Occurrence, antifungal susceptibility, and virulence factors of opportunistic yeasts isolated from Brazilian beaches

BACKGROUND Opportunistic pathogenic yeast species are frequently associated with water habitats that have pollution sources of human or animal origin. Candida albicans has already been suggested as a faecal indicator microorganism for aquatic environments. OBJECTIVES The goal of this study was to investigate the occurrence of C. albicans and other opportunistic yeasts in sand and seawater samples from beaches in Brazil to assess their correlation with Escherichia coli, and to characterise the pathogenic potential of the yeast isolates. METHODS Opportunistic species (yeasts that grow at 37ºC) were isolated from sand and seawater samples from eight beaches in Brazil during the summer and the winter. Opportunistic yeast species were evaluated for their susceptibility to antifungal drugs, virulence factors, and the in vitro and in vivo biofilm formation. Strains were selected to carry out virulence tests using BALB/c mice. FINDINGS Several water samples could be classified as inappropriate for primary contact recreation in relation to E. coli densities. C. albicans was isolated in low densities. Of the 144 opportunistic yeasts evaluated, 61% displayed resistance or dose-dependent sensitivity to at least one tested drug, and 40% produced proteinase. Strains of C. albicans and Kodamaea ohmeri exhibited the highest rates of adhesion to buccal epithelial cells. All the C. albicans strains that were tested were able to undergo morphogenesis and form a biofilm on catheter fragments in both in vitro and in vivo experiments. It was possible to confirm the pathogenic potential of three of these strains during the disseminated infection test. MAIN CONCLUSIONS The identification of opportunistic yeast species in seawater and sand samples from Brazilian beaches suggest a potential risk to the health of people who use these environments for recreational purposes.

Mortalidad prenatal en el Centro Hospitalario Pereira Rossell, Montevideo. Análisis de 845 casos de autopsia entre 2005 y 2016 / Stillbirth at Pereira Rossell Hospital in Montevideo. Analysis of 845 autopsies between 2005 and 2016

Resumen: Antecedentes: con la mejora de la atención del embarazo se ha reducido el número de mortinatos en el mundo desarrollado. Pero en los países subdesarrollados y en vías de desarrollo constituyen un problema sanitario. Objetivo: conocer las patologías que subyacen en los casos de autopsia de mortinatos del Centro Hospitalario Pereira Rossell, a los efectos de contribuir a la reducción de la mortalidad fetal. Material y método: se realiza un estudio observacional, descriptivo de recolección de información en forma retrospectiva de las autopsias de los de mortinatos del Centro Hospitalario Pereira Rossell de los últimos 12 años (2005-2016). Las autopsias y las placentas fueron realizadas de acuerdo al protocolo habitual en patología perinatal. Los datos del estudio se analizaron conjuntamente. Resultados: se constataron malformaciones congénitas en 17,7% e infección congénita en la autopsia en 20,4%. La infección en conjunto (en autopsia y/o placenta) se identificó en 383 casos (45,3%). Se identificó lúes en 10,5% de los mortinatos. Había elementos fetales de asfixia en 11,5% y una miscelánea de patologías en 3,5% de los casos. En 50,4% la autopsia propiamente dicha no tenía alteraciones, pero en 90% de ellas se identificaron lesiones placentarias que pudieron ser responsables de la muerte fetal. Se observó bajo flujo sanguíneo útero placentario en 14,2% de las placentas, corioamnionitis en 30,5% de las placentas, y hematoma retroplacentario en 26,6% de las placentas. La muerte fue indeterminada en 4,9% de los casos. Conclusiones: un elevado porcentaje de los casos tienen patologías evitables y tratables. Se identificaron patologías potencialmente recurrentes y enfermedades que ameritan tratar a la madre. Los estudios de los mortinatos deben ser considerados en los protocolos sanitarios a los efectos de reducir la mortalidad fetal.

