Challenges of Internationalization

The Revista HCPA has been prepared for a new challenge in the next years: its internationalization. This broad term, in the context of scientific journals, actually means that the periodic ultimately sought to be a vehicle for publishing scientific content on all fields of medical sciences including, basic, pharmacological and clinical research, from and to a worldwide readers and researchers community

Teste de Hodge Modificado na detecção de KPC: um procedimento a ser aperfeiçoado ou esquecido?

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Challenges of Internationalization

The Revista HCPA has been prepared for a new challenge in the next years: its internationalization. This broad term, in the context of scientific journals, actually means that the periodic ultimately sought to be a vehicle for publishing scientific content on all fields of medical sciences including, basic, pharmacological and clinical research, from and to a worldwide readers and researchers community

Clinical characteristics of 1,260 patients during an outbreak of carbapenem-resistant Acinetobacter spp in Porto Alegre, Brazil

Introdution: Over the last decade, Acinetobacter baumannii has been an important cause of nosocomial infections worldwide. The objective of this study was to assess clinical and epidemiological characteristics of patients during a large citywide- documented outbreak of carbapenem-resistant A. baumannii (CRAb). Methods: Retrospective cross-sectional study that evaluated the information obtained from the official notification system data of CRAb from the Health Department, Porto Alegre, Brazil, in the period of July 1st, 2007 to December 31st, 2008. The association among variables was analyzed with SPSS 13.0. Results: A total of 1,260 CRAb from infection (608 [48.3%]) or colonization (652 [51.7%]) were reported in 18 hospitals. Most patients (53.5%) were hospitalized at intensive care units and have been exposed to invasive procedures, but 757 (60.7%) patients had no underlying comorbidity reported. A total of 1,143 (90.7%) patients received some antimicrobial 90 days before CRAb detection and 36.4% received a carbapenem. The outcome was available for 618 (49.0%) patients and 54.3% of them died. The prevalence ratio (PR) of infection was statistically significant for variables admission to public hospitals; trauma and use of antibiotic in previous 90 days.Conclusion: This study suggests that in the context of an outbreak, baseline comorbidities and previous carbapenem exposure may be less important risk factors for CRAb infection/colonization

Revista HCPA: Contínua evolução

A Revista do Hospital de Clínicas de Porto Alegre/Faculdade de Medicina da Universidade Federal do Rio Grande do Sul apresenta um longo histórico de evolução científica desde suas primeiras edições, em 1981, até a sua versão mais atual (maio de 2013) no formato eletrônico. Não há dúvidas que foi o grande empenho de todos os Editores-chefe anteriores da RHCPA (bem como Editores de Área e todos os outros colaboradores) juntamente com a estrutura de funcionamento que o HCPA mantém (recursos humanos qualificados, disponibilidade de recursos, tecnologia, espaço físico, etc.) que elevaram o nível científico da nossa Revista. Agora em 2013 a RHCPA contará com dois novos Editores-chefe (Prof. Alexandre P. Zavascki e Prof. Afonso L. Barth), que deverão dar continuidade ao trabalho de excelência da RHCPA

Revista HCPA: Contínua evolução

A Revista do Hospital de Clínicas de Porto Alegre/Faculdade de Medicina da Universidade Federal do Rio Grande do Sul apresenta um longo histórico de evolução científica desde suas primeiras edições, em 1981, até a sua versão mais atual (maio de 2013) no formato eletrônico. Não há dúvidas que foi o grande empenho de todos os Editores-chefe anteriores da RHCPA (bem como Editores de Área e todos os outros colaboradores) juntamente com a estrutura de funcionamento que o HCPA mantém (recursos humanos qualificados, disponibilidade de recursos, tecnologia, espaço físico, etc.) que elevaram o nível científico da nossa Revista. Agora em 2013 a RHCPA contará com dois novos Editores-chefe (Prof. Alexandre P. Zavascki e Prof. Afonso L. Barth), que deverão dar continuidade ao trabalho de excelência da RHCPA

Reappraisal of Pseudomonas aeruginosa hospital-acquired pneumonia mortality in the era of metallo-β-lactamase-mediated multidrug resistance: a prospective observational study

INTRODUCTION: Hospital-acquired pneumonia (HAP) due to Pseudomonas aeruginosa is associated with high mortality rates. The metallo-β-lactamases (MBLs) are emerging enzymes that hydrolyze virtually all β-lactams. We aimed to assess P. aeruginosa HAP mortality in a setting of high-rate MBL production METHODS: A prospective cohort study was performed at two tertiary-care teaching hospitals. A logistic regression model was constructed to identify risk factors for 30-day mortality. RESULTS: One-hundred and fifty patients with P. aeruginosa HAP were evaluated. The 30-day mortality was 37.3% (56 of 150): 57.1% (24 of 42) and 29.6% (32 of 108) for patients with HAP by MBL-producing P. aeruginosa and by non-MBL-producing P. aeruginosa, respectively (relative risk, 1.93; 95% confidence interval (CI), 1.30–2.85). The logistic regression model identified a higher Charlson comorbidity score (odds ratio, 1.21; 95% CI, 1.04–1.41), presentation with severe sepsis or septic shock (odds ratio, 3.17; 95% CI, 1.30–7.72), ventilator-associated pneumonia (odds ratio, 2.92; 95% CI, 1.18–7.21), and appropriate therapy (odds ratio, 0.24; 95% CI, 0.10–0.61) as independent factors for 30-day mortality. MBL production was not statistically significant in the final model. CONCLUSION: MBL-producing P. aeruginosa HAP resulted in higher mortality rates, particularly in patients with ventilator-associated pneumonia, most probably related to the less frequent institution of appropriate antimicrobial therapy. Therapeutic approaches should be reviewed at institutions with a high prevalence of MBL

