Sepsis neonatal tardía nosocomial en una unidad de terapia intensiva: agentes etiológicos y localización más frecuente / Late onset neonatal sepsis in an intensive care neonatal unit: etiological agents and most frequent location

Resumen Introducción: La sepsis neonatal nosocomial (SNN) es una entidad frecuente en las unidades de cuidados intensivos, donde causa una gran morbimortalidad. La ubicación más frecuente es bacteriemia, seguido de neumonía asociada a ventilador mecánico y vía urinaria. Objetivo: Conocer la etiología y localización más frecuente de la infección en el SNN. Población, Material y Métodos: Estudio retrospectivo, de prevalencias de enero a diciembre de 2015, realizado en la Unidad de Cuidados Intensivos Neonatal de un hospital de alta complejidad. Fueron incluidos todos los neonatos. Resultados: Se incluyeron 70 pacientes, se analizaron 88 episodios de SNN. La localización más frecuente fue sangre 40% de los casos, seguido de orina y aspirado traqueal en 25% respectivamente. Los microorganismos más frecuentemente aislados fueron Staphylococcus de diferentes tipos, seguido de Acinetobacter baumannii multi-resistente. La afectación del SNC fue de 32%. La mortalidad fue de 34%, elevándose a 50% ante un segundo episodio de SNN. La terapia empírica de elección fue vancomicina y carbapenem, ajustándose a antibiograma. Conclusiones: La infección más frecuente fue la bacteremia, principalmente por Staphylococcus resistentes a meticilina. La afectación del SNC fue elevada, lo mismo que la mortalidad.

Introduction: Nosocomial neonatal sepsis (NNS) is a frequent entity in intensive care units, causing great morbidity and mortality. The most frequent site is blood, followed by lungs and urine. Objective: To know the etiology and most frequent localization of infection in the NNS. Population, Material and Methods: Cross sectional study, from January to December 2015, performed in a teaching hospital. All newborns infants were included. Results: 70 patients were included, 88 episodes of NNS were analyzed. The most frequent localization was bacteremia in 40% of cases, followed by urinary tract infection and VAP in 25% respectively. The bacteria most frequently isolated were staphylococci of different types, followed by multiresistant Acinetobacter. The CNS involvement was 32%. Mortality was 34%, rising up to 50% with a second episode of NNS. The empirical therapy of choice was vancomycin and carbapenem, adjusting to antibiogram. Conclusions: The most frequent infection was bacteremia, mainly by staphylococci resistant to methicillin. CNS involvement was elevated, as well as mortality.

Epidemiología de las infecciones urinarias asociadas a catéter y no asociadas a catéter en un hospital universitario de tercer nivel / Nosocomial urinary tract infection: an analysis beyond urinary catheterization

Resumen Introducción: Las infecciones urinarias asociadas a la atención de la salud (ITU-AAS) representan un importante problema sanitario, siendo poco conocidas sus características cuando no están asociadas a cateterización urinaria u ocurren fuera de unidades de cuidados intensivos (UCI). Objetivos: Determinar las características de los pacientes con ITU-AAS, etiología y susceptibilidad antimicrobiana de las mismas, tanto asociadas a catéter (ITU-C) como no asociadas a catéter (ITU-noC), en UCI y en sala general. Materiales y Métodos: Se realizó un estudio analítico retrospectivo de corte transversal entre 2009 y 2013 en un hospital universitario de tercer nivel. Se identificaron todos los episodios de ITU-AAS, diferenciándolas en ITU-C e ITU-noC. Resultados: Se incluyeron 253 episodios de ITU-AAS, siendo más frecuentes las ITU-C (60,9%) respecto a ITU-noC. Un 37,4% de ITU-noC y 59,7% de ITU-C ocurrieron en UCI. Los microorganismos aislados más frecuentemente fueron Escherichia coli, Klebsiella pneumoniae y Enterococcus sp. El 19% de los bacilos gramnegativos fueron productores de β-lactamasa de espectro extendido, siendo su frecuencia similar en ambos grupos. Conclusión: Las co-morbilidades de los pacientes con ITU-AAS, los agentes etiológicos responsables y sus correspondientes espectros de sensibilidad, fueron similares en los grupos de ITU-C e ITU-noC, tanto en sala general como en UCI.

