The evolution of the resistance of Staphylococcus aureus found on healthcare workers correlated with local consumption of antibiotics

OBJECTIVE: Correlate the evolution of the resistance of Staphylococcus aureus collected from healthcare workers with the local consumption of antibiotics. MATERIAN AND METHODS: Open prospective research.Study Site. General Reference Hospital with 200 beds in a 700,000 inhabitant region, in Ponta Grossa, Paraná, Brazil. RESULTS: Two collections (samples) of Staphylococcus aureus isolates were obtained from healthcare-workers during an approximate four-year interval. Samples 1 (n= 200) and 2 (n= 270) had this bacterium in 63 (32 percent) and 90 (33 percent) of the patients, respectively. At the same time, the annual consumption of antibiotics in DDD/1,000 patient-days was determined. The variation of resistance was significantly smaller (m.s.d.=12.11) for gentamycin (p<0.01) and (m.s.d.=9.22) for Tobramycin (p<0.05). The correlation between variation in resistance and antibiotic consumption was not significant. Workers studied in the two samples showed a significant (p<0.01) frequency (c²=10.44) for persistent nasal carriage and for non carriage. Methicillin resistant Staphylococcus aureus was found in 12 (6 percent) patients of sample 1 and 11 patients (4 percent) of sample 2. CONCLUSION: Stability of resistance allows us to maintain therapeutic outlines. The variation in bacterial resistance in the twice-sampled population (n=105) indicated the selection pressure of the hospital environment. The resistance that was found is representative of the hospital microbiota; this relationship represents a biological model, based on the healthcare-workers' interaction with colonizing bacteria and nosocomial infections. New studies could improve this model for other bacteria, to determine the tendency for resistance and help guide the antibiotic use.

The evolution of the resistance of Staphylococcus aureus found on healthcare workers correlated with local consumption of antibiotics.

OBJECTIVE: Correlate the evolution of the resistance of Staphylococcus aureus collected from healthcare workers with the local consumption of antibiotics. MATERIAN AND METHODS: Open prospective research. Study Site. General Reference Hospital with 200 beds in a 700,000 inhabitant region, in Ponta Grossa, Paraná, Brazil. RESULTS: Two collections (samples) of Staphylococcus aureus isolates were obtained from healthcare-workers during an approximate four-year interval. Samples 1 (n= 200) and 2 (n= 270) had this bacterium in 63 (32%) and 90 (33%) of the patients, respectively. At the same time, the annual consumption of antibiotics in DDD/1,000 patient-days was determined. The variation of resistance was significantly smaller (m.s.d.=12.11) for gentamycin (p<0.01) and (m.s.d.=9.22) for Tobramycin (p<0.05). The correlation between variation in resistance and antibiotic consumption was not significant. Workers studied in the two samples showed a significant (p<0.01) frequency (chi2=10.44) for persistent nasal carriage and for non carriage. Methicillin resistant Staphylococcus aureus was found in 12 (6%) patients of sample 1 and 11 patients (4%) of sample 2. CONCLUSION: Stability of resistance allows us to maintain therapeutic outlines. The variation in bacterial resistance in the twice-sampled population (n=105) indicated the selection pressure of the hospital environment. The resistance that was found is representative of the hospital microbiota; this relationship represents a biological model, based on the healthcare-workers' interaction with colonizing bacteria and nosocomial infections. New studies could improve this model for other bacteria, to determine the tendency for resistance and help guide the antibiotic use.

Avaliaçäo crítica do diagnóstico e profilaxia secundária de 259 casos de febre remática / Critical evaluation of diagnostic and secondary prophylaxis in 259 cases of rheumatic fever

A febre reumática é uma doença inflamatória, sistêmica e auto-imune, associada à infecçäo recente por Streptococcus beta-hemolítico do grupo A. A doença acomete, geralmente, crianças na faixa etária de 5 a 14 anos de idade. É uma doença prevalente em países em desenvolvimento, fortemente ligada a fatores ambientais, a baixas condiçöes sócio-econômicas e a aglomerados, podendo resultar em morte prematura e incapacidade precoce, devido ao comportamento cardíaco. Assim, este trabalho teve por objetivo determinar a frequência de pacientes com cardiopatia de origem reumática atendidos no Hospital de Clínicas da Universidade Federal do Paraná. Para este estudo procedemos à análise de 547 prontuários médicos de pacientes com diagnóstico de cardiopatia, atendidos e internados neste hospital no período de janeiro de 1992 a novembro de 1994, levando em consideraçäo dados como idade, sexo, etnia, idade da primeira manifestaçäo clínica de febre reumática, nível sérico da antiestreptolisina. O (ASO), cultura de material de orofaringe, tratamento profilático, clínico e cirúrgico. Com este estudo observou-se que dos 547 pacientes, 259 (47,3 por cento) apresentavam firmado o diagnóstico de cardiopatia reumática, dos quais apenas 61,5 por cento preenchiam os critérios de Jones para o diagnóstico de febre reumática. Com relaçäo à profilaxia secundária observou-se que os procedimentos terapêuticos näo seguiam aqueles preconizados na literatura, uma vez que 86,8 por cento dos pacientes apresentavam, entre outras manifestaçöes, sinais de cardite, e apenas 6,2 por cento receberam profilaxia com penicilina benzatina 1.200.000 U i.m. a cada 21 dias, como é recomendado para países com alta prevalência desta doença. Além disto, 35,9 por cento näo fizeram profilaxia secundária ou a fizeram de forma irregular