RESUMO
Biosurfactants, sustainable alternatives to petrochemical surfactants, are gaining attention for their potential in medical applications. This study focuses on producing, purifying, and characterizing a glycolipid biosurfactant from Candida sp. UFSJ7A, particularly for its application in biofilm prevention on siliconized latex catheter surfaces. The glycolipid was extracted and characterized, revealing a critical micellar concentration (CMC) of 0.98 mg/mL, indicating its efficiency at low concentrations. Its composition, confirmed through Fourier transform infrared spectroscopy (FT-IR) and thin layer chromatography (TLC), identified it as an anionic biosurfactant with a significant ionic charge of -14.8 mV. This anionic nature contributes to its biofilm prevention capabilities. The glycolipid showed a high emulsification index (E24) for toluene, gasoline, and soy oil and maintained stability under various pH and temperature conditions. Notably, its anti-adhesion activity against biofilms formed by Escherichia coli, Enterococcus faecalis, and Candida albicans was substantial. When siliconized latex catheter surfaces were preconditioned with 2 mg/mL of the glycolipid, biofilm formation was reduced by up to 97% for E. coli and C. albicans and 57% for E. faecalis. These results are particularly significant when compared to the efficacy of conventional surfactants like SDS, especially for E. coli and C. albicans. This study highlights glycolipids' potential as a biotechnological tool in reducing biofilm-associated infections on medical devices, demonstrating their promising applicability in healthcare settings.
Assuntos
Biofilmes , Candida , Catéteres , Glicolipídeos , Tensoativos , Glicolipídeos/farmacologia , Glicolipídeos/química , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Tensoativos/farmacologia , Tensoativos/química , Candida/efeitos dos fármacos , Candida/fisiologia , Catéteres/microbiologia , Látex/química , Látex/farmacologia , Escherichia coli/efeitos dos fármacos , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/fisiologia , Candida albicans/efeitos dos fármacos , Candida albicans/fisiologiaRESUMO
In this work, we present the modification of a medical-grade silicone catheter with the N-vinylimidazole monomer using the grafting-from method at room temperature and induced by gamma rays. The catheters were modified by varying the monomer concentration (20-100 vol%) and the irradiation dose (20-100 kGy). Unlike the pristine material, the grafted poly(N-vinylimidazole) chains provided the catheter with hydrophilicity and pH response. This change allowed for the functionalization of the catheters to endow it with antimicrobial features. Thus, the quaternization of amines with iodomethane and bromoethane was performed, as well as the immobilization of silver and ampicillin. The inhibitory capacity of these materials, functionalized with antimicrobial agents, was challenged against Escherichia coli and Staphylococcus aureus strains, showing variable results, where loaded ampicillin was amply better at eliminating bacteria.
Assuntos
Escherichia coli , Imidazóis , Silicones , Staphylococcus aureus , Escherichia coli/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Silicones/química , Imidazóis/química , Imidazóis/farmacologia , Catéteres/microbiologia , Testes de Sensibilidade Microbiana , Polivinil/química , Anti-Infecciosos/química , Anti-Infecciosos/farmacologia , Antibacterianos/farmacologia , Antibacterianos/química , Ampicilina/química , Ampicilina/farmacologia , Raios gamaRESUMO
A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.
Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.
La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.
