Mônica de Abreu Rodrigues

Bacteriological analysis of platelets and cases of septic reactions associated with transfusion of contaminated samples.

INTRODUCTION For years, platelet transfusion therapy has been playing an important role in controlling patients with hematological and oncological diseases. However, platelet transfusion represents a serious risk for bacterial sepsis. This study aimed to verify the bacterial contamination index in platelet concentrates (PCs) obtained from the Blood Center of the State of Rio Grande do Sul (HEMORGS). METHODS All 612 samples of PCs from HEMORGS were analyzed in August 2009 and January 2010. We used a qualitative methodology which was modified manually in order to detect bacterial contamination. The patients who received the platelet units with confirmed positive cultures had their medical records analyzed. After the prospective study, a retrospective analysis of the samples of PCs checked by the bacteriological control from HEMORGS since its foundation (2008) until 2010 was made. RESULTS Four hundred and eighty samples (10 monthly samples of plateletpheresis and 10 of whole blood-derived platelets) were analyzed in order to compare the contamination index for both studies. Of 1092 samples, 15 were found to be contaminated (6 of retrospective analysis and 9 of prospective). In prospective study, isolated microorganisms were nine Staphylococcus epidermidis, but in retrospective two Staphylococcus sp., two glucose non-fermenting gram negative bacilli, one Streptococcus sp. and one Proteus mirabilis. We report 3 feasible cases of bacterial sepsis associated with the transfusion of CPs analyzed by prospective study. CONCLUSION Bacterial sepsis associated with platelet transfusion is today the most frequent infectious complication of transfusion medicine. Although complex, it is important to recognize transfusion sepsis in patients to reduce morbidity and mortality.

Evaluation of constitutive and inducible resistance to clindamycin in clinical samples of Staphylococcus aureus from a tertiary hospital

INTRODUCTION Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) have become common in hospitals and the community environment, and this wide resistance has limited patient treatment. Clindamycin (CL) represents an important alternative therapy for infections caused by S. aureus. Antimicrobial susceptibility testing using standard methods may not detect inducible CL resistance. This study was performed to detect the phenotypes of resistance to macrolides-lincosamides-streptogramin B (MLSB) antibiotics, including CL, in clinical samples of S. aureus from patients at a tertiary hospital in Santa Maria, State of Rio Grande do Sul, Brazil. METHODS One hundred and forty clinical isolates were submitted to the disk diffusion induction test (D-test) with an erythromycin (ER) disk positioned at a distance of 20mm from a CL disk. The results were interpreted according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI). RESULTS In this study, 29 (20.7%) of the 140 S. aureus samples were resistant to methicillin (MRSA), and 111 (79.3%) were susceptible to methicillin (MSSA). The constitutive resistance phenotype (cMLSB) was observed in 20 (14.3%) MRSA samples and in 5 (3.6%) MSSA samples, whereas the inducible resistance phenotype (iMLSB) was observed in 3 (2.1%) MRSA samples and in 8 (5.8%) MSSA samples. CONCLUSIONS The D-test is essential for detecting the iMLSB phenotype because the early identification of this phenotype allows clinicians to choose an appropriate treatment for patients. Furthermore, this test is simple, easy to perform and inexpensive.

PREVALÊNCIA E PERFIL DE SENSIBILIDADE DE Staphylococcus aureus ISOLADOS EM UM HOSPITAL ESCOLA NA CIDADE DE SANTA MARIA, BRASIL

