The modified Hodge test is a useful tool for ruling out klebsiella pneumoniae carbapenemase

OBJECTIVE: Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase. METHOD: From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk. RESULTS: Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively. CONCLUSION: Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase-2. The test may therefore be regarded as a good epidemiological tool

Interactive tele-education applied to a postgraduate clinical microbiology course

A emergência de resistências bacterianas, principalmente quando associadas ao ambiente hospitalar, representa, mundialmente, um problema de saúde pública. A diversidade de mecanismos de resistências configura um desafio terapêutico e a escolha de antibióticos deve ser individualizada e baseada em antibiogramas locais. O laboratório de microbiologia representa um apoio estratégico para o rápido diagnóstico das doenças infecciosas e deve funcionar com sistemas de alerta para informar a comunidade médica sobre novos mecanismos de resistência bacteriana. O objetivo deste estudo foi estruturar e aplicar um curso de extensão universitária em microbiologia clínica por meio de teleducação interativa para capacitação de profissionais. O conteúdo científico foi definido em função das competências associadas à prática laboratorial. O curso foi estruturado em onze módulos divididos em três semestres, sendo 70% a distância, 22% presencial e 8% do tempo dedicado a monografia, como modelo misto, com ambientes de aprendizagem a distância e presencial integrados. Em todos os módulos foram propostos estudo a distância, tarefas para o estímulo à pesquisa bibliográfica (revisão de artigos e questionários) e aulas presenciais, teóricas e práticas. O grupo de alunos foi composto por 28 participantes com perfil diversificado, médicos e microbiologistas, originários de vinte cidades brasileiras diferentes. Dois dos motivos para a participação dos alunos foi a flexibilidade do tempo e local de estudo, reduzindo a ausência do seu local de trabalho. O desempenho demonstrado pelo grupo durante o curso foi satisfatório. Após um ano do término do curso foi realizada uma visita ao ambiente de trabalho dos alunos para correlação do seu desempenho no curso com as mudanças realizadas na prática da rotina microbiológica. Houve uma diferença significativa entre os índices de mudanças nas práticas microbiológicas realizadas nos locais de trabalho dos alunos, antes e depois da sua participação no curso, sendo que 76,9% dos procedimentos verificados foram modificados. Na avaliação subjetiva, os participantes informaram que o curso promoveu mudanças comportamentais e que voltariam a se matricular em um modelo educacional semelhante. A qualificação profissional estimulou a autonomia profissional. O uso de tecnologias interativas permitiu a participação de profissionais de diversas regiões do país, representando uma alternativa para inovação do processo de ensino em microbiologia clínica. O resultado deste estudo indica perspectivas para a consolidação do uso da teleducação interativa para criação de programas de educação continuadaThe emergence of bacterial resistance, especially when associated with the hospital environment, represents a worldwide public health problem. The diversity of resistance mechanisms forms an important therapeutic challenge, and the selection of antibiotics should be individualized and based on local and institutional antibiograms. Microbiology laboratories represent a strategic support for a fast diagnosis of infectious disease to notify the medical community about new mechanisms of resistance. This study aimed to design and implement an academic extension course in clinical microbiology via interactive tele-education for training of professionals. The scientific content was defined according to competencies associated with laboratory practices. The course was structured in eleven modules divided into three semesters: 70% distance learning, 22% on campus (mixed model with distance learning environments and integrated presence) and 8% monographs. All the modules have been proposed for remote study, to present tasks for the investigation of the literature (review articles and questionnaires), as well as for the on-campus classroom, from both a theoretical and practical perspective. The group of students was composed of 28 physicians and microbiologists with diverse profiles from 20 Brazilian cities. Two reasons students gave for their participation were the need for scheduling flexibility and the need for a place to learn that would not require absence from their place of work. The performance demonstrated by the group during the course was satisfactory. A year after finishing the course, visits were made to the students work environments to correlate performance with the changes made in routine microbiological practice. A significant difference was found between the rates of change in microbiological practices conducted in the workplaces of the students before and after their participation in the course; 76.9% of modified procedures were verified. In subjective evaluation, the participants reported that the course promoted behavioral changes and that they would return to enroll in a similar educational model. The qualification stimulated professional autonomy. The use of interactive technologies allowed the participation of professionals from various regions of the country, representing an alternative to the innovation of teaching in clinical microbiology. The results indicate prospects for the consolidation of the use of interactive tele-education to create programs of continuing educatio

Streptococcus pneumoniae: susceptibility to penicillin and moxifloxacin

Objective: To determine the minimum inhibitory concentrations (MICs) of parenteral penicillin and moxifloxacin against Streptococcus pneumoniae strains isolated at a hospital center. Methods: In-vitro, prospective study involving 100 S. pneumoniae isolates collected from patients who had been treated, between October of 2008 and July of 2010, at the Hospital das Clinicas complex of the University of Sao Paulo School of Medicine, located in the city of Sao Paulo, Brazil. The isolates were obtained from respiratory tract cultures or blood samples unrelated to meningeal infections, and they were tested for penicillin and moxifloxacin susceptibility by E-test. The MIC category interpretations were based on updated standards. Results: All isolates were fully susceptible to parenteral penicillin (MIC <= 2 mu g/mL), and, consequently, they were also susceptible to amoxicillin, ampicillin, third/fourth generation cephalosporins, and ertapenem. Of the S. pneumoniae strains, 99% were also susceptible to moxifloxacin, and only one strain showed an MIC = 1.5 mu g/mL (intermediate). Conclusions: Our results showed high susceptibility rates to parenteral penicillin and moxifloxacin among S. pneumoniae isolates unrelated to meningitis, which differs from international reports. Reports on penicillin resistance should be based on updated breakpoints for non-meningitis isolates in order to guide the selection of an antimicrobial therapy and to improve the prediction of the clinical outcomes