Vancomycin resistant enterococcus spp (VRE): follow up during 9 years in a tertiary teaching hospital in southern Brazil

Introduction: Infection with vancomycin-resistant Enterococcus spp (VRE) has been a worldwide problem since mid 1980's and, in Brazil, since 1996. This study was conducted to evaluate the experience with VRE in our institution.Methods: A prospective cohort study from 2000 to 2009 was conducted at Hospital São Lucas da PUCRS. All hospitalized patients with VRE positive culture were included and followed from their diagnosis until they were negative for VRE or their discharge. Only the first admission for each VRE positive patient was included. Pulsed field gel electrophoresis (PFGE) was performed to determine how VRE had spread.Results: A total of 315 cases of VRE were identified, 224 of which were isolated from rectal swabs. Vancomycin-resistant/ampicilin susceptible Enterococcus faecalis were identified in 312 isolates. PFGE was performed in 47 VRE isolates that presented an indistinguishable migratory profile. The median length of hospital stay and length of stay before VRE isolation were 46 days and 21 days, respectively; 52% of the patients were aged 60 and above. The annual distribution of the new VRE cases showed a clear decrease from 2000 to 2009.Discussion: This study shows a substantial VRE colonization (71%) with a homogenous pattern that emphasizes its transversal spread. Predominance of E. faecalis differs from the literature which largely describes a higher prevalence of vancomycin-resistant Enterococcus faecium . The follow up of VRE during 9 years in our institution highlighted the importance of continuous surveillance to prevent outbreaks in our hospital.

Bacteriology of chronic apical periodontitis

O conhecimento mais aprofundado sobre a microbiologia endodôntica é um recurso fundamental para entender o papel das bactérias na origem e desenvolvimento das Periodontites Apicais Crônicas, bem como para oferecer subsídios para a instituição de uma terapêutica adequada. Este trabalho tem o propósito de investigar a composição bacteriana das Periodontites Apicais Crônicas, identificando os microrganismos encontrados nos canais radiculares de 20 dentes necróticos com lesão periapical. Após o isolamento absoluto do dente em questão e o acesso à cavidade pulpar, uma lima Hedstroen n° 15 foi introduzida no canal para a liberação de raspas de dentina. Em seguida, água destilada foi introduzida e aspirada do canal radicular. O material aspirado foi semeado imediatamente nos meios de agar sangue, Mac Conkey e azida sódica para identificação de aeróbios e nos meios agar sangue brucella, FEAS (agar sangue fenil etanol) e tioglicolato para a identificação de anaeróbios. A atmosfera de anaerobiose foi obtida através de um sistema físico-químico em jarra de anaerobiose, imediatamente após a semeadura. A incubação e posterior identificação dos microrganismos foi realizada na Unidade de Microbiologia do Hospital de Clínicas de Porto Alegre. Os Streptococcus sp. grupo viridans foram os microrganismos mais comumente isolados entre as bactérias aeróbias. Também foi possível identificar algumas bactérias anaeróbias como, Eubacterium sp., Bacteroides sp., Peptostreptococcus sp. e Propionibacterium sp.A deep knowledge about endodontic microbiology is a fundamental resourse to understand the role of bacteria in the origin and development of chronic apical periodontitis as well as to provide database for adequate therapy. Our objective was to investigate the composition of bacterial flora in chronic apical periodontitis and to identify in vivo the microorganisms found in 20 root canals with periapical disease. After isolating a tooth with a rubber dam and access in the pulp system, a Hedstroen file no 15 was introduced in to the canal in order to remove dentin debries. Imediatelly after, distilled water was introduced and aspirated from the root canal. The aspirated material was spreaded into culture media composed by blood agar, MacConkey, aside blood agar (identify aerobes), brucella blood agar, FEAS and thioglycolate (identify anaerobes). The anaerobes conditions were obtained in GasPak jar immediately after spreading. The incubation and identification was achieved at the Clinical Hospital of Porto Alegre (HCPA) — Microbiology Unit. The predominant isolates were streptococcus sp. Group viridans. In this study we were able to identify some potentially pathogenic bacteria in chronic apical periodontitis such as Streptococcus sp. group viridans, Eubacterium sp., Enterococcus sp., Bacteroides sp., Peptostreptococcus sp. and Propionibacterium sp.

Enhancing tuberculosis diagnosis by polymerase chain reaction: An experience at a tertiary hospital

Introduction: Tuberculosis (TB) persists as a severe global public health issue. The aim of the present study was to evaluate the performance of an in-house TB PCR (polymerase chain reaction) in sputum.Methods: DNA from sputum specimens were submitted to a nested-PCR protocol for the IS6110 region detection. PCR results were compared to those of the traditional methods for TB diagnosis, i.e., acid-fast bacilli (AFB) smear microscopy and culture. We analyzed sputum samples obtained from 133 patients.Results: A total of 48 (36%) cultures yielded indeterminate results due to contamination. This high contamination rate may be explained by the fact that samples from fibrocystic patients were included in this study. Additionally, other five samples were positive for nontuberculous mycobacteria (NTM). Therefore, it was possible to compare 80 patients for M. tuberculosis detection. We found 14 positive samples: five presented positive results in the three methods (5/14; 35.7%), two were positive in culture and PCR (2/14; 14.3%), one was positive in AFB and PCR (1/14; 7.1%), five were positive only in PCR (5/14; 35.7%) and 1 was positive only in culture (1/14; 7.1%). Thus, positivity rates for each technique were: 7.5% for AFB (6/80), 10% for culture (8/80) and 16.25% for PCR (13/80). Among the 48 patients who had indeterminate results in sputum culture, two samples were positive in PCR.Conclusion: Considering the limitations of the traditional methods, the use of PCR as a molecular technique could be advantageous for TB diagnosis.