Etiologia e sensibilidade bacteriana em infecções do tracto urinário

As infecções do tracto urinário (ITU) são muito prevalentes no ser humano, ocupando o segundo lugar, logo a seguir às infecções respiratórias. Os principais microrganismos envolvidos têm-se mantido relativamente constantes, ao longo dos tempos, sendo o seu tratamento, em muitos casos, realizado empiricamente, recorrendo-se a antibióticos que, à partida, serão de espectro alargado e conseguirão debelar a infecção. O objectivo fundamental deste trabalho, foi o de conhecer o comportamento das estirpes mais prevalentes que provocam infecções do tracto urinário e avaliar se se manifesta alguma evolução das suas resistências aos antibióticos, em dois períodos temporais distintos. O estudo, retrospectivo, foi realizado no Hospital Sousa Martins, recorrendo-se a 100 uroculturas com resultado positivo, metade do ano 2002 e as restantes do ano 2007. Todas as urinas foram semeadas em gelose de CLED. A identificação e o seu respectivo antibiograma foram realizados no sistema VITEK 1 (bioMérieux). De entre os principais resultados destaca-se que a estirpe mais prevalente no ano de 2002 foi E. coli constituindo 64% das estirpes identificadas, seguida da S. marcescens com 16% e da K. pneumoniae com 14%. Em relação ao ano de 2007, predominou novamente a E. coli com 66% das infecções urinárias, seguida da P. aeruginosa com 14%. Quanto ao comportamento face aos antibióticos das estirpes mais prevalentes, verificamos que ocorreu um aumento de sensibilidade da Escherichia coli face à amoxicilina (68,8% em 2002 para 93,9% em 2007), face à ampicilina (56,3% em 2002 para 75,8% em 2007) e à cefalotina (84,4% em 2002 para 93,9% em 2007). Apenas aumentou a sua resistência face ao trimetoprim, sendo que no ano 2002 apresentava uma resistência de 18,8% e no 2007 este valor passou a 24,2%. A Klebsiella pneumoniae aumentou a sua capacidade de resistência à amoxicilina (0% no ano 2002 para 75% no ano 2007), tornou-se completamente resistente à ampicilina e diminui a sua sensibilidade à cefalotina (85,7% em 2002 e apenas 25% em 2007). Aumentou ainda a sua resistência à pefloxacina, uma vez que em 2002 todas as estirpes foram sensíveis e em 2007 apenas 25% apresentaram sensibilidade perante este antibiótico. Em relação ao trimetoprim verificou-se também um acentuado aumento de resistência por parte desta bactéria, sendo que em 2002 apenas 28,6% das estirpes de Klebsiella pneumoniae eram resistentes, ao passo que em 2007 este número passou para 75%. Apenas aumentou a sua susceptibilidade à netilmicina, passando de uma sensibilidade de 85,7% em 2002 para 100% em 2007. A partir dos resultados podemos constatar que a Escherichia coli não alterou muito o seu comportamento face aos antibióticos testados, aumentando mesmo a sua sensibilidade em alguns casos. Já em relação à Klebsiella pneumoniae, há uma clara diminuição da sua sensibilidade face à maioria dos antibióticos testados

