hospital create shared care technologies based on sociability.

Humans , Infant, Newborn , Cross Infection/epidemiology , Disease Outbreaks , Enterococcus faecium/drug effects , Gram-Positive Bacterial Infections/epidemiology , Intensive Care Units, Neonatal , Vancomycin Resistance , Bacterial Typing Techniques , Cross Infection/microbiology , Cross Infection/prevention & control , Enterococcus faecium/isolation & purification , Gram-Positive Bacterial Infections/prevention & control , Infection Control/methods
Arq. bras. oftalmol ; 78(2): 123-125, Mar-Apr/2015. graf
Article in English | LILACS | ID: lil-744297


In 2010, there were estimated to be approximately 60.5 million people with glaucoma. This number is expected to increase to 79.6 million by 2020. In 2010, there were 8.4 million people with bilateral blindness caused by glaucoma, and this number is expected in increase to 11.2 million by 2020. Filtering implants are special devices that have been developed to reduce intraocular pressure in patients with refractory glaucoma. The success rate of these implants is relatively low, and they continue to fail over time. To avoid failure caused by the formation of scar tissue around the implants, attempts have been made to drain the aqueous humor to various sites, including the venous system, lacrimal sac, sinuses, and conjunctival fornix. Recently, a system to shunt aqueous humor from the anterior chamber to the peritoneum has been developed. The surgical technique involved in this system is a modification of the technique currently used by neurosurgeons for the treatment of hydrocephalus. We present the first case operated using this technique.

Calcula-se que em 2010 havia provavelmente 60,5 milhões de pessoas com glaucoma, com aumento previsto para 79,6 milhões em 2020; a cegueira bilateral por glaucoma era detectada em 8,4 milhões de pessoas, em 2010, e com aumento estimado para 11,2 milhões em 2020. Dispositivos especiais foram desenvolvidos para reduzir a pressão intraocular em pacientes com glaucoma refratário, chamados implantes de filtragem. A taxa de sucesso destes implantes é relativamente baixa, e sabe-se que elas continuam a diminuir ao longo do tempo. Para evitar as falhas produzidas pela cicatrização de tecido em torno dos implantes, foram feitas tentativas de drenagem do humor aquoso para diferentes locais, tais como o sistema venoso, saco lacrimal, os seios paranasais e fórnice conjuntival. Revendo o tratamento atual da hidrocefalia, uma técnica de derivação a partir da câmara anterior para o peritônio foi desenvolvida. A técnica cirúrgica desenvolvida é uma modificação da técnica atualmente utilizada por neurocirurgiões para o tratamento de hidrocefalia. Apresentamos o primeiro caso operado com esta técnica.

Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Vancomycin Resistance , Vancomycin/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Case-Control Studies , Logistic Models , Microbial Sensitivity Tests , Multivariate Analysis , Methicillin-Resistant Staphylococcus aureus/drug effects , Risk Factors , Staphylococcal Infections/drug therapy , Vancomycin/therapeutic use
Arq. bras. oftalmol ; 78(2): 76-81, Mar-Apr/2015. tab, graf
Article in English | LILACS | ID: lil-744299


Purpose: To compare visual outcomes, corneal astigmatism, and keratometric readings in patients with keratoconus who underwent intrastromal corneal ring implantation (ICRSI) alone with those who underwent ICRSI combined with ultraviolet A riboflavin-mediated corneal collagen crosslinking (CXL). Methods: Pre- and post-operative best-corrected distance visual acuity (BCDVA), spherical error, cylindrical error, and mean keratometry were retrospectively compared over a period of 2 years in patients with keratoconus who underwent only ICRSI (group 1) versus those in patients who underwent combined ICRSI-CXL (group 2). Results: Thirty-two eyes of 31 patients were evaluated. CXL was performed in 10 cases (31%), and there were no complications or need for ring repositioning. BCDVA improved from 0.54 to 0.18 in the group 1 and from 0.56 to 0.17 in the group 2. Spherical and cylindrical errors and mean keratometry values significantly decreased in both groups. No patient postoperatively had visual acuity (VA) of less than 20/60 on refraction, and 78% exhibited VA better than or equal to 20/40 with spectacles (72% of group 1 and 90% of group 2). Improvement in the spherical equivalent (SE) value was observed in the group 1 (from -5.89 ± 3.37 preoperatively to -2.65 ± 2.65 postoperatively; p<0.05) and group 2 (from -6.91 ± 1.93 preoperatively to -2.11 ± 3.01 postoperatively; p<0.05). Conclusion: Both techniques can be considered safe and effective in improving VA and refractive SE values, in decreasing the curvature of the cone apex in the topographical analysis, and in decreasing corrected diopters postoperatively in patients with keratoconus. .

