Estudo microbiológico de águas de poços artesianos para consumo humano na região de Santa Maria, RS / Microbiological study of artesian wells water for human consumption in the region of Santa Maria, RS

Objetivo: A água é de extrema importância para a saúde humana e essencial para a sobrevivência dos seres vivos. Águas subterrâneas de poços artesianos são menos contaminadas por não estarem expostas aos poluentes. Este estudo efetuou a análise microbiológica de águas de poços artesianos para o consumo humano. Métodos: As análises foram realizadas no Laboratório de Análises Microbiológicas, Departamento de Microbiologia e Parasitologia, Centro de Ciências da Saúde da Universidade Federal de Santa Maria. Através da técnica dos tubos múltiplos e do número mais provável por mililitro de amostra se obteve a contagem de coliformes totais e coliformes termotolerantes. A contagem de bactérias heterotróficas foi realizada em placas de Petri com meio Ágar Padrão Contagem. E a pesquisa e confirmação de Escherichia coli por Ágar Eosina Azul de Metileno e testes bioquímicos, respectivamente. Resultados: Verificou-se que 68% das amostras estavam próprias para consumo humano, em 21% foi emitido um alerta e 11% estavam impróprias. Foi confirmada E. coli em 96% das amostras impróprias. Além disso, Pseudomonas aeruginosa foi encontrada em oito das amostras analisadas. Em relação ao tratamento com cloro, 85% das amostras cloradas estavam próprias. Dividiu-se o estudo em quatro períodos para efetuar um comparativo da potabilidade, o último período do estudo demonstrou um maior nível de potabilidade quando comparado ao primeiro. Conclusão: Estes dados são de grande relevância para a população e a conscientizam sobre um controle microbiológico frequente a fim de obter níveis menores ou isentos de bactérias, evitando contaminações que podem ser nocivas à saúde humana.

Objective: Water is very important for human health and essential to survival of living beings. Groundwater from artesian wells is the least contaminated because it is not exposed to pollutants. This study performed the microbiological analysis of artesian well water to human consumption. Methods: These analyses were performed at the Microbiological Analysis Laboratory, Department of Microbiology and Parasitology, Health Sciences Center of the Federal University of Santa Maria. Using the multiple tube technique and the Most Probable Number per milliliter of the sample, the Total Coliform and Thermotolerant Coliform counts were obtained. Heterotrophic Bacteria counts were performed in Plate Count Agar Petri dishes. And the research and confirmation of Escherichia coli by Methylene Blue Eosin Agar and biochemical tests, respectively. Results: Checked that 68% of the samples were found to be safe to human consumption, 21% were alerted and 11% were inappropriate. E. coli was confirmed in 96% of improper samples. In addition, Pseudomonas aeruginosa was found in eight of the samples analyzed. Regarding chlorine treatment, 85% of chlorinated samples were safe to human consumption. The study was divided into four periods to make a potability comparison, the last period of the study showed a higher level of potability when compared to the first one. Conclusion: These data are of great relevance to the population and make them aware of frequent microbiological control in order to obtain lower or bacteria-free levels. This avoids contamination that can be harmful to human health.

Synthesis, characterization and biological activity of a gold(I) triazenide complex against chronic myeloid leukemia cells and biofilm producing microorganisms

ABSTRACT The enhancement of anti-leukemia therapy and the treatment of infections caused by multidrug-resistant pathogens are major challenges in healthcare. Although a large arsenal of drugs is available, many of these become ineffective, and as a result, the discovery of new active substances occurs. Notably, triazenes (TZCs) have been consolidated as a promising class of compounds, characterized by significant biological activity, especially antiproliferative and antimicrobial properties. The aim of this study is the synthesis and characterization of a new triazenide complex of gold (I), as well as the in vitro assessment of its antiproliferative activity against the K562 cell line (Chronic Myeloid Leukemia), and antibacterial activity against bacterial isolates of biofilm-producing coagulase-negative staphylococci. The combination of TZC with gold metal tends to have a synergistic effect against all biofilm-producing isolates, with Minimum Inhibitory Concentration values (MIC) between 32 and 64 µg mL-1. It has also shown activity against K562 cell line, getting an IC50=4.96 µM. Imatinib mesylate (Glivec) was used as reference, with IC50=3.86 µM. To the best of our knowledge, this study represents the first report of the activity of a TZC complexed with gold ion in the oxidation state (I) against microorganisms that produce biofilm and K562 cells.