Efeitos da aplicação do laser diodo de Arseneto de Gálio (AS-GA) na osteoartrite experimental em coelhos

Foram avaliados os efeitos do laser a diodo de Arseneto de Gálio (As-Ga) aplicado no joelho de coelhos portadores de osteoartrite induzida pela aplicação intra-articular de carragenina. A avaliação clínica in vivo demonstrou diminuição dos sinais inflamatórios e da dor, permitindo melhor desempenho e maior amplitude de movimento do joelho dos coelhos tratados, em comparação aos dos animais não tratados. As avaliações macro e microscópica post-mortem evidenciaram processos degenerativos decorrentes da administração de carragenina em ambos os grupos, tratado com laser e não-tratado (controle). Os resultados permitiram inferir que o laser diminuiu os mediadores químicos, reduzindo a resposta inflamatória e lesões locais, inclusive a degradação dos glicosaminoglicanos. A análise histológica da membrana sinovial demonstrou a presence de células inflamatórias, distribuídas difusamente ou em focos, em maior intensidade nos grupos controle. A laserterapia retardou o caráter progressivo da osteoartrite induzida no joelho de coelhos.The aim of this study was to evaluate the effects of gallium arsenate (Ga-As) diode laser application on rabbits knees with ostheoarthritis induced by intrarticularinjection of carrageenan. Clinical evaluation in vivo showed that there was reduction in inflammatory signs and pain, with treated animals presenting a better performance and greater amplitude of movements, if compared with untreated animals. The degenerative processes resulting from the administration of carrageenan were evidenced in both groups by post mortem gross and microscopic appearance in both treated and control groups, which allowed inferring that laser diminished the presence of chemical mediators, reducing the inflammatory response and local lesions, including the degradation of glycosaminoglycans. Histological analysis of the synovial membrane revealed the presence of inflammatory cells distributed diffusely or in foci, the intensity of which was higher in control groups. The progression rate of induced ostheoarthritis was slowed down by lasertherapy

Vivência de violência entre escolares brasileiros: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE) Violence exposures by school children in Brazil: results from the National Adolescent School-based Health Survey (PeNSE)

Este artigo apresenta os principais resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE). Aplicou-se questionário em uma amostra de conglomerados de 60.973 estudantes do 9º ano do ensino fundamental de escolas públicas e privadas das capitais dos estados brasileiros e do Distrito Federal, entre março e junho de 2009. Analisam-se prevalências e intervalos de confiança de 95% (IC95%) das situações de violência envolvendo adolescentes. Foram identificadas as seguintes situações: insegurança no trajeto casa-escola (6,4%; IC95%: 6,1%-6,8%) e na escola (5,5%; IC95%: 5,2%-5,8%); envolvimento em brigas com agressão física (12,9%; IC95%: 12,4%-13,4%), com arma branca (6,1%; IC95%: 5,7%-6,4%) ou arma de fogo (4,0%; IC95%: 3,7%-4,3%); agressão física por familiar (9,5%; IC95%: 9,1%-9,9%). As situações de violência foram mais prevalentes entre estudantes do sexo masculino. Houve grande variação segundo as cidades estudadas. Os adolescentes estão expostos a diferentes manifestações de violência nas instituições que supostamente deveriam garantir sua proteção e desenvolvimento saudável e seguro - a escola e o lar. Esses resultados visam apoiar medidas de promoção à saúde e prevenção desses fatores de risco.<br>This article presents the main results of the National Adolescent School-based Health Survey (PeNSE). A questionnaire was applied to a sample of 60,973 students of the 9th year of Junior high school in public and private schools of the Brazilian state capitals and the Federal District, between March and June 2009. The prevalence and confidence interval of 95% (CI 95%) of the violence situations involving adolescents were analyzed. The following situations were identified: lack of safety on the way home-school (6.4%; CI95%: 6.1%-6.8%) and at school (5.5%; CI95%: 5.2%-5.8%); involving fights with physical aggression (12.9%; CI95%: 12.4%-13.4%), with knife (6.1%; CI95%: 5.7%-6.4%) or fire arm (4.0%; CI95%: 3.7%-4.3%); physical aggression by family member (9.5%; CI95%: 9.1%-9.9%). Violence situations were more prevalent among male students. There were great variations among the cities studied. Adolescents are exposed to different violence manifestations in the institutions that supposedly must assure their protection and healthy development: school and the home. These results aim to support health promotion measures and prevention of these risk factors