Objetivo: Comparar os resultados visuais, astigmatismo corneano e ceratometria em pacientes com ceratocone submetidos a implante de anel corneano intraestromal (ICRSI) e quando em combinação com radiação ultravioleta associado ao crosslinking do colágeno corneano mediada pela riboflavina (CXL). Métodos: Comparou-se retrospectivamente pacientes com ceratocone submetidos somente a implante de anel corneano intraestromal (grupo 1) versus o mesmo procedimento associado ao crosslinking em um período de 2 anos. Avaliou-se acuidade visual com correção, equivalente esférico, ápice do cone na topografia e adaptação com lentes de contato pré e pós operatórios. Resultados: O estudo avaliou 32 olhos de 31 pacientes. Em 10 casos (31%) foi realizado crosslinking corneano, não havendo complicações ou necessidade de reposicionamento do anel. Acuidade visual corrigida pré e pós-operatória, componentes esférico e cilíndrico da refração e valores de ceratometria media diminuíram significativamente em ambos os grupos. Após o implante, nenhum paciente apresentou acuidade visual pior que 20/60 e 78% apresentaram acuidade corrigida melhor ou igual a 20/40 (72% do grupo 1 e 90% do grupo 2). Observou-se diminuição no valor do equivalente esférico no grupo 1 (de -5,89 ± 3,37 pré-operatório para -2,65 ± 2,65 pós-operatório; p<0,05) e no grupo 2 (de -6,91 ± 1,93 pré-operatório para -2,11 ± 3,01 pós-operatório; p<0,05). Conclusão: Ambas as técnicas podem ser consideradas seguras e eficazes na melhora da acuidade visual e equivalente esférico, diminuição do ápice de curvatura do cone na análise topográfica e na redução de dioptrias a serem corrigidas no pós-operatório de pacientes com ceratocone. .

Humans , Alcohols/pharmacology , Anti-Infective Agents, Local/pharmacology , Enterococcus/drug effects , Hand Disinfection , Colony Count, Microbial , Hand/microbiology , Infection Control , Vancomycin Resistance
Article in English | WPRIM | ID: wpr-34572


BACKGROUND: Recently, the iNtRON VRE vanA/vanB real-time PCR (iNtRON; iNtRON Biotechnology, Korea) assay, a multiplex real-time PCR method, was introduced. In this prospective study, we compared the iNtRON assay with the Seeplex VRE ACE detection kit (Seeplex; Seegene, Korea), a conventional multiplex PCR assay. METHODS: A chromogenic agar-based culture, in which pre-selected vancomycin-resistant enterococci (VRE) was grown and subsequently plated on blood agar with vancomycin disks, was regarded as the reference method. A total of 304 consecutive rectal swab specimens were tested for VRE by culture and by iNtRON and Seeplex PCR assays. For the PCR assays, specimens were enriched for 16-24 hr before PCR. RESULTS: VRE were isolated from 44 (14.5%) specimens by chromogenic agar-based culture. The clinical sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the iNtRON assay were 100% (95% confidence interval: 89.8%-100%), 99.2% (96.9%-99.9%), 95.6% (83.6%-99.2%), and 100% (98.2%-100%), respectively, while those of the Seeplex assay were 97.7% (86.2%-99.9%), 99.6% (97.5%-99.9%), 97.7% (86.2%-99.9%), and 99.6% (97.5%-99.9%), respectively. The iNtRON assay had a detection limit of 3,159 copies/microL and 13,702 copies/microL for the vanA and vanB genes, respectively. No cross-reactivity was observed in 11 non-VRE bacterial culture isolates. CONCLUSIONS: The overall performance of the iNtRON assay was comparable to that of a chromogenic agar-based culture method for prompt identification of VRE-colonized patients in hospitals. This assay could be an alternative or supportive method for the effective control of nosocomial VRE infection.

Bacterial Proteins/genetics , Bacterial Typing Techniques/methods , Carbon-Oxygen Ligases/genetics , DNA, Bacterial/metabolism , Gram-Positive Bacterial Infections/microbiology , Humans , Reagent Kits, Diagnostic , Real-Time Polymerase Chain Reaction , Vancomycin Resistance/genetics , Vancomycin-Resistant Enterococci/genetics
Article in English | WPRIM | ID: wpr-76674


BACKGROUND/AIMS: Liver transplant patients are at high risk for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) colonization. We evaluated patients before and after liver transplant using active surveillance culture (ASC) to assess the prevalence of MRSA and VRE and to determine the effect of bacterial colonization on patient outcome. METHODS: We performed ASC on 162 liver transplant recipients at the time of transplantation and 7 days posttransplantation to monitor the prevalence of MRSA and VRE. RESULTS: A total of 142 patients had both nasal and rectal ASCs. Of these patients, MRSA was isolated from 12 (7.4%) at the time of transplantation (group 1a), 9 (6.9%) acquired MRSA posttransplantation (group 2a), and 121 did not test positive for MRSA at either time (group 3a). Among the three groups, group 1a patients had the highest frequency of developing a MRSA infection (p < 0.01); however, group 2a patients had the highest mortality rate associated with MRSA infection (p = 0.05). Of the 142 patients, VRE colonization was detected in 37 patients (22.8%) at the time of transplantation (group 1b), 21 patients (20%) acquired VRE posttransplantation (group 2b), and 84 patients did not test positive for VRE at either time (group 3b). Among these three groups, group 2b patients had the highest frequency of VRE infections (p < 0.01) and mortality (p = 0.04). CONCLUSIONS: Patients that acquired VRE or MRSA posttransplantation had higher mortality rates than did those who were colonized pre-transplantation or those who never acquired the pathogens. Our findings highlight the importance of preventing the acquisition of MRSA and VRE posttransplantation to reduce infections and mortality among liver transplant recipients.

Adult , Enterococcus/isolation & purification , Female , Gram-Positive Bacterial Infections/diagnosis , Humans , Liver Transplantation/adverse effects , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Middle Aged , Prevalence , Prospective Studies , Republic of Korea/epidemiology , Risk Factors , Staphylococcal Infections/diagnosis , Time Factors , Treatment Outcome , Vancomycin Resistance