Antimicrobial susceptibility profile and research of mec A and erm genes in coagulase-negative staphylococci isolated from platelet concentrates bags

Abstract In recent years, several studies have described the clinical impact of bacterial infection associated with transfusion of platelet concentrates (PCs). Among the blood components, PCs are responsible for the highest rates of bacterial contamination as well as septic transfusion reactions. We assessed antimicrobial susceptibility profile, resistance to methicillin (MRCoNS), and resistance to macrolides, lincosamides and streptogramins of group B (MLSB) of 16 coagulase-negative staphylococci (CoNS) isolates from an investigation in 691 PCs bags. We then compared conventional and automated phenotypic methods, disc diffusion test (DD) and VITEK(r) 2, respectively as well as phenotypic and genotypic methods (Polymerase Chain Reaction - PCR). All CoNS were susceptible to vancomycin. The disc diffusion test characterized 18.75% as MRCoNS and 37.5% with inducible resistance to MLSB (iMLSB), and with VITEK(r) 2, 6.3% and 31.25%, respectively. The mecA gene was detected in 18.75% and the erm gene in 31.25% of the isolates. In this study, we found equal percentage values between presence of the mecA gene by PCR and resistance to methicillin using cefoxitin by DD test, evidence of the erm gene by PCR, and iMLSB resistance by automation (VITEK(r) 2). Moreover, we identified three strains with beta-lactamase overproduction, and the occurrence of a bigger mistake was verified when automation was compared with DD test. And we observed that D-test was the most reliable for the detection of iMLSB resistance in Staphylococcus sp.

INVESTIGATION OF BIOFILM FORMATION IN COAGULASE-NEGATIVE STAPHYLOCOCCI ISOLATED FROM PLATELET CONCENTRATE BAGS.

Platelet Concentrates (PCs) are the blood components with the highest rate of bacterial contamination, and coagulase-negative staphylococci (CoNS) are the most frequently isolated contaminants. This study investigated the biofilm formation of 16 contaminated units out of 691 PCs tested by phenotypic and genotypic methods. Adhesion in Borosilicate Tube (ABT) and Congo Red Agar (CRA) tests were used to assess the presence of biofilm. The presence of icaADC genes was assessed by means of the Polymerase Chain Reaction (PCR) technique. With Vitek(r)2, Staphylococcus haemolyticus was considered the most prevalent CoNS (31.25%). The CRA characterized 43.8% as probable biofilm producers, and for the ABT test, 37.5%. The icaADC genes were identified in seven samples by the PCR. The ABT technique showed 85.7% sensitivity and 100% specificity when compared to the reference method (PCR), and presented strong agreement (k = 0.8). This study shows that species identified as PCs contaminants are considered inhabitants of the normal skin flora and they might become important pathogens. The results also lead to the recommendation of ABT use in laboratory routine for detecting biofilm in CoNS contaminants of PCs.

INVESTIGATION OF BIOFILM FORMATION IN COAGULASE-NEGATIVE STAPHYLOCOCCI ISOLATED FROM PLATELET CONCENTRATE BAGS

Platelet Concentrates (PCs) are the blood components with the highest rate of bacterial contamination, and coagulase-negative staphylococci (CoNS) are the most frequently isolated contaminants. This study investigated the biofilm formation of 16 contaminated units out of 691 PCs tested by phenotypic and genotypic methods. Adhesion in Borosilicate Tube (ABT) and Congo Red Agar (CRA) tests were used to assess the presence of biofilm. The presence of icaADC genes was assessed by means of the Polymerase Chain Reaction (PCR) technique. With Vitek(r)2, Staphylococcus haemolyticus was considered the most prevalent CoNS (31.25%). The CRA characterized 43.8% as probable biofilm producers, and for the ABT test, 37.5%. The icaADC genes were identified in seven samples by the PCR. The ABT technique showed 85.7% sensitivity and 100% specificity when compared to the reference method (PCR), and presented strong agreement (k = 0.8). This study shows that species identified as PCs contaminants are considered inhabitants of the normal skin flora and they might become important pathogens. The results also lead to the recommendation of ABT use in laboratory routine for detecting biofilm in CoNS contaminants of PCs.

Staphylococcal scalded skin syndrome in a premature newborn caused by methicillin-resistant Staphylococcus aureus: case report.

CONTEXT: Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT: A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive) developed in blood cultures performed on the day of death (seventh day), and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day). The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria.

