Rio De Janeiro Hospital Research Articles

Use of antimicrobials in pediatric wards of five Brazilian hospitals

The use of antimicrobials (AMs) in pediatric infections is common practice and use may be inappropriate leading to antimicrobial resistance. Off-label AM use is also common in this group and can result in drug-related problems. There is lack of DUR data in Brazil and in Latin America, specially for AM pediatric use. The aim of this study was to describe the utilization of AMs in hospitalized children in five hospitals in Brazil. We conducted an observational study of the utilization of AMs in pediatric wards in hospitals in the states of Ceará (CE), Sergipe (SE), Rio de Janeiro (RJ), Rio Grande do Sul (RS) and the Federal District (DF). Data derived from patient medical records and prescriptions were collected over a six-month period in each hospital. The number of AMs used by each patient was recorded, and AM use was assessed using Days of therapy (DOT) and Length of therapy (LOT) per 1000 patient days according to different patient characteristics. Off-label (OL) use was described according to age. The study analyzed data from 1020 patients. The sex and age distributions were similar across the five hospitals. However, differences were found for comorbidities, history of ICU admission and length of hospital stay. The most common diseases were respiratory tract infections. There were wide variations in DOT/1000PD (278–517) and LOT/1000PD (265–390). AM utilization was highest in the hospital in SE. The consumption of second-generation penicillins and cephalosporins was high. The prevalence of OL use of AMs was higher for patients in the RJ hospital, in infants, in patients who underwent prolonged hospital stays, and in patients who used multiple AMs. The AM that showed the highest prevalence of OL use was azithromycin, in both oral and parenteral formulations. Overall AM use was high and showed differences in each setting, possibly influenced by local characteristics and by prescribing standards adopted by pediatricians.

Longitudinal Follow-Up of Gross Motor Function in Children with Congenital Zika Virus Syndrome from a Cohort in Rio de Janeiro, Brazil.

Knowledge of how congenital Zika syndrome (CZS) impacts motor development of children longitudinally is important to guide management. The objective of the present study was to describe the evolution of gross motor function in children with CZS in a Rio de Janeiro hospital. In children with CZS without arthrogryposis or other congenital osteoarticular malformations who were followed in a prospective cohort study, motor performance was evaluated at two timepoints using the Gross Motor Function Classification System (GMFCS) and the Gross Motor Function Measurement test (GMFM-88). Among 74 children, at the baseline evaluation, the median age was 13 (8–24) months, and on follow-up, 28 (24–48) months. According to GMFCS at the second timepoint, 6 children were classified as mild, 11 as moderate, and 57 as severe. In the GMFM-88 assessment, children in the severe group had a median score of 10.05 in the baseline evaluation and a follow-up score of 12.40, the moderate group had median scores of 25.60 and 29.60, and the mild group had median scores of 82.60 and 91.00, respectively. Although a small developmental improvement was observed, the motor impairment of children was mainly consistent with severe cerebral palsy. Baseline motor function assessments were predictive of prognosis.

Increased biofilm formation by Staphylococcus aureus clinical isolates on surfaces covered with plasma proteins.

Introduction. Biofilm formation is a major virulence factor associated with Staphylococcus aureus infections. However, the influence of plasma proteins on biofilm formation of clinical isolates in vitro remains unclear.Hypotheses. We hypothesized that coating surfaces with plasma proteins might induce biofilm formation by S. aureus of different clonal lineages.Aim. To evaluate biofilm production by clinical S. aureus isolates of different clonal lineages isolated in Rio de Janeiro hospitals and investigated the presence of biofilm-associated genes.Methodology. This study assessed biofilm production of 60 S. aureus isolates in polystyrene microtitre plates with and without fibrinogen or fibronectin. The biochemical composition of the biofilm matrices was determined and the biofilm formation on fibrinogen-coated surfaces was also evaluated by confocal laser scanning microscopy. The presence of biofilm-related genes was detected by PCR, and the typing and functionality of agr operon was also evaluated.Results. Most of the isolates (45 %) were weak biofilm producers or non-producers. However, most of them presented a significant increase in biofilm production on plates covered with plasma proteins. There was no significant difference in biofilm formation between methicillin-resistant and -susceptible S. aureus isolates, or between different clonal lineages, except for ST30-IV (weak producers) and ST239-III (strong producers). The fnbB gene was associated with higher biofilm production.Conclusion. An increase in biofilm production in the presence of plasma proteins highlights the importance of investigating biofilm formation by S. aureus clinical isolates under different conditions since this virulence factor contributes to persistent infections and increased resistance to antimicrobials.