Assuntos
Humanos , Feminino , Infecções Urinárias/complicações , Infecções Urinárias/mortalidade , Infecções Urinárias/prevenção & controle , Infecções Urinárias/tratamento farmacológico , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Sistema Urinário , Mulheres , Ciprofloxacina/uso terapêutico , Infecção Hospitalar/complicações , Infecção Hospitalar/transmissão , Escherichia coli/patogenicidade , Catéteres/microbiologia , Higiene das Mãos , Ampicilina/uso terapêutico , Unidades de Terapia Intensiva , Anti-Infecciosos/uso terapêutico , Antibacterianos/uso terapêuticoRESUMO
Cross-infection in contrast injectors is still a subject under discussion with little understanding. This study evaluated the biosafety of non-return valves (NRVs). Initially, the maximum pressure during backflow of intact and disrupted flexible diaphragms (FDs) from NRVs, as well as the functionality of connectors with NRVs were verified. The performance of air columns interposed by water in connectors with NRVs was analyzed, and the diffusion distance of crystal violet through connectors with NRVs was measured. The efficacy of NRVs as a barrier to bacterial contamination from backflow was evaluated. Finally, a clinical study of bacteriological contamination from syringes was conducted. There were differences among the maximum tolerated pressure by intact and disrupted FDs. Disrupted FDs showed no failures in the functionality of connectors with NRVs based on the lack of air bubbles released. Air columns could move through connectors with NRVs with intact and disrupted FDs. The longest diffusion distance of crystal violet was 6 cm of connector length, and NRVs showed efficacy as a barrier to bacterial contamination. In the clinical study, there was no bacterial growth in any of the evaluated samples. In conclusion, biosafety depends on the functionality of NRVs as well as proper practical clinical performance.
Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/prevenção & controle , Catéteres/microbiologia , Infecção Hospitalar/prevenção & controle , Contaminação de Medicamentos/prevenção & controle , Contaminação de Equipamentos/prevenção & controle , Radiologia , Infecções Bacterianas/microbiologia , Humanos , Infusões IntravenosasRESUMO
AIMS: To study the individual and combined contribution of catechin, protocatechuic and vanillic acids to inhibit the adhesion of uropathogenic Escherichia coli (UPEC) on the surface of silicone catheters. METHODS AND RESULTS: The adhesion of UPEC to silicone catheters during the exposure to nonlethal concentrations of phenolic compounds was measured, as well as changes in motility, presence of fimbriae, extra-cellular polymeric substances, surface charge, hydrophobicity and membrane fluidity. The phenolic combination reduced 26-51% of motility, 1 log CFU per cm2 of adhered bacteria and 20-40% the carbohydrate and protein content in the biofilm matrix. Curli fimbriae, surface charge and cell hydrophobicity were affected to a greater extent by the phenolic combination. In the mixture, vanillic acid was the most effective for reducing bacterial adhesion, extra-polymeric substance production, motility, curli fimbriae and biofilm structure. Notwithstanding, protocatechuic acid caused major changes in the bacterial cell surface properties, whereas catechin affected the cell membrane functionality. CONCLUSION: Catechin, protocatechuic and vanillic acids have different bacterial cell targets, explaining the synergistic effect of their combination against uropathogenic E. coli. SIGNIFICANCE AND IMPACT OF STUDY: This study shows the contribution of catechin, protocatechuic and vanillic acids in producing a synergistic mixture against the adhesion of uropathogenic E. coli on silicone catheters. The action of catechin, vanillic and protocatechuic acids included specific contributions of each compound against the E. coli membrane's integrity, motility, surface properties and production of extracellular polymeric substances. Therefore, the studied mixture of phenolic compounds could be used as an antibiotic alternative to reduce urinary tract infections associated with silicone catheters.