Staphylococcal scalded skin syndrome in a premature newborn caused by methicillin-resistant Staphylococcus aureus: case report / Síndrome da pele escaldada estafilocócica em um recém-nascido prematuro causada por Staphylococcus aureus meticilina-resistente: relato de caso

CONTEXT: Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT: A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive) developed in blood cultures performed on the day of death (seventh day), and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day). The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria.

CONTEXTO: A síndrome da pele escaldada estafilocócica é uma doença esfoliativa de pele. São raros os relatos desta síndrome causada por Staphylococcus aureusresistente à meticilina em neonatos, mas, quando presentes, exigem diagnóstico e tratamento rápidos para diminuir a morbidade e mortalidade. RELATO DE CASO: Uma menina recém-nascida prematura, pesando 1.520 g ao nascimento, com idade gestacional de 29 semanas e 4 dias, desenvolveu síndrome da pele escaldada estafilocócica no quinto dia de vida. As culturas de sangue coletadas no primeiro e quarto dias foram negativas, mas houve desenvolvimento de Pseudomonas aeruginosa e Enterococcus sp. (vancomicina sensível) na hemocultura realizada no dia do óbito (sétimo dia) e Pseudomonas aeruginosa e Serratia marcescens foram identificadas nas culturas de secreção da nasofaringe, nádega e da secreção abdominal. Na cultura do coto umbilical (sétimo dia), além desses dois bacilos Gram-negativos, foi isolado o Staphylococcus aureus resistente à meticilina. O diagnóstico da síndrome da pele escaldada estafilocócica foi baseado em critério clínico.

Assessment of coagulase-negative staphylococci isolated from blood cultures of patients with leukemia in the period 2009-2011 / Avaliação de Staphylococcus coagulase negativo isolados de hemoculturas de pacientes com leucemia no período compreendido entre 2009 a 2011

Leukemic patients have high probability of developing bacteremia, especially due to the impairment of their immune system and as a consequence of chemotherapy. These infections have been growing significantly in different regions, particularly in university hospitals and are responsible for high rates of morbidity and mortality. We evaluated coagulase-negative staphylococci (CoNS) isolated from blood cultures from patients with leukemia. A retrospective study of blood cultures in the period from 2009 to 2011 was conducted at the University Hospital of Santa Maria. In the period of this study was possible to analyze 282 positive blood cultures, being 46.45% (131/282) caused by CoNS. Staphylococcus epidermidis was the prevalent specie. Regarding the hospitalization sectors of patients, the Treatment Center for Children with Cancer showed the highest prevalence, 67.37%. The isolates were predominant in males and in the age group between 0-22 years old. In this study the CoNS represented the most isolated microorganisms. The resistance presented by these microorganisms is a concern since it limits the treatment for bloodstream infections in these patients with compromised immune system. Retrospective studies of prevalence provide us with results for the local epidemiology to be known, considered essential for the antimicrobial treatment, especially when referring to patients with a weakened immune system and admitted in university hospitals.

Pacientes leucêmicos possuem grande probabilidade de desenvolver bacteremia, especialmente devido ao acometimento de seu sistema imune e como consequência da quimioterapia. Esse tipo de infecção vem aumentando significativamente em diferentes regiões, principalmente nos hospitais universitários, e são responsáveis por altas taxas de morbidade e mortalidade. Foram avaliados Staphylococcus coagulase negativos isolados de culturas de sangue de pacientes com leucemia. Realizou-se a avaliação de Staphylococcus coagulase negativo (SCoN) isolados de hemoculturas de pacientes com leucemia. Efetuou-se um estudo retrospectivo das hemoculturas realizadas no período de 2009 a 2011 no Hospital Universitário de Santa Maria. No período deste estudo foi possível analisar 282 hemoculturas positivas, sendo 46,45% (131/282) causadas por SCoN. Staphylococcus epidermidis foi a espécie prevalente. Em relação aos setores de internação dos pacientes, o Centro de Tratamento da Criança com Câncer mostrou a maior prevalência, 67,37%. Os isolamentos predominaram em pacientes do sexo masculino e na faixa etária compreendida entre 0 a 22 anos. Neste estudo os SCoN representaram os microrganismos mais isolados. A resistência apresentada por estes microrganismos constitui preocupação, uma vez que limita as opções de tratamento por infecções de corrente sanguínea neste tipo de pacientes com o sistema imune comprometido. Estudos retrospectivos de prevalência nos fornecem resultados para que seja conhecida a epidemiologia local, considerada essencial para o tratamento antimicrobiano, principalmente quando se refere aos pacientes com o sistema imune debilitado e internados em hospitais universitários.