Introduction: Nosocomially acquired urinary tract infections (NAUTI) represent an important public health issue, but its characteristics when they are not catheter associated (CA-UTI) or when they take place outside intensive care units (ICU) are poorly understood. Objectives: To determine the patients' characteristics, etiology and antimicrobial susceptibility of NAUTI, both CA-UTI and no CA-UTI, in general ward and ICU. Methods: We conducted a retrospective analytic cross-sectional study, between 2009 and 2013, in a third level universitary hospital. All NAUTI episodes were identified, classifying them as CA-UTI and no CA-UTI. Results: We included 253 episodes of NAUTI, being CA-UTI (60,9%) more frequent than no CA-UTI. A 37,4% of no CA-UTI and 59,7% of CA-UTI were identified in ICU. The most frequently isolated microorganisms were Escherichia coli, Klebsiella pneumoniae and Enterococcus sp. A 19% of extended spectrum betalactamase producing gram negative bacilli were found, without differences between groups. Conclusion: Patients's comorbidities, microorganisms associated to NAUTI and its antimicrobial susceptibility were similar in CA-UTI and no CA-UTI, as in general ward and ICU.

Evaluación de test rápidos y diseño de una estrategia para la detección y caracterización de carbapenemasas en cepas de bacilos gramnegativos / Test evaluation and strategy proposal to detect and to characterize carbapenemase-producing gram negative bacilli

Resumen Introducción: La detección de bacilos gramnegativos productores de carbapenemasas es compleja, existiendo actualmente varios test disponibles. La confirmación mediante la caracterización molecular de la enzima no está disponible en todos los laboratorios del país. Objetivo: Plantear una estrategia rápida, eficiente y sencilla para la detección y confirmación de carbapenemasas en cepas de bacilos gramnegativos. Material y Métodos: Se utilizaron 39 aislados productores y ocho no productores de carbapenemasas para evaluar los test fenotípicos Carba NP, CarbAcineto NP, Blue-Carba y validar el test molecular Xpert® Carba-R directo de la colonia en comparación con RPC convencional. Resultados: La sensibilidad para Carba NP, CarbAcineto NP y Blue-Carba fue de 79,5; 87,2 y 84,6%, respectivamente; mientras que la especificidad fue de 100; 100 y 87,5%, respectivamente. La concordancia entre RPC convencional y Xpert® Carba-R fue de 100%. El límite de detección para Xpert® Carba-R fue diferente según el tipo de carbapenemasa: 40,8 ufc/reacción par KPC y NDM y 30,6 ufc/reacción para VIM. Discusión: En aislados con susceptibilidad disminuida a carbapenémicos se propone realizar un tamizaje con CarbAcineto NP, para luego caracterizar la carbapenemasa con Xpert® Carba-R y adoptar las medidas de contención específica: para cada caso.

Introduction: The detection of carbapenemase-producing gram negative bacilli is complicated, because there are available multiple options of test. The confirmation of the enzyme by molecular characterization is not available in all laboratories in our country. Objective: To propose a fast, efficient and simple strategy to detect and confirm CPB. Materials and Methods: 39 CPB isolates and 8 non-producing were used to evaluate the phenotypic test Carba NP, CarbAcineto NP and Blue-Carba, validating the test Xpert® Carba-R, to be used directly with bacterial colonies with conventional PCR. Results: The sensitivity of Carba NP, CarbAcineto NP and Blue-Carba was 79,5; 87,2 y 84,6%, respectively; and specificity was 79.5; 87.2 and 84.6%, respectively. The limit of detection of Xpert® Carba-R was different for each carbapenemasa: 40.8 ufc/reaction to KPC and NDM and 30.6 ufc/reaction to VIM. Discussion: On isolates with decreased susceptibility to carbapenems we propose to use as screening the test CarbAcineto NP, follow by Xpert®Carba-R to characterize the carbapenemase and adopt specific infection control measures.

