Augusto Diogo Filho

Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

Although central vascular catheters (CVC) are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI) caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU) from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU)/20 cm(2) (p=0.03; odds ratio (OR) =6.89) and catheter tip (p=0.01; OR=7.95). The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

O etil-2-cianoacrilato como selante após ressecção parcial de ceco em rattus norvegicus albinus

OBJECTIVE To evaluate the use of ethyl-2-cyanoacrylate in the treatment of an injury caused in a partially excluded segment of the mouse gut: the cecum. METHODS We used 45 male Wistar rats, divided into three equal groups; in all there was performed a partial resection of the cecum. The groups were designated as Group 1: the lesion was treated with application of ethyl-2-cyanoacrylate, Group 2: suture and application of ethyl-2-cyanoacrylate, Group 3: purse-string suture. The animals were monitored postoperatively and half of each group was necropsied 14 days after the procedure, the remaining on the 28th. They were subjected to macroscopic evaluation, had cecal samples collected for histological examination and the findings were submitted to statistical analysis. RESULTS Weight gain after the experiment was different among groups (p=0.028). The presence of microabscesses was higher at 28 days postoperatively in group 2 when compared to group 3 (p=0.003). The collagen deposition on the 28th postoperative day was greater in group 1 (p=0.036) and intensity of inflammation at the 14th postoperative day was greater in group 1 (p=0.045). In the other parameters there was no statistical difference. CONCLUSION The use of ethyl-2-cyanoacrylate was effective in the treatment of cecal stump exclusion of rats as for macroscopic and microscopic findings and postoperative outcome.

Experimental model in the qualitative and quantitative assessment of non-Helicobacter gastric microflora under proton pump inhibitors action

PURPOSE To evaluate models of gastric material collection from Wistar rats with and without using proton pump inhibitors(PPIs). METHODS Twenty-four rats underwent intraperitoneal omeprazol treatment, and other 12 received similar treatment with 0.9% saline. All animals underwent collection of gastric material samples, after stomach removal, by either biopsies, or aspirates, or swabs. Samples were bacteriologically processed in order to identify species and strains. Values are described as natural logarithm of colony former units per mL [Ln(CFU/mL)]. Kruskal-Wallis and Mann-Whitney non-parametric tests were used, and p<0.05 was set as statistically significant. RESULTS Significant difference was not seen for Ln (UFC/mL) values among the three methods of collection irrespective of using or not omeprazol. Also, significant difference was not seen in Ln (UFC/mL) values when comparing a method with each others, either using omeprazol or placebo. A significant increase of bacteria strains occurred when PPI was used, and this was seen on the three ways of collection, mainly in biopsy and swab. CONCLUSION No difference occurred among the three methods of collecting bacteria samples from stomachs of rats, either when using placebo or omeprazol. A remarkable change is seen on animals bacterial microflora when PPIs are used, and bacteria are better identified when swab and biopsy are used.

Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia

BACKGROUND AND OBJECTIVE The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization. METHODS From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis. RESULTS Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45 h (18-118) (p=0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis. CONCLUSION Postoperative epidural catheter analgesia, under these study conditions, was found to be low risk for bacterial colonization in patients at surgical wards.

Etiology and pathogenesis of bloodstream infections associated with the use of long-term central vascular catheter (CVC) in patients who undergone gastrointestinal surgery

CVC is the main factor of risk of bloodstream infections. This study purpose was determining both etiology and pathogenesis of these infections in 80 patients who undergone gastrointestinal surgery and who worn long lasting CVC, in the institution HC-UFU. Cultures were made in nostril, skin of the insertion site, tip and catheter hub, in addition to hemoculture in those suspects of sepsis. The colonization incidence rate of the catheter tip was 12.5/ 1,000 catheter days and the CVC associate infection rate was 3.1/1,000 catheter days. Frequencies of skin, hub and catheter tip colonization were 13.8%, 8.9% and 13.3%, respectively. Coagulase-negative Staphylococci were the most found microorganisms in nostril (74%), skin (45.4%) and hub (75%) and Gram-negative bacilli (50%), followed by S. aureus (25%) the most common ones in catheter tip. Approximately 51% of patients received antibiotics and most of them (53.7%) had therapeutic purpose. The frequency of patients with clinical sepsis was 27.5%. Three cases of bacteremia associated with the use of CVC were detected (3.8%), with S. aureus in two of them and K. pneumoniae in the third one. There was not seen any association of skin and hub colonization with their presence in the catheter tip and in the blood of these patients, but S. aureus was recovered from nostril of those with sepsis by this pathogenic agent. A greater concern is suggested over preventive measures and control of these primary and secondary bloodstream, as well as catheter tip colonization.