Análise do Perfil de Sensibilidade frente aos antimicrobianos de bactérias isoladas de bacteremias em um hospital universitário / Análisis de la susceptibilidad de los antimicrobianos frente a bacterias aisladas de bacteriemias en un hospital universitario / Analysis of the antimicrobial susceptibility profile of bacteria isolated from bacteriemias in a university hospital

Introdução: bacteremia é uma das complicações mais frequentes e graves que acometem, principalmente pacientes imunodeprimidos. É responsável por prolongar o período de hospitalização e está associada com elevadas taxas de morbidade e mortalidade dos pacientes internados. Objetivo: identificar os microrganismos associados à bacteriemia e analisar seu perfil de sensibilidade frente aos antimicrobianos em um Hospital Terciário. Métodos: foi realizado um estudo retrospectivo e transversal, no qual foram incluídas todas as hemoculturas em que houve o crescimento de microrganismos viáveis. Resultados: um total de 1080 amostras foram avaliadas neste estudo. O patógeno mais isolado foi o Staphylococcus epidermidis (24 por cento/n=259), seguido do Staphylococcus hominis (6,8 por cento/n=74). Todas as bactérias Gram-positivas foram sensíveis frente à daptomicina, tigeciclina, linezolida e vancomicina. Além do mais, 42,31 por cento dos isolados do gênero Staphylococcus foram caracterizados fenotipicamente como Staphylococcus coagulase negativa resistentes à meticilina (MRSCoN). Conclusão: a maioria das bacteremias foram ocasionadas por Staphylococcus coagule negativos (SCoN). Entre esses, uma taxa considerável foi resistente à meticilina. Dessa forma, o antibioticoterapia deveriam ser reconsiderados, principalmente nos pacientes que sobem a bordo escolas nas unidades críticas(AU)

Introducción: La bacteriemia es una de las complicaciones más comunes y graves que afectan principalmente a pacientes inmunocomprometidos. Incrementa la hospitalización y se relaciona con una alta morbilidad y mortalidad. Objetivo: identificar los microorganismos asociados con bacteriemia y analizar su perfil de susceptibilidad antimicrobiana en un hospital de tercer nivel. Métodos: estudio retrospectivo y transversal que incluyó todos los hemocultivos que mostraron crecimiento de microorganismos viables. Se estudiaron 1080 cultivos. Resultados: El organismo más aislado fue Staphylococcus epidermidis (24 por ciento / n = 259), seguido por Staphylococcus hominis (6,8 por ciento / n = 74). Todas las bacterias grampositivas fueron susceptibles a la daptomicina, tigecyline, vancomicina y linezolid. Por otro lado, el 42,31 por ciento de Staphylococcus coagulasa negativos aislados se caracterizaron fenotípicamente como resistente a la meticilina (MRSCon). Conclusiones: la mayoría de las bacteriemias fueron causadas por Staphylococcus coagulasa negativo con una importante resistencia a la meticilina; en consecuencia, la institución debe volver a analizar el tratamiento antibiótico principalmente para pacientes hospitalizados en unidades de cuidados críticos(AU)

Introduction: bacteremia is one of the most common and serious complications that mainly affect immunocompromised patients. It accounts for the extension of hospitalization and is related to high morbidity and mortality rates in inpatients. Objective: to identify microorganisms associated with bacteremia and to analyze their antimicrobial susceptibility profile in a tertiary hospital. Methods: retrospective and cross-sectional study including all the hemocultures that showed viable microorganism growth. Results: one thousand eighty samples were evaluated in this study. The most isolated pathogen was Staphylococcus epidermidis (24 percent/n=259), followed by Staphylococcus hominis (6.8 percent/n=74). All Gram-positive bacteria were susceptible to Daptomycin, Tigecyline, Vancomycin and Linezolid. On the other hand, 42.31 percent of the isolated Coagulase-negative Staphylococcus were phenotipically characterized as methicillin-resistant (MRSCon). Conclusions: the majority of bacteriemias was caused by Coagulase negative Staphylococcus with significant methicillin-resistance; consequently, the institution must reanalyze the antibiotic treatment mainly for hospitalized patients in critical care units(AU)

Atividade antibacteriana de um composto triazenido com ouro frente a cepas bacterianas e isolados clínicos / Actividad antibacteriana de un triazenido compuesto de oro frente a las cepas bacterianas y los aislados clínicos / Antibacterial activity of gold complexed triazenid against bacterial strains and clinical isolates

