Characterization of Uropathogenic Escherichia coli Reveals Hybrid Isolates of Uropathogenic and Diarrheagenic (UPEC/DEC) E. coli.

(1) Background: Pathogenic Escherichia coli are divided into two groups: diarrheagenic (DEC) and extraintestinal pathogenic (ExPEC) E. coli. ExPEC causing urinary tract infections (UTIs) are termed uropathogenic E. coli (UPEC) and are the most common cause of UTIs worldwide. (2) Methods: Here, we characterized 112 UPEC in terms of phylogroup, serotype, the presence of virulence factor-encoding genes, and antimicrobial resistance. (3) Results: The majority of the isolates were assigned into the phylogroup B2 (41.07%), and the serogroups O6 (12.5%) and O25 (8.9%) were the most frequent. Five hybrid UPEC (4.5%), with markers from two DEC pathotypes, i.e., atypical enteropathogenic (aEPEC) and enteroaggregative (EAEC) E. coli, were identified, and designated UPEC/aEPEC (one isolate) and UPEC/EAEC (four isolates), respectively. Three UPEC/EAEC harbored genes from the pap operon, and the UPEC/aEPEC carried ibeA. The highest resistance rates were observed for ampicillin (46.4%) and trimethoprim/sulfamethoxazole (34.8%), while 99.1% of the isolates were susceptible to nitrofurantoin and/or fosfomycin. Moreover, 9.8% of the isolates were identified as Extended Spectrum ß-Lactamase producers, including one hybrid UPEC/EAEC. (4) Conclusion: Our data reinforce that hybrid UPEC/DEC are circulating in the city of Botucatu, Brazil, as uropathogens. However, how and whether these combinations of genes influence their pathogenicity is a question that remains to be elucidated.

Evaluation of MALDI-TOF VITEK®MS and VITEK® 2 system for the identification of Staphylococcus saprophyticus.

AIM: To compare two identification methods for coagulase-negative staphylococci (CoNS) isolated from patients with urinary tract infections, VITEK® 2 and MALDI-TOF VITEK®MS, with genotypic identification by internal transcribed spacer PCR (ITS-PCR). RESULTS: A total of 217 CoNS isolates were studied. Agreement of the VITEK® 2 system with ITS-PCR was 84.8%, with 98% sensitivity and 100% specificity. Thirty-one of the 33 strains incorrectly identified by VITEK® 2 belonged to the species Staphylococcus saprophyticus. MALDI-TOF VITEK®MS showed an excellent correlation with ITS-PCR since it correctly identified all CoNS isolates. CONCLUSION: MALDI-TOF VITEK®MS is more accurate than the automated VITEK® 2 system in identifying CoNS isolated from urinary tract infections to species level, particularly urinary isolates of S. saprophyticus.

Effectiveness of Surface Cleaning and Disinfection in a Brazilian Healthcare Facility.

BACKGROUND: Failures in the processes of cleaning and disinfecting health service surfaces may result in the spread and transfer of pathogens that are often associated with healthcare-related infections and outbreaks. AIMS: To assess the effectiveness of environmental surface cleaning and disinfection in a hospital clinic. METHOD: The study was conducted in a nursing ward with 45 beds. A total of 80 samples from five high-touch surfaces were evaluated before and after cleaning and disinfection, using the following methods: visual inspection, adenosine triphosphate bioluminescence assay, aerobic colony count, Staphylococcus aureus colony count, and evaluation of resistance to methicillin. The data analysis used nonparametric comparative and correlative tests to observe any differences in the pre- and post- cleaning and disinfection results for the surfaces assessed. RESULTS: Effective cleaning and disinfection had a significant effect on only two surfaces when measured for the presence of adenosine triphosphate, the inner bathroom door handle (p=0.007) and the toilet bowl (p=0.01). When evaluated for Staphylococcus aureus colony count, the toilet flush handle also demonstrated a significant effect (p=0.04). CONCLUSION: The effectiveness of cleaning and disinfection of the surfaces tested was not satisfactory. An educational intervention is recommended for the cleaning and disinfection staff and the nursing team at the healthcare facility. RELEVANCE TO CLINICAL PRACTICE: The data in the study revealed that daily hospital cleaning and disinfection in the sampled sites are not sufficient in medical and surgical wards. Hospital cleanliness must be reevaluated from the point of view of materials, such as an adequate supply of clean cloths, in addition to establishing more precise cleanliness protocols and accurate monitoring systems.