Pressure ulcer as a reservoir of multiresistant Gram-negative bacilli: risk factors for colonization and development of bacteremia

The purpose of this study was to identify the risk factors that predispose patients who are hospitalized with pressure ulcers (PUs) colonized by Gram-negative bacilli (GNB) to develop bacteremia. In addition, we also detected main phenotypes of resistance in infected and uninfected PUs. A prospective cohort study was conducted at the Clinical Hospital of the Federal University of Uberlândia including patients with Stage II or greater PUs, colonized or not with GNB, from August 2009 to July 2010. Infected ulcers were defined based on clinical signs and on positive evaluation of smears of wound material translated by a ratio of polymorphonuclear cells to epithelial cells ≥2:1, after Giemsa staining. A total of 60 patients with Stage II PUs were included. Of these 83.3% had PUs colonized and/or infected. The frequency of polymicrobial colonization was 74%. Enterobacteriaceae and GNB non-fermenting bacteria were the most frequent isolates of PUs with 44.0% of multiresistant isolates. Among patients who had infected PUs, six developed bacteremia by the same microorganism with a 100% mortality rate. In addition, PUs in hospitalized patients were major reservoir of multiresistant GNB, also a high-risk population for the development of bacteremia with high mortality rates.

Relationship of Helicobacter pylori seroprevalence with the occurrence and severity of psoriasis

BACKGROUND Psoriasis is a chronic inflammatory disease that affects the skin and joints and has a multifactorial etiology. Recently, it has been suggested that Helicobacter pylori infection may contribute as a trigger for the development of the disease. OBJECTIVES To determine the prevalence of H. pylori seropositivity in patients with psoriasis and to evaluate the relation between disease severity and H. pylori infection. METHODS H. pylori infection was assessed in psoriatic patients and controls by using H. pylori IgG quantitative enzyme immunoassay (ELISA test). The patients were classified according to the severity of the disease (PASI score). RESULTS One hundred and twenty six patients with psoriasis (73 females and 53 males); mean age 50.48 years; 65 patients (51.59%) had severe psoriasis, 40 (31.75%) moderate psoriasis and 21 (16.67%) mild psoriasis. Twenty one healthy volunteers included as a control group, mean age of 41.05 years, 13 females and 8 males. One hundred and eleven patients with psoriasis tested serologically, 80 (72.07%) were seropositive compared with 7 positive volunteers (33.33%; P=0.002). Forty-nine (75.38%) patients with severe psoriasis were positive, 25 (62.50%) with moderate psoriasis were positive and 6 (28.57%) with mild psoriasis were positive (P=0.045). Study limitations: none. CONCLUSIONS H. pylori infection influences the development of psoriasis and severity of the disease.

Provas de função pulmonar no pré e pós-operatório de redução gastrica por celiotomia ou por videolaparoscopia

BACKGROUND: Evaluate pulmonary function pre and postoperative period of patients submitted to Roux-en-Y gastric bypass by laparotomy and video laparoscopy. METHOD: Between october 2004 until october 2005, 38 patients were submitted to Roux-en-Y gastric bypass, 17 of them (9 woman and 8 man) by laparotomy (age and BMI mean of 32±9,8 years and 47±7,2Kg/m2, respectively) and 20 (13 woman and 7 man) by video laparoscopy (age and BMI mean of 35±9,6years and 44±5,9Kg/m2, respectively). All of them were submitted to espirometry, blood gas transcutaneous (oximetry) and respiratory frequency monitoring before and after surgery (until the 30th hour) and were also evaluated by a modified pain visual analogic scale (VAS) at the espirometry. RESULTS: In pre-operative, all patients presented normal pulmonary function tests. We observed a significant mean reduction of 38,5% in FVC, 39,11% in FEV1 and 37% in PEF in laparotomy group (LG). In the video laparoscopy group (VG) there was a mean reduction of 38.37% in FVC, 35.53% in FEV1 and 41.57% in PEF. The respiratory frequency had a mean increase of 16.98 and 14.79% in LG and VG respectively, both with statistic significance. The mean operating time was 179±17,7 minutes in LG and 163,4±14,5 minutes in VG. Pain scores were 3.5 in LG and 3.40 in VG. The incidence of post-operatory complications was about 2%. CONCLUSION: We concluded that the patients with degree 2 or morbid obesity presented normal espirometry values in pre-operative and, after being submitted to gastric bypass technique (laparotomy or videolaparoscopy), they developed an espirometric standard compatible with pulmonary restriction in early post-operative.