Introdução: de uma forma alarmante, estudos demonstraram que nos últimos anos ocorreu um grande aumento na resistência bacteriana frente aos antibióticos. Consequentemente, há uma grande necessidade de descoberta de novas substâncias ativas, e entre essas, os compostos triazenos vêm demonstrado-se como uma classe promissora de metalofármacos, com significativa atividade antimicrobiana. Além do mais, a associação do radical farmacofórico triazenos com metais, como o ouro, favorece a produção de moléculas com maior atividade biológica. Objetivo: avaliar a atividade antibacteriana in vitro do composto triazenos inédito complexado com ouro no estado de oxidação I {(1-(2-bromofenil)-3-(2-nitrofenil)triazenido(trifenilfosfina)ouro(I)}, frente a cepas bacterianas padrões de referência American Type Culture Collection e isolados clínicos com resistência múltipla as drogas (MDR). Métodos: a atividade antibacteriana do composto triazenos foi determinada através do método de Concentração Inibitória Mínima, baseado no Clinical and Laboratory Standards Institute de 2012. A CIM foi caracterizada visualmente, como a menor concentração que inibiu completamente o crescimento dos microrganismos nos poços de diluição. Resultados: o composto em estudo apresentou pronunciada atividade antibacteriana, sendo ativo em 43,4 por cento (10/23) das bactérias testadas, mostrando-se seletivo frente a cepas Gram positivas. Conclusão: o complexo triazenos apresentou estreito espectro de ação, sendo ativo somente frente aos microrganismos classificados como Gram positivos, demonstrando assim uma alternativa para a concepção de uma nova classe de metalofármacos com atividade antibacteriana(AU)

Introducción: de una manera alarmante, los estudios han demostrado que en los últimos años hubo un gran aumento de la resistencia bacteriana a los antibióticos. Por consiguiente, hay una gran necesidad para el descubrimiento de nuevas sustancias activas, y entre estas, los compuestos triazenos se muestran como una clase prometedora de metalofármacos con actividad antimicrobiana significativa. Por otra parte, la asociación de triazeno farmacóforo radical con metales como el oro favorece la producción de moléculas con actividad biológica superior. Objetivo: evaluar la actividad antibacteriana in vitro del compuesto sin precedentes triazeno complejado con oro en el estado de oxidación I {(1-(2-bromofenil)-3-(2-nitrofenil)triazenido(trifenilfosfina)ouro(I)}, frente a las cepas de las normas bacterianas, cepas de referencia American Type Culture Collection y los aislados clínicos con resistencia múltiple a los medicamentos. Métodos: la actividad antibacteriana del triazeno compuesto se determinó por el método de la concentración inhibitoria mínima, sobre la base de estándares clínicos y de laboratorio de 2012. Este método se caracteriza visualmente como la menor concentración que inhibió completamente el crecimiento de microorganismos en los pocillos de dilución. Resultados: el compuesto de ensayo mostró actividad antibacteriana pronunciada, el cual fue activo en 43,4 por ciento (10/23) de las bacterias ensayadas, uy mostró ser selectivo contra las cepas grampositivas. Conclusión: el complejo triazeno mostró estrecho espectro de acción, el cual es activo solo frente a los microorganismos clasificados como grampositivos, lo que demuestra una alternativa para la concepción de una nueva clase de metalofármacos con actividad antibacteriana(AU)

Introduction: several studies have revealed that the increase of bacterial resistance to antibiotic is really alarming in the last few years. Consequently, the discovery of new active substances is a must and the triazene compounds appear as a promising class of metal drugs with significant antimicrobial action. On the other hand, the association of radical pharmacophorous triazene with metals such as gold facilitates the production of greater biological action molecules. Objective: to evaluate the in vitro antibacterial activity of this unprecedented compound called gold complexed with triazene at oxidation state I {(1-(2-bromophenyl)-3-(2-nitrophenyl)triazenide (triphenylphosphane) gold(I)} against the bacterial standard strains, American Type Culture Collection reference strains and the multiple drug resistance clinical isolates. Methods: the antibacterial activity of the compound triazene was estimated by the minimal inhibitory concentration method on the basis of the clinical and laboratory standards 2012. This method is visually characterized as the lowest concentration that fully inhibited the bacterial growth in the dilution wells. Results: the tested compound showed significant antibacterial activity, being active in 43.4 percent (10/23) of tested bacteria and selective for Gram-positive strains. Conclusions: triazene complex showed narrow action spectrum since it is only active against Gram-positive microorganisms, which is in turn an alternative for conception of a new class of metal drugs with antibacterial action(AU)