Assuntos
Antibacterianos/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Biofilmes/efeitos dos fármacos , Catequina/farmacologia , Hidroxibenzoatos/farmacologia , Infecções Urinárias/microbiologia , Escherichia coli Uropatogênica/efeitos dos fármacos , Ácido Vanílico/farmacologia , Catéteres/microbiologia , Sinergismo Farmacológico , Infecções por Escherichia coli/microbiologia , Fímbrias Bacterianas/efeitos dos fármacos , Fímbrias Bacterianas/genética , Fímbrias Bacterianas/metabolismo , Humanos , Fenóis/farmacologia , Silicones/análise , Escherichia coli Uropatogênica/crescimento & desenvolvimento , Escherichia coli Uropatogênica/fisiologiaRESUMO
AIM: To evaluate the activity and effectiveness of impregnated central venous catheters (CVC) against Klebsiella pneumoniae biofilms. METHODS AND RESULTS: The antimicrobial activity and durability of impregnated-CVCs were evaluated over time and the size of zones of inhibition (ZI) was measured. Biofilm formation was observed by quantitative culture and also by scanning electron microscopy. The catheters impregnated with chlorhexidine/silver sulfadiazine (CHX/SS) reduced bacteria counts by 0·3 log and were most effective (P < 0·01) against Klebsiella pneumoniae biofilms N-acetylcysteine/levofloxacin (NAC/LEV) catheters. It was observed that the catheter impregnated with NAC/LEV had initially the largest average ZI size being statistically significant (P < 0·01). The NAC/LEV combination remained active until day 30, whereas the combination of CHX/SS was completely inactivated from day 15 on. CONCLUSIONS: The NAC/LEV combination showed greater durability on the catheters, but it was the CHX/SS combination that had the greater initial efficacy in bacterial inhibition. It was also observed that NAC/LEV-impregnated catheters do not prevent the emergence of resistant subpopulations inside the inhibition halos during antimicrobial susceptibility tests. SIGNIFICANCE AND IMPACT OF THE STUDY: Our results highlighted that the in vitro efficacy of antimicrobial-impregnated CVCs is limited by time and that their colonization occurred earlier than expected. Our data also demonstrated that NAC/LEV remained active until day 30 of evaluation and CHX/SS combination was completely inactivated from day 15 on. Our findings suggested that implantable devices should be carefully used by medical community.
Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Catéteres/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Acetilcisteína/farmacologia , Biofilmes/crescimento & desenvolvimento , Clorexidina/farmacologia , Farmacorresistência Bacteriana , Klebsiella pneumoniae/fisiologia , Levofloxacino/farmacologia , Sulfadiazina de Prata/farmacologia , Fatores de TempoRESUMO
Systemic infections due to Candida tropicalis are conditions which can frequently lead to death. The aim of this report is to describe the features of C. tropicalis biofilm in a patient with catheter-associated fungemia.
Assuntos
Candida tropicalis/isolamento & purificação , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/patologia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/patologia , Neoplasias da Língua/complicações , Biofilmes/crescimento & desenvolvimento , Candidíase Invasiva/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Catéteres/microbiologia , Humanos , Microscopia Eletrônica de VarreduraRESUMO
In the present work, some surface properties of the fungi Scedosporium apiospermum, S. aurantiacum, S. minutisporum, and Lomentospora prolificans and their capability to adhere to and form a biofilm on diverse surfaces were evaluated. All four species had high conidial surface hydrophobicity and elevated electronegative zeta potentials. Abundant quantities of melanin were detected at the conidial surface, whereas sialic acid was absent. The numbers of non-germinated and germinated conidia adhered to poly-L-lysine-covered slides was higher than on glass after 4 h of fungi-surface contact. Additionally, after 72 h of interaction a typical biofilm structure had formed. Mature biofilms were also observed after 72 h on a nasogastric catheter (made from polyvinyl chloride), a late bladder catheter (siliconized latex), and a nasoenteric catheter (polyurethane). Interestingly, biofilm biomass increased considerably when the catheters had previously been incubated with serum. These results confirm that Scedosporium/Lomentospora spp. are capable of forming biofilms on diverse abiotic surfaces.
Assuntos
Ascomicetos/química , Biofilmes , Scedosporium/química , Esporos Fúngicos/química , Catéteres/microbiologia , Interações Hidrofóbicas e Hidrofílicas , Melaninas/química , Propriedades de SuperfícieRESUMO
Candida tropicalis has emerged as one of the major Candida non-C. albicans species, in terms of epidemiology and virulence. Despite its virulence, C. tropicalis pathogenic mechanism has yet not been fully defined. The current study aimed to demonstrate the interaction of mature C. tropicalis ATCC 750 biofilm formed on catheter with different human cell lines. In vitro mature (72â¯h)â¯C. tropicalis biofilms were produced on small catheter fragments (SCF) and were mainly composed by blastoconidia. Then, migration of yeast cells from mature biofilm to human cell surfaces (HeLa and HUVEC) was investigated. After contact with both cell lines, the surface of SCF, containing mature C. tropicalis biofilm, exhibited predominantly the filamentous form. Meanwhile, fresh biofilm formed on human cell surfaces also revealed mainly of blastoconidia involved by extracellular matrix. Total biomass and metabolic activity from the remaining biofilm on SCF surface, after direct contact with human cells, exhibited a significant reduction. Mature C. tropicalis biofilm modified its extracellular matrix components, after contact with human cells. Thus, we described for the first time an easy and simple in vitro model with catheter, which could be a powerful tool for future studies that desires to elucidate the mechanisms involved in C. tropicalis biofilm.