Etiologia e sensibilidade bacteriana em infecções do tracto urinário

AbstractIntroductionUrinary tract infections (UTI) are very prevalent in Humans immediately following respiratory infections. The main microorganisms involved have remained relatively constant over time, and their treatment, in many cases, has been done empirically, making use of antibiotics that, in principle, are supposed to have an extended-spectrum and are able to eradicate the infection.ObjectiveThe main objective of this work was to understand the behaviour of the most prevalent strains that cause urinary tract infections and assess if we can discern some trends in their resistance to antibiotics during two different time periods.Material and methodsThe retrospective study was carried out at Local Health Unit (Guarda), involving the use of 200 cultures with a positive result, for half of the year 2002 and for the rest of the year 2007. All urine samples were plated on agar CLED. The identification and their respective antibiotic were performed at VITEK 2 system (bioMérieux).ResultsThe main results suggested that the most prevalent strain in 2002 was E. coli constituting 64% of the strains identified, followed by S. marcescens with 16% and K. pneumoniae with 14%. For the year 2007, E. coli prevailed again with 66% of urinary infections, followed by P. aeruginosa with 14%. As far as the behavior of more prevalent strains towards antibiotics is concerned we found that there was an increased sensitivity of Escherichia coli compared to amoxicillin (68.8% in 2002 to 93.9% in 2007), compared to ampicillin (56.3% in 2002 to 75.8% in 2007) and to cephalothin (84.4% in 2002 to 93.9% in 2007). It only increased its resistance to trimethoprim, in 2002 it had a resistance of 18.8% and this number rose to 24.2% in 2007. Klebsiella pneumoniae has increased its capacity of resistance to amoxicillin (0% in 2002 to 75% in 2007), became completely resistant to ampicillin and reduced its sensitivity to cephalothin (85.7% in 2002 and only 25% in 2007). They also increased their resistance to pefloxacin, since in 2002 all strains were sensitive and in 2007 only 25% showed sensitivity to this antibiotic. For trimethoprim there was also a sharp increase of resistance to this bacterium: in 2002 only 28.6% of Klebsiella pneumoniae strains were resistant while in 2007 this figure rose to 75%. Klebsiella pneumoniae only increased its susceptibility to netilmicin, from a sensitivity of 85.7% in 2002 to 100% in 2007.DiscussionFrom the results we can see that Escherichia coli did not change its performance towards the antibiotics tested, even increasing its sensitivity in some cases. In relation to Klebsiella pneumoniae, there is a clear decrease in their sensitivity to most antibiotics tested.ConclusionIt is necessary to know the prevalence of the main bacteria that infect the urinary tract in order to continue empirical treatments with antibiotics

Prevalencia de Staphylococcus Aureus en profesionales de la salud en la región centro de Portugal

[ES] El diagnóstico y tratamiento de las enfermedades requiere inevitablemente una interacción física entre los profesionales de la salud y sus pacientes. Ello implica tanto al médico que ha de explorar al paciente como, sobre todo, a otro tipo de profesionales sanitarios, cuya interacción es, un muchas ocasiones, incluso más intensa (personal de enfermería, auxiliares, fisioterapeutas...), extendiéndose con frecuencia a un grupo de personas mucho más heterogéneo (estudiantes de medicina y enfermería, personal de cocina, barberos, etc.). Todas estas personas pueden comportarse como vehículo de transmisión de microorganismos colonizadores a los pacientes, pero también en sentido contrario, de los pacientes a otras personas no colonizadas, tanto dentro como fuera del hospital. A ello hay que añadir el papel que puede desempeñar el propio paciente, una vez dado de alta, vehiculando microorganismos al ámbito extrahospitalario. Incluso en este ámbito, además de los cuidadores habituales, los cada vez más frecuentes equipos de atención domiciliaria podrían comportarse como difusores de estas colonizaciones dentro del propio ámbito comunitario. 5 Dissertação de Doutoramento de Francisco Rodrigues Esta transmisión de persona a persona es un factor epidemiológico básico en las infecciones hospitalarias y en la difusión de microorganismos como Staphylococcus aureus resistente a meticilina, y Clostridium difficile, entre otros. En los últimos años van cobrando además importancia progresiva los centros de cuidados medios y de pacientes crónicos, por la gran permeabilidad existente entre estos centros y los hospitales, y la frecuencia con que en estos centros se acumulan factores de riesgo similares a los nosocomiales en cuanto a características de los pacientes, presión antibiótica, etc. Por todas estas razones, es clara la necesidad de un control y un conocimiento de la flora normal, transitoria y residente de profesionales de la salud, en especial de los microorganismos potencialmente más patógenos. En este contexto, destaca S. aureus, y en particular S. aureus resistente a la meticilina (MRSA), debido a su importancia como patógeno nosocomial, al papel en su epidemiología de la transmisión de persona a persona, y a la alta prevalencia de este microorganismo en Portugal, que es el país con las cifras de prevalencia más altas de Europa

Estudo dos comportamentos e riscos nos infectados pelo VIH com e sem coinfecção pelo VHB e/ou VHC