Objetivou-se caracterizar a prevalencia e o perfil de suscetibilidade de Staphylococcus aureus isolados no Hospital Universitario de Santa Maria (HUSM), atraves de levantamento de dados junto ao Laboratorio de Analises Clinicas, durante o periodo de abril a junho de 2009. Foram solicitadas 3270 culturas, sendo que 1123 (34%) resultaram positivas. A prevalencia de S. aureus em relacao as culturas positivas foi de 89 (7,93%). Verificou-se que 33% das cepas foram resistentes a oxacilina e que 34,45% apresentaram resistencia relacionada ao gene erm. Elevada sensibilidade ao sulfametoxazol-trimetoprima (72/80%) foi evidenciada pela automacao e nenhuma cepa mostrou-se resistente a vancomicina. Portanto, a prevalencia de S. aureus no HUSM e a resistencia a oxacilina foram inferiores ao observado em outros hospitais terciarios brasileiros. The objective ofthis study was to characterize the prevalence and susceptibility prof ile ofStaphylococcus aureus isolates at University Hospital ofSantaMaria, through data collection at the Laboratory ofClinicalAnalysis, duringApril to June 2009. Were requested 3270 cultures and 1123 (34%) were positive. The prevalence of S. aureus in relation to positive cultures was 89 (7,93%). It was f ound that these strains, 33% were resistant to oxacillin and 34.45% showed resistance related erm gene. High sensitivity to trimethoprim-sulf amethoxazole (72/80%) was detected f or the automation and no strain showed resistance to vancomycin. Theref ore, the prevalence of S. aureus and oxacillin resistance at HUSM were lower than observed in other tertiary hospitals in Brazil. Descritors: Prevalence; Staphylococcus aureus; Bacterial inf ection, Oxacillin.

Staphylococcal scalded skin syndrome in a premature newborn caused by methicillin-resistant Staphylococcus aureus: case report

CONTEXT Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive) developed in blood cultures performed on the day of death (seventh day), and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day). The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria.

Prevalence of methicillin-resistant Staphylococcus aureus in a University Hospital in the South of Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) stand out as one of the main agents causing nosocomial and community infections. This retrospective study aimed to analyze the MRSA predominance in a university hospital in the south of Brazil and it was carried out for five years (from 2007 to 2011). 616 MRSA (33,3% of the total) were isolated and an important reduction in the MRSA predominance was observed along the study. Although it was registered a reduction in the MRSA predominance, male adult patients (41-70 years old), who were in the Medical Clinic and Adult ICU, had the highest infection rates and concerning MRSA isolates rates, these were higher in blood and tracheal aspirates. In conclusion, studies of this type are becoming relevant to recognize pathogens like MRSA and to determine its predominance.

CARACTERIZAÇÃO DE CULTURAS DE URINA REALIZADAS NO LABORATÓRIO DE ANÁLISES CLÍNICAS DO HOSPITAL UNIVERSITÁRIO DE SANTA MARIA – SANTA MARIA, RS, NO PERÍODO DE 2007 À 2010

A infeccao do trato urinario (ITU) e considerada uma das doencas mais comuns de origem bacteriana. Objetivou-se determinar a prevalencia de ITU em pacientes atendidos no Hospital Universitario de Santa Maria, o agente mais isolado, a incidencia entre os sexos e a faixa etaria mais acometida. Realizou-se um estudo retrospectivo das uroculturas solicitadas no HUSM, no periodo de 2007 a 2010, as quais foram cultivadas no setor de Microbiologia do Laboratorio de Analises Clinicas. Dos 34.898 exames solicitados, 6.190 (17,74%) foram positivos. O sexo feminino apresentou o maior percentual de positividade (72,94%) e a faixa etaria feminina mais acometida foi entre 14 a 40 anos (37,6%) e a masculina entre 41 a 64 anos (10,6%). O microrganismo prevalente foi a Escherichia coli com 31,9%. A partir deste estudo pode-se verificar que os bacilos gram-negativos (BGN) foram os patogenos prevalentes, alem disso, ocorreu um significativo numero de isolados de Candida sp.

Contaminação bacteriana em concentrados plaquetários: identificação, perfil de sensibilidade aos antimicrobianos e sepse associada à transfusão

INTRODUCTION Bacterial sepsis associated with the transfusion of platelet concentrates (PCs) results in serious clinical implications for patients. Given these implications, certain procedures have been integrated into the preparation and quality control of blood components to reduce the risk of bacterial contamination. This article describes the prevalence of bacterial contamination on transfused PCs, the bacterial spectrum detected and their antimicrobial susceptibility profile and transfusion reactions in receptors. METHODS A total of 292 PCs (278 random and 14 per apheresis) from the Blood Center of the State of Rio Grande do Sul (HEMORGS), located in the city of Santa Maria, were tested. Quantities of 100 μL and 200 μL were collected from platelet bag tubing and seeded using two methodologies. RESULTS Using the qualitative methodology, bacteria were isolated in five units (1.7%; 5/292), while only one was isolated using the quantitative methodology. Staphylococcus epidermidis was the microorganism identified in all samples. Two patients died of transfusion-related sepsis. CONCLUSIONS Bacterial contamination due to PC transfusion is considered a major public health problem due to its association with high rates of morbidity and mortality. In this study only gram-positive microorganisms were isolated and none of the samples obtained by apheresis presented contamination.

