Staphylococcus aureus in tonsils of patients with recurrent tonsillitis: prevalence, susceptibility profile, and genotypic characterization

ABSTRACT Introduction: Bacterial tonsillitis is an upper respiratory tract infection that occurs primarily in children and adolescents. Staphylococcus aureus is one of the most frequent pathogens in the etiology of tonsillitis and its relevance is due to its antimicrobial resistance and persistence in the internal tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures of antibiotic therapy. Material and methods: In this study we evaluated 123 surgically removed tonsils from patients who had history of recurrent tonsillitis. The tonsils were submitted to microbiological analysis for detection of S. aureus. The isolates were identified by PCR for femA gene. Antimicrobial susceptibility of the isolates was determined by disk diffusion tests. All isolates were submitted to PCR to detect mecA and Panton-Valentine leucocidin (PVL) genes. The genetic similarity among all isolates was determined by pulsed field gel electrophoresis. Results: Sixty-one S. aureus isolates were obtained from 50 patients (40.7%) with mean age of 11.7 years. The isolates showed high level resistance to penicillin (83.6%), 9.8% had inducible MLSb phenotype, and 18.0% were considered multidrug resistant (MDR). mecA gene was detected in two isolates and the gene coding for PVL was identified in one isolate. The genetic similarity analysis showed high diversity among the isolates. More than one genetically different isolate was identified from the same patient, and identical isolates were obtained from different patients. Conclusions: MDR isolates colonizing tonsils even without infection, demonstrate persistence of the bacterium and possibility of antimicrobial resistance dissemination and recurrence of infection. A specific clone in patients colonized by S. aureus was not demonstrated.

Hygienic, sanitary, physical, and functional conditions of Brazilian public school food services / Condições físico-funcionais e higiênico-sanitárias das unidades de alimentação e nutrição de escolas da Região Centro-Oeste, Brasil

OBJECTIVE: To verify the physical, functional, hygienic, and sanitary conditions of the food services of municipal schools located in the Brazilian Midwest region. METHODS: This is a cross-sectional study of 296 school food services conducted from February to June 2012. The food services were assessed by a semi-structured check list divided into the following sections: physical conditions, available equipment, food handlers' conduct, and food service cleaning processes and procedures. The study variables were classified as compliant or noncompliant with the regulations passed by the National Sanitary Surveillance Agency. RESULTS: Noncompliances were found in all study food services, especially with respect to food service conditions, and the wiring and plumbing in the food preparation area. In this section, 62.7 to 95.9% of the food services did not comply with nine out of the thirteen study items. The main problems were: poorly cleaned external areas, deteriorated walls, floors, ceilings, roofs, drains, and roof gutters; and unscreened doors and windows, allowing the entrance of insects; among others. The main noncompliance regarding processes and procedures was the uncontrolled temperature of the ready-to-eat foods. CONCLUSION: The conditions of the study food services are unsatisfactory for the production of safe meals, possibly compromising meal quality, food safety, and the effectiveness of the School Food Program. .

OBJETIVO: Verificar as condições físico-funcionais e higiênico-sanitárias das Unidades de Alimentação de Nutrição de escolas públicas municipais localizadas na Região Centro-Oeste do País. MÉTODOS: Estudo transversal, realizado entre fevereiro e junho de 2012, em 296 unidades de alimentação e nutrição escolares. Aplicou-se nestas unidades checklist semi-estruturado, dividido em blocos referentes às condições estruturais, disponibilidade de equipamentos, atuação dos manipuladores de alimentos, processos e procedimentos e higienização ambiental. Considerando as determinações da Agência Nacional de Vigilância Sanitária para Unidades de Alimentação e Nutrição, classificou-se as variáveis analisadas em conforme ou não conforme. RESULTADOS: Em todas as unidades de alimentação e nutrição que participaram do estudo identificou-se inadequações, com destaque para às condições dos edifícios e instalações da área de preparo dos alimentos. Neste bloco, 62,7 a 95,9% das unidades apresentaram não conformidade para nove dos treze itens avaliados, os principais problemas foram: higienização precária da área externa; paredes, pisos, forros, tetos, ralos e canaletas inadequados; portas e janelas sem telas de proteção contra a entrada de insetos, dentre outros. Quanto aos processos e procedimentos, a principal inadequação foi a falta de controle de temperatura dos alimentos prontos para o consumo. CONCLUSÃO: As unidades de alimentação e nutrição pesquisadas apresentam-se em condições insatisfatórias para a produção de uma alimentação escolar segura do ponto de vista higiênico-sanitário, o que ...

Methicillin-resistant Staphylococcus aureus nasal carriage in neonates and children attending a pediatric outpatient clinics in Brazil

Background: In Latin America, few studies have been carried out on methicillin-resistant Staphylococcus aureus carriage in the pediatric population. We conducted a survey of nasal S. aureus carriage in neonates and in children attending the pediatric outpatient clinics in a large Brazilian city with high antimicrobial consumption. Methods: Pernasal swabs of neonates were collected upon admission and at discharge in four neonatal intensive care units and of children less than five years of age during outpatient visits. Methicillin-resistant S. aureus isolates were characterized for antibiotic susceptibility, mec gene presence, pulsed-field gel electrophoresis, spa type, SCCmec-type, multilocus sequence type, and presence of Panton-Valentine leukocidin genes. Results: S. aureus was carried by 9.1% and 20.1% of the 701 neonates and of 2034 children attending the outpatient clinics, respectively; methicillin-resistant S. aureus carriage was detected in 0.6% and 0.2%, of the these populations, respectively. Healthcare-associated methicillin-resistant S. aureus strains found in neonates from neonatal intensive care units and outpatients were genetically related to the Brazilian (SCCmec-III, ST239) and to the Pediatric (SCCmec-IV, ST5) clones. Community-associated methicillin-resistant S. aureus was only detected in outpatients. None of the methicillin-resistant S. aureus strains contained the Panton-Valentine leukocidin gene. Methicillin-resistant S. aureus strains related to the Brazilian clone showed multidrug resistance pattern. Conclusions: Despite the high antibiotic pressure in our area, and the cross transmission of the healthcare-associated methicillin-resistant S. aureus clones between neonatal intensive care units and outpatients, the prevalence of methicillin-resistant S. aureus carriage is still low in our setting. .