Comparative genomics of MRSA strains from human and canine origins reveals similar virulence gene repertoire

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen associated with a wide variety of infections in humans. The ability of MRSA to infect companion animals has gained increasing attention in the scientific literature. In this study, 334 dogs were screened for MRSA in two cities located in Rio de Janeiro State. The prevalence of MRSA in dogs was 2.7%. Genotyping revealed isolates from sequence types (ST) 1, 5, 30, and 239 either colonizing or infecting dogs. The genome of the canine ST5 MRSA (strain SA112) was compared with ST5 MRSA from humans—the main lineage found in Rio de Janeiro hospitals—to gain insights in the origin of this dog isolate. Phylogenetic analysis situated the canine genome and human strain CR14-035 in the same clade. Comparative genomics revealed similar virulence profiles for SA112 and CR14-035. Both genomes carry S. aureus genomic islands νSAα, νSAβ, and νSAγ. The virulence potential of the canine and human strains was similar in a Caenorhabditis elegans model. Together, these results suggest a potential of canine MRSA to infect humans and vice versa. The circulation in community settings of a MRSA lineage commonly found in hospitals is an additional challenge for public health surveillance authorities.

Genetic Relatedness of NDM-Producing Klebsiella pneumoniae Co-Occurring VIM, KPC, and OXA-48 Enzymes from Surveillance Cultures from an Intensive Care Unit.

Klebsiella pneumoniae is an opportunistic bacterial pathogen most commonly associated with nosocomial infections, especially in intensive care unit (ICU) patients. Routine surveillance cultures for carbapenemase-producing Enterobacteriaceae have become a common practice for hospital infection prevention. The objective of this study was to investigate the genetic relatedness of carbapenem-resistant K. pneumoniae carrying blaNDM gene across multilocus sequence typing (MLST) scheme. Surveillance rectal swabs from 4,463 ICU patients admitted to the Rio de Janeiro hospital (March 2016-2017) were screened on CHROMagar mSuperCARBA. Of these, 631 isolates were subjected to VITEK 2 system for phenotypic microbial identification and antibiotic susceptibility testing. Out of 631 isolates, 108 were identified as K. pneumoniae, 103 of which were confirmed by PCR of 16S-23S rDNA internal transcribed spacer (ITS). Eleven blaNDM-positive isolates were subsequently screened for blaKPC, blaBKC, blaIMP, blaVIM, blaSPM, blaOXA-48, and mcr-1-8 genes. Twenty-seven percent (3/11) revealed co-occurrence with KPC, OXA-48, and VIM, 46% (5/11) with KPC and VIM, and 18% (2/11) with VIM type. No strains harbored the blaBKC, blaSPM, blaIMP, and mcr-1 to 8 resistance genes. All 11 isolates were resistant to β-lactams, ciprofloxacin 90%, tigecycline 82%, gentamicin 73%, and amikacin 18%, and were classified as multidrug resistant (MDR), extensively drug resistant (XDR), and pandrug resistant (PDR). Molecular epidemiology data based on MLST revealed 11 different STs, 8 of which were novel and 3 were previously described. Six out of the eight new STs were associated with MDR and PDR strains and two clonal complexes were reported, including CC258 and CC15. The coexistence of NDM-producing K. pneumoniae and other carbapenemase has been frequently described worldwide. Moreover, we report for the first time K. pneumoniae co-harboring up to four carbapenemases from active surveillance cultures.