Prevalência e perfil de sensibilidade de bactérias isoladas da urina de gestantes atendidas no serviço de obstetrícia de um hospital terciário

Objetivos : Avaliar a prevalencia e o perfil de sensibilidade aos antimicrobianos de bacterias isoladas de uroculturas de gestantes atendidas no ambulatorio do Servico de Obstetricia do Hospital Universitario de Santa Maria, Brasil. Metodos : Foi realizado um estudo retrospectivo dos laudos emitidos pelo Laboratorio de Analises Clinicas do Hospital Universitario de Santa Maria. Foram incluidas no estudo todas as uroculturas positivas de gestantes atendidas no ambulatorio do Servico de Obstetricia deste hospital, no periodo de janeiro a dezembro de 2014. Os testes de identificacao dos micro-organismos isolados e os perfis de sensibilidade frente aos antimicrobianos foram efetuados por meio de um sistema automatizado. Resultados : No periodo do estudo foram identificadas neste laboratorio 423 uroculturas positivas provenientes de gestantes. A bacteria Gram negativa Escherichia coli foi a mais prevalente (46,50% das culturas positivas). A segunda bacteria mais frequente foi a Gram positiva Staphylococcus saprophyticus (6,2%). O fungo Candida spp. foi isolado de 94 (21,8%) amostras de urina. Nitrofurantoina e amoxicilina/acido clavulânico foram os antimicrobianos com menor taxa de resistencia por parte de E. coli (91,33% e 90,77% de sensibilidade, respectivamente). Ja frente as bacterias Gram positivas prevalentes, ampicilina foi a que mostrou maior sensibilidade. Conclusoes : O perfil de suscetibilidade apresentado neste estudo indica que a escolha para o tratamento da ITU na gestacao pode recair em nitrofurantoina e/ou amoxicilina/acido clavulânico para as bacterias Gram negativas. Tendo em vista a prevalencia encontrada, esses antimicrobianos podem ser iniciados empiricamente antes do resultado da urocultura, nos casos de ITU sintomatica. Este estudo ratifica, entretanto, a importância da realizacao da urocultura entre os exames pre-natais e sua repeticao no terceiro trimestre da gravidez, tendo em vista a variedade de micro-organismos identificados e os diferentes perfis de sensibilidade aos antimicrobianos testados.

ABORDAGEM DAS DOENÇAS SEXUALMENTE TRANSMISSÍVEIS NA ADOLESCÊNCIA: REVISÃO DE LITERATURA

O estudo objetivou reportar sobre os riscos de contagio das Doencas Sexualmente Transmissiveis (DSTs), apresentando as principais formas de transmissao, sinais e sintomas associados, tratamento e prevencao. Realizou-se uma revisao bibliografica no periodo de abril a junho de 2015, por meio das bases de dados (SciELO, PubMed, LILACS e BIREME), cartilhas e materiais do Ministerio da Saude, publicados entre 2003 a 2015 envolvendo os descritores: “doencas sexualmente transmissiveis”, “adolescente”, “sexualidade” e “vulnerabilidade em saude” no idioma ingles e portugues. A busca resultou em 63 publicacoes das quais 58 foram selecionadas a partir da leitura dos resumos dos materiais para elaboracao deste trabalho por abordarem o tema proposto. Pode se observar que a disseminacao das DSTs entre a populacao jovem e crescente, sendo necessario investir continuamente em acoes de carater educativo que visem a reducao dos fatores de riscos e possam contribuir para sua cidadania. Descritores: Doencas Sexualmente Transmissiveis; Adolescente; Sexualidade; Vulnerabilidade em Saude.