Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996), and fungi (p = 0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.

Uso da EDTACaNa2 por via intramuscular no tratamento por intoxicação por chumbo: a propósoto de um caso clinico / Use EDTACaNa2 intramusculary in the treatment of lead poisoning: a report of a clinical case

This essay aims at evaluating the amount of lead excreted in urine right after taking the chelating calcium disodium salt of ethylenediaminetetracetic acid (EDTACaNa2) IM. EDTACaNa2 was absorbed by an worker chronically intoxicated by lead. The dose was 300mg daily for three days, IM. During the in- patient treatment there lead was dosed in blood (Pb-S), in urine (Pb-U) and urinary d -aminolevulinic (ALA-U). No side effects of the drug were observed. The therapy diminished 26 per cent Pb-S concentration. The serial evaluation of Pb-U excretion showed a meaningful increase after the first dose; its peak occurred 9 hours after it was taken and this increase persisted in the following days, while the drug was maintained, but in a lower proportion. The ALA-U value did not alter during the treatment. In this case the use of the chelating EDTACaNa2, IM, was effective and safe to treat lead poisoning. To control the effectiveness of the chelating course of treatment and the eventual necessity of another cycle of chelating therapy, the Pb-U dosing must be carried out in the urine collected up to 12 hours after the drug is taken via IM.

O objetivo deste estudo é avaliar a concentração de chumbo excretado na urina nas horas subseqüentes à administração do quelante etilenodiaminotetracetato cálcico dissódico (EDTACaNa2) por via intramuscular (IM). Foi administrado EDTACaNa2 em um trabalhador com intoxicação crônica por chumbo. A dose aplicada foi de 300mg/dia, por 3 dias consecutivos, via IM. Durante o tratamento, realizado em regime hospitalar, foram dosados chumbo no sangue (Pb-S), chumbo na urina (Pb-U) e ácido delta aminolevulínico na urina (ALA-U). Não foram observados efeitos adversos da droga. A terapia diminuiu em 26 por cento a concentração de Pb-S. A avaliação seriada da excreção de Pb-U mostrou um aumento significativo após a primeira dose da medicação, tendo seu pico após 9 horas da sua administração; este aumento persistiu nos dias subsequentes,enquanto se mantinha a medicação, mas em menor proporção. O valor de ALA-U não teve alterações durante o tratamento. O uso do quelante EDTACaNa2 via IM, mostrou-se eficaze seguro para o tratamento de saturnismo neste caso. Para controle da efetividade da sua administração e da eventual necessidade de outro ciclo de terapia quelante, a dosagem de Pb-U deverá ser realizada na urina coletada até no mínimo 12 horas após a administração da droga via IM.

Antibiotic resistance patterns of pediatric community-acquired urinary infections

Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77 percent. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55 percent and 51 percent). The antibiotic resistance rates for E. coli were: nitrofurantoin (6 percent), nalidixic acid (14 percent), 1st generation cephalosporin (13 percent), 3rd generation cephalosporins (5 percent), aminoglycosides (2 percent), norfloxacin (9 percent) and ciprofloxacin (4 percent). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population.

Açäo da colchicina na fibrose hepática: estudo experimental em camundongos esquistossomóticos / Action of colchicine in hepatic fibrosis: an experimental study in schistosomic mice

Os autores estudam a açäo da colchicina sobre a fibrogênese hepática em camundongos esquistossomóticos e verificam, através da microscopia óptica e de polarizaçäo, evidente reduçäo da mesma nos camundongos tratados com esse alcalóide

Schwannoma gástrico gigante: apresentaçäo de um caso / Giont gastric chwannoma: a case report

Os AA apresentam um caso raro de schwannoma gástrico gigante, fazendo uma revisäo da literatura e tecendo comentários sobre a conduta cirúrgica e os aspectos anatomopatológicos

Avaliaçäo da imunidade celular e aspectos anatomopatológicos em portadores de esquistossomose mansônica / Evaluation of cellular immunity and anatomo-pathological aspects in schistosomiasis mansoni patients

Estudaram-se 98 pacientes portadores de esquistossomose mansônica quanto a aspectos imunológicos e anatomopatológicos. De 67 pacientes com a forma hepatointestinal, 46% apresentaram biópsias hepáticas normais, 25% com aspectos sugestivos de esquistossomose e 33% com achados inespecíficos. Em 31 pacientes com a forma hepatosplênica encontraram-se granulomas esquistossomóticos em 32%. A hepatite crônica ativa foi somente encontrada nesse grupo, em 6% dos doentes. Na forma HE foi maior a incidência de respostas negativas aos antígenos cutâneos de hipersensibilidade tardia (intradérmicos e sensibilizados de contato). Contudo, a avaliaçäo por estímulo de linfócitos in vitro com PHA näo mostrou diferença entre os dois grupos de pacientes

Distribuiçäo do colágeno I e III nas pancreatites crônicas alcoólicas e näo alcoólicas pelo método picro sirius polarizaçäo / Distribution of collagen I and III in alcoholic and non-alcoholic chronic pancreatitis by the picro sirius polarizations method

Estuda-se a distribuiçäo dos colágenos I e III nas pancreatites crônicas alcoólicas e näo alcoólicas utilizando o método picro sirius polarizaçäo, notando-se em ambas o predomínio das fibras tipo I sobre as do tipo III com aspectos característicos (densas e fragmentadas) e invadindo a regiäo intralobular. Um elemento característico das pancreatites crônicas alcoólicas é o aumento relativo das fibras do tipo III intralobular

Leiomioma gástrico gigante / Giant gastric leiomyoma

Descreve-se um caso de leiomioma gástrica de grandes dimensöes (14 x 16cm) cuja sintomatologia era dor epigástrica e no hipocôndrio direito. A massa tumoral deslocava a vesícula biliar, fato evidenciado pelo colecistograma e era extrínseca ao estômago, como evidenciou a ultra-sonografia. É destacada a raridade de um leiomioma gástrico dessas dimensöes e descrita tanto a conduta como os aspectos anatomopatológicos