Fasciite necrosante por Streptococcus agalactiae em paciente diabética ? relato de caso / Necrotizing fasciitis caused by Streptococcus agalactiae in a diabetic patient ? case report

Objetivos: Descrever um caso de fasciite necrosante e choque séptico ocasionado por Streptococcus agalactiae, que acometeu uma paciente com diabetes mellitus. Esta análise foi realizada através dos dados do prontuário e resultados de exames laboratoriais da paciente, que estava internada no Hospital Universitário de Santa Maria, em Santa Maria, Rio Grande do Sul.Descrição do caso: Paciente do gênero feminino, 73 anos, diagnosticada com diabetes mellitus e cirrose micronodular, foi internada com suspeita de septicemia, simultânea a uma infecção no membro inferior esquerdo, cuja hipótese diagnóstica inicial foi de celulite. Pelas características do quadro clínico, foi feito o diagnóstico de fasciite necrosante. Hemoculturas de dois sítios diferentes positivaram para S. agalactiae. A paciente foi a óbito por choque séptico.Conclusões: O relato deste caso enfatiza a gravidade da fasciite necrosante, que pode ocorrer principalmente em pacientes portadores de fatores predisponentes como diabetes mellitus e cirrose.

Aims: To report an unusual case of necrotizing fasciitis and septic shock caused by Streptococcus agalactiae, which affected a patient with diabetes mellitus. This analysis was performed using data from medical records and laboratory tests results, who was admitted to the University Hospital of Santa Maria, in Santa Maria, Rio Grande do Sul, Brazil.Case description: Female patient, 73 years old, diagnosed with diabetes mellitus and micronodular cirrhosis, was admitted with suspected septicemia simultaneous with an infection in the left lower limb, which initial diagnostic hypothesis was cellulitis. Based on characteristics of the clinical picture, the diagnosis of necrotizing fasciitis was done. Blood cultures from two different sites were positive for S. agalactiae. The patient died with septic shock.Conclusions: This case report emphasizes the severity of necrotizing fasciitis, which may occur especially in patients with predisposing factors such as diabetes mellitus and cirrhosis.

Bacteriological analysis of platelets and cases of septic reactions associated with transfusion of contaminated samples.

INTRODUCTION: For years, platelet transfusion therapy has been playing an important role in controlling patients with hematological and oncological diseases. However, platelet transfusion represents a serious risk for bacterial sepsis. This study aimed to verify the bacterial contamination index in platelet concentrates (PCs) obtained from the Blood Center of the State of Rio Grande do Sul (HEMORGS). METHODS: All 612 samples of PCs from HEMORGS were analyzed in August 2009 and January 2010. We used a qualitative methodology which was modified manually in order to detect bacterial contamination. The patients who received the platelet units with confirmed positive cultures had their medical records analyzed. After the prospective study, a retrospective analysis of the samples of PCs checked by the bacteriological control from HEMORGS since its foundation (2008) until 2010 was made. RESULTS: Four hundred and eighty samples (10 monthly samples of plateletpheresis and 10 of whole blood-derived platelets) were analyzed in order to compare the contamination index for both studies. Of 1092 samples, 15 were found to be contaminated (6 of retrospective analysis and 9 of prospective). In prospective study, isolated microorganisms were nine Staphylococcus epidermidis, but in retrospective two Staphylococcus sp., two glucose non-fermenting gram negative bacilli, one Streptococcus sp. and one Proteus mirabilis. We report 3 feasible cases of bacterial sepsis associated with the transfusion of CPs analyzed by prospective study. CONCLUSION: Bacterial sepsis associated with platelet transfusion is today the most frequent infectious complication of transfusion medicine. Although complex, it is important to recognize transfusion sepsis in patients to reduce morbidity and mortality.

Evaluation of bacterial growth inhibition by mercaptopropionic acid in metallo-ß-lactamase detection on multidrug-resistant Acinetobacter baumannii.

INTRODUCTION: Metallo-ß-lactamase (MBL) has been reported all over the world. METHODS: The inhibitory effect of mercaptopropionic acid (MPA) on bacterial growth was evaluated by comparison between disk diffusion and broth dilution methodology with determination of the minimum inhibitory concentration (MIC) for multidrug-resistant Acinetobacter baumanni strains. RESULTS: MPA significantly inhibited growth of the strains. CONCLUSIONS: The use of MPA can affect the results in phenotypic methods of MBL detection.

