RESUMEN

BACKGROUND: Candidemia is an increasing problem in tertiary care hospitals worldwide. Here, we report the first outbreak of candidemia caused by fluconazole-resistant C. parapsilosis (FRCP) strains in Brazil. METHODS: This was a cross-sectional study of clinical and microbiological data of all candidemic episodes diagnosed from July 2011 to February 2012 in a 200-bed tertiary care hospital. Initial yeast identification and susceptibility testing were performed using the VITEK 2 - System. Isolates of Candida spp. resistant to fluconazole were sent to a reference laboratory (LEMI-UNIFESP) for further molecular identification and confirmation of resistance by CLSI microdilution test. A multivariate analysis was conducted to identify factors associated with FRCP infection. RESULTS: We identified a total of 40 critically ill patients with candidemia (15 women) with a median age of 70 years. The incidence of candidemia was 6 cases/1,000 patients admissions, including 28 cases (70 %) of infection with C. parapsilosis, 21 of which (75 %) were resistant to fluconazole. In only 19 % of FRCP candidemia cases had fluconazole been used previously. The results of our study indicated that diabetes is a risk factor for FRCP candidemia (p = 0.002). Overall, mortality from candidemia was 45 %, and mortality from episodes of FRCP infections was 42.9 %. CONCLUSIONS: The clustering of incident cases in the ICU and molecular typing of strains suggest horizontal transmission of FRCP. Accurate vigilant monitoring for new nosocomial strains of FRCP is required.

Asunto(s)

Antifúngicos , Candidemia/microbiología , Brotes de Enfermedades , Farmacorresistencia Fúngica , Fluconazol , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Candida , Candidemia/epidemiología , Infección Hospitalaria/microbiología , Estudios Transversales , Femenino , Hospitales , Humanos , Incidencia , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Tipificación Molecular , Factores de Riesgo , Adulto Joven

RESUMEN

No início deste novo milênio, crescente aumento da resistência bacteriana aos antibióticos disponíveis vem-se caracterizando como evento preocupante. Por outro aspecto, tem havido desinteresse da indústria na produção de novos antimicrobianos. Desse modo, o tratamento das infecções está se tornando um desafio crescente. Esta revisãodiscorre sobre o tema, procurando caracterizar a magnitude do problema e como lidar com este na prática assistencial diária nos hospitais. A presente abordagem enfoca os germes Gram-negativos hospitalares, tendo por ponto de partida os principais mecanismos de resistência neles identificados.

---

At the beginning of this new millennium, an increasing bacterial resistance to the available antibiotics has been characterized as an overwhelming event. On the other hand, there was a lack of interest from industry in producing new antimicrobials. Thus the treatment of infections is becoming an increasing challenge. This review on the subject tries to characterizethe magnitude of the problem and how to cope with daily practice in hospitals. The approach focuses on the nosocomial Gram-negative species having as a starting point its main identified mechanisms of resistance.

RESUMEN

Introdução. O Staphylococcus aureus resistente à meticilina é um problema identificado nos hospitais e, mais recentemente, na comunidade. Objetivo. Identificar a prevalência de Staphylococcus aureus resistente à meticilina em pacientes internados. Métodos. Foi realizado, no período de janeiro a dezembro de 2006, levantamento de todas as hemoculturas positivas de Staphylococcus aureus de três hospitais públicos (A, B e C) e em três hospitais privados (D, E e F) do Distrito Federal.Resultados. Foram identificadas 265 amostras positivas de S. aureus com prevalência de 47,9%. Dentre os hospitais analisados, encontraram-se 69,1% (97/67) na instituição A; 28,6% (63/18) em B; 73,2% (41/30) em C; 14,8%(27/4) em D; 18,2% (22/4) em E; e 26,7% (15/4) na instituição F.Conclusão. A prevalência global de Staphylococcus aureus resistente à meticilina das instituições avaliadas é elevada e compatível com dados nacionais e internacionais. No entanto, a distribuição foi heterogênea com prevalência maior nas instituições públicas.

---

Introduction. The meticilin resistent Staphylococcus aureus is a problem identified in hospitals and more recently in the community. Objective. Identify the prevalence of meticilin resistent Staphylococcus aureus in hospitalized patients. Methods. A survey of all Staphylococcus aureus positive blood cultures from January to December 2006 was carried at six hospitals, three public (A, B and C) and three private (D, E e F) institutions at the Distrito Federal. Results. Two hundred and sixty five Staphylococcus aureus positive samples were identified with a prevalence of 47,9% of the meticilin resistent strand. Of all the analyzed hospitals a prevalence of 69.1% (97/67) for the institution A; 28.6% (63/18) for the B; 73.2% (41/30) for the C; 14.8% (27/4) for the D; 18.2% (22/4) for the E; 26.7% (15/4) for the F. Conclusion. The global prevalence of meticilin resistent Staphylococcus aureus at evaluated institutions is high and compatible with national and international data. However the distribution was heterogeneous with a higher prevalence in public institutions.

Asunto(s)

Humanos , Técnicas de Laboratorio Clínico , Bacterias Gramnegativas/patogenicidad , Coagulasa , Hospitales Privados , Hospitales Públicos , Medios de Cultivo , Pacientes Internos , Staphylococcus aureus , Técnicas Microbiológicas

RESUMEN

A serologic inquiry was performed in order to estimate the prevalence of the anti-HCV antibody in a population of 151 HIV infected patients under treatment at the Hospital Universitário de Brasília. The anti-HCV test was positive in 27 (CI 95% 12.3 – 25.1) patients (17,9%). A case-control study was also performed to identify risk factors for HCV infection in 92 selected patients (23 cases and 69 controls). The main mean of acquisition of HCV among patients was probably use of intravenous (p < 0.001, OR 45.00, CI 95% 8.04 – 956.68) or inhalant drugs (p < 0.001, OR 22.50, CI 95% 6.37 – 763.85), followed by tattoos (p=0.04, OR 3.29, CI 95% 1.12 – 9.37), blood transfusion before 1993 (p = 0.03, OR 5.62, CI 95% 1.28 – 50.09) and sexual contact with many partners (p = 0.03, OR 5.00, CI 95% 1.35 – 20.98).

---

Foi realizado um inquérito sorológico para estimar a prevalência do anticorpo anti-VHC na população de 151 pacientes portadores do HIV em tratamento no Hospital Universitário de Brasília. A positividade do anti-VHC ocorreu em 27 (IC95% 12,3- 25,1) pacientes (17,9%). Também se realizou um estudo caso-controle para identificar os fatores de risco para aquisição do VHC. Para isso foram selecionados 92 pacientes (23 casos e 69 controles). A principal via de aquisição do VHC foi provavelmente o uso de drogas injetáveis (p < 0,001, OR 45,00, IC 95% 8,04 – 956,68) ou de drogas inalatórias (p < 0,001, OR 22,50, IC 95% 6,37 – 763,85), seguido por tatuagem (p = 0,04, OR 3,29, IC 95% 1,12 – 9,37), transfusão sanguínea anterior a 1993 (p = 0,03, OR 5,62, IC 95% 1,28 – 50,09) e hábitos sexuais com múltiplos parceiros (p = 0,03, OR 5,00, IC 95% 1,35 – 20,98).