RESUMO
OBJECTIVE: To describe the microbiological findings from bandage contact lenses in patients who work in a hospital environment submitted to photorefractive keratectomy (PRK). METHODS: This prospective comparative case series enrolled 43 eyes of 22 volunteers (28.05 ± 3.50 years). Fourteen individuals (n = 27) were health care professionals who work in health care facilities or community physician's offices. Eight individuals (n = 16) were patients who do not work in hospital environment. Photorefractive keratectomy was performed using standard technique, and a silicone hydrogel bandage contact lens was placed on the cornea and evaluated for adequate fit. Seven days after surgery, the bandage lenses were removed and imprinted in the following culture media: blood agar, chocolate agar, anaerobic-selective agar, and Sabouraud agar. When microbial growth was detected, the microorganism was identified, colony-forming units were quantified, and morphology and Gram-staining properties were analyzed. All isolates were tested for susceptibility to various antibiotics. Significance was assessed by Fisher exact test. RESULTS: Microbial growth was detected in 16.27% of all contact lenses samples. No fungi or anaerobes were found. Microbial growth was only observed in bandage lenses removed from patients who work in hospital environments. Most microorganisms found were sensitive to all antibiotics tested. CONCLUSION: These results suggest that working in hospital environments increase contamination of the contact lenses after PRK.
Assuntos
Bactérias/isolamento & purificação , Lentes de Contato Hidrofílicas/microbiologia , Contaminação de Equipamentos , Exposição Ocupacional/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Ceratectomia Fotorrefrativa , Adulto , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Estudos de Casos e Controles , Contagem de Colônia Microbiana , Equipamentos Descartáveis/microbiologia , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Masculino , Ceratectomia Fotorrefrativa/métodos , Estudos ProspectivosRESUMO
We assessed the effect of a double concentration of supplemental polymyxin B, amphotericin B, nalidixic acid, trimethoprim and azlocillin (PANTA) added to the Mycobacterial Growth Indicator Tube (MGIT) on contamination and positivity rates in 216 sputum cultures. Contamination rates were respectively 12.9% and 5.5% for samples processed using standard and double PANTA concentrations (P = 0.0001, McNemar's test). Thirty-five per cent of cultures performed using standard PANTA and 36.5% of those performed using two-fold PANTA concentrations were positive for Mycobacterium tuberculosis, compared to 25.9% of cultures inoculated on Ogawa medium. These results suggest that the use of MGIT with 2× PANTA may be useful in reducing culture contamination without reducing the diagnostic yield.
Assuntos
Antibacterianos/farmacologia , Técnicas Bacteriológicas/instrumentação , Equipamentos Descartáveis/microbiologia , Contaminação de Equipamentos/prevenção & controle , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Anfotericina B/farmacologia , Azlocilina/farmacologia , Meios de Cultura , Relação Dose-Resposta a Droga , Humanos , Mycobacterium tuberculosis/crescimento & desenvolvimento , Ácido Nalidíxico/farmacologia , Polimixina B/farmacologia , Valor Preditivo dos Testes , Estudos Prospectivos , Trimetoprima/farmacologia , Tuberculose Pulmonar/microbiologiaRESUMO
Se presentan los resultados de un estudio realizado en 421 pacientes que se sometieron a procedimientos invasores utilizando catéteres con fines diagnósticos y terapéuticos en la Unidad de Hemodinamia de un hospital público en el período julio-diciembre del año 2003. El objetivo de la investigación fue conocer si existen riesgos en la re-utilización de catéteres de angiografía empleados en dicha unidad y que son catalogados como de uso único. Para este fin se seleccionó como metodología de investigación la de estudio epidemiológico de tipo analítico observacional de cohortes prospectivas. De la población estudiada, 63,4 por ciento correspondió a población masculina con edad promedio de 64 años. Del total de los pacientes 27 por ciento presentaban diabetes mellitus y 24 por ciento obesidad. El 82 por ciento de los procedimientos tenía fines diagnósticos y 74 por ciento fueron realizados con catéteres reutilizados. Se encontró 4,3 por ciento de complicaciones infecciosas locales o reacciones a pirógenos; sin embargo, no se encontró diferencia significativa entre el grupo que fue intervenido con catéteres de primer uso respecto a los que utilizaron catéteres antes usados (p < 0,05) en ninguna de las variables estudiadas.