Assuntos
Biofilmes/crescimento & desenvolvimento , Candida tropicalis/crescimento & desenvolvimento , Catéteres/microbiologia , Interações Hospedeiro-Patógeno , Candida tropicalis/fisiologia , Células Endoteliais/microbiologia , Células Epiteliais/microbiologia , Células HeLa , Células Endoteliais da Veia Umbilical Humana , Humanos , Hifas/crescimento & desenvolvimentoRESUMO
Hemodialysis, which is a kidney failure treatment that uses hemodialysis machine, dialyzer, dialysis solution, catheters, and needles, favors biofilm formation. This study evaluates whether Aspergillus, Candida, and Fusarium can form biofilm in dialysis fluids. Biofilms were grown in 96-well microplates containing solutions (acid and basic) consisting of dialysate, dialysate per se, or dialysate plus glucose as culture medium. The biofilms were incubated at 30⯰C for 72â¯h, quantified by the violet crystal methodology, and visualized by transmission electron microscopy. All the fungi formed biomass in all the tested solutions. However, Bonferroni analysis revealed that the dialysate facilitated Aspergillus biomass development, whereas the dialysate and dialysate with glucose provided similar Fusarium oxysporum biomass development. Candida parapsilosis development was favored in biofilms grown in basic electrolytic solution. Electron micrographs of biofilms that grew on catheters after 72â¯h showed that Aspergillus formed abundant hyphae; the extracellular matrix was visible on the surface of some hyphae when Aspergillus was grown in the dialysate. A multilayered hyphal structure emerged when F. oxysporum biofilms were incubated in the dialysate with glucose. C. parapsilosis biofilm growth in basic solution elicited a dense network of yeasts and pseudohyphae as well as the extracellular matrix; the biofilm was attached across the catheter length. This study may contribute to the formulation of new strategies to monitor biofilm formation and to increase knowledge associated with fungal biofilms in the dialysis environment.
Assuntos
Biofilmes/crescimento & desenvolvimento , Contaminação de Equipamentos , Equipamentos e Provisões/microbiologia , Fungos/metabolismo , Diálise Renal/instrumentação , Aspergillus/isolamento & purificação , Aspergillus/metabolismo , Biomassa , Candida/isolamento & purificação , Candida/metabolismo , Catéteres/microbiologia , Soluções para Diálise , Fusarium/isolamento & purificação , Fusarium/metabolismo , Glucose/metabolismo , Hifas/crescimento & desenvolvimento , Microscopia Eletrônica de VarreduraAssuntos
Infecções Relacionadas a Cateter/diagnóstico , Catéteres/microbiologia , Redução de Custos/economia , Controle de Infecções/métodos , Políticas , Bacteriemia/diagnóstico , Brasil , Infecções Relacionadas a Cateter/microbiologia , Análise Custo-Benefício/economia , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Humanos , Controle de Infecções/economia , Técnicas Microbiológicas , Flebite/diagnósticoRESUMO
BACKGROUND AND AIMS: Attention to patient safety has increased recently due to outbreaks of nosocomial infections associated with GI endoscopy. The aim of this study was to evaluate current cleaning and disinfection procedures of endoscope channels with high bioburden and biofilm analysis, including the use of resistant mycobacteria associated with postsurgical infections in Brazil. METHODS: Twenty-seven original endoscope channels were contaminated with organic soil containing 10(8) colony-forming units/mL of Pseudomonas aeruginosa, Staphylococcus aureus, or Mycobacterium abscessus subsp bolletii. Biofilms