Prevalencia de uropatógenos y sensibilidad antimicrobiana en lactantes menores de 2 años provenientes de la comunidad con diagnóstico de infección de vías urinarias / Prevalence of uropathogens and antimicrobial susceptibility in infants younger than 2 years of age from the community with a diagnosis of urinary tract infection

RESUMEN Introducción: la infección urinaria (IU) es una patología frecuente en los niños. La prevalencia de los uropatógenos varía de acuerdo a las regiones geográficas e incluso entre los diferentes centros asistenciales. El conocimiento de dicha prevalencia y de la sensibilidad a los antimicrobianos ayuda a la elección de la antibioticoterapia empírica inicial, permitiendo de esa manera, el control del cuadro agudo y evitando la resistencia bacteriana. Objetivo determinar la sensibilidad de los uropatógenos a los antimicrobianos obtenidos de urocultivos de niños menores de 24 meses con diagnóstico de IU provenientes de la comunidad. Material y métodos: estudio observacional, descriptivo, retrospectivo, de corte transverso. Se analizaron los expedientes clínicos y resultados de urocultivos de lactantes menores de 24 meses internados en el Departamento de Pediatría del Hospital Nacional en el período comprendido entre enero de 2012 a diciembre de 2014 , con diagnóstico de IU. Resultados: los uropatógenos más frecuentemente obtenidos fueron: Escherichia coli (67,6%) seguido de Klebsiella pneumoniae (18,3%), Enterobacter cloacae (8,4%), Pseudomonas aeruginosa (2,8%) y otros en 2,9%. La sensibilidad de la E. coli a la ciprofloxacina, las cefalosporinas y aminoglucósidos fue alta. El 14,6% de Escherichia coli fue productora de betalactamasa de espectro extendido (BLEE). El 100% de las cepas de Klebsiella pneumoniae fuer sensible a amikacina, ciprofloxacina y acidonalidíxico. Conclusiones: el germen más frecuentemente encontrado fue E. coli, seguido de la Klebsiella pneumoniae. El tratamiento de elección recomendado es la combinación de cefalospinas de primera generación asociado a aminoglucósidos, ya que con este esquema se cubrirá más del 95% de los uropatógenos causantes de infección de vías urinarias de la comunidad. Los gérmenes productores de infección urinaria atípica, deberán ser investigados.

ABSTRACT Introduction Urinary tract infection (UTI) is a common pathology in children. The prevalence of uropathogens varies according to geographic regions and even between different care centers. Knowledge of this prevalence and antimicrobial susceptibility helps to choose the initial empirical antibiotic therapy, thus allowing the control of the acute condition and avoiding bacterial resistance. Objective to determine the sensitivity of uropathogens to antimicrobials obtained from urine cultures of children younger than 24 months with diagnosis of UTI from the community. Material and methods: observational, descriptive, retrospective, cross-sectional study. We analyzed the clinical records and results of urine cultures of infants under 24 months admitted to the Department of Pediatrics of the National Hospital in the period between January 2012 and December 2014, diagnosed as UI. Results: the most frequent uropathogen was Escherichia coli (67.6%) followed by Klebsiella pneumoniae (18.3%), Enterobacter cloacae (8.4%), Pseudomonas aeruginosa (2.8%) and others in 2, 9%. The sensitivity of E. coli to ciprofloxacin, cephalosporins and aminoglycosides was high. 14.6% of Escherichia coli was a producers of extended spectrum betalactamase (ESBL). 100% of Klebsiella pneumoniae strains was a sensitive to amikacin, ciprofloxacin and acidonaldehyde. Conclusions: the more frequent germ found was E. coli, followed by Klebsiella pneumoniae. The recommended treatment of choice is the combination of first-generation cephalosporins associated with aminoglycosides, as this scheme will cover more than 95% of the uropathogens that cause urinary tract infection in the community. Germs producing atypical urinary infection should be investigated.

Qualidade protéica de multimisturas distribuídas em Alfenas, Minas Gerais, Brasil / Protein quality from multimixture distributed in Alfenas, Minas Gerais, Brazil

OBJETIVOS: O propósito do estudo foi avaliar a qualidade protéica de quatro multimisturas distribuídas para combater a desnutrição em comunidades do Município de Alfenas-MG. MÉTODOS: Foram utilizados ratos da raça Wistar, machos, distribuídos ao acaso em 6 grupos (n=6) em gaiolas individuais de aço inox, com temperatura controlada (25°C, desvio padrão= 2°C), durante 14 dias. O grupo padrão recebeu dieta à base de caseína, o grupo controle dieta livre de nitrogênio e os outros quatro grupos experimentais receberam dietas à base de multimistura. Para avaliação da qualidade protéica foram utilizados os métodos biológicos Quociente de Eficiência Protéica, Razão Protéica Líquida, Utilização Protéica Líquida e Digestibilidade Verdadeira. RESULTADOS: O quociente de eficiência protéica, a razão protéica líquida e a digestibilidade dos grupos recebendo multimistura foram inferiores (p<0,05) ao da caseína. A utilização protéica líquida promovida pelas dietas à base de multimisturas foi inferior à dieta à base de caseína em todos os grupos experimentais, exceto no grupo cuja multimistura apresentava maior proporção de leite em pó e não era adicionada de pó de sementes, de folha de mandioca e de casca de ovo. A digestibilidade das multimisturas foi em torno de 89 por cento, entretanto a utilização protéica foi de, aproximadamente, 27 por cento. CONCLUSÃO: Conclui-se que as multimisturas apresentaram baixa retenção protéica, não sendo adequadas para o crescimento dos animais ou até mesmo para a manutenção do peso corporal em um dos grupos teste.

OBJECTIVE: The study was developed to evaluate the protein quality of four multimixtures distributed in communities in Alfenas, MG, Brazil, to combat malnutrition. METHODS: Male Wistar rats were randomaly assigned to one of six groups (n=6) and individually housed in stainless steel cages on controlled temperature (25°C, standard deviation 2°C) for 14 days. The standard group was fed a casein diet, control group was fed a free nitrogen diet and four-test groups were fed different multimixture diets. A biological assay was carried out to determine the protein quality by Protein Efficiency Ratio, Net Protein Ratio, Net Protein Utilization and True Protein Digestibility. RESULTS: The Multimixture test groups showed lower (p<0.05) Protein Efficiency Ratio, Net Protein Ratio and digestibility than casein group. The net retention protein from multimixture test groups was lower (p<0.05) than casein group, except the group fed with multimixture contained a higher powdered milk proportion and was not added with powdered seeds, leaf cassava and egg shell powders in their formula. The multimixture digestibility was roughty 89 percent however the protein retention was approximately 27 percent. CONCLUSION: In conclusion, the multimixture showed low protein retention, did not promote adequate animal growth and was not capable of maintaining body weight in one multimixture test-group.