Weighing Polyurethane-Covered Implant Benefits and the Risk of BIA-ALCL

Sir: There is an increasing concern regarding breast implants causing breast implant–associated anaplastic large cell lymphoma (BIA-ALCL).1,2 There is immunological and histological evidence relating breast implants to ALCL, but the epidemiological evidence is weak. Early in 2019, an Australian study1 reported different rates of BIA-ALCL according to implant surface area and roughness. The authors estimated a higher incidence rate of BIA-ALCL in the polyurethane (PU) group at nearly 6.5 cases for every 10,000 implants sold after 9 years of exposure. This finding is relevant as it is a result of an effort to bring some light to a field where there is lot to clarify. There are several challenges in estimating such rates, mostly involving how to achieve accurate data.3 Besides, other elements may play a role as contributing causes of BIA-ALCL, such as genetic profile (JAK/STAT3) or genetic background, immunological profile, subsequent events leading to implant biofilm, environmental exposure, ethnicity, and so on.3 Ignoring other causes and not adjusting for their potential effect may lead to bias due to confounding.4 The logistic regression approach, used in the report, may only estimate risk up to a time limit, defined at the study design.4 Therefore, it is not clear how the authors incorporated the time issue for the risk estimation over time. For instance, was each year considered a different cohort, or were rates estimated considering all sales up to the event? In addition, the authors state that there was a difference in time of exposure to the different surfaces/trademarks, but there was no further discussion of how this might impose limitations on rate interpretation. In this context, a usual epidemiological approach of incidence density rate estimation (events/implant-year) over time would probably suffice, as it gives an idea of risk, it allows dynamic population context, it is possible to decompose the rates over the periods of interest, and it allows you to explore cohort and period/generation effects.4 The authors state that there were cluster patterns in the data,1 which was suspected to be related to certain surgeons and hospitals, raising a concern about implant infection as a cause. Surgical site infection is a preventable condition, and it was not clear if in these clusters the infection rates were above or below an acceptable limit at the time of implantation. There is a matter of clinical relevance. Polyurethane implants are easier to manipulate, they have higher adherence, and there is less free displacement throughout the capsular space compared with smooth surface implants.5 The BIA-ALCL rate may be relatively higher in the polyurethane group, but it has lower rates than other conditions that also require implant removal, such capsule contracture, rupture, and malposition. In addition, in its early stages, when most of patients are diagnosed, the lymphoproliferative condition has a very good prognosis, requiring no additional treatment.1 The physician must inform the patient of all risks, particularly the risks of all events that may require implant removal or jeopardize the aesthetic result, including the risk of BIA-ALCL. Together, the patient and the surgeon should decide what is best. DISCLOSURE Drs. Cintra, Massiere Y Correa, and Brasil are scientific consultants for Silimed. The remaining authors have no financial interests to disclose. No funding was received for this communication. Henrique P. L. Cintra, Dr.Universidade Estadual do Rio de JaneiroHospital Universitário Pedro Ernesto Wanda Elizabeth Massiere Y Correa, Dr.Pontifícia Universidade Católica Amanda T. BaptistaRoberta C. MillnaSergio Carlos A. J. JuniorSilimed Indústria de Implantes LTDA Pedro Emmanuel A. A. do Brasil, Ph.D.Fundação Oswaldo CruzInstituto Nacional de Infectologia Evandro ChagasRio de Janeiro, Brasil

High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit.

Staphylococcal colonization is a risk factor for healthcare-associated infections, which are frequent in Neonatal Intensive Care Units (NICU). This study analyzed microbiology, epidemiology and clinical aspects of Staphylococcus spp. colonizing neonates. Nasal or periumbilical swabs were evaluated from 175 newborns admitted to a NICU of a Rio de Janeiro hospital from March to September 2009. Clinical data were obtained from the medical records. SCCmec typing and the mecA and Panton-Valentine Leukocidin (PVL) genes were detected by PCR. Clonal diversity was evaluated by pulsed-field gel electrophoresis. Staphylococcus spp. isolates were detected in 98 (56%) neonates, 66.3% of them had birth weight ≤ 2500 g, 62.2% were preterm (˂ 37 weeks) and the mean length of hospitalization was 14.9 days. Among the 133 isolates identified, 48.1% were S. epidermidis, 23.3% S. haemolyticus and 13.5% S. aureus. Methicillin-resistant Staphylococcus isolate was detected in 77.6% of neonates. The methicillin-resistant S. aureus isolates carried the SCCmec type IV, while 94.6% of S. epidermidis and 85.7% of S. haemolyticus presented non-typeable cassettes. Among the S. aureus, 55.6% had PVL genes and the USA800 genotype was prevalent. Two genotypes of S. epidermidis and one of S. haemolyticus clustered 42.2% and 25.8% of the isolates, respectively. S haemolyticus colonization was associated with the use of parenteral nutrition and mechanical ventilation. High rate of neonates colonized by methicillin-resistant Staphylococcus species and the permanence of clones circulating in the NICU highlight the importance for continuous and preventive surveillance in this high-risk population.

