Clonality, outer-membrane proteins profile and efflux pump in KPC- producing Enterobacter sp. in Brazil.

BACKGROUND: Carbapenems resistance in Enterobacter spp. has increased in the last decade, few studies, however, described the mechanisms of resistance in this bacterium. This study evaluated clonality and mechanisms of carbapenems resistance in clinical isolates of Enterobacter spp. identified in three hospitals in Brazil (Hospital A, B and C) over 7-year. METHODS: Antibiotics sensitivity, pulsed-field gel electrophoresis (PFGE), PCR for carbapenemase and efflux pump genes were performed for all carbapenems-resistant isolates. Outer-membrane protein (OMP) was evaluated based on PFGE profile. RESULTS: A total of 130 isolates of Enterobacter spp were analyzed, 44/105 (41, 9%) E. aerogenes and 8/25 (32,0%) E. cloacae were resistant to carbapenems. All isolates were susceptible to fosfomycin, polymyxin B and tigecycline. KPC was present in 88.6% of E. aerogenes and in all E. cloacae resistant to carbapenems. The carbapenems-resistant E. aerogenes identified in hospital A belonged to six clones, however, a predominant clone was identified in this hospital over the study period. There is a predominant clone in Hospital B and Hospital C as well. The mechanisms of resistance to carbapenems differ among subtypes. Most of the isolates co-harbored blaKPC, blaTEM and /or blaCTX associated with decreased or lost of 35-36KDa and or 39 KDa OMP. The efflux pump AcrAB-TolC gene was only identified in carbapenems-resistant E. cloacae. CONCLUSIONS: There was a predominant clone in each hospital suggesting that cross-transmission of carbapenems-resistant Enterobacter spp. was frequent. The isolates presented multiple mechanisms of resistance to carbapenems including OMP alteration.

Candida parapsilosis candidaemia in a neonatal unit over 7 years: a case series study.

OBJECTIVE: To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years. DESIGN: Case series study. SETTING: A 2000-bed tertiary-care university hospital at São Paulo, Brazil. PARTICIPANTS: Neonates hospitalised in a 63-bed neonatal unit. PRIMARY AND SECONDARY OUTCOME MEASURES: We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 through 2008 and the main microbiological, clinical and epidemiological aspects of this disease in neonates. During the study period an outbreak occurred, an infection control programme was implemented, and isolates from blood and hand healthcare workers (HCWs) were submitted to molecular typing. RESULTS: During 7 years, there were 36 cases of C parapsilosis fungaemia and annual incidence varied from 0 to 19.7 per 1000 admissions. Evaluating 31 neonates with fungemia, the mean age at diagnosis was 19 days. All children except for one were premature; all had received total parenteral nutrition and all but one had used central venous catheter. Three neonates had received antifungal treatment previously to the diagnosis. Thirty-day mortality was 45%. Only lower birthweight was associated with mortality. C parapsilosis species complex was isolated from hand cultures in eight (11%) of the HCWs (one isolate was identified as C orthopsilosis). By molecular typing no HCW isolate was similar to any of the blood isolates. CONCLUSIONS: The incidence of C parapsilosis fungemia in a neonatal unit varied widely over 7 years. We observed in our series a higher death rate than that reported in European countries and the USA.

Melhorando a aderência a higienização das mãos em uma Unidade de Terapia Intensiva / Improving adherence of hands hygiene in a Intensive Care Unit

A higienização das mãos é a medida mais simples, com menor custo e mais efetiva na prevenção das infecções hospitalares. Considerando a baixa adesão ao procedimento, optamos por avaliar o impacto de soluções alcoólicas na higienização das mãos. Avaliar a adesão dos profissionais de saúde à higiene das mãos com o uso de soluções alcoólicas. Observação direta para coleta de dados de prática de higiene das mãos. Uso do software Epi-Info 6.0 para análise dos resultados. Foram realizadas 603 observações de oportunidades/indicações de higienização. Ocorreu um aumento na adesão à higienização das mãos com o uso de soluções alcoólicas (17 por cento versus 28 por cento, p< 0,05). Houve um aumento significativo na adesão à higiene das mãos após a introdução de soluções alcoólicas.

