High frequency of colonization and absence of identifiable risk factors for methicillin-resistant Staphylococcus aures (MRSA) in Intensive Care Units in Brazil

Colonization of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA) is of increasing concern. To evaluate this problem in Intensive Care Units (ICUs) in Brazil, we studied 100 patients admitted to two ICUs from april to june, 1997. Of the 100 patients, 70 were male, 53 were age 60 years or older, 55 were previously hospitalized, 78 were transferred to the ICU from other hospital units, 49 had received antibiotic therapy, and 66 had undergone recent surgery. Nasal and axillary swab cultures were obtained on admission and every 48 hours thereafter until discharge. MRSA were identified by plating any cultured S. aureus on Mueller-Hinton agar containing 6µg/ml of oxacillin. At the time of admission, 46 (46 percent) of the patients were colonized with MRSA. No associated risk factors for acquiring MRSA (age, previous hospitalization, prior surgery) could be identified. Of the 54 patients negative for MRSA on admission, 28 (52 percent) became colonized while in the ICU. Sixteen (22 percent) of the 74 colonized patients (colonized either on admission or during ICU stay) had associated respiratory or urinary tract infections due to MRSA, and 9 (56 percent) died. No correlation with special risk factors (invasive procedures, antibiotic use, age, chronic disease) was identified. MRSA occurred frequently, but there was minimal evidence of associated risk factors. Thus, control of MRSA cannot be accomlished by targeting special factors alone, but requires attention to preventing microbial spread in all areas. Of special concern is the high frequency of acquiring the organism in the ICU (52 percent). Education concerning the importance of hand washing, environmental surface cleaning, and barrier protection from infected patients is needed.

Amigdalite crônica: estudo imunohistoquímico e histológico / Cronic tonsilitis: inmunohistochemical and histologic study

Um estudo histológico e imunohistoquímico, foi realizado em 35 amígadas, provenientes de cirurgias em crianças de ambos os sexos com idade de 2 a 12 anos. Em todos os 35 pacientes havia indicaçäo histológico deu-se importância a presença de folículos linfóides, centros germinativos, presença ou näo de fibrose, necrose e presença ou näo de neutrófilos nas criptas. Segundo estes padröes e de acordo com a classificaçäo proposta por Lopes e Mimica em 1982, foram encontradas 22 classificáveis no grupo I e 13 no tipo II. Do ponto de vista imunológico, fez-se a análise imunohistoquímica do tecido amigdaliano, obedecendo-se a uma avaliaçäo quantitativa em campos histológicos e quantificadas as imunoglobulinas segundo a sua positividade em 100 células por campo, de uma cruz (+) a quatro cruzes. Em todas amígdalas estudadas houve um predomínio no encontro de IgG sobre a IgA, confirmando achados anteriores de Fioretti (1974). Nossos achados sugerem a existência de um quadro histológico e imunohistoquímico característico, na amigdalite crônica infantil