Nutrição parenteral: panorama das amostras analisadas no Instituto Nacional de Controle de Qualidade em Saúde / Parenteral nutrition: overview of the samples analyzed at the National Institute for Quality Control in Health / Nutrición parenteral: panorama de las muestras analizadas en el Instituto Nacional de Control de Calidad en Salud

Justificativa e objetivos: A Nutrição Parenteral Total (NPT) possui grande importância clínica no tratamento e prevenção da desnutrição de pacientes com problemas no sistema digestório. Apesar das boas práticas de manipulação de NPT estarem bem estabelecidas, a contaminação desses produtos ainda ocorre, e esses produto permanecem como um medicamento de alto risco pelo Institute for Safe Medication Practices. O presente estudo teve como objetivo obter um panorama sobre os dados documentais das amostras de nutrição parenteral encaminhadas ao Instituto Nacional de Controle de Qualidade em Saúde da Fundação Oswaldo Cruz. Métodos: Foi realizado um estudo qualitativo descritivo e quantitativo, com base em um coorte transversal de amostras de NPT analisadas no período de 2000 a 2016. Resultados: Foram encaminhadas 134 amostras de NPT no período do estudo. 11,20% das amostras foram encaminhadas em 2001, 0,80%, em 2005, 8,20%, em 2006, 16,40% em 2007, 63,40% em 2013. Seis amostras (4,5%) foram canceladas e 113 submetidas ao ensaio de esterilidade, resultando em 13,3% de amostras insatisfatórias. Conclusão: No período do estudo, quatro eventos suspeitos de contaminação bacteriana por enterobactérias em NPTs administradas em pacientes foram relatados, sendo três deles ainda não descritos na literatura. Para que a segurança dos pacientes que fazem uso de NPT seja garantida, sugere-se que as normas que regulamentam a terapia com NPT sejam revisadas e atualizadas e sejam estabelecidos programas de monitoramento da qualidade dessas preparações.(AU)

Background and objectives: Total parenteral nutrition (TPN) has great clinical importance in malnutrition treatment and prevention in patients with digestive problems. Although good practices for handling TPN are well established, contamination of these products still occurs, and this product remains listed as a higher risk drug by the Institute for Safe Medication Practices. The present study aimed to obtain an overview of the documentary data of the parenteral nutrition samples sent to the National Institute for Quality Control in Health (INCQS) of Fundação Oswaldo Cruz. Methods: This is a qualitative descriptive and quantitative study carried out based on a cross-section of TPN samples analyzed from 2000 to 2016. Results: A total of TPN 134 samples were sent during the study period. 11.20% of the samples were sent in 2001, 0.80% in 2005, 8.20% in 2006, 16.40% in 2007, 63.40% in 2013. Six samples (4.5%) were canceled and 113 submitted to sterility testing, resulting in 13.3% unsatisfactory samples. Conclusion: During the study period, four suspected events of enterobacterial contamination in TPNs administered to patients were reported, three of which have not yet been described in the scientific literature. For the safety of patients using TPN to be guaranteed, it is suggested that the norms that regulate TPN therapy be reviewed and updated, and programs to monitor the quality of these preparations should be established.(AU)

Justificatión y objetivos: La Nutrición Parenteral Total (NPT) tiene una gran importancia clínica en el tratamiento y la prevención de la desnutrición en pacientes con problemas en el sistema digestivo. Aunque las buenas prácticas para el manejo del TNP están bien establecidas, la contaminación de estos productos aún ocurre, y este producto sigue siendo catalogado como un medicamento de alto riesgo por el Institute for Safe Medication Practices. El presente estudio tuvo como objetivo obtener una visión general de los datos documentales de muestras de nutrición parenteral enviadas a Instituto Nacional de Control de Calidad en Salud (INCQS) por Fundação Oswaldo Cruz. Métodos: Se realizó un estudio descriptivo cualitativo y cuantitativo basado en una sección transversal de muestras de NPT analizadas entre 2000 y 2016. Resultados: Se enviaron un total de 134 muestras de NPT durante el período de estudio. 11,20% de las muestras enviadas en 2001, 0,80%, en 2005, 8,20%, en 2006, 16,40%, en 2007, 63,40%, en 2013. Seis muestras (4,5%) fueron cancelados y 113 sometidos a la prueba de esterilidad, resultando en 13,3% de muestras insatisfactorias. Conclusión: Durante el período de estudio, se informaron cuatro eventos sospechosos de contaminación por enterobaterias en NPT administrados a pacientes, tres de los cuales aún no se han descrito en la literatura. Para garantizar la seguridad de pacientes que usan NPT, se sugiere revisar y actualizar las normas que regulan la terapia de NPT y se deben establecer programas para controlar la calidad de estas preparaciones.(AU)

Genome sequence of a multidrug-resistant Corynebacterium striatum isolated from bloodstream infection from a nosocomial outbreak in Rio de Janeiro, Brazil

Multidrug-resistant (MDR) Corynebacterium striatum has been cited with increased frequency as pathogen of nosocomial infections. In this study, we report the draft genome of a C. striatum isolated from a patient with bloodstream infection in a hospital of Rio de Janeiro, Brazil. The isolate presented susceptibility only to tetracycline, vancomycin and linezolid. The detection of various antibiotic resistance genes is fully consistent with previously observed multidrug-resistant pattern in Corynebacterium spp. A large part of the pTP10 plasmid of MDR C. striatum M82B is present in the genome of our isolate. A SpaDEF cluster and seven arrays of CRISPR-Cas were found.