Espondilodiscitis: experiencia clínica en un hospital general de Chile / Spondylodiscitis: clinical experience in a Chilean general hospital

Introducción: La espondilodiscitis (ED) implica prolongados períodos de hospitalización, de latencia diagnóstica y riesgo de complicaciones a largo plazo. No existen publicaciones recientes en Chile al respecto. Objetivos: Caracterizar un grupo de pacientes con ED. Pacientes y Métodos: Serie clínica, que incluyó pacientes en un período de ocho años. Resultados: 37 pacientes, 37,8% mujeres y 62,2% hombres, con promedio etario 66,8 años; 64,9% adultos mayores, 35,1% diabéticos y 21,6% con co-morbilidad urológica. Los principales síntomas fueron dolor y fiebre. 89,2% tuvo elevación de VHS. 86,5% contó con resonancia magnética, que siempre fue confirmatoria, siendo la columna lumbar la localización más frecuente (43,2%). Se identificó etiología en 28/37 pacientes: en 71,4% cocáceas grampositivas (Staphylococcus aureus predominantemente), sólo en 10,7% M. tuberculosis. Staphylococcus aureus estuvo asociado a co-morbilidades médicas en forma significativa (p < 0,05) y el grupo de bacilos gramnegativos a historia hepatobiliar y/o intestinal (p < 0,05). El método de mayor rendimiento fue el cultivo obtenido por punción quirúrgica. El tratamiento antimicrobiano fue indicado en promedio por 63,8 días (IQR 53-72), con reacciones adversas en 18,9%. La estadía hospitalaria fue 38,9 días promedio, no existiendo fallecidos durante este período. 18,9% presentó secuelas motoras. Discusión: La mayoría de pacientes con ED correspondió a adultos mayores, siendo S. aureus la principal etiología. Hubo una baja frecuencia de M. tuberculosis. Resultó considerable la magnitud de efectos adversos asociados a la terapia antimicrobiana y las complicaciones neurológicas.

Background: Spondylodiscitis (SD) involves long periods of hospitalization, diagnostic latency and risk of long-term complications. No updated series are available in Chile and a change in demographic features and etiology is suspected. Aim: To characterize a group of patients with SD. Patients and Methods: Clinical series including patients over an 8 year period. Results: We identified 37 patients; 37.8% women and 62.2% men (mean age 66.8 years); 64.9% were elderly; 35.1% had diabetes and 21.6% urological comorbidity. Main symptoms were pain and fever. Erythrocyte sedimentation rate was elevated in 89.2%, and 86.5% patients had MRI, which was always confirmatory. Lumbar spine was the most common site of infection (43.2%). Etiology was identified in 28/37 patients: 71.4% yielded grampositive cocci (Staphylococcus aureus predominantly), Mycobacterium tuberculosis was identified in only 10.7%. Staphylococcus aureus was associated to medical comorbidities (p < 0,05) and gramnegative bacilli to hepatobiliar or intestinal symptoms (p < 0,05). Culture obtained by a surgical procedure had the highest yield. The average duration of antibiotic therapy was 63.8 days (IQR 53-72). Treatment-related side effects were detected in 18.9% of patients. The average hospital stay was 38.9 days. No deaths occurred during hospitalization. Motor sequelae were present in 18.9% of this series. Discussion: Most patients with SD were older adults. Staphylococcus aureus was predominant and M. tuberculosis was uncommon. Antibiotic side effects were relevant as well as the neurological complications.

Susceptibility Pattern of Aerobic Bacterial Isolates from Wound Swab.