Frequency and carbapenems susceptibility profile of non-fermenting Gram-negative bacilli isolated from clinical samples between 2007 and 2012 / Frequência e perfil de suscetibilidade aos carbapenêmicos de bastonetes Gram-negativos não fermentadores de glicose isolados de amostras clínicas entre 2007 e 2012

ABSTRACT Introduction: One of the major problems in health services is the occurrence of healthcare-associated infections (HAIs) by microorganisms resistant to various antimicrobials. Objectives: To describe the frequency and susceptibility profile of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenems in the hospital from Fundação Santa Casa de Franca, São Paulo, Brazil. Methods: The susceptibility of P. aeruginosa and A. baumannii to carbapenems from 304 clinical isolates between 2007 and 2012 was retrospectively analyzed from a microbiology database at the clinical laboratory of the hospital of Fundação Santa Casa de Franca, São Paulo, Brazil. Results: From isolated and identified strains, 236 (5.3%) P. aeruginosa were susceptible to imipenem (2007 - 69.6% to 2012 - 41.7%) and meropenem (2007 - 63.3% to 2012 - 25%). In addition, all 68 (1.7%) A. baumannii isolates were susceptible to both antibiotics. Conclusion: A. baumannii resistance to carbapenems was not identified; however, there was a decrease in susceptibility to carbapenems over the years for P. aeruginosa.

RESUMO Introdução: Um dos grandes problemas nos serviços de saúde é a ocorrência de infecções relacionadas com assistência à saúde (IRAS) por microrganismos resistentes a vários antimicrobianos. Objetivos: Descrever a frequência e o perfil de suscetibilidade de Pseudomonas aeruginosa e Acinetobacter baumannii aos carbapenêmicos no hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Métodos: Retrospectivamente, a suscetibilidade de P. aeruginosa e A. baumannii aos carbapenêmicos foi analisada em 304 isolados clínicos entre 2007 e 2012, a partir de um banco de dados do setor de microbiologia do laboratório clínico do hospital da Fundação Santa Casa de Franca, São Paulo, Brasil. Resultados: Das cepas isoladas e identificadas, 236 (5,3%) P. aeruginosa eram suscetíveis a imipenem (2007 - 69,6% a 2012 - 41,7%) e meropenem (2007 - 63,3% a 2012 - 25%). Além disso, todos os 68 (1,7%) isolados de A. baumannii eram suscetíveis aos dois antibióticos. Conclusão: Não foi identificada resistência de A. baumannii aos carbapenêmicos, no entanto houve diminuição da suscetibilidade aos carbapenêmicos no decorrer dos anos para P. aeruginosa.

Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion.

PURPOSE:: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). METHODS:: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. RESULTS:: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. CONCLUSION:: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion / Incidência de neovasos de segmento anterior durante o tratamento de edema macular secundário a oclusão da veia central da retina

ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

RESUMO Objetivo: Analisar as taxas de incidência de neovascularização do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundário a oclusão de veia central da retina (OVCR), em tratamento com injeções intravítreas de triamcinolona (IVTA) ou bevacizumab (IVB). Métodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundário a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primário foi a taxa de incidência de NSA no mês 6. Os desfechos secundários foram alterações médias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerência óptica, até o mês 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e três (37,50%) olhos no grupo tratado com injeções intravítreas de Triamcinolona, Não houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferença estatisticamente significante (p<0,05) entre os grupos, somente no mês 1. A EFC não apresentou diferenças estatisticamente significantes (p<0,05) entre os grupos ao longo dos 12 meses. GNV ocorreu em um olho apesar do tratamento com laser e este paciente necessitou de intervenção cirúrgica. Conclusão: O tratamento precoce com injeções intravítreas de Anti VEGF podem diminuir as taxas de neovascularização do segmento anterior e glaucoma neovascular após oclusão de veia central da retina.

