Inter-hospital dissemination of glycopeptide-resistant Enterococcus faecalis in Brazil.

The antimicrobial susceptibility patterns of 73 glycopeptide-resistant Enterococcus faecalis isolates from nine hospitals in Brazil were analysed by the disk diffusion method and Etests. Isolates were typed by pulsed-field gel electrophoresis (PFGE), and vancomycin resistance genes were detected by PCR. The isolates shared a single major PFGE pattern, with six subtypes, and all were positive for vanA. These results indicate the occurrence of inter-hospital dissemination of glycopeptide-resistant E. faecalis in São Paulo, and raise concerns about the rapid dissemination of this pathogen throughout Brazil.

In vitro antimicrobial activity of the aminoglycoside arbekacin tested against oxacillin-resistant Staphylococcus aureus isolated in Brazilian hospitals.

Arbekacin is an aminoglycoside used in Japan for treating infections caused by gentamicin and oxacillin-resistant S. aureus (ORSA). The objective of this study was to determine the in vitro antimicrobial activity of arbekacin against 454 clinical isolates of ORSA. The isolates were consecutively collected between January and July, 2000, from patients hospitalized in 8 Brazilian medical centers. The antimicrobial susceptibility testing was performed by disk diffusion method according to NCCLS recommendations. The vast majority of the isolates, 453 strains (99.8%), were considered susceptible to arbekacin based on the criteria proposed by the Requirements for Antibiotic Products of Japan. Only 1 isolate (0.2%) was classified as resistant. On the other hand, high rates of resistance were demonstrated for other aminoglycosides, such as gentamicin (97.6% resistance) and amikacin (97.0% resistance). Resistance rate was also high for ciprofloxacin (98.0%). All isolates were considered susceptible to vancomycin. The excellent in vitro antimicrobial activity of arbekacin demonstrated in this study indicates that this antimicrobial agent may play an important role in the treatment of severe ORSA infections, especially those that show poor clinical response with vancomycin monotherapy. Since the aminoglycosides should not be used as monotherapy to treat Gram positive infections, further studies evaluating in vitro and in vivo synergistic activity of arbekacin combinations are necessary to clarify the clinical role of this aminoglycoside.

In vitro antimicrobial activity of linezolid tested against vancomycin-resistant enterococci isolated in Brazilian hospitals.

The emergence of vancomycin-resistant enterococci (VRE) has been described recently in Brazil. This is in contrast to the USA and Europe, where the VRE appeared in the late 1980s. The progressive increase in VRE isolation poses important problems in the antimicrobial therapy of nosocomial infections. Treatment options and effective antimicrobial agents for VRE are often limited and the possibility of transfer of vancomycin genes to other Gram-positive microorganisms continues. In the search for antimicrobial agents for multiresistant Gram-positive cocci, compounds such as linezolid and quinupristin/dalfopristin have been evaluated. The present study was conducted to evaluate the in vitro activity of the oxazolidinone linezolid and 10 other antimicrobial agents, including quinupristin-dalfopristin, against multiresistant enterococci isolated in Brazilian hospitals. Thirty-three vancomycin resistant isolates (17 Enterococcus faecium and 16 E. faecalis), were analyzed. Strains were isolated from patients at São Paulo Hospital, Oswaldo Cruz Hospital, Hospital do Servidor Público Estadual, Santa Marcelina Hospital, Santa Casa de Misericórdia de São Paulo, and Hospital de Clínicas do Paraná. The samples were tested by a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. All isolates were molecular typed using pulsed-field gel electrophoresis (PFGE). Linezolid was the most active compound against these multiresistant enterococci, showing 100% inhibition at the susceptible breakpoints. Quinupristin/dalfopristin and teicoplanin showed poor activity against both species. The molecular typing results suggest that there has been interhospital spread of vancomycin resistant E. faecium and E. faecalis among Brazilian hospitals. The results of this study indicate that linezolid is an appropriate therapeutic option for the treatment of vancomycin-resistant enterococci infections in Brazil.

[Anorexia nervosa and a psychosomatic investigation]. / A anorexia nervosa e a investigação em psicossomática.

The paper begins with a revision of diagnostic criteria of Anorexia Nervosa (AN), stressing the importance of early diagnosis and transitional forms between AN and Bulimia Nervosa. A retrospective study of 13 female patients with AN, treated during 1990 in Lisbon Psychiatric University Clínica (Hospital de Santa Maria, Lisboa) is then described. The Authors outline some common characteristics of the sample, many difficulties in the early relationship mother-child, shown by maternal unsatisfaction on feeding the baby and with changing of food. Concluding, the Authors point out some directions for eating disorder's investigation, starting with a multidisciplinary work including biological and cultural factors and understanding of individual development and family dynamics.

[Research on psychosomatic disease. Various theoretical and methodologic aspects]. / A investigação em psicossomática. Alguns aspectos teóricos e metodológicos.

This article mentions ther present main lines of psychosomatic research either in what concerns the elimination of the concept of psychosomatic illness, or in what concerns its etiological understanding of the peculiar ways of therapeutic approach. We specify some methodological problems resulting from using several instruments to collect data and measure them. We analyse the theoric relevance of the constructs: depressive equivalents and, specially, the alexithymia one. Starting from the consensual phenomonological description of this construct, we explain its psychodynamic understanding, its neurophysiologic basis and sociocultural determination. We question the relationship between alexithymia and psychosomatic illness. We point out the pertinency of its utilization as a risk or maintainance factor and the possibility of its modelling by ambiance factors. We clarify the main heuristic contributions of this construct to psychosomatic investigation and we analyse, critically and concisely, the validity and fidelity of some instruments of measure built to measure it. It is necessary to pay prior attention to psychosomatic investigation in the health area. We propose lines of investigation to be developed in our country that should have a multidisciplinary perspective.