Wound swab culture is the most frequently employed method of confirming wound infection. A regular bacteriological review of infected wounds is necessary to provide qualitative health care particularly when blind treatment is a necessity as in underdeveloped and developing nations. Materials and Methods: A total of 614 Wound swabs sample were received in the department during the study period. Direct Gram staining of the specimens were done after which they were inoculated in Blood agar and MacConkey agar plates and antibiotic sensitivity was done according to CLSI guideline. Result: A total of 496 strains were isolated out of which 232 (46.77%) were Gramnegative bacilli and 264(53.23%) were Gram-positive cocci. Out of the 466 culture positive samples, 29 samples showed polymicrobial growth. E coli was the most common pathogen isolated. Of the 156 isolates of Staphylococcus aureus 68 was from ward and 88 from Out Patient Department (OPD) of which 31(45.58%) and 30(34.09%) were determined to be methicillin resistant (MRSA) respectively. Out of 95 isolates of Coagulase Negative Staphylococcus(CoNS ), 56 was from ward and 39 from OPD. Methicillin Resistant Staphylococcus (MRCoNS) prevalence rate was 46 (82.14%) and 28(71.79%) for ward and OPD respectively. The gram negative isolates were most sensitive to imipenem and it was least sensitive to cephalosporin groups of antibiotics. Conclusion: The most commonly isolated pathogen from wound swab specimens was Gram positive bacteria but 46.77% of the isolates were Gram negative bacteria so antimicrobial coverage for Gram negative bacteria should be included in treatment of wound infection.

Emergence of cefepime resistance in gram-negative induced nosocomial infections

The rapid emergence of antibiotic resistance, especially broad-spectrum antibiotics, resulted in the avid use of new potent antibiotics. Ceftriaxone and ceftazidime, two third-generation cephalosporin, are usually used to manage complicated and uncomplicated infections. The use of cefepime in resistant infections is increasing gradually, which put this potent antibiotic at risk of resistance. During an 18-month period, a total of 220 gram-negative bacteria including Pseudomonas spp, Serratia spp, Acinetobacter spp, Proteus spp, E-coli and Kiebsiella spp. have been isolated by standard microbiological methods from nosocomial surgical site, abscess, blood stream and urinary tract infections. MIC of antibiotics on isolated bacteria was determined by gradient concentration method. Totally, 29.4%, 19.5% and 23.3% of isolated bacteria with MIC /= 256micro g/ml to cefepime, cefiriaxone and ceftazidime was also observed in 47.1%, 70.8% and 62.5% of cases, respectively [p<0.05]. High level resistance to cefepime were more commonly observed for pseudomonas [73.1%] and Klebsiella spp. [73.5%], respectively [p<0.05]. According to CLSI criteria, 47.1% of isolated bacteria in this study showed high level of resistance [MIC >/= 256micro g/ml] to cefepime. Therefore application of cefepime, as a drug of choice, for gram-negative organisms is not reasonable. Our result demonstrated that this potent antibiotic should not be used as a choice for empiric antibiotic therapy, in the cases of nosocomial infections caused by gram-negative organisms

Comparison of Clinical Characteristics between Cryptogenic and Biliary Pyogenic Liver Abscess / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to evaluate the characteristics of cryptogenic and biliary pyogenic liver abscess by comparing the clinical aspects between the two groups. METHODS: Of 119 patients treated for pyogenic liver abscess from 2000 to 2004, 82 subjects with cryptogenic liver abscess and 21 with biliary abscess were analysed retrospectively. RESULTS: There were no significant differences between the two groups regarding clinical symptoms. The characteristics of abscess were similar except the size of abscess. The size of abscess less than 5 cm in diameter was more common in billiary group than in cryptogenic group (p=0.004). Compare to cryptogenic group, biliary group had more positive culture test from abscess (100% vs. 69%, p=0.006). Especially, E. coli isolated from abscess culture (28% vs. 7%, p=0.014) and blood culcure (23% vs. 4%, p=0.035) were more common in biliary group than in cryptogenic group. There was no difference in mortality between the two groups (biliary vs. cryptogenic: 4.8% vs. 0%, p=0.204). However, the rate of clinical improvement was higher in cryptogenic group than in biliary group (92.7% vs. 66.7%, p=0.001). CONCLUSIONS: Biliary liver abscess had similar clinical characteristics to cryptogenic origin. Biliary liver abscess had smaller abscess size and more positive abscess culture rates than cryptogenic abscess. Improvement rate without complication and recurrence was higher in cryptogenic group than biliary group.