with the same microorganisms were developed on the inner surface of channels with the initial inoculum of 10(5) colony-forming units/mL. Channels were reprocessed following current protocol, and samples from cleaning and disinfection steps were analyzed by bioluminescence for adenosine triphosphate, cultures for viable microorganisms, and confocal microscopy. RESULTS: After contamination, adenosine triphosphate levels increased dramatically, and high bacterial growth was observed in all cultures. After cleaning, adenosine triphosphate levels decreased to values comparable to precontamination levels, and bacterial growth was demonstrated in 5 of 27 catheters, 2 with P aeruginosa and 3 with M abscessus. With regard to induced biofilm, a remarkable reduction occurred after cleaning, but significant microbial growth inhibition occurred only after disinfection. Nevertheless, viable microorganisms within the biofilm were still detected by confocal microscopy, more so with glutaraldehyde than with peracetic acid or O-phataladehyde. CONCLUSION: After the complete disinfection procedure, viable microorganisms could still be detected within the biofilm on endoscope channels. Prevention of biofilm development within endoscope channels should be a priority in disinfection procedures, particularly for ERCP and EUS.
Assuntos
Biofilmes/crescimento & desenvolvimento , Desinfecção/métodos , Endoscópios Gastrointestinais/microbiologia , Contaminação de Equipamentos/prevenção & controle , Trifosfato de Adenosina/análise , Brasil , Catéteres/microbiologia , Contagem de Colônia Microbiana , Desinfetantes , Glutaral , Medições Luminescentes , Microscopia Confocal , Mycobacterium/crescimento & desenvolvimento , Ácido Peracético , Pseudomonas aeruginosa/crescimento & desenvolvimento , Staphylococcus aureus/crescimento & desenvolvimento , o-FtalaldeídoRESUMO
The pathogenic and consistent effect of discrimination on mental health has been largely documented in the literature. However, there are few studies measuring multiple types of discrimination, evaluating the existence of a dose-response relationship or investigating possible effect modifiers of such an association. To investigate the association between experiences of discrimination attributed to multiple reasons and common mental disorders, including the adjustment for potential confounders, assessment of dose-response relations, and examination of effect modifiers in undergraduate students from southern Brazil. In the first semester of 2012, 1,023 students from the Universidade Federal de Santa Catarina answered a self-administered questionnaire on socio-demographic characteristics, undergraduate course, experiences of discrimination and common mental disorders. Associations were analyzed through logistic regression models, estimation of The study results showed that students reporting discrimination at high frequency and intensity were 4.4 (95%CI 1.6 - 12.4) times more likely to present common mental disorders. However, the relationship between discrimination and common mental disorders was protective among Electrical Engineering students, when compared to Accounting Sciences students who did not report discrimination. The findings suggest that the dose-response relationship between experiences of discrimination and common mental disorders reinforces the hypothetical causal nature of this association. Nevertheless, the modification of effect caused by the undergraduate course should be considered in future studies for a better understanding and measurement of both ...
