Outbreaks of colistin-resistant and colistin-susceptible KPC-producing Klebsiella pneumoniae in a Brazilian intensive care unit.

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE), especially those that produce Klebsiella pneumoniae carbapenemase (KPC) and are associated with colistin resistance, pose a severe health threat due to the limited treatment options. AIM: To describe two outbreaks of KPC-producing K. pneumoniae in an adult intensive care unit (AICU) in Brazil. In May 2015, 14 patients had colistin-susceptible KPC-producing strains (ColS-KPC), and in July 2015, nine patients had colistin-resistant KPC-producing strains (ColR-KPC). METHODS: Between September 2014 and August 2015, we performed surveillance at a university hospital and all CRE were tested for blaKPC genes. Clonality was investigated by pulsed-field gel electrophoresis. Resistance to colistin was confirmed by broth microdilution method. Consumption of carbapenems and colistin was expressed as defined daily doses. FINDINGS: In all, 111 patients with CRE were identified during the surveillance period; K. pneumoniae was the major isolate (77.13%). The two outbreaks were identified when infection rates (KPC per 1000 patient-days) exceeded the background level. Rates of carbapenem and colistin consumption were high. Control measures (bedside alcohol gel, contact precautions, regular rectal swabs) did not curtail the outbreaks. Mortality rates were 42.9% and 44.4% for ColS-KPC- and ColR-KPC-infected patients, respectively. After the death of four infected patients with ColR-KPC, the unit was closed to new admissions. CONCLUSION: Our experience demonstrates the serious risks presented by KPC, and especially ColR-KPC, in Brazilian AICUs. Selective pressure from excessive antibiotic use and transmission on healthcare workers' hands were likely the major factors in transmission.

New magnetic fluid developed with natural organic compounds biocompatible.

This work was developed with an aqueous suspension of maghemite nanoparticles and colloidal emulsions with nanoparticles of magnetite. The nanoparticles were synthesized by co-precipitation method. The first was the magnetic emulsion nanoparticles of maghemite dispersed in the aqueous extract obtained from the leaf embauba (Cecropia Obtusifolia), whose tree is native to Central and South America. Thereby achieving the magnetic fluid extract embauba stabilized with ionic buffer solution pH 7.4. A second emulsion was prepared with colloidal magnetite nanoparticles with surfaces previously coated with oleic acid as a means of dispersing and using the oil extracted from in nature seed Andiroba (Carapa Guianensis), tree of the Brazilian Amazon. These new magnetic fluids the nanoparticles were characterized by Photoacoustic spectroscopy (PAS) to determine the coating layer of molecules on the surfaces of nanoparticles. In aqueous ionic magnetic fluid Cecropia Obtusifolia (MFCO) chlorogenic acid contributes to the electron density in the presence of four groups alcohols, a ketone group and a carboxylic group. In magnetic fluid-based oil andiroba MFAD PAS spectra show that oleic acid molecules are tightly linked on the surface of the nanoparticles.

[Anhidrotic ectodermal dysplasia syndrome in the neonatal period - case report] / Síndrome da displasia ectodérmica anidrótica no período neonatal - relato de caso.

OBJECTIVE: To describe a rare syndrome affecting children, and to urge pediatricians to consider this diagnosis when investigating idiopathic fever in neonates. METHODS: We report a case of anhidrotic ectodermal dysplasia syndrome in a 10 day old newborn in the neonatal intensive care unit at Hospital Geral de Caxias do Sul. The child presented recurrent episodes of fever since the first days of life. RESULTS: The patient presented dry mucus, dry skin, and fever. Skin biopsy was performed in the childacute;s back. Absence of sweat and sebaceous glands as well as hypoplasia of follicular structures were identified. The patient is receiving adequate treatment, and is being followed as an outpatient. CONCLUSION: Anhidrotic ectodermal dysplasia syndrome is a rare disorder that must be considered when investigating newborns with recurrent episodes of fever. During the neonatal period, the clinical manifestations of the disease are subtle and unspecific. Such findings become more visible after a few months of life. There is no definitive treatment for this syndrome.

[Early neonatal mortality in Caxias do Sul: a cohort study] / Mortalidade neonatal precoce no município de Caxias do Sul: um estudo de coorte.

OBJECTIVES: To establish the profile of neonates in Caxias do Sul city, and to study early neonatal mortality, its causes and related variables.METHODS: This cohort study enrolled 5,545 newborns, which were followed up to 7 days after birth. The probability of early neonatal mortality was calculated and multiple logistic regression was performed to relate all studied variables to the outcome of early neonatal death.RESULTS: The observed probability of early neonatal mortality was 7.44 per thousand live births. The incidence of premature births and low birth weight was 9.4% and 8.1%, respectively. Fifty five percent of the neonates were born through cesarean section, which were related to socioeconomic and educational level. Previous history of neonatal mortality, maternal age > 35 years, gestational age, Apgar score < 7, male sex and low birth weight were related to early neonatal death. The main cause of death was hyaline membrane disease, followed by congenital cardiopaties, extreme preterm and abruptio placentae.CONCLUSION: Even though the observed probability of early neonatal mortality was low, some deaths may have been avoided if better prenatal and delivery care, as well as newborn assistance had been offered.