Nitrogenase activity of Beijerinckia derxii is preserved under adverse conditions for its growth

In order to evaluate the response of Beijerinckia derxii ICB-10 to different environmental factors, growth curves and specific nitrogenase activity were studied. Tested conditions were as follows: a) media with different pH values (2.5, 2.8, 4.2 and 5.7); b) medium supplemented with 230 æM aluminium sulphate; c) media with two different potassium phosphate concentrations (50 mM and 100 mM); d) shaken or still cultures; e) medium supplemented with 40 mM sodium thiosulphate. Growth curves and specific nitrogenase activity at pH 4.2 were closely similar to those for cultures at pH 5.7 (standard condition), whereas no growth occurred at pH 2.5. Changes in growth curves and/or specific nitrogenase activity were observed under the following conditions: I) pH 2.8 (decrease in initial CFU number, reduction of maximum specific growth rate, reduced number of generations and stimulation of nitrogenase activity), II) presence of aluminium (early death phase), III) 50 mM PO4(3-) (reduction of maximum specific growth rate), IV) 100 mM PO4(3-) (reduction of both number of generations and maximum specific growth rate as well as early death phase), V) low O2 availability (increasing nitrogenase activity), and VI) presence of thiosulphate (reduction of maximum specific growth rate; early death phase and high stimulation of nitrogenase activity). The data obtained showed the high variability of the cell growth response to environmental factors. Nitrogenase activity was always preserved even when population growth was affected

Primeras identificaciones de Rahnella aquatilis en Costa Rica / Firts identification of Rahnella aquatilis in Costa Rica

Se reporta el aislamiento de Rahnella aquatilis en dos pacientes, en muestras de secreción umbilical con fístula entero cutánea y orina de infección urinaria obtenida por punción vesical. Se mencionan las características bioquímicas que permiten su clasificación, así como su comportamiento ante los antimicrobianos. Se reporta que ambos casos se resolvieron exitosamente. Se hace revisión de la literatura al respecto y se señala la baja frecuencia de aislamiento de esta bacteria, en el campo clínico, a nivel mundial

Prevalent nosocomial gram negative aerobic bacilli and their antimicrobial susceptibility pattern in intensive care unit

OBJECTIVE: To determine the type of prevalent aerobic gram-negative bacilli and their sensitivity pattern among nosocomial isolates. DESIGN: Prospective collection of clinically significant nosocomial gram negative bacilli. SETTING: Tertiary care hospital in Karachi. METHOD: One hundred isolates were identified by standard methods and minimum inhibitory concentration was checked by epsilometer test. The most frequent isolates were Eschericia coli [43%] followed by Klebsiella pneumoniae [18%] Acinetobacter spp. [7%] Enterobacter spp. [7%] and Klebsiella spp. other than pneumoniae [7%]. Most of the isolates of dominant species [E. coli and Klebsiella pneumoniae] were multiresistant including third generation cephalosporins. This study indicates that most effective antibiotics imipenem and amikacin inhibited most of the isolates. Imipenem alone or amikacin in combination with one broad spectrum beta-lactam drug should be used in initial empiric therapy in any life threatening nosocomial infection

Antimicrobial susceptibility pattern of gram-negative aerobic isolates from intensive care units in Saudi Arabia; a multicenter study