O efeito deletério e consistente das experiências discriminatórias sobre a saúde mental tem sido amplamente documentado na literatura. No entanto, são escassos os trabalhos que aferem múltiplos tipos de discriminação, avaliam a existência de relação dose-resposta ou investigam possíveis modificadores de efeito dessa associação. Investigar a associação entre experiências discriminatórias por múltiplos motivos e sofrimento psíquico, incluindo a avaliação de efeito dose-resposta, o ajuste para potenciais confundidores e o exame de modificadores de efeito em estudantes universitários do sul do Brasil. No primeiro semestre de 2012, 1.023 graduandos da Universidade Federal de Santa Catarina responderam a um questionário autopreenchível sobre características sociodemográficas, curso de graduação, experiências discriminatórias e sofrimento psíquico. As associações foram analisadas com modelos de regressão logística, estimação de razões de chance e seus respectivos intervalos de confiança de 95% (IC95%). Observou-se que estudantes que relataram sofrer discriminação em alta frequência e intensidade apresentaram 4,4 (IC95% 1,6 - 12,4) vezes mais chance de apresentar sofrimento psíquico. Entretanto, a relação da discriminação com o sofrimento psíquico foi protetora em meio aos graduandos de Engenharia Elétrica, quando comparados aos de Ciências Contábeis não discriminados. A partir do estudo, concluiu-se que a relação dose-resposta entre experiências discriminatórias e sofrimento psíquico reforça a hipótese de natureza causal dessa associação. Contudo, a modificação de efeito ocasionada pelo curso de graduação deve ser considerada em investigações futuras para uma melhor compreensão de ambos os fenômenos e suas estratégias de mensuração.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Antissepsia , Neoplasias da Mama/cirurgia , Catéteres/microbiologia , Mamoplastia , Mastectomia , Infecção da Ferida Cirúrgica/prevenção & controle , Neoplasias da Mama/complicações , Neoplasias da Mama/patologia , Catéteres/efeitos adversos , Drenagem/efeitos adversos , Seguimentos , Estadiamento de Neoplasias , Cuidados Pós-Operatórios , Prognóstico , Estudos Prospectivos , Infecção da Ferida Cirúrgica/etiologiaRESUMO
Nosocomial fungal bloodstream infections (BSI) are increasing significantly in hospitalized patients and Candida parapsilosis has emerged as an important pathogen responsible for numerous outbreaks. The objective of this study was to evaluate C. parapsilosis sensu lato infection scenarios, regarding species distribution and strain relatedness. One hundred isolates of C. parapsilosis sensu lato derived from blood cultures and catheter tips were analysed by multiplex microsatellite typing and by sequencing D1/D2 regions of the ribosomal DNA. Our results indicate that 9.5â% of patients presented infections due to C. parapsilosis and Candida orthopsilosis, 57.1â% due to C. parapsilosis, 28.3â% due to C. orthopsilosis and 4.8â% due to Candida metapsilosis. Eighty per cent of the C. parapsilosis BSIs were due to a single strain that was also identified in the catheter, but in 10â% of the cases C. parasilosis was identified in the catheter but the BSI was due to C. orthopsilosis. There is a significant probability that C. parapsilosis isolates collected from the same patient at more than 3 months interval are of different strains (Pâ=â0.0179). Moreover, several isolates were identified persistently in the same hospital, infecting six different patients. The incidence of polyfungal BSI infections with C. parapsilosis and C. orthopsilosis is reported herein for the first time, emphasizing the fact that the species identified in the catheter is not always responsible for the BSI, thus impacting the treatment strategy. The observation that strains can remain in the hospital environment for years highlights the possible existence of reservoirs and reinforces the need for accurate genotyping tools, such as the markers used for elucidating epidemiological associations and detecting outbreaks.
Assuntos
Candida/classificação , Candida/isolamento & purificação , Candidemia/microbiologia , Candidemia/patologia , Coinfecção/microbiologia , Coinfecção/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Sangue/microbiologia , Candida/genética , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Catéteres/microbiologia , Criança , Pré-Escolar , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Repetições de Microssatélites , Pessoa de Meia-Idade , Epidemiologia Molecular , Dados de Sequência Molecular , Tipagem Molecular , Técnicas de Tipagem Micológica , Filogenia , RNA Ribossômico 28S/genética , Análise de Sequência de DNA , Adulto JovemRESUMO
BACKGROUND: Invasive candidiasis is a major invasive fungal infection. It has high lethality, and even higher if not treated early. There is no consensus on antifungal treatment in patients with positive catheter tip culture for Candida spp. The objective of this study was to evaluate the impact of antifungal therapy and mortality of patients with positive culture for Candida spp. in catheter tip that have negative blood culture. METHODS: The PubMed database was searched to identify articles related to Candida and catheter. Articles with adequate data were included. RESULTS: Of 1208 studies initially screened, 5 met the selection criteria. All were retrospective studies. In all, 265 patients were evaluated for outcomes 'candidemia' and 'invasive candidiasis' and 158 for the outcome 'mortality.' Antifungal therapy had no impact on the development of invasive fungal disease (Odds ratio (OR) = 1.41; 95% confidence interval (CI) = 0.56-3.52). Also there was no benefit of therapy on mortality (OR = 1.02; 95% CI = 0.54-1.95). CONCLUSION: Due to the poor quality of the studies no conclusion can be made. Randomized prospective studies are needed to better evaluate this therapeutic strategy.
