Antimicrobial resistance in Streptococcus pneumoniae: mechanisms and current epidemiology

Infections caused by Streptococcus pneumoniae are a worrisome public health problem worldwide. Young children and elderly are the main age group affected and the highest burden of the disease are among developing countries. Pneumococcal infections cause 11% of the total of infant deaths, representing the leading cause of child death currently preventable by vaccination. Epidemiologic information about pneumococci in Brazil is somehow restrict, but available data reinforce the worrisome occurrence of pneumococcal diseases, which are commonly treated empirically. Limitations in the diagnostic methods, along with the severity of disease contribute to this behavior. Thus, surveillance studies are crucial to define the prevalence of resistant strains both globally or in a particular region, as these strains may compromise empirical therapeutical choices. However, although different clones of PNSP are internationally distributed, and considering diseases other than meningitis, the prevalence to penicillin is quite low, making this old, safe, and inexpensive drug an attractive first choice to treat pneumococcal infections. The widespread use of conjugate vaccines among children, influencing the circulation of resistant clones and the distribution of serotypes reinforces the need of surveillance studies to define prevalence of resistance.Infections caused by Streptococcus pneumoniae are a worrisome public health problem worldwide. Young children and the elderly are the main age groups affected and the highest burden of the disease is found in developing countries. Pneumococcal infections cause 11% of the total infant deaths, representing the leading cause of child death currently preventable by vaccination. Epidemiologic information about pneumococci in Brazil is somehow restricted, but available data reinforce the worrisome occurrence of pneumococcal diseases, which are commonly treated empirically. Limitations in the diagnostic methods, along with the severity of disease contribute to this behavior. Thus, surveillance studies are crucial to define the prevalence of resistant strains both globally and in a particular region, as these strains may compromise empirical therapeutic choices. However, although different clones of penicillin non-susceptible pneumococci are internationally distributed, and considering diseases other than meningitis, the prevalence of resistance to penicillin is quite low, making this old, safe, and inexpensive drug an attractive first choice to treat pneumococcal infections. The widespread use of conjugate vaccines among children, influencing the circulation of resistant clones and the distribution of serotypes reinforces the need of surveillance studies to define the prevalence of resistance

Molecular epidemiology of heteroresistant vancomycin-intermediate Staphylococcus aureus in Brazil

AbstractTo determine the epidemiological and molecular characteristics of 12 Staphylococcus aureus isolates presenting heteroresistance to vancomycin in laboratories of two cities in Santa Catarina, southern Brazil. Epidemiological data, including the city of isolation, health institution, and date of isolation were considered, as well as the associated clinical specimen. For molecular characterization, we analyzed the staphylococcal cassette chromosome types, the erm gene presence, and the genomic diversity of isolates using pulsed-field gel electrophoresis. The 12 isolates of S. aureus were previously confirmed as heteroresistance to vancomycin using the population analysis profile–area under curve. Regarding genetic variability, two clones were detected: the main one (clone A) composed of four isolates and the clones B, with two isolates. For clone A, two isolates presented identical band patterns and were related to the same hospital, with an interval of 57 days between their isolation. The other isolates of this clone showed no epidemiological link between them because they were isolated in different hospitals and had no temporal relationship. The other clone showed no detectable epidemiological relationship. The heteroresistance to vancomycin recovered in Santa Catarina State from 2009 to 2012 had, in general, heterogeneous genomic patterns based on pulsed-field gel electrophoresis results, which is in accordance with the fact that these isolates had little or no epidemiological relationship among them. Due to the characteristic phenotypic instability and often prolonged vancomycin therapy for selection, clonal spread is not as common as for other resistance mechanisms disseminated through horizontal gene transfer

Susceptibility profiles and correlation with pneumococcal serotypes soon after implementation of the 10-valent pneumococcal conjugate vaccine in Brazil