To determine the pattern and prevalence of recognized categories of resistance to broad-spectrum antibiotics in seven Intensive Care Units [ICUs] in the Kingdom. A multicenter study was established to carry out susceptibility tests on at least 100 isolates from patients admitted into ICUs of seven hospitals in various areas in the Kingdom. Tests were performed using the Microscan MIC Plus type MIC panel. Setting: Microbiology laboratories and ICUs of seven hospitals in the Kingdom. Four hundred and seventy eight patients admitted into the study provided 703 isolates, which were examined for beta-lactamase production. The dominant species isolated were Ps. aeruginosa [148], E.coli [117] and Kleb. pneumoniae [11]. In all but one center, most isolates resistant to 3rd generation cephalosporins were E. coli and Klebsiella spp. with multi-resistance pattern consistent with extended spectrum B-lactamase [ESBL]. Inducible Enterobacteriaceae [IE], with chromosomal type-1 cephalosporinases were next in importance, followed by Ps.aeruginosa. Amikacin was the most effective aminoglycoside least affected by IE, while amoxil/clavulanate had a low impact on conferring sensitivity on the isolates. Blood culture isolates showed a strong contribution of resistance from inducible Enterobacteriaceae, principally nosocomial Serratia spp. and Enterobcater spp. with linked resistance to the aminoglycosides. The superiority of imipenem and ciprofloxacin over other antibiotics for empiric therapy of bacteremia in ICU patients was evident from the susceptibility data of all isolates

Imipenem - cilastatina versus ceftazidima - amikacina para el tratamiento de pacientes neutropénicos febriles / Imipenem - cilastatine versus ceftazidime - amikacin in the treatment of febril neutropenic patients

Aim: To compare the efficacy of imipenem - cilastatine and ceftazidime - amikacin in the treatment of febril neutropenic patients. Design: Open prospective and randomized clinical study. Patients: 52 patients (26 females) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive Imipenem - cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid. Results: Global response to initial therapy was 53 percent in patients receiving imipenem - cilastatine and 37 percent in those receiving ceftazidime - amikacin (p=ns). When other antimicrobial were added, a 90 and 85 percent infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem - cilastatine and 12 episodes in tha group receiving ceftazidime - amikacin had Gram positive cocci as the sole treatment outcome. Three patients receiving imipenem - cilastatine (10 percent) and 4 receiving ceftazidime - amikacin (13 percent) died. Superinfections and toxicity related to antibiotics were minimal in both groups. Conclusions: imipenem - cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febril episodes in neutropenic patients

Determinación de bacterias patógenas en el área quirúrgica de gineco-obstetricia del Centro Materno-Infantil San Lorenzo de los Mina, mayo-junio 1989 / Determination of pathogen bacterias in surgical area of gyneco-obstetrics of the Centro Materno-Infantil San Lorenzo de los Mina, May-June 1989

Se realizó un estudio observacional, analítico y transversal, durante los meses de mayo y junio 1989, para la determinación de la presencia de bacterias patógenas en el área quirúrgica de gineco-obstetricia en el Centro Materno Infantil San Lorenzo, de Los Mina, Distrito Nacional, R. D. Se cultivaron muestras que fueron tomadas del personal médico, paramedico y del área quirúrgica (equipos hospitalarios, instrumental quirúrgico y ambiente del quirófano), de donde se tomaron 25 cultivos, 10 en el personal mencionado y 15 en el área quirúrgica. En total hubo crecimiento en 8 cultivos para un 32 por ciento , todos ellos bacilos gram negativos

Estudo da sensibilidade de germes a antimicrobianos in vitro: resultados iniciais em colecistite aguda litiásica / Sensibility assay in vitro of microorganisms to antibiotics: preliminary results in gallstone acute cholecystitis