Genetic mutations in the quinolone resistance-determining region are related to changes in the epidemiological profile of methicillin-resistant Staphylococcus aureus isolates.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important causative agent of nosocomial infections. Mutations in the quinolone resistance-determining regions (QRDRs) of the gyr and par genes have been described. This study aimed to characterise phenotypic and genotypic fluoroquinolone resistance in 69 MRSA isolates of different clonal lineages from hospitals in Rio de Janeiro, Brazil. QRDR mutations in the gyrA, gyrB, parC and parE genes were detected by DNA sequencing. Minimum inhibitory concentrations (MICs) for ciprofloxacin and moxifloxacin were determined by broth microdilution. The occurrence of associations between mutations and MICs among the different clonal lineages of MRSA isolates was then verified. Most isolates from the USA400/ST1/SCCmec IV lineage, but mainly USA100/ST5/SCCmec II isolates, which have been more recently found in Rio de Janeiro hospitals, showed different patterns of mutations, including double mutation in the QRDR of parC (Ser-80⿿⿿⿿Tyr and Glu-84⿿⿿⿿Lys/Gly) and/or gyrA (Ser-84⿿⿿⿿Leu and/or Glu-88⿿⿿⿿Lys) associated with higher moxifloxacin and ciprofloxacin MICs (MIC90, ⿥8⿿mg/L and 256⿿mg/L, respectively). On the other hand, all USA800/ST5/SCCmec IV and the BEC/ST239/SCCmec III isolates, which have disappeared from hospitals, showed single mutations in parC (Ser-80⿿⿿⿿Phe) and gyrA (Ser-84⿿⿿⿿Leu or Glu-88⿿⿿⿿Gly) and lower fluoroquinolones MICs (MIC90, ⿥2⿿mg/L and ⿥16⿿mg/L). This study highlights an increase in the number and types of mutations in the QRDRs ofgyrA and parC associated with high fluoroquinolones MICs that may be related to changes in the epidemiological profile of MRSA isolates from hospitals in Rio de Janeiro.

Molecular Markers of Antimicrobial Resistance in Methicillin-Resistant Staphylococcus aureus SCCmec IV Presenting Different Genetic Backgrounds.

Methicillin-resistant Staphylococcus aureus (MRSA) carrying SCCmec type IV has emerged in hospitals worldwide. The aim of this study was to evaluate phenotypic and molecular characteristics of antimicrobial resistance in MRSA SCCmec IV isolates, presenting different genetic backgrounds, isolated from hospitals in Rio de Janeiro. The antimicrobial resistance of 128 S. aureus type IV isolates from 11 hospitals was characterized by the disk diffusion test and minimum inhibitory concentration (MIC) test. Mutations in parC gene, which encodes ciprofloxacin resistance, and genes associated with macrolide-lincosamide-streptogramin B (MLSb) resistance were also investigated. MRSA isolates belonging to USA400/ST1 (60 isolates), USA800/ST5 (40), USA1100/ST30 (13), and other 11 (15) lineages were mainly resistant to erythromycin (68%), ciprofloxacin (56%), and clindamycin (50%). The highest antimicrobial resistance rates were found among USA400 isolates (p < 0.05). The majority of them (90%) carried only the erm(C) gene and mainly presented two mutation types in the parC gene. The msr(A) gene was most frequently found among USA800 isolates (p < 0.05). Among MRSA type IV isolates from Rio de Janeiro hospitals, multiresistance, including mutations in parC gene, was associated to the USA400/ST1, while the msr(A) gene was associated with USA800/ST5 isolates, highlighting that these lineages could have more potential to persist in a hospital environment.

Molecular characterization of Staphylococcus aureus isolates carrying the Panton-Valentine leukocidin genes from Rio de Janeiro hospitals

In a collection of 50 pvl-positive Staphylococcus aureus isolates from 10 Rio de Janeiro hospitals, 18 (36%) were from bloodstream infections, and 31 (62%) carried the SCCmec IV. Among 25 (50%) isolates of the USA1100/ST30/CC30 lineage present in 8 hospitals, 1 isolate was characterized as vancomycin-intermediate S. aureus.