The importance of protecting surgical instrument tables from intraoperative contamination in clean surgeries

OBJECTIVE to compare the degree of bacterial contamination of surgical instrument tables used in clean surgical procedures, either protected with plastic fields, sterilized with ethylene oxide, or disinfected with 70% alcohol and 1% iodine solutions. This is a randomized clinical trial in which samples were collected from the surfaces of surgical instrument tables before and after each procedure. Microbiological analysis was performed to identify microorganisms and their respective antimicrobial resistance. RESULTS Bacterial growth in the surgeries using sterilized plastic was 5.71% before and 28.6% after surgery and, 2.9% and 45.7% respectively in surgeries using disinfection with 70% alcohol and 1% iodine solutions; no statistical difference was found between the methods. CONCLUSION both methods present similar protection, however, 70% alcohol and 1% iodine do not generate solid waste.OBJETIVO: analisar o grau de contaminacao bacteriana da mesa de instrumentais cirurgicos, apos o uso de campo plastico esterilizado por oxido de etileno ou a desinfeccao com solucao de alcool a 70% e iodo a 1%, em procedimentos cirurgicos limpos. METODOS: Trata-se de experimento clinico randomizado, com coletas de amostras das superficies das mesas de instrumentais cirurgicos, antes e depois de cada procedimento, com posterior analise microbiologica para identificacao dos microrganismos e sua resistencia antimicrobiana. RESULTADOS: nas cirurgias em que o plastico esterilizado foi utilizado, o crescimento bacteriano foi de 5,71% antes e 28,6% apos a cirurgia, enquanto que nas desinfeccoes com solucao de alcool a 70% e iodo a 1%, o crescimento foi de 2,9% antes e 45,7% apos, sem diferenca significativa entre os metodos empregados. CONCLUSOES: os dois metodos tem poder de protecao semelhante, considerando que o alcool a 70% e iodo a 1% nao geram residuos solidos.

Comment on Helicobacter pylori seroprevalence and the occurrence and severity of psoriasis - Reply

©2017 by Anais Brasileiros de Dermatologia Dear editor, As mentioned in the article in question, the selected control group had 21 volunteers without skin diseases and without gastrointestinal symptoms.1 This group was composed of people with similar socioeconomic status as the patients and who were accompanying those patients during the visits or who had been attended at a neighboring outpatient clinic. We agree that our control group had a small number of participants because of the difficulty in getting healthy people willing to undergo blood collection without any material gain in return. The methods for the diagnosis of Helicobacter pylori are divided into invasive and non-invasive. In our study, we used the Elisa serological test, a noninvasive method ideal for epidemiological studies, based on the identification of H. pylori-specific IgG antibodies in the patient’s serum. However, the has some restrictions. It only detects host exposure to the bacterium, without diagnosing active infection (true infection) (Krogfelt et al., 2005).2 We chose this method due to its reduced cost and the low complexity of accomplishment in relation to other diagnostic methods. We believe that the patient’s contact with H. pylori alone is sufficient to trigger the immunological cascade implicated in the pathogenesis of psoriasis. As in our study, Qayoom and Ahmad detected H. pylori antibodies in 40% of psoriasis patients and 10% of control subjects (healthy subjects without gastrointestinal complaints) and concluded that H. pylori plays a causal role in the pathogenesis of psoriasis.3 Similarly, Fathy et al. compared 20 plaque psoriasis patients with 20 healthy volunteers, matched for age and gender, and tested them for H. pilory antibodies using the Elisa test. The mean prevalence of seropositivity in psoriatic patients was significantly higher when compared to controls. Also, the high values correlated with the severity of the disease. They concluded that there is a link between H. pylori and psoriasis and that the bacterium may also influence the pathogenesis of the disease.4 q