Dissertação de mestrado em SIDAIn this work we had as the main purpose the population’s characteristics study, their behaviours and the risks of the HIV bearers, with or without co-infection by HBV and/or HCV. According to our work and doing a small introduction to each one of the viruses, it was first made a bibliographical revision with the purpose of the evaluation of the science state, falling back upon reference works. They were done surveys to 95 individuals, all coming of the external consultation of infectology from the Joaquim Urbano Hospital - Porto, who were distributed in two groups. The group I was constituted by HIV bearers, with or without co-infection by HBV and/or HCV and the group II, of control, included bearers of HBV, HCV or HBV and HCV. Sixty six elements were integrated in the group I and the remaining ones in the group II. The sample was predominantly constituted by elements of the masculine gender (82,1%) and most (66,7%) interfered in the age group between 26 and 39 years old. In what concerns the scholarship 55,8% just stopped the basic teaching. 66,3% are or were already toxic dependents by intravenous, being, most (96,8%) consumers more than two years and still 68,3% refer the share of needles and syringes during the drugs consumption by intravenous way. According to the pathology, 5,3% were infected by HBV, 20% by HCV and 32,6% by HIV. In the remaining cases, 5,3% presented coinfection by HBV/HCV, 4,2% by HBV/HIV, 26,3% were bearers of HCV and HIV, 6,3% were simultaneously infected by HBV, HCV and HIV, had most of them (81,1%) been diagnosed for more than two years. According to the infection acquisition way, we recorded a balance among the ones who say that they have been infected due to the use of drugs by intravenous and the ones who refer the sexual relations as the cause of their pathology. Both of these acquirements forms corresponded mostly to the answers. Bearers of B hepatitis had a tendency to associate their infection to sexual relations, bearers of HCV, there was a balance among the ones who refer the use of drugs as the cause and the ones who don't know the infection cause and among the HIV bearers most of them pointed the sexual relations as the probable cause of the virus acquisition. When co-infection of HIV exists with one or two hepatotropic virus, there was a major individuals' tendency to associate the pathology to the drugs. The bearers of HBV and HCV also pointed the similar reason

Innovative resources and models for learning e-skills for young people with disabilities

The present study focuses on the analysis of a series of resources and innovative models created within an European project called #TV T21 Community# e-Skills, social inclusion and employability” with the objective of understanding their use in learning contexts for young people with disabilities. An analytic description of the different elements developed such as: guides, games, mobile applications, practical models and even workshops will be given. In addition to the research that has been carried out, and its theoretical basis, questionnaires, group dynamics and observation were also implemented. At the end of the research, we can conclude that the present project, known as a strategic partnership for youth, meets the fundamental requirements to apply a set of innovative and necessary resources to meet the criteria of inclusion, equality and digital employability. These aspects are outlined as priorities by the European Disability Strategy 2010-2020 and the World Report on Disability

Insigts in familial amyloidotic polyneuropathy portuguese type (Val30Met)salivary glands.

Doutoramento em Ciências MédicasDoctoral Degree in Medical Science

A clinical-pathological and survival study of oral squamous cell carcinomas from a population of the north of Portugal

Objectives: Our aim was to analyze the clinical, pathological, and outcome characteristics of oral squamous cell carcinomas (OSCC) from a population of the north of Portugal. Material and Methods: We conducted a descriptive study of 128 OSCC diagnosed between the years of 2000 and 2010 in the Centro Hospitalar do Porto. Through of the review of the clinical records we studied several clinical, pathological, and outcome variables. The overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier method and log-rank test. Cox regression method was used for multivariate analysis. Results: Of 128 patients with OSCC, 83 (64.8%) were male and 45 (35.2%) were female, (mean age of 62.13±15.57 years). The most affected location was the tongue (n=52; 40.6%). The most common cause of reference was a nonhealing ulcer (n=35; 28.9%) followed by oral pain (n=27; 22.3%). Sixty (60.6%) patients were tobacco consumers and 55 (57.3%) alcohol consumers. The cumulative 3-years OS rate was 58.6% and DFS was 55.4%. In multivariable analysis for OS, we found an adverse independent prognostic value for advanced tumour size (p<0.001) and for the presence of perineural permeation (p=0.012). For DFS, advanced stage tumours presented adverse independent prognostic value (p<0.001). Conclusions: OSCC occurred most frequently in males, in older patients, and in patients with tobacco and/or alcohol habits. TNM and tumour stage additionally to the perineural permeation were the most important prognostic factors for the survival of these patients, contributing to identify high-risk subgroups and to guide therapy