Summary: Background: the number of stillbirth cases has been reduced in the developed countries due to improvements in pregnancy care. It is important to know the causes in order to prevent fetal death. Early identification of risk factors for stillbirth may reduce the number of cases. The objective of this paper is to identify the underlying pathologies of the cases that underwent an autopsy at Pereira Rossell Hospital in Montevideo, in order to contribute to the reduction of fetal mortality. Methods: this is a retrospective and descriptive study of autopsy and placental examinations, performed at the Pediatric Pathology Laboratory of Pereira Rossell Hospital in Montevideo. A standard protocol was applied. Data were analyzed overall. Results: congenital malformations were identified in 17.7% of cases; congenital infection in the fetus was found in 20.4%. Infection altogether (in the autopsy and/or the placenta) was identified in 383 cases (45.3%). Syphilis was diagnosed in 10.5% of the stillborn. Fetal evidence of asphyxia accounted for 11.5% and miscellaneous pathologies 3.5%. In 50.4% of cases the autopsy did not reveal alterations, but 90% of corresponding placentas had lesions that could have caused the death of the fetus. Maternal underperfusion or malperfusion was found in 14.2% of the placentas. Chorioamnionitis was seen in 30.5%. A retroplacental hematoma was seen in 26.6%. Stillbirth was of unexplained in 4.9% of the cases. Conclusion: a high percent of the cases studied had a preventable pathology. Many recurrent lesions were identified as well as cases that required additional medication to the mother. The results of the pathology examination should be considered in order to reduce the stillbirth rate.

Prevalência de infecções hospitalares em unidade de terapia intensiva / Prevalence of nosocomial infection in intensive care unit

JUSTIFICATIVA E OBJETIVOS: A infecção hospitalar (IH) representa uma condição grave que influencia na morbimortalidade dos pacientes que permanecem internados. Em unidade de terapia intensiva (UTI), os pacientes encontram-se acamados por tempo prolongado, imunodeprimidos, com doenças graves que necessitam de monitoramento invasivo e uso de antibióticos de largo espectro, tornando-os mais suscetíveis às IH. O objetivo deste estudo foi avaliar a prevalência e o perfil microbiológico das IH na UTI, bem como a evolução dos pacientes notificados.MÉTODO: O estudo foi realizado no Hospital Pró-Clínicas no período de fevereiro a dezembro de 2008. Os casos de IH ocorridos foram notificados através da Ficha de Notificação de Infecção Hospitalar e os respectivos dados foram analisados no programa Doctor Clean versão 3.0.3.RESULTADOS: No período do estudo foram notificados 26 casos de IH. Sua prevalência foi no sexo masculino (57,69%), entre a 7ª e 8ª décadas, sendo o trato respiratório o local mais acometido (44,19%) e o micro-organismo mais isolado foi o Proteus mirabilis (22,22%).CONCLUSÃO: A partir dos resultados obtidos pode-se traçar um perfil microbiológico próprio da UTI, sendo possível programar uma terapêutica empírica mais eficaz e direcionada, reduzindo os custos hospitalares, o tempo de internação dos pacientes e o surgimento de micro-organismos multirresistentes.(AU)

BACKGROUND AND OBJECTIVES: The nosocomial infection (NI) is a serious condition that affects the mortality of patients who remain hospitalized. In an Intensive Care Unit (ICU) patients are bedridden for long periods, compromised, with serious illnesses that require invasive monitoring and use of broad spectrum antibiotics, making them more susceptible to NI's. The study aims to assess the prevalence and microbiological profile of NI's in the ICU and the evolution of the patients reported.METHOD: The study was performed at Hospital Pró-Clínicas from February to December of 2008. The cases of IH occurred were reported through the Notification Form Hospital Infection and the data were analyzed with the Doctor Clean program version 3.0.3.RESULTS: Throughout the study period were reported 26 cases of IH. Its prevalence was among males (57.69%), between the 7th and 8th decades, the respiratory tract was the most commonly affected (44.19%) and the most isolated microorganism was Proteus mirabilis (22.22%).CONCLUSION: From the results obtained one can draw a microbiological profile of the ICU itself, it is possible to implement an empirical therapy more accurately and efficiently, reducing hospital costs, length of hospital patients and the emergence of resistant microorganisms.(AU)