[Bacterial contamination on platelet concentrates: identification, antimicrobial susceptibility profile and transfusion-related sepsis]. / Contaminação bacteriana em concentrados plaquetários: identificação, perfil de sensibilidade aos antimicrobianos e sepse associada à transfusão.

INTRODUCTION: Bacterial sepsis associated with the transfusion of platelet concentrates (PCs) results in serious clinical implications for patients. Given these implications, certain procedures have been integrated into the preparation and quality control of blood components to reduce the risk of bacterial contamination. This article describes the prevalence of bacterial contamination on transfused PCs, the bacterial spectrum detected and their antimicrobial susceptibility profile and transfusion reactions in receptors. METHODS: A total of 292 PCs (278 random and 14 per apheresis) from the Blood Center of the State of Rio Grande do Sul (HEMORGS), located in the city of Santa Maria, were tested. Quantities of 100 µL and 200 µL were collected from platelet bag tubing and seeded using two methodologies. RESULTS: Using the qualitative methodology, bacteria were isolated in five units (1.7%; 5/292), while only one was isolated using the quantitative methodology. Staphylococcus epidermidis was the microorganism identified in all samples. Two patients died of transfusion-related sepsis. CONCLUSIONS: Bacterial contamination due to PC transfusion is considered a major public health problem due to its association with high rates of morbidity and mortality. In this study only gram-positive microorganisms were isolated and none of the samples obtained by apheresis presented contamination.

[Oxacillin-resistant coagulase-negative Staphylococci bacteremia at a teaching hospital in Santa Maria, State of Rio Grande do Sul, Brazil]. / Bacteremias por Staphylococcus coagulase negativos oxacilina resistentes em um hospital escola na cidade de Santa Maria, Estado do Rio Grande do Sul.

INTRODUCTION: This study aimed to characterize the prevalence and susceptibility profile to oxacillin-resistant Coagulase-negative Staphylococci strains isolated from blood cultures in a teaching hospital, located in Santa Maria, RS. In addition, different methodologies for phenotypic characterization of mecA-mediated oxacillin resistance were compared with genotypic reference testing. METHODS: After identification (MicroScan - Siemens), the isolates were tested for antimicrobial sensitivity using disk diffusion and automation (MicroScan - Siemens). The presence of mecA gene was identified by the polymerase chain reaction molecular technique. RESULTS: The most common species was Staphylococcus epidermidis (n=40, 67%). The mecA gene was detected in 54 (90%) strains, while analysis of the sensitivity profiles revealed a high rate of resistance to multiple classes of antimicrobial drugs. However, all isolates were uniformly sensitive to vancomycin and tigecycline. The cefoxitin disk was the phenotypic method that best correlated with the gold standard. CONCLUSIONS: Analysis of the clinical significance of CoNS isolated from hemocultures and the precise detection of oxacillin resistance represent decisive factors for the correct choice of antibiotic therapy. Although vancomycin constitutes the normal treatment in most Brazilian hospitals, reduction in its use is recommended.

Contaminação bacteriana em concentrados plaquetários: identificação, perfil de sensibilidade aos antimicrobianos e sepse associada à transfusão / Bacterial contamination on platelet concentrates: identification, antimicrobial susceptibility profile and transfusion-related sepsis

INTRODUÇÃO: Devido à sepse bacteriana associada à transfusão de concentrados plaquetários (CPs) ter sérias consequências clínicas para os pacientes, alguns procedimentos têm sido incorporados na preparação e no controle de qualidade dos componentes sanguíneos para reduzir o risco da contaminação bacteriana. Este artigo descreve a prevalência da contaminação bacteriana dos CPs que foram transfundidos, o espectro bacteriano detectado com seu perfil de sensibilidade aos antimicrobianos e as reações transfusionais nos receptores. MÉTODOS: Um total de 292 CPs (278 randômicos e 14 por aférese), proveniente do Hemocentro do Estado do Rio Grande do Sul (HEMORGS) de Santa Maria foi testado. As quantidades de 100μL e 200μL foram coletadas da porção tubular da bolsa de plaquetas e semeadas utilizando dois tipos de metodologias. RESULTADOS: Em cinco unidades(1,7 por cento; 5/292) foram isoladas bactérias pela metodologia qualitativa e apenas uma pela quantitativa. Staphylococcus epidermidis foi o microrganismo identificado em todas as amostras. Dois pacientes apresentaram sepse associada à transfusão com desfecho fatal. CONCLUSÕES: A contaminação bacteriana pelas transfusões de CPs constitui-se num importante problema de saúde pública devido a sua associação com altas taxas de morbidade e mortalidade. Neste estudo, somente microrganismos gram-positivos foram isolados sendo que nenhuma amostra obtida por aférese apresentou contaminação.