SummaryObjectivesTo evaluate the susceptibility patterns among Streptococcus pneumoniae recovered during the years 2010–2012 and to correlate these with serotypes.MethodsPneumococci from invasive sites were serotyped by sequential multiplex PCR and/or Quellung reaction. Etest strips were used to determine the minimal inhibitory concentrations, and the Clinical and Laboratory Standards Institute (CLSI) guidelines were used for interpretation. Genetic determinants of macrolide resistance were assessed by PCR, and the occurrence of the D phenotype was analyzed following the recommendations of the CLSI.ResultsOne hundred fifty-nine S. pneumoniae were studied; most were recovered from blood and were associated with serotypes 14, 3, 4, 23F, 20, 7F, 12F, 19A, and 19F. Pneumococcal conjugate vaccine PCV7, PCV10, and PCV13 and 23-valent polysaccharide vaccine serotypes represented 38.2%, 48.7%, 64.5%, and 85.5%, respectively. β-Lactam non-susceptibility (non-meningitis) was basically related to serotype 19A. For meningitis, it was observed in 21.4% (serotypes 14, 3, 9V, 23F, and 24F). Resistance to erythromycin occurred in 8.2% and mefA was the most common macrolide genetic determinant. One isolate was resistant to levofloxacin. Non-susceptibility to trimethoprim–sulfamethoxazole was 37.7% and to tetracycline was 22.0%.ConclusionsOur population of pneumococci represents a transition era, soon after the introduction of PCV10. Non-susceptible patterns were found to be associated with classical PCV serotypes (especially serotype 14), which is still highly prevalent, and non-PCV10 ones (19A), which may disseminate, occupying the biological niche left by the vaccine serotypes

A promoção da saúde através do ensino da lavagem das mãos em escola pública de Araucária, no Paraná

As mãos favorecem a transmissão de patógenos. Assim, lavá-las corretamente e com frequência é fundamental para a prevenção de doenças. Utilizando metodologias participativas e de pesquisa-ação, este estudo visou apresentar uma atividade que promovesse a educação em saúde a partir da correta lavagem das mãos. O público alvo foram crianças com idades entre quatro e onze anos, além de seus pais. As intervenções ocorreram em dois dias, baseando-se em práticas lúdicas com uso de tinta guache, em uma escola pública de Araucária. O aproveitamento dos participantes foi analisado durante as atividades por meio de perguntas orais. Ao todo, 145 crianças e aproximadamente 20 pais participaram da dinâmica, sendo que as crianças contribuíram ativamente, enquanto entre os pais houve hesitação inicial. Apesar disso, ambos responderam às perguntas avaliativas de forma correta ao final da prática. O projeto foi avaliado por professores da escola por meio de formulários e obteve como média 9,82 - o que permite afirmar que as atividades foram adequadas, pertinentes e bem aplicadas

Impactos da violência obstétrica às mulheres brasileiras: uma revisão integrativa

The aim is to identify scientific studies about obstetric violence caused by health professionals and to evaluate its consequences. This is an integrative literature review of articles published in Portuguese selected from the VHL, WoS, SciELO and PubMed databases. The articles were chosen through the search with the descriptors: Obstetric violence, health professionals, women, Brazil and health impacts, using the Boolean operator AND as a tool for crossing the descriptors. Nine articles published in the period from 2015 to 2022 were reviewed. Obstetric violence can be associated with verbal and psychological offenses, for that it is necessary to detect the physical and psychological impacts of such impetuosity, since it has repercussions on trauma, pain, postpartum depression, development of anxiety and lower demand for health services after childbirth. It appears, therefore, the existence of limitations involving the theme, due to the scarcity of direct and objective literature, requiring the development of more research.Objetiva-se identificar estudos científicos acerca da violência obstétrica causada por profissionais da área da saúde e avaliar suas consequências. Trata-se de uma revisão integrativa da literatura de artigos publicados em português selecionados nas bases de dados BVS, WoS, SciELO e PubMed. Os artigos foram escolhidos por meio da busca com os descritores: Violência obstétrica, profissionais da saúde, mulheres, Brasil e impactos na saúde, sendo utilizado o operador booleano AND como ferramenta para o cruzamento dos descritores. Foram revisados 09 artigos publicados no período de 2015 a 2022. A violência obstétrica pode estar associada a ofensas verbais e psicológicas, para tanto é necessário detectar os impactos físicos e psicológicos de tal impetuosidade, visto que repercute em traumas, dores, depressão pós-parto, desenvolvimento de ansiedade e menor procura nos serviços de saúde após o parto. Depreende-se, portanto, a existência de limitações envolvendo a temática, devido à escassez na literatura direta e objetiva, sendo necessário o desenvolvimento de mais pesquisas

Impactos da violência obstétrica às mulheres brasileiras: uma revisão integrativa