Assuntos
Masculino , Humanos , Feminino , Angiografia Coronária/efeitos adversos , Angiografia Coronária/instrumentação , Cateterismo/efeitos adversos , Hospitais Públicos , Estudos de Coortes , Estudos Epidemiológicos , Reutilização de Equipamento , Equipamentos Descartáveis/microbiologia , Instrumentos Cirúrgicos/microbiologia , Estudos ProspectivosRESUMO
PURPOSE: To evaluate the bacterial contamination of bandage disposable soft contact lenses used in patients following photorefractive keratectomy (PRK) and to correlate our findings with clinical data. METHODS: Forty-six patients (81 eyes) underwent PRK. Immediately after each procedure, disposable soft contact lenses were positioned with sterile forceps. After 3 days, the lenses were removed in a sterile manner, placed in sterile Eppendorf pipettes containing 8 mL of enriched brain heart infusion broth, and analyzed for microbial contamination. RESULTS: Seven positive cultures were found: six gram positive cocci (7.4%) and one gram negative bacillus (1.2%). There was no clinical correlation with these findings. CONCLUSION: Isolated microorganisms were similar to those described in the literature as agents of bacterial keratitis and are components of the normal ocular flora. Klebsiela pneumoniae--considered an occasional or transient flora--was the exception. All isolated microorganisms but K. pneumoniae were sensitive to most of the antibiotics tested. Our findings suggest that the risk of infectious keratitis after PRK related to soft contact lens wear for 3 days seems to be low, which may be because lenses were not manipulated by the patient during the wearing period, and the postoperative antibiotic regimen was strictly followed by patients. However, care should be taken to instruct patients in proper lens care practices to reduce the risk of bacterial keratitis in contact lens wear following PRK.
Assuntos
Bacillus/isolamento & purificação , Lentes de Contato Hidrofílicas/microbiologia , Equipamentos Descartáveis/microbiologia , Contaminação de Equipamentos , Bactérias Gram-Negativas/isolamento & purificação , Cocos Gram-Positivos/isolamento & purificação , Ceratectomia Fotorrefrativa , Adulto , Antibacterianos/farmacologia , Bacillus/efeitos dos fármacos , Bacillus/crescimento & desenvolvimento , Contagem de Colônia Microbiana , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/prevenção & controle , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/crescimento & desenvolvimento , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/crescimento & desenvolvimento , Humanos , Lasers de Excimer , Masculino , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Erros de Refração/reabilitação , Procedimentos Cirúrgicos RefrativosRESUMO
PURPOSE: To describe a case of bilateral corneal ulcers caused by Pseudomonas in a disposable soft contact lens wearer. This case study discusses the role of patient examination, contact lens care instruction, and adequate patient supervision in reducing the risk of serious potential complications. METHODS AND RESULTS: A 17 year old student who had been using disposable soft contact lenses on an extended wear basis for 6 months presented complaining of pain in the left eye. When he was examined, a corneal ulcer with surrounding infiltrate was observed in the superior middle periphery of the left eye. Samples were collected for culture, and treatment with fortified cefalotin and gentamicin was started. After 8 hours the patient returned, now complaining of pain in the right eye. Examination of the right eye revealed a diffused keratitis with a mucopurulent discharge. A culture was taken, and the same treatment was instituted. The laboratory tests revealed Pseudomonas in both eyes. The bilateral corneal ulcers responded to therapy after 1 week of treatment. CONCLUSIONS: We discuss the factors involved in the occurrence of infectious keratitis in contact lens wearers, and stress that even disposable contact lens wear can be associated with serious complications. This case also highlights extended wear as one of the main risk factors for complications in disposable soft contact lens wear.