Assuntos
Antifúngicos/uso terapêutico , Candida/efeitos dos fármacos , Candidemia/tratamento farmacológico , Candidíase/tratamento farmacológico , Candida/isolamento & purificação , Candidemia/microbiologia , Candidemia/mortalidade , Candidíase/microbiologia , Candidíase/mortalidade , Catéteres/microbiologia , Humanos , Razão de Chances , Estudos RetrospectivosRESUMO
Fundamento En los últimos 20 años ha habido un cambio considerable en el rol de la traqueostomía en la edad pediátrica. La obstrucción de la vía aérea superior secundaria a infecciones dejó de constituir la causa más común de traqueostomía en el niño. Asimismo, las alteraciones estructurales de la vía aérea superior y la necesidad de asistencia ventilatoria prolongada o crónica se han convertido en las indicaciones más frecuentes de traqueostomías pediátricas.Objetivo Determinar la incidencia de la traqueostomía en nuestro medio, sus principales indicaciones, complicaciones e influencia en la mortalidad. MetodologíaSe realizó un estudio descriptivo retrospectivo de los pacientes que requirieron traqueostomía en la unidad de cuidados intensivos pediátricos del Hospital Pediátrico Docente José Martí de Sancti Spíritus, Cuba, en un período de diez años, desde 1999 hasta 2008. Resultados Fue necesario practicar traqueostomía a 14 (0,5 por ciento) pacientes del total de ingresados durante ese período, de ellos 9 (64,2 por ciento) eran menores de un año. La indicación más frecuente fue la necesidad de ventilación mecánica prolongada asociada a patología neurológica con 10 (71,42 por ciento) casos. Las malformaciones e infecciones agudas de las vías aéreas superiores constituyeron indicaciones poco frecuentes. Las principales complicaciones que se presentaron fueron infección en 10 (71,4 por ciento) casos y la obstrucción en 4 (28,5 por ciento), siendo aislados más comúnmente la Pseudomonas aeruginosa en seis (60 por ciento), el Staphylococcus aureus en tres (30 por ciento), la Klebsiella pneumoniae en tres (30 por ciento) y el Enterobacter cloacae en tres (30 por ciento). Además, cuatro (28,5 por ciento) pacientes fueron decanulados exitosamente, fallecieron cinco (35,7 por ciento) y sólo en uno (7,14 por ciento) la causa se relacionó con la traqueostomía.
Introduction There has been a significant change in the role of pediatric tracheostomy over the last twenty years. Obstruction of the upper airway caused by infectious agents is no longer the leading cause of tracheostomy in children. Structural anomalies of the upper airway as well as the need for prolonged ventilator assistance have become the most frequent indication for pediatric tracheostomy. ObjectiveThe purpose of this paper is to assess the incidence, indications, complications, and role in mortality of tracheostomy in our pediatric population. MethodsA retrospective descriptive study of pediatric patients who underwent tracheostomy was conducted between 1999 and 2008 in the Pediatric Intensive Care Unit of the José Martí de Sancti Spiritus Pediatric Teaching Hospital in Cuba. Results Tracheostomy was performed in 14 patients during the period of the study (0.5 percent of admitted patients). Nine of them (64.2 percent) were younger than one year. The most frequent indication for the procedure was the need for prolonged mechanical ventilation in patients with neurologic disorders in 10 patients (71.42 percent). Upper airway malformations and acute infections were infrequent indications for tracheostomy. The most frequent complications were infectious in 10 patients (71.4 percent) and obstruction in four patients (28.5 percent). The following germs were found: Pseudomona aeruginosa in six patients (60 percent), Staphylococcus aureus in three patients (30 percent), and Enterobacter cloacae in three patients (30 percent). Furthermore, four patients were successfully decannulated (28.5 percent), five patients died (35.7 percent) but only in one (7.14 percent), death could be attributed to tracheostomy. Conclusion The need for prolonged mechanical ventilation in patients with neurologic disorders was the main indication for tracheostomy in our pediatric population; most of these children were younger than one year. The procedure had little.
