Paula Carolina Bejo Wolkers

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

OBJECTIVE: To determine the prevalence of serotypes and antimicrobial susceptibility of strains of pneumococcus in children and to evaluate the implications for vaccine formulation. METHODS: Strains of pneumococcus obtained from children admitted with invasive diseases were isolated at Hospital de Clinicas of Universidade Federal de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, Sao Paulo, Brazil, for further identification, serotyping, and determination of antimicrobial susceptibility. RESULTS: From April 1999 to December 2008, 142 strains of pneumococcus, obtained from children under 5 years of age, were analyzed. Seventy-five (52.8%) patients were male, and the age ranged from 1 to 60 months (mean age = 19±15.4 months; median = 15 months). The most common diagnoses were pneumonia [92 cases (64.8%)] and meningitis [33 cases (23.2%)]. The strains were mostly isolated from blood [61 samples (43%)], pleural fluid [52 samples (36.6%)], and cerebrospinal fluid [28 samples (19.7%)]. The most common serotypes were 14, 5, 6B, 1, 6A, 18C, 19A, 3, 9V, 19F, 23F, 9N, and 10A. There were 14 [9.9%] penicillin-resistant strains, which was detected only in the following serotypes: 14, 6B, 19F, 19A, and 23F, being predominant from 2004 to 2008 (p = 0.000). There was reduced susceptibility to co-trimoxazole (79.5%), erythromycin and clindamycin (11.3% each), and ceftriaxone (5.6%). CONCLUSIONS: Penicillin resistance was detected in 9.9% of the strains, being predominant from 2004 to 2008. Twenty different pneumococcal serotypes were identified, and 71.9% of the serotypes were represented in the 7-valent conjugate vaccine (PN CRM7) currently available.

Novos pontos de corte de sensibilidade nas taxas de resistência antimicrobiana de cepas invasivas de pneumococo

OBJETIVO: Avaliar impacto dos novos pontos de corte de sensibilidade a penicilina nas taxas de resistencia de cepas de pneumococo obtidas de criancas com pneumonia. METODOS: Cepas de pneumococo isoladas no laboratorio de analises clinicas do Hospital de Clinicas de Uberlândia, Uberlândia (MG), a partir de amostras de pacientes internados foram enviadas ao Instituto Adolfo Lutz, Sao Paulo (SP), para confirmacao da identificacao, sorotipagem e determinacao da sensibilidade aos antimicrobianos. RESULTADOS: De abril de 1999 a dezembro de 2008 foram enviadas ao Instituto Adolfo Lutz 330 cepas de pneumococo, sendo 195 (59%) provenientes de pacientes com diagnostico de pneumonia. Destas, foram analisadas 100 cepas de pacientes com idade ≤ 12 anos; a idade dos pacientes variou de 1 a 12,6 anos, com media de 2,4 e mediana de 1,7 anos; 47 pacientes eram do sexo masculino; as fontes de recuperacao foram sangue (42%) e liquido pleural (58%). Foram detectadas 35 cepas oxacilina-resistentes: segundo os criterios do Clinical and Laboratory Standards Institute (CLSI) de 2007 [concentracao inibitoria minima (CIM) ≤ 0,06 µg/mL para sensibilidade (S), 0,12 a 1 µg/mL para resistencia intermediaria (RI) e ≥ 2 µg/mL para resistencia plena (RP)], 22 cepas apresentaram RI e 11, RP para penicilina. De acordo com os criterios atuais do CLSI de 2008 (≤ 2 µg/mL para S, 4 µg/mL para RI e ≥ 8 µg/mL para RP) apenas uma cepa confirmou RI a penicilina. Detectou-se resistencia a cotrimoxazol (80%), tetraciclina (21%), eritromicina (13%), clindamicina (13%) e ceftriaxona (uma cepa, simultaneamente resistente a penicilina). CONCLUSOES: Com a aplicacao dos novos pontos de corte para sensibilidade in vitro, as taxas de resistencia a penicilina cairam 97%, de 33 para 1%.

Repercussions of hospitalization due to fall of the elderly: health care and prevention

OBJECTIVE To know the repercussions of the fall reported by the elderly and their caregiver during hospitalization in a public hospital in Florianópolis city from October to December 2014. METHOD Exploratory research with a qualitative approach, conducted by depth interviews with 16 participants, the eight elderly were hospitalized for falls and eight elderly caregivers. Data analysis were performed through the Thematic Content Analysis. RESULTS It was evidenced the thematic axis: Faller Elderly supported by four thematic categories: Changes caused by Falls, I am a faller, I take care of me and Prevention of the Fall. The repercussions of the fall were evidenced in the impairment of the health condition, self-care and functional capacity. We observed the naturalization of the phenomenon and the passivity with the harmful consequences of the event. Final Considerations: The fall is valued the more negative its repercussion, such as the need for hospitalization and surgery. Managing the vulnerability of the elderly, especially in primary care, evaluating their comorbidities and their internal and external environment, will minimize unfavorable consequences and the social and financial cost of hospitalizations.

Atenção primária à criança com diabetes mellitus tipo 1: perspectiva de cuidadores

Resumo Objetivo: Avaliar e comparar a qualidade da atencao primaria ofertada as criancas com diabetes mellitus tipo 1 entre os tipos de servicos publicos de atencao a saude na experiencia dos seus principais cuidadores. Metodos: Estudo transversal, fundamentado em avaliacao em saude, a partir de entrevistas com 55 cuidadores de criancas com diabetes mellitus tipo 1, com base no instrumento de avaliacao Primary Care Assessment Tool-versao crianca. Resultados: Grande parte dos atributos da atencao primaria a saude apresentou escores considerados [...]