Oral soft tissue biopsies in Oporto, Portugal: an eight year retrospective analysis

Background: The diseases that affect the oral cavity are wide and diverse, comprising a broad spectrum of either benign or malignant lesions. However, few histological-based studies were performed for the evaluation of oral cavity lesions, and very few directed to oral soft tissue pathology. The aim of this study was to carry out pioneering research, within a Portuguese population, to determine the frequency and characteristics of oral malignancies, po - tential malignant disorders, and soft benign tissues pathologies submitted for biopsy in a north Portugal (Oporto) hospital population. Material and Methods: We performed a retrospective study of soft tissue, oral cavity biopsies, in a hospital north of Portugal (Oporto) between 1999 and 2006. We analysed information on gender, age, location of the lesion, and the histopathological diagnosis. Results: A total of 1042 oral biopsies were observed, 557(53.5%) in females and 485 (46.5%) in males, with a mean age of 51.7 years (S.D. ±17.6). The topographic location most frequently affected was labial mucosa (n=306). Considering the nature of the lesions, 700 (67.2%) corresponded to non-neoplasic lesions, 45 (4.3%) to potentially malignant disorders, and 297 (28.5%) to neoplasms (93 benign and 204 malignant). Non-neoplasic lesions were more prevalent in female gender (59.9%) when compared with potentially malignant disorders (46.7%) and neoplasms (39.4%) ( P < 0.001). Non-neoplasic lesions presented the lower mean age (49.2±17.6) and potentially malignant di - sorders the highest mean age (60.5±14.5) ( P < 0.001). The most common lesion of entire sample was fibro-epithelial hyperplasia (n=186; 17.9%), followed by squamous cell carcinoma (n=158; 15.1%). Conclusions: Fibro-epithelial hyperplasia, followed by squamous cell carcinoma, was the most common pathologies. This pioneering study provided, for the first time, data about the proportion of squamous cell carcinoma when compared with benign conditions in a Portuguese hospital population