Pretende-se atualizar os dados microbiológicos em colecistite aguda litásica identificando os microorganismos eventualmente presentes nesta situaçäo, bem como verificar o aspecto de açäo de algumas drogas antimicrobianas atualmente disponíveis. Com este objetivo, säo incluídos 22 doentes operados em regime de urgência, com diagnósticos pré-operatórios de colecistite aguda litiásica. A bile vesicular, colhida por punçäo no intra-operatório, foi semeada em preparados apropriados para o crescimento de germes aeróbios e de anaeróbios. Verificou-se crescimento bacteriano constituído exclusivamente de germes aeróbios, únicos ou associados. Dos germes identificados, houve predominância de Gram-negativso (75,0%). Entre os microorganismos mais freqüentemente identificados figuravam a Escherichia coli, a Klebsiela pneumoniae e o Streptococcus sp. Foram testados 16 antimicrobianos para Gram-negativos e 19 para Gram-positivos. Verificaram diferentes níveis de resistência bacteriana a cada uma destas drogas. As melhores respostas foram obtidas com o Cloranfenicol (Gram+) e com a Cefotaxima sódica e Pefloxacin (Gram-). A Escherichia coli, germe mais freqüente entre aqueles identificados, mostrou-se, mais vezes, sensível à Gentamicina, Pefloxacin, Cefotaxima sódica e Tobramicina. Conclui-se, ao cotejar com os dados disponíveis na literatura, que a microflora nestas situaçöes näo sofreu alteraçäo ao longo do tempo, porém, qualitativamente, há necessidade periódica de se avaliar a sensibilidade destes germes em relaçäo aos antimicrobianos em uso. Atualmente, os antimicrobianos acima relacionados parecem constituir as melhores opçöes terapêuticas frente a infecçöes agudas das vias biliares

Ulceras de córnea em serviço de referência / Corneal ulcers in reference service

A determinaçäo dos agentes etiológicos causadores de úlcera de córnea é importante devido a incidência variável de microorganismos nas diferentes regiöes do país. No presente trabalho realizado com os dados obtidos junto ao laboratório de Microbiologia Ocular da Escola Paulista de Medicina foram analisados 126 pacientes representando 13% da amostragem geral, com diagnóstico de úlcera de córnea da qual foi colhido material para bacterioscopia, citologia e cultura, desta forma procedeu-se a identificaçäo do agente etiológico e sua sensibilidade aos agentes antimicrobianos. Dos casos estudados houve predomínio de pacientes do sexo masculino sendo traumatismo corneano (14%) o fator predisponente mais citado nos dados de anamnese. Em relaçäo ao uso de medicaçäo tópica 47% utilizavam antibióticos e 6% corticóides até 24 horas antes da colheita de material. Houve comprovaçäo de ceratite infecciosa em 76 pacientes (61%) - em 11 casos apenas o exame direto do material colhido foi positivo para microorganismos e a cultura negativa. Nos casos em que a cultura foi positiva observou-se um crescimento maior em ágar sangue (45%) e forma identificados 74 microorganismos sendo que em 9 exames forma isoladas mais de uma bacteria...

Métodos para identificar bacilos gramnegativos no fermentadores (BGNnF) / Methods for the identification on non-fermentating gramnegative bacilli

Se emplearon los esquemas de King-Weaver, Gilardi, Pickett y el sistema automatizado Quantum II para identificar 53 cepas de los bacilos gramnegativos no fermentadores (BGNnF). Se encontró que los esquemas que identifican la totalidad de las cepas estudiadas son el de Gilardi y Pickett, seguido del esquema King-Weaver, con el cual se identificó a 46 cepas (86.8%). Empleando el sistema Quantum II, se identificaron 16 cepas (30.2%), siendo los géneros identificados: Pseudomonas 60.4%, Acinetobacter 28.3% y Moraxella en 11.3%. Después de analizar los resultados obtenidos, para la identificación de bacilos gramnegativos no fermentadores más frecuentemente aislados en nuestro medio, se propone el uso de las siguientes pruebas: reacción de citocromoxidasa, movilidad, desarrollo en gelosa Mac-Conkey y gelosa SS, base O/F con glucosa y manitol, reducción de nitratos y gas a partir de nitrato. Con estas pruebas se logra identificar con rapidez y bajo costo la mayoría de las cepas de BGNnF causantes de infecciones en el humano

Advantage of Sandiford's counterstain in detection of Gram negative bacteria in clinical specimens.

Confirmation of bacterial in clinical specimens using Gram's stain with the Sandiford's modification was found to be more useful, especially when Gram-negative bacteria with other forms coexisted, than ordinary Gram's stain. It was useful for staining histopathological specimens also. We believe that this method deserves wider recognition and should be used as a standard procedure in laboratories.