Assuntos
Feminino , Lactente , Pré-Escolar , Criança , Traqueostomia/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Distribuição por Idade e Sexo , Bactérias/isolamento & purificação , Cuba , Catéteres/microbiologia , Epidemiologia Descritiva , Hospitais Pediátricos , Seleção de Pacientes , Estudos Retrospectivos , Respiração Artificial/efeitos adversos , Traqueostomia/efeitos adversos , Traqueostomia/mortalidadeRESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) is the causal agent of multiple nosocomial infections worldwide, including catheter-associated bacteremia in hemodialysis patients. The purposes of this work were to genetically characterize a group of MRSA isolates from catheter-related infections of ambulatory Mexican hemodialysis patients and to determine whether the strains are the same as those carried by the patients in their anterior nares. Sixteen pairs of MRSA isolates from the catheter (cat) and anterior nares (N) of hemodialysis patients were compared using pulsed-field gel electrophoresis (PFGE), PCR detection of adhesion genes and other virulence markers, and an antibiogram. Three pairs of N/cat MRSA isolates (18.7 %) with identical resistograms also showed the same combination of PCR-detected markers and PFGE pattern; one additional pair showed only an identical electrophoretic PFGE pattern. Of the MRSA isolates, 75 % (n = 24) were resistant to ≥ 7 antibiotics, 4 isolates were resistant to 11 antibiotics, and 7 isolates were resistant to the 12 antibiotics tested. The most frequent virulence marker combination found was spa, clfA, clfB, cna, bbp, ebps, map/eap, sdrC, sdrD, sdrE, ica, agr (65.6 %, n = 21). The SCCmec alleles of the 32 MRSA isolates were IV (n = 20), I (n = 7), II (n = 4), and V (n = 1), and no SCCmec type III MRSA was found. The genotypic characterization of the MRSA isolates studied in this work will contribute to a better understanding of the virulence gene makeup of catheter-colonizing S. aureus strains and will help to lower the infection risk in these patients.
Assuntos
Catéteres/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Fatores de Virulência/genética , Adulto , Idoso , Distribuição de Qui-Quadrado , DNA Bacteriano/química , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Humanos , Staphylococcus aureus Resistente à Meticilina/genética , México , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Diálise RenalRESUMO
OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36%) of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82%) were more significantly involved than gram-negative ones (9.09%) and fungi (9.09%), with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.
Assuntos
Catéteres/microbiologia , Contaminação de Equipamentos/estatística & dados numéricos , Fungos/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Seringas/microbiologia , Contaminação de Medicamentos , Embalagem de Medicamentos , Fungos/classificação , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Hospitais de Ensino , Irã (Geográfico)RESUMO
OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36%) of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82%) were more significantly involved than gram-negative ones (9.09%) and fungi (9.09%), with the highest frequency for Staphylococcus epidermidis. CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.
Assuntos
Catéteres/microbiologia , Contaminação de Equipamentos/estatística & dados numéricos , Fungos/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Seringas/microbiologia , Contaminação de Medicamentos , Embalagem de Medicamentos , Fungos/classificação , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Hospitais de Ensino , Irã (Geográfico)RESUMO
Few data related to the care of children injured in an earthquake are available. The objective of our study was to analyze the results of clinical and microbiologic characteristics of children treated in a Fort de France hospital after the Haiti earthquake. Bacteria were mainly Gram-negative bacteria. Some of these infections seemed to be environmental; a significant portion was related to acquisition during hospitalization.