Surface cleaning effectiveness in a walk-in emergency care unit: Influence of a multifaceted intervention.

BACKGROUND: Cleaning of surfaces is essential in reducing environmental bioburdens and health care-associated infection in emergency units. However, there are few or no studies investigating cleaning surfaces in these scenarios. Our goal was to determine the influence of a multifaceted intervention on the effectiveness of routine cleaning of surfaces in a walk-in emergency care unit. METHODS: This prospective, before-and-after interventional study was conducted in 4 phases: phase I (situational diagnosis), phase II (implementation of interventions-feedback on results, standardization of cleaning procedures, and training of nursing staff), phase III (determination of the immediate influence of interventions), and phase IV (determination of the late influence of interventions). The surfaces were sampled before and after cleaning by visual inspection, adenosine triphosphate bioluminescence assay, and microbiologic culture. RESULTS: We sampled 240 surfaces from 4 rooms. When evaluated by visual inspection and adenosine triphosphate bioluminescence, there was a progressive reduction of surfaces found to be inadequate in phases I-IV (P < .001), as well as in culture phases I-III. However, phase IV showed higher percentages of failure by culture than phase I (P = .004). CONCLUSIONS: The interventions improved the effectiveness of cleaning. However, this effect was not maintained after 2 months.

Oxacillin resistance and antimicrobial susceptibility profile of Staphylococcus saprophyticus and other staphylococci isolated from patients with urinary tract infection.

BACKGROUND: Staphylococcus saprophyticus is the second most frequent community-acquired causative agent of urinary tract infection (UTI). The objective of this study was to evaluate the susceptibility profile and resistance detection in Staphylococcus species. isolated from patients with UTI. MATERIALS AND METHODS: The isolates were investigated using the disk diffusion method, Vitek I system, E-test®, and detection of the mecA gene. RESULTS: Most isolates (76.2%) were resistant to oxacillin by the disk diffusion method, followed by those resistant to penicillin (72.2%). The oxacillin disk diffusion method, E-test, and Vitek I method showed higher sensitivity (94.4%) and lower specificity (28.9, 26.5, and 24.0%, respectively) than the cefoxitin disk diffusion test (sensitivity: 83.5%, specificity: 85.5%) for the detection of oxacillin resistance. CONCLUSIONS: The large number of oxacillin-resistant isolates indicates that the breakpoint value recommended by the Clinical and Laboratory Standards Institute may overestimate oxacillin resistance in S. saprophyticus. Thus, changes in these guidelines are necessary for the correct detection of this resistance.

O enfermeiro e o tratamento de feridas: em busca da autonomiado cuidado / Nurses and wound treatment: searching for care autonomy

O cuidado com feridas é uma atividade do cotidiano do enfermeiro. Entretanto, esse cuidado esbarra naquestão da autonomia desse profissional em suas atividades junto aos pacientes portadores de feridas. Opropósito deste estudo é avaliar a Legislação de Enfermagem brasileira sobre a autonomia do Enfermeiro nocuidado de feridas na perspectiva da prevenção e tratamento. Trata-se de uma pesquisa descritiva exploratóriacujas fontes de pesquisas foram os sites dos Conselhos Regionais de Enfermagem (CORENs) da Federaçãobrasileira e o site do Conselho Federal de Enfermagem (COFEN), bem como textos que versem sobre oassunto. Constata-se escassez de legislação acerca da autonomia do enfermeiro no tratamento de feridas;uma vez que apenas 11 documentos foram compilados os quais estão distribuídos entre seis CORENs.