Etiology and bacterial susceptibility to urinary tract infections

RESUMO - Introdução: As infecções do tracto urinário (ITU) são muito prevalentes no Ser Humano, ocupando o segundo lugar, logo a seguir às infecções respiratórias. Os principais microrganismos envolvidos têm-se mantido relativamente constantes, ao longo dos tempos, sendo o seu tratamento, em muitos casos, realizado empiricamente, recorrendo-se a antibióticos que, à partida, serão de espectro alargado e conseguirão debelar a infecção. Objectivo: O objectivo fundamental deste trabalho, foi o de conhecer o comportamento das estirpes mais prevalentes que provocam infecções do tracto urinário e avaliar se se manifesta alguma evolução das suas resistências aos antibióticos, em dois períodos temporais distintos. Material e métodos: O estudo, retrospectivo, foi realizado na Unidade Local de Saúde da Guarda, recorrendo-se a 200 uroculturas com resultado positivo, metade do ano 2002 e as restantes do ano 2007. Todas as urinas foram semeadas em gelose de CLED. A identificação e o seu respectivo antibiograma foram realizados no sistema VITEK 2 (bioMérieux). Resultados: De entre os principais resultados destaca-se que a estirpe mais prevalente no ano de 2002 foi E. coli constituindo 64% das estirpes identificadas, seguida da S. marcescens com 16% e da K. pneumoniae com 14%. Em relação ao ano de 2007, predominou novamente a E. coli com 66% das infecções urinárias, seguida da P. aeruginosa com 14%. Quanto ao comportamento face aos antibióticos das estirpes mais prevalentes, verificamos que ocorreu um aumento de sensibilidade da Escherichia coli face à amoxicilina (68,8% em 2002 para 93,9% em 2007), face à ampicilina (56,3% em 2002 para 75,8% em 2007) e à cefalotina (84,4% em 2002 para 93,9% em 2007). Apenas aumentou a sua resistência face ao trimetoprim, sendo que no ano 2002 apresentava uma resistência de 18,8% e no 2007 este valor passou a 24,2%. A Klebsiella pneumoniae aumentou a sua capacidade de resistência à amoxicilina (0% no ano 2002 para 75% no ano 2007), tornou-se completamente resistente à ampicilina e diminui a sua sensibilidade à cefalotina (85,7% em 2002 e apenas 25% em 2007). Aumentou ainda a sua resistência à pefloxacina, uma vez que em 2002 todas as estirpes foram sensíveis e em 2007 apenas 25% apresentaram sensibilidade perante este antibiótico. Em relação ao trimetoprim verificou-se também um acentuado aumento de resistência por parte desta bactéria, sendo que em 2002 apenas 28,6% das estirpes de Klebsiella pneumoniae eram resistentes, ao passo que em 2007 este número passou para 75%. Apenas aumentou a sua susceptibilidade à netilmicina, passando de uma sensibilidade de 85,7% em 2002 para 100% em 2007. Discussão: A partir dos resultados podemos constatar que a Escherichia coli não alterou muito o seu comportamento face aos antibióticos testados, aumentando mesmo a sua sensibilidade em alguns casos. Já em relação à Klebsiella pneumoniae, há uma clara diminuição da sua sensibilidade face à maioria dos antibióticos testados. Conclusão: Claramente sugere-se a necessidade de estudar a prevalência das principais bactérias implicadas nas infecções urinárias, assim como a sua susceptibilidade aos antibióticos.ABSTRACT - Introduction: Urinary tract infections (UTI) are very prevalent in Humans immediately following respiratory infections. The main microorganisms involved have remained relatively constant over time, and their treatment, in many cases, has been done empirically, making use of antibiotics that, in principle, are supposed to have an extended-spectrum and are able to eradicate the infection. Objective: The main objective of this work was to understand the behaviour of the most prevalent strains that cause urinary tract infections and assess if we can discern some trends in their resistance to antibiotics during two different time periods. Material and methods: The retrospective study was carried out at Local Health Unit (Guarda), involving the use of 200 cultures with a positive result, for half of the year 2002 and for the rest of the year 2007. All urine samples were plated on agar CLED. The identification and their respective antibiotic were performed at VITEK 2 system (bioMérieux). Results: The main results suggested that the most prevalent strain in 2002 was E. coli constituting 64% of the strains identified, followed by S. marcescens with 16% and K. pneumoniae with 14%. For the year 2007, E. coli prevailed again with 66% of urinary infections, followed by P. aeruginosa with 14%. As far as the behavior of more prevalent strains towards antibiotics is concerned we found that there was an increased sensitivity of Escherichia coli compared to amoxicillin (68.8% in 2002 to 93.9% in 2007), compared to ampicillin (56.3% in 2002 to 75.8% in 2007) and to cephalothin (84.4% in 2002 to 93.9% in 2007). It only increased its resistance to trimethoprim, in 2002 it had a resistance of 18.8% and this number rose to 24.2% in 2007. Klebsiella pneumoniae has increased its capacity of resistance to amoxicillin (0% in 2002 to 75% in 2007), became completely resistant to ampicillin and reduced its sensitivity to cephalothin (85.7% in 2002 and only 25% in 2007). They also increased their resistance to pefloxacin, since in 2002 all strains were sensitive and in 2007 only 25% showed sensitivity to this antibiotic. For trimethoprim there was also a sharp increase of resistance to this bacterium: in 2002 only 28.6% of Klebsiella pneumoniae strains were resistant while in 2007 this figure rose to 75%. Klebsiella pneumoniae only increased its susceptibility to netilmicin, from a sensitivity of 85.7% in 2002 to 100% in 2007. Discussion: From the results we can see that Escherichia coli did not change its performance towards the antibiotics tested, even increasing its sensitivity in some cases. In relation to Klebsiella pneumoniae, there is a clear decrease in their sensitivity to most antibiotics tested. Conclusion: It is necessary to know the prevalence of the main bacteria that infect the urinary tract in order to continue empirical treatments with antibiotics.info:eu-repo/semantics/publishedVersio