Natural Ventilation by Air Captors and Extractors Sheds in Hospitals in Brazil: Wind Tunnel Measurements

Natural ventilation is an efficient design strategy for the passive cooling of buildings, especially in tropical countries such as Brazil. Among the ventilation strategies, sheds can be highlighted. These structures consist of roof openings that work as air captors or extractors depending on their location in relation to the prevailing wind directions. The hospitals of the Sarah Network, designed by the Brazilian architect Joao Filgueiras Lima, Lele, are worldwide known for using these elements to improve natural ventilation. This paper analyses the natural ventilation performance of sheds for air collecting and extracting in two Sarah hospitals located in the cities of Salvador and Rio de Janeiro. In each building, the sheds were analyzed for air extracting and collecting. The analyses were carried out by reduced physical models in an atmospheric boundary layer wind tunnel. The wind velocity was measured at external and internal points of the buildings, using hot-wire anemometers. The results show that the wards in Rio de Janeiro hospital are 17% more ventilated than the ones in the Salvador hospital. However, this difference occurs not only because of the collecting sheds but also because of set of openings and the configuration of the covering in hospitals in Rio de Janeiro.

Linezolid-resistant Staphylococcus haemolyticus and Staphylococcus hominis: single and double mutations at the domain V of 23S rRNA among isolates from a Rio de Janeiro hospital

In this work, the molecular and phenotypic antimicrobial resistance and clonal diversity of 10 linezolid-resistant Staphylococcus spp. isolates were investigated. The 7 Staphylococcus haemolyticus isolates presented Staphylococcal cassete chromosome mec (SCCmec) V and belonged to the same pulsed-field gel electrophoresis pulsotype. Their MICs for oxacillin, vancomycin, and linezolid were ≥256μg/mL, 1–4μg/mL, and 8–16μg/mL, respectively. The 3 S. hominis presented MIC values 32 to >256μg/mL, 2–4μg/mL, and 12–24μg/mL, and all carried the nontypeable SCCmec (ccr1 + mecA class) and belonged to 2 different genotypes. The cfr gene was not found, but the mutation G2603T was detected in S. haemolyticus and C2190T and G2603T in Staphylococcus hominis in 23S rRNA. This study demonstrates the spread of a linezolid-resistant S. haemolyticus genotype and, for the first time, describes the mutation C2190T among S. hominis isolates with a double mutation in Brazil.

Antimicrobial synergism against different lineages of methicillin-resistant Staphylococcus aureus carrying SCCmec IV

To evaluate the synergistic activity of antimicrobial drugs against lineages of methicillin-resistant Staphylococcus aureus (MRSA) carrying SCCmec IV. The biofilm production and related genes were also detected. Forty two MRSA isolates were tested for biofilm production and related genes. Biofilm/biomass susceptibility to gentamicin (G), linezolid (L), rifampicin (R) and vancomycin (V) was determined for six isolates from three lineages prevalent in Rio de Janeiro hospitals in concentrations ranging from 0·25 to 64 μg ml(-1). Biomass was evaluated by microtitre plate test and number of viable cells (CFU cm(-2)) and inspected by epifluorescence microscopy. All isolates presented the icaA and sasG genes, but only 38% were biofilm producers. There were 50 and 45% biomass reductions when concentrations ≥4 μg ml(-1) of R or L and ≥16 μg ml(-1) of G or V, respectively, were used. Synergism tests produced a 55% biomass reduction with R(2μgml-1) + G(16μgml-1), R(2μgml-1) + L(2μgml-1), R(2μgml-1) + V(4μgml-1), and L(2μgml-1) + V(4μgml-1). Number of viable cells was reduced from 2 to 3 logs with R(2μgml-1) + L(2μgml-1) and R(2μgml-1) + V(4μgml-1). Synergisms involving R plus L and R plus V caused important reductions in biofilm/biomass and the number of viable cells. Drug combinations should be considered in the chemotherapies of MRSA-SCCmec IV infections. Biofilms in MRSA infections restrict the clinical choice of antimicrobials. Thus, knowledge of the best options for monotherapy and drug synergisms could improve clinical results.