Efectos de la asignación enfermera-paciente a través de la evaluación clínica (TISS-28) / Effects of patient-nurse assignment through clinical evaluation (TISS-28)

Introducción: En la década de los 70' en el Instituto Mexicano del Seguro Social (IMSS) se realizaron investigaciones para determinar el índice enfermera-paciente, con el propósito de dotar a los servicios de los recursos humanos, sin embargo dada la situación dinámica de los servicios es necesario tener un sistema que permita la reasignación de los recursos. Objetivo: Evaluar el resultado de la asignación enfermera-paciente a través de un sistema de evaluación clínica del paciente en unidades de cuidados intensivos (TISS-28). Metodología: Se efectuó un estudio cuasi-experimental, se capacitó al personal de enfermería para que valorara a los pacientes que ingresaran a la UCI, y de acuerdo al puntaje obtenido se determinó el número de pacientes que cada enfermera debía atender. Se llevó un registro de los días estancia de los pacientes. Resultados: La valoración de los pacientes al ingreso demandó la asignación de una enfermera por paciente, mismo que fue modificándose; para el tercer día la relación cambió del 1:2 o 1:3 y los días estancia no rebasaron los 5 días con una significancia estadística de <0.001. Conclusiones: La asignación enfermera-paciente según complejidad de los procedimientos de enfermería requeridos, evaluados por TISS-28 disminuyó los días estancia de los pacientes en la unidad de cuidados intensivos post-quirúrgica del hospital en estudio.

At the Mexican Institute of Social Security from 1971 to 1973, several studies have been conducted in relation to the nurse-patient index under the following criteria: a) definition of the indexes according to the type of unit; b) distribution of labor time and c) adequate hierarchiazation in teaching and intedepartamental relationships. Due to this we decided to assess the impact of nurse-patient designation using a patient clinical assessment system in intensive care units based on the application of the TISS 28 that determines the nurse-patient index according to specific nursing care. Objective: Assess the impact of the nurse-patient designation through a clinical assessment system of patients at a Post Surgical Intensive Care Unit. Methodology: A quasi-experimental study was conducted. The population studied was constituted by patients at the Post-Surgical Intensive Care Unit. A patient census was taken of those patients that were admitted during the study. Results: The number of days patients were hospitalized presented statistically significant differences. Conclusions: The nurse-patient designation significantly decreased the number of days of hospitalization of patients admitted to the post-surgical intensive care unit.

CONSTRUCCION DE PUENTES CON INCRUSTACIONES TIPO BROCHE, EN EL TERCIO MEDIO DE LAS CARAS PALATINAS Y/O LINGUALES DE LAS PIEZAS DENTARIAS

Este tipo de puentes está indicando en pacientes de todos los estratos sociales, puesto qu elas incrustaciones metálicas no sólo pueden construirse en rexilium, sino, en cualquier otro metal. Esta indicandopara la construcción en el sector anterior, como posterior, de la arcada dentaria. Está indicado para reemplazar una sola pieza dentaria perdida, sea anterior o posterior. Por la forma de la preparación cavitaria nos garantiza una retención y estabilidad del puente. En este trabajo no se ve el metal por vestibular, lo cuál satisface al paciente desde el punto de vista estético. No se recomienda para la construcción tomar en cuenta dientes versionados, careados o con obturación, poque al preparar la cavidad que alojará las incrustaciones debilitaria las paredes de dichos pilares. Este puente no es recomendado para reemplazar más de dos piezas dentarias, puesto que se toma en cuenta tan sólo dos pilares como soporte

Linfadenite inguinal ulcerada tuberculosa / Ulcered inguinal lynfadenitis tuberculose

Os autores apresentam relato de três casos de linfadenite inguinal ulcerada tuberculosa. A escassez de casos na literatura motivou-nos esta apresentaçäo

Estudo clínico-epidemiológico de 1.001 casos de doença meningocócica no Instituto Estadual de Infectologia Säo Sebastiäo 1983-1988 / Clinical-epidemiological study of 1.001 cases of meningococcal diseases in the Säo Sebastiäo Institute of Infectolohy in the period 1983-1985

A thousand and one cases were revised in retrospective of the meningococcal disease in the Säo Sebastiäo Institute of Infectology in the period 1983-1988. Tjhe criteria for inclusion were: symptoms compatible with meningococcal diseae (petechiae and/or purpura associated or not to meningitidis), detection of gram negative diplicocci, test of the latex and/or positive culture in the CSF for N. meningitis. Tje progressive increase occurred in the number of cases without having any lost in the older age group. Predominance remained of 78% in children of 12 years, bein 46% in children of 4 years, with a greater incidence in males. The greater number of cases occured in the second half of the year. The death rate remained about 15%, and the death occurred mainly in the first 24 hours. The diagnosis was made on a bacteriological bais in 83.2% of the cases. Of the total of 805 cultures realized 33.7% were positive but not identified, 7.8% of group A, 31.3% of the group B, 5.4% of the group C and 21.6% negtive. A predominance occurred of the serogroup b beginning in 1985. The clinical form more frequent was the meningoencephalitis 42.7%, followed by meningitis with purpura 36%, purpura with meningitidis and shock 10.9%, purpura with shock 6.8%, and purpura without meningitidis 2.7%. Deafness was the most common residual effect totalizing 3% of the cases