Wound care is a daily activity for the nurses. However, this care is limited to these professionals when theissue is their autonomy mainly in relation to activities with the patients with wounds. The purpose of thisstudy is to evaluate the Legislation of Brazilian Nursing on the Nurse’s autonomy in the wound care accordingto prevention and treatment. It is an exploratory descriptive research whose sources were the sites ofRegional Council of Nursing (CORENs) of the Brazilian Federation and the site of Federal Council of Nursing(COFEN) as well as texts dealing with this subject. Legislation shortage was observed concerning thenurse’s autonomy in the wound treatment; once only 11 documents were compiled which are distributedamong six CORENs.

Sítio cirúrgico: avaliação e intervenções de enfermagem no pós-operatório / Surgical site: nursing evaluation and interventions in the postoperative

A cicatrização do sítio cirúrgico envolve uma série de eventos interdependentes que tem como objetivo reparar o tecido lesado. O objetivo deste estudo foi atualizar, por meio da revisão de literatura, os profissionais que diretamente cuidam do sítio cirúrgico no pós-operatório. As fontes analisadas foram organizadas e categorizadas de acordo com a temática: sinais e sintomas esperados em cada fase da cicatrização, necessidade de coberturas após 24 horas e a técnica de coletar material microbiológico do sítio cirúrgico infectado. Considera-se que a avaliação do sítio cirúrgico, no pós-operatório, é uma das atividades do enfermeiro que contribui para melhor recuperação do paciente aos seus cuidados

Intervenções de enfermagem ao paciente com dor / Nursing interventions to the patient with pain

A dor é uma das principais causas de sofrimento humano, comprometendo a qualidade de vida das pessoas e refletindo no seu estado físico e psicossocial. A dor é, sem dúvida, uma das mais íntimas e exclusivas sensaçõesexperimentadas pelo ser humano, envolve vários componentes sensoriais, afetivos e cognitivos, sociaise comportamentais. Embora uma pessoa consiga sobreviver com dor, ela interfere no seu bem-estar, nas relações sociais e familiares, no desempenho do seu trabalho, influenciando assim a sua qualidade de vida. Portanto, a avaliação da dor se constitui uma premissa na prática do enfermeiro, buscando um cuidado individualizado e dirigindo-se à causa desencadeante da dor a fim de aliviá-la. O objetivo deste artigo de atualização foi descrever a partir da literatura especializada, dados relacionados à avaliação da dor e cuidados de enfermagem ao paciente com dor. Percebe-se, que a dor é um fenômeno subestimado nos pacientes e neste sentido a educação em enfermagem necessita repensar a formação do enfermeiro...

O cuidado de enfermagem nos procedimentos de coleta para análise microbiológica de feridas: aplicabilidade de duas técnicas / Nursing care in collecting procedures for microbiological analysis from wounds: two techniques applicability

Neste estudo, comparou-se a técnica de coleta de material microbiológico de feridas por irrigação-aspiração como uma alternativa à técnica de "swab" na qualificação e quantificação de bactérias de 20 feridas de etiologias diversas. Os microrganismos mais freqüentes nas feridas analisadas foram: Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus sp (coagulase-) e Escherichia coli, respectivamente. Em três momentos foram identificadas apenas na técnica de irrigação-aspiração as seguintes bactérias: Streptococcus beta, Proteus mirabilis e Staphylococus epidermidis. Uma média de 2,4 bactérias foi capturada por ferida, enquanto com a técnica de "swab", 2,3 bactérias. Apenas para a cepa de Pseudomonas aeruginosa e houve diferença estatisticamente significante utilizando-se a técnica de irrigação-aspiração. Conclui-se que esta técnica é eficaz, quando comparada com o "swab", na qualificação e quantificação de bactérias...