Expressão não verbal do paciente no cuidado: percepção do enfermeiro em unidade cardiointensiva

Este estudo trata da percepção de enfermeiros relativa à observação, à identificação e à análise da comunicação não verbal para traduzir a reação e o sentimento do paciente. Realizado em 2009 em um hospital no Rio de Janeiro com quatorze enfermeiros. RESULTADOS: A comunicação não verbal foi citada no banho no leito (12%), pré-operatório (12%), pós-operatório (12%), admissão (12%), punção venosa (12%), visita familiar (8%), preparo de material (3%), dissecção venosa (3%), aspiração (3%), cardioversão (3%); 18% das enunciações não atendidas referem-se a situações de medo da morte (pré-operatório) e à incapacidade diante do abandono familiar. Os autores destacam que 7% dos pensamentos são representados por palavras, 38%, pela paralinguagem e 55%, pelos sinais corporais. CONSIDERAÇÕES: O enfermeiro observa, identifica e analisa a CNV para traduzir a reação, o sentimento do paciente e as necessidades a serem atendidas pelo cuidado.

Development of a virtual tool for monitoring quality of care in acute myocardial infarction via the internet

BackgroundMeasurement of quality indicators contributes to monitoring the performance of initial treatment of ST-elevated myocardial infarction (STEMI). ObjectiveTo develop a virtual tool to calculate performance indicators of initial treatment of STEMI online via the internet. MethodsWe identified critical elements of the therapeutic process and formulated indicators in a retrospective pilot study, and developed a virtual tool for prospective data collection on initial treatment of STEMI. Rio de Janeiro hospitals with emergency care units were selected and invited to participate in the project. Online reports were developed to be accessed at www.qualiiam.icict.fiocruz.br/indicadores.php and analyzed. ResultsFive hospitals agreed to participate in the project and monitored treatment of different numbers of patients with a diagnosis of STEMI (A=7, B=14, C=16, D=44 and E=43). Aspirin was administered in 94.6% of cases, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 76.1% and beta-blockers in 82.5%; 68.4% of patients with no contraindication received fibrinolysis. In no case was door-to-needle time less than 30min, and mean time was 122min. All patients admitted to hospitals with catheterization facilities underwent primary angioplasty; mean door-to-balloon time in these patients was 161min; in only 28% was it less than 90min. ConclusionThe system can be used as a tool to monitor the performance of initial treatment of patients with STEMI. Analysis of these indicators in the future may help to evaluate the contribution of online reporting to the development of better treatment practices.

Desenvolvimento de um sistema para monitoramento da qualidade do atendimento ao infarto agudo do miocárdio via WEB

BackgroundMeasurement of quality indicators contributes to monitoring the performance of initial treatment of ST-elevated myocardial infarction (STEMI). ObjectiveTo develop a virtual tool to calculate performance indicators of initial treatment of STEMI online via the internet. MethodsWe identified critical elements of the therapeutic process and formulated indicators in a retrospective pilot study, and developed a virtual tool for prospective data collection on initial treatment of STEMI. Rio de Janeiro hospitals with emergency care units were selected and invited to participate in the project. Online reports were developed to be accessed at www.qualiiam.icict.fiocruz.br/indicadores.php and analyzed. ResultsFive hospitals agreed to participate in the project and monitored treatment of different numbers of patients with a diagnosis of STEMI (A=7, B=14, C=16, D=44 and E=43). Aspirin was administered in 94.6% of cases, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 76.1% and beta-blockers in 82.5%; 68.4% of patients with no contraindication received fibrinolysis. In no case was door-to-needle time less than 30min, and mean time was 122min. All patients admitted to hospitals with catheterization facilities underwent primary angioplasty; mean door-to-balloon time in these patients was 161min; in only 28% was it less than 90min. ConclusionThe system can be used as a tool to monitor the performance of initial treatment of patients with STEMI. Analysis of these indicators in the future may help to evaluate the contribution of online reporting to the development of better treatment practices.

Characteristics related to antimicrobial resistance and biofilm formation of widespread methicillin-resistant Staphylococcus epidermidis ST2 and ST23 lineages in Rio de Janeiro hospitals, Brazil