Sphygmomanometers and thermometers as potential fomites of Staphylococcus haemolyticus: biofilm formation in the presence of antibiotics

BACKGROUND The association between Staphylococcus haemolyticus and severe nosocomial infections is increasing. However, the extent to which fomites contribute to the dissemination of this pathogen through patients and hospital wards remains unknown. OBJECTIVES In the present study, sphygmomanometers and thermometers were evaluated as potential fomites of oxacillin-resistant S. haemolyticus (ORSH). The influence of oxacillin and vancomycin on biofilm formation by ORSH strains isolated from fomites was also investigated. METHODS The presence of ORSH on swabs taken from fomite surfaces in a Brazilian hospital was assessed using standard microbiological procedures. Antibiotic susceptibility profiles were determined by the disk diffusion method, and clonal distribution was assessed in pulsed-field gel electrophoresis (PFGE) assays. Minimum inhibitory concentrations (MICs) of oxacillin and vancomycin were evaluated via the broth microdilution method. Polymerase chain reaction (PCR) assays were performed to detect the mecA and icaAD genes. ORSH strains grown in media containing 1/4 MIC of vancomycin or oxacillin were investigated for slime production and biofilm formation on glass, polystyrene and polyurethane catheter surfaces. FINDINGS ORSH strains comprising five distinct PFGE types were isolated from sphygmomanometers (n = 5) and a thermometer (n = 1) used in intensive care units and surgical wards. ORSH strains isolated from fomites showed susceptibility to only linezolid and vancomycin and were characterised as multi-drug resistant (MDR). Slime production, biofilm formation and the survival of sessile bacteria differed and were independent of the presence of the icaAD and mecA genes, PFGE type and subtype. Vancomycin and oxacillin did not inhibit biofilm formation by vancomycin-susceptible ORSH strains on abiotic surfaces, including on the catheter surface. Enhanced biofilm formation was observed in some situations. Moreover, a sub-lethal dose of vancomycin induced biofilm formation by an ORSH strain on polystyrene. MAIN CONCLUSIONS Sphygmomanometers and thermometers are fomites for the transmission of ORSH. A sub-lethal dose of vancomycin may favor biofilm formation by ORSH on fomites and catheter surfaces.

Biofilm production by multiresistant Corynebacterium striatum associated with nosocomial outbreak

Corynebacterium striatum is a potentially pathogenic microorganism that causes nosocomial outbreaks. However, little is known about its virulence factors that may contribute to healthcare-associated infections (HAIs). We investigated the biofilm production on abiotic surfaces of multidrug-resistant (MDR) and multidrug-susceptible (MDS) strains of C. striatum of pulsed-field gel electrophoresis types I-MDR, II-MDR, III-MDS and IV-MDS isolated during a nosocomial outbreak in Rio de Janeiro, Brazil. The results showed that C. striatum was able to adhere to hydrophilic and hydrophobic abiotic surfaces. The C. striatum 1987/I-MDR strain, predominantly isolated from patients undergoing endotracheal intubation procedures, showed the greatest ability to adhere to all surfaces. C. striatum bound fibrinogen to its surface, which contributed to biofilm formation. Scanning electron microscopy showed the production of mature biofilms on polyurethane catheters by all pulsotypes. In conclusion, biofilm production may contribute to the establishment of HAIs caused by C. striatum.

Clonal multidrug-resistant Corynebacterium striatum within a nosocomial environment, Rio de Janeiro, Brazil

Corynebacterium striatum is a potentially pathogenic microorganism with the ability to produce outbreaks of nosocomial infections. Here, we document a nosocomial outbreak caused by multidrug-resistant (MDR) C. striatum in Rio de Janeiro, Brazil. C. striatum identification was confirmed by 16S rRNA and rpoB gene sequencing. Fifteen C. striatum strains were isolated from adults (half of whom were 50 years of age and older). C. striatum was mostly isolated in pure culture from tracheal aspirates of patients undergoing endotracheal intubation procedures. The analysis by pulsed-field gel electrophoresis (PFGE) indicated the presence of four PFGE profiles, including two related clones of MDR strains (PFGE I and II). The data demonstrated the predominance of PFGE type I, comprising 11 MDR isolates that were mostly isolated from intensive care units and surgical wards. A potential causal link between death and MDR C. striatum (PFGE types I and II) infection was observed in five cases.

Avaliação da contaminação microbiana em produtos desinfetantes de uso geral / Microbial contamination in household disinfectant products

Em vista de um estudo desenvolvido no Setor de Saneantes do Instituto Nacional de Controle deQualidade em Saúde da Fundação Oswaldo Cruz, referente à avaliação da atividade antimicrobiana dedesinfetantes, no presente trabalho foram analisados produtos desinfetantes de uso geral disponíveis nomercado brasileiro. Os desinfetantes foram coletados aleatoriamente, dos quais três (produtos A, B e C),apresentaram contaminação microbiana. Para efetuar o isolamento e a identificação dos microrganismoscontaminantes foram utilizados o aparelho Vitek® 2, a amplificação e o sequenciamento do gene rRNA16S. A análise realizada por meio de Vitek® 2 revelou a presença das bactérias Serratia marcescens eAchromobacter xylosoxidans, respectivamente, nos produtos A e B. No produto C foram detectadasAeromonas salmonicida pelo Vitek® 2 e Burkholderia lata pela técnica de amplificação da reação em cadeiada polimerase.