Is the Oral Cavity of Intensive Care Unit Pediatric Patients More Susceptible to Methicillin-Resistant Staphylococcus aureus Infection?

Objective: The aim of this study was to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the oral cavity of pediatric patients hospitalized at an intensive care unit (ICU). Methodology: Thirty ICU patients (group 1) and 30 healthy patients (group 2), between 1 and 12 years of age, matched by sex and age, were selected from a public hospital in Brazil. After oral examinations, biological specimens (nostril swab, oral mucosa, and supragingival biofilm) were collected from both groups to verify the presence of Staphylococcus aureus. Identification occurred after growth in Tryptic Soy Broth with 7.5% of NaCl for 48 hours, growth in Mannitol Salt Agar, gram staining, catalase, and coagulase tests. S. aureus isolates were submitted to antibiotic sensitivity test. Results: Only 36.7% of patients in the ICU perform oral hygiene during the hospitalization period and 41.7% presented high level of dental biofilm accumulation. The presence of S. aureus was similar in patients from group 1 (43.3%, 13) and group 2 (50.0%, 15) (p = 0.60). Both groups presented 18 samples each that tested positive for S. aureus. However, when considering patients infected by MRSA, the prevalence was higher in group 1 (eight; 26.7%) than in group 2 (five; 16.7%) but no statistical difference was observed (p = 0.53). In group 1, nine MRSA samples were resistant to erythromycin and seven to clindamycin. In group 2, two MRSA samples were resistant to erythromycin and two to clindamycin. Conclusions: Although ICU children did not show a significant higher carriage of MRSA when compared with the healthy group in the population studied, the number of highly resistant strains in the oral cavity isolated from ICU patients adds an important risk factor to be considered by the medical team as possible source of systemic infections, extended hospital stay, and poor outcomes.

Garré`s osteomyelitis: a case report with a 6-month follow-up

Introduction: Garrè's osteomyelitis is a rare, chronic infection associated with proliferative periostitis that induces reactional bone neoformation. Objective: To report the clinical case of successful treatment of Garre's osteomyelitis in a young patient. Case report: An 11-year-old girl visited a dental clinic with complaints of volume increase in the mandibular border accompanied by pain and facial asymmetry. Computed tomography revealed extensive tooth destruction, a periapical lesion, and several radiopaque bone laminations parallel to the mandible cortex, all findings suggestive of Garrè's osteomyelitis. The patient was treated by tooth removal and antibiotic therapy, and the condition was completely resolved, with decreased facial asymmetry at the 6-month follow up. Conclusion: Once the diagnosis of Garrè's osteomyelitis is established and proper treatment is provided, the prognosis tends to be extremely favorable and bone remodeling should be considered until the affected surface returns to its normal anatomy.

Introdução: A osteomielite de Garrè é um tipo raro e crônico de infecção óssea associado a periostite proliferativa que induz neoformação óssea reacional. Objetivo: relatar o caso clínico de osteomielite de Garrè em uma paciente jovem tratada com sucesso. Relato de caso : Paciente do gênero feminino, 11 anos compareceu ao serviço odontológico com queixa de aumento de volume em borda de mandíbula acompanhada de dor e assimetria facial. A tomografia computadorizada revelou extensa destruição dentária associada a lesão periapical e a presença de várias laminações ósseas radiopacas paralelas ao cortical da mandibula, sugerindo o diagnóstico de osteomielite de Garrè. O caso foi tratado com a remoção do elemento dentário associado a antibioticoterapia, o que resolveu completamente a infecção e diminuiu a assimetria facial conforme constatado após 6 meses de proservação. Conclusão: Uma vez estabelecido o diagnóstico de osteomielite de Garrè, e a infecção adequadamente tratada, o prognóstico tende a ser extremamente favorável e a remodelação óssea deve ocorrer continuamente até que a superfície retorne à sua anatomia normal.

Análise clínica e prevalência de espécies de candida na cavidade bucal de pacientes pediátricos hospitalizados em UTI / Clinical analysis and prevalence of Candida species in the oral cavity of pediatric patients hospitalized in ICU

O presente estudo teve como objetivo determinar a condição bucal e a prevalência de Candida spp na cavidade bucal de pacientes pediátricos internados em UTI e comparar os dados encontrados com um grupo controle. Para isso, foram selecionados 30 pacientes de UTI (grupo I) e 30 pacientes saudáveis (grupo II), com idade entre 1 e 12 anos, pareados por sexo e idade. Inicialmente, foram realizados, a coleta de dados e exames intra e extra-bucais. Após essa etapa, espécimes clínicos (swab de mucosa e biofilme supragengival) foram coletados de ambos os grupos para verificar o crescimento positivo das espécies de Candida. Estes foram cultivados em meio de cultura CHROMagar® e as colônias que apresentaram crescimento foram armazenadas e posteriormente identificadas através da espectrometria de massa (MALDI-TOF MS®). Observou-se que 100% do grupo II e apenas 36.7% dos pacientes de UTI realizavam higiene bucal e de acordo com os resultados obtidos os índices de biofilme foram maiores e mais significativos no grupo I. O crescimento de espécies de Candida, tanto em biofilme quanto em swab, foi maior no grupo I e a espécie mais prevalente foi a C. guilliermondii (61,5% em swab e 46.2% em biofilme) seguida da C. albicans (34.6% em ambos os espécimes). A média de unidades formadoras de colônia (UFC) apresentou diferença significativa entre os grupos (p=0,01), sendo que o grupo I foi o único que apresentou crescimento forte. Houve correlação significativa entre o motivo de internação referente a infecção bacteriana e necessidades odontológicas. Os resultados foram analisados através do SPSS versão 20 e comparados por meio dos testes Qui-quadrado e Man- Whitney com nível de significância de 95% (p≤0,05). Dessa forma, conclui-se que os pacientes internados em UTI apresentam maior necessidade de tratamentos odontológicos e crescimento mais significativo de espécies de Candida, em relação aos pacientes saudáveis. O que ressalta a importância da presença do cirurgião- dentista em ambiente hospitalar. (AU)

The present study aimed to determine the oral condition and prevalence of Candida spp into the oral cavity of pediatric patients hospitalized in ICU and compare the data found with a control group. For this, 30 ICU patients (group I) and 30 healthy patients (group II), aged between 1 and 12 years, matched by sex and age, were selected. Initially, data collection and intra- and extra-oral examinations were performed. After that, clinical specimens (mucosal swab and supragingival biofilm) were collected from both groups to verify positive growth of the Candida species. These were grown in CHROMagar® and colonies showing growth were stored and subsequently identified by mass spectrometry (MALDI-TOF MS®). According to the results, it was observed that 100% of group II and only 36.7% of ICU patients performed oral hygiene and that the biofilm indexes were increased and more significant in group I. The growth of Candida species, both in biofilm and swab was higher in group I and the most prevalent species was C. guilliermondii (61.5% in swab and 46.2% in biofilm) followed by C. albicans (34.6% in both specimens). The mean number of colony trainning unit (CTU) presented a significant difference between the groups (p = 0.01), and the group I was the only one that presented strong growth. There was a significant correlation between reasons for hospitalization due to bacterial infection and dental needs. The results were analyzed using SPSS version 20 and compared using Kruskall Wallis and Man- Whitney tests with a significance level of 95% (p≤0.05). Thus, it is concluded that ICU patients present a greater need for care and dental treatments and a more significant growth of Candida species, in relation to healthy patients. This highlights the importance of dentist's presence in a hospital. (AU)