INTRODUCTION: Bacterial sepsis associated with the transfusion of platelet concentrates (PCs) results in serious clinical implications for patients. Given these implications, certain procedures have been integrated into the preparation and quality control of blood components to reduce the risk of bacterial contamination. This article describes the prevalence of bacterial contamination on transfused PCs, the bacterial spectrum detected and their antimicrobial susceptibility profile and transfusion reactions in receptors. METHODS: A total of 292 PCs (278 random and 14 per apheresis) from the Blood Center of the State of Rio Grande do Sul (HEMORGS), located in the city of Santa Maria, were tested. Quantities of 100μL and 200μL were collected from platelet bag tubing and seeded using two methodologies. RESULTS: Using the qualitative methodology, bacteria were isolated in five units (1.7 percent; 5/292), while only one was isolated using the quantitative methodology. Staphylococcus epidermidis was the microorganism identified in all samples. Two patients died of transfusion-related sepsis. CONCLUSIONS: Bacterial contamination due to PC transfusion is considered a major public health problem due to its association with high rates of morbidity and mortality. In this study only gram-positive microorganisms were isolated and none of the samples obtained by apheresis presented contamination.

Bacteremias por Staphylococcus coagulase negativos oxacilina resistentes em um hospital escola na cidade de Santa Maria, Estado do Rio Grande do Sul / Oxacillin-resistant coagulase-negative Staphylococci bacteremia at a teaching hospital in Santa Maria, State of Rio Grande do Sul, Brazil

INTRODUÇÃO: Neste estudo, objetivou-se caracterizar a prevalência e o perfil de suscetibilidade de cepas de Staphylococcus coagulase negatives resistentes à oxacilina isoladas de culturas de sangue, em um hospital escola, localizado na Cidade de Santa Maria. Além disso, buscou-se comparar ao teste genotípico de referência, diferentes metodologias fenotípicas para a caracterização da resistência mediada pelo gene mecA. MÉTODOS: Após identificação (MicroScan® - Siemens), os isolados foram submetidos a testes de sensibilidade antimicrobiana a partir da difusão do disco e automação (MicroScan® - Siemens). A presença do gene mecA foi evidenciada através da técnica molecular de reação em cadeia da polimerase. RESULTADOS: A espécie prevalente foi Staphylococcus epidermidis (67 por cento). O gene mecA foi detectado em 90 por cento das cepas e conforme análise dos perfis de sensibilidade, observou-se um índice elevado de resistência a várias classes de antimicrobianos. Contudo, todos os isolados mostraram-se uniformemente sensíveis à vancomicina e tigeciclina. O disco de cefoxitina foi a metodologia fenotípica que melhor correlacionou-se com o padrão ouro. CONCLUSÕES: A análise da significância clínica de SCN isolados de hemoculturas e a detecção precisa da resistência à oxacilina representam fatores decisivos para a instituição correta da antibioticoterapia. Apesar da vancomicina constituir o tratamento usual na maioria dos hospitais brasileiros, tem a redução de seu emprego recomendada.

INTRODUCTION: This study aimed to characterize the prevalence and susceptibility profile to oxacillin-resistant Coagulase-negative Staphylococci strains isolated from blood cultures in a teaching hospital, located in Santa Maria, RS. In addition, different methodologies for phenotypic characterization of mecA-mediated oxacillin resistance were compared with genotypic reference testing. METHODS: After identification (MicroScan® - Siemens), the isolates were tested for antimicrobial sensitivity using disk diffusion and automation (MicroScan® - Siemens). The presence of mecA gene was identified by the polymerase chain reaction molecular technique. RESULTS: The most common species was Staphylococcus epidermidis (n=40, 67 percent). The mecA gene was detected in 54 (90 percent) strains, while analysis of the sensitivity profiles revealed a high rate of resistance to multiple classes of antimicrobial drugs. However, all isolates were uniformly sensitive to vancomycin and tigecycline. The cefoxitin disk was the phenotypic method that best correlated with the gold standard. CONCLUSIONS: Analysis of the clinical significance of CoNS isolated from hemocultures and the precise detection of oxacillin resistance represent decisive factors for the correct choice of antibiotic therapy. Although vancomycin constitutes the normal treatment in most Brazilian hospitals, reduction in its use is recommended.