Staphylococcus epidermidis is a leading cause of hospital-acquired infections, mostly associated with the use of medical devices in seriously ill or immunocompromised patients. Currently, the characteristics of methicillin-resistant S. epidermidis (MRSE) isolates from Rio de Janeiro hospitals are unknown. In this study, staphylococcal chromosomal cassette mec (SCCmec) types, antimicrobial susceptibility profiles, biofilm formation genes, and multilocus sequence types (MLST) were investigated in 35 MRSE clinical isolates. The collection of isolates was previously well characterized by pulsed-field gel electrophoresis (PFGE) into 2 main genotypes (A and B, 22 isolates) and 10 sporadic genotypes (13 isolates). MLST revealed a total of 8 different sequence types (STs), but ST2 and ST23, which were icaAB-positive, represented the majority (71.4%) of MRSE isolates tested. Almost all isolates (91.4%) belonged to clonal complex 2. SCCmec types III and IV were identified among 71.4% of the isolates, while the remaining was nontypeable. The predominant MRSE genotypes were defined as SCCmec type III/ST2 (PFGE type A) and SCCmec type IV/ST23 (PFGE type B) isolates, which were both associated with high antimicrobial resistance and presence of biofilm-related genes.

Uso de plasma autólogo em dermolipectomia abdominal: nota prévia

Autologous plasma began to be studied in the 90's, mainly because its adhesive and angiogenic properties and the presence of growth factors of platelet origin. In fact, plasma can be isolated from autologous manner, from the patient's own blood and obtained in its two parts: a high concentration of platelets (platelet-rich plasma - PRP) and one with low concentration of platelets (platelet-poor plasma - PPP). The present study is in development at the Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (UFRJ-HUCFF) and Marcilio Dias Naval Hospital (HNMD), both in Rio de Janeiro. The objective is to evaluate the properties of platelet-poor plasma, particularly its adhesive action, in patients referred for restorative abdominal dermolipectomy, to reduce postoperative collections, such as hematoma and seroma, two major complications in this type of surgery.

Controle de infecção oral em pacientes internados: uma abordagem direcionada aos médicos intensivistas e cardiologistas

This paper aims to find the current level of periodontal med-care knowledge, as well as the possible existence of some oral infection control protocol regarding hospitalized patients. Our sample gathered 110 cardiologists and intensive care units doctors selected from medical teams of five Rio de Janeiro hospitals. Preliminary numbers: 75.4% said to have heard something about Periodontal Medicine, although only 30% out of this group admitted to have read something concerning such subject. On the other side, only 2.7% of the sample informed to do consistent information searching along their patients anamnese, while 58.2% out of this group admitted such procedure conditional to the patient's general state at the due moment. Through such numbers, we tend to come up to the conclusion that, be it either through direct or indirect Periodontal Medicine technical information (and consequently with regards to the absolut importance of preservation and control of oral biofilm and its impact on one's systemic health), the matter has been dimly spread among medical groups. The search also revealed the probability that Rio de Janeiro hospitals lack either units or agents designed for prevention and control of oral infection; consequently, such organizations do not have any kind of protocols, reliable or not, concerned to oral infections.

Uso de ciclosporina 0,05% tópica no tratamento do olho seco de pacientes portadores do vírus HIV

OBJETIVO: O presente estudo comparou a eficacia do tratamento da sindrome do olho seco em pacientes infectados pelo HIV com suplementacao lacrimal (carboximetilcelulose sodica 0,5%) ou com suplementacao lacrimal associada a terapia anti-inflamatoria (carboximetilcelulose sodica 0,5% e ciclosporina 0,05%). METODOS: Vinte pacientes portadores do virus HIV provenientes do ambulatorio de Infectologia do Hospital Universitario Clementino Fraga Filho da Universidade Federal do Rio de Janeiro foram selecionados. O diagnostico de sindrome do olho seco foi baseado no questionario para olho seco (Ocular Surface Disease Index - OSDI®), teste de Schirmer I, tempo de ruptura do filme lacrimal e coloracao da superficie ocular com rosa bengala a 1%. Os pacientes foram distribuidos em dois grupos com dez pacientes (20 olhos) e acompanhados durante seis meses. O grupo I foi tratado com colirio de carboximetilcelulose sodica 0,5% e o grupo II foi tratado com a associacao de carboximetilcelulose sodica 0,5% e ciclosporina 0,05% topica. RESULTADOS: Comparando os resultados no inicio e no final do tratamento, a associacao com ciclosporina 0,05% mostrou-se superior (p < 0,05) para o teste de Schirmer I. CONCLUSAO: O presente estudo sugere que o uso de ciclosporina 0,05% topica melhora a producao lacrimal em pacientes infectados pelo HIV, apresentando um importante papel como adjuvante no tratamento do olho seco nestes pacientes.