The aim is to identify scientific studies about obstetric violence caused by health professionals and to evaluate its consequences. This is an integrative literature review of articles published in Portuguese selected from the VHL, WoS, SciELO and PubMed databases. The articles were chosen through the search with the descriptors: Obstetric violence, health professionals, women, Brazil and health impacts, using the Boolean operator AND as a tool for crossing the descriptors. Nine articles published in the period from 2015 to 2022 were reviewed. Obstetric violence can be associated with verbal and psychological offenses, for that it is necessary to detect the physical and psychological impacts of such impetuosity, since it has repercussions on trauma, pain, postpartum depression, development of anxiety and lower demand for health services after childbirth. It appears, therefore, the existence of limitations involving the theme, due to the scarcity of direct and objective literature, requiring the development of more research.Objetiva-se identificar estudos científicos acerca da violência obstétrica causada por profissionais da área da saúde e avaliar suas consequências. Trata-se de uma revisão integrativa da literatura de artigos publicados em português selecionados nas bases de dados BVS, WoS, SciELO e PubMed. Os artigos foram escolhidos por meio da busca com os descritores: Violência obstétrica, profissionais da saúde, mulheres, Brasil e impactos na saúde, sendo utilizado o operador booleano AND como ferramenta para o cruzamento dos descritores. Foram revisados 09 artigos publicados no período de 2015 a 2022. A violência obstétrica pode estar associada a ofensas verbais e psicológicas, para tanto é necessário detectar os impactos físicos e psicológicos de tal impetuosidade, visto que repercute em traumas, dores, depressão pós-parto, desenvolvimento de ansiedade e menor procura nos serviços de saúde após o parto. Depreende-se, portanto, a existência de limitações envolvendo a temática, devido à escassez na literatura direta e objetiva, sendo necessário o desenvolvimento de mais pesquisas

Total fraction of mononuclear cell or stromal vascular fraction transplant associated with cellulosic membrane in experimental cutaneous wounds in rabbits

The skin presents various important functions to the organism. The maintenance of its integrity is fundamental, among others, to prevent penetration of microorganisms and exit of liquids essential to life maintenance. Due to its constant environment exposure, the skin is highly susceptible to trauma which can result solutions of continuity. The healing of wounded skin should be fast and many alternatives are searched for, aiming to reduce repair time and to guarantee a functional and esthetically acceptable scar. One option to repair injured tissues which is ever more viable is cellular therapy with adult stem cells. The aims of this study consisted in evaluating the transplant of total mononuclear cell fraction (TMCF) from bone marrow (BM) or stromal vascular fraction (SVF) from adipose tissue (AT), associated with the use of cellulose membrane. To carry out this experiment, 20 rabbits were randomly divided in four groups with five animals each. After induction of the experimental cutaneous wound, Group A did not receive any treatment; group B received only cellulose membrane; and groups C and D, in addition to receiving the membrane, were submitted to autologous transplant of TMCF, with total cell value between 6,92 x 10(6) and 4,91 x 10(7) and a viability of 82 to 97% or SVF, with total cell value between 9,6 x 10(5) and 6,5 x 10(6) and a viability of 66 a 87%, respectively. At the end of the evaluation period, the three treated groups presented significant statistical difference of wound area in relation to the control group, and the group which received SVF from adipose tissue presented the shortest wound healing time.A pele apresenta diversas funções importantes para o organismo. A manutenção de sua integridade é fundamental, entre outras, para impedir a penetração de microrganismos e a perda de líquidos essenciais à manutenção da vida. Por estar constantemente exposta ao meio ambiente, a pele é altamente susceptível a traumas que podem acarretar soluções de continuidade. A cicatrização da pele ferida deve ser rápida e diversas alternativas são buscadas, visando à redução do tempo de reparo a fim de garantir cicatriz funcional e esteticamente aceitável. Uma opção cada vez mais viável para reparar tecidos danificados é a terapia celular com células-tronco adultas. Os objetivos deste trabalho consistiram em avaliar o transplante da fração total de células mononucleares (FTCM) da medula óssea (MO) e da fração vascular estromal (FVE) do tecido adiposo (TA), associado ao uso da membrana celulósica. Para realização deste experimento, 20 coelhos foram divididos aleatoriamente em quatro grupos com cinco animais cada. Após a indução da ferida cutânea experimental, o grupo A, não recebeu nenhum tratamento, o grupo B, recebeu apenas membrana celulósica e os grupos C e D, além de receberem a membrana, foram submetidos a transplante autólogo da FTCM, com valor total de células entre 6,92 x 10(6) a 4,91 x 10(7) e uma viabilidade de 82 a 97% ou da FVE, com valor total de células entre 9,6 x 10(5) e 6,5 x 10(6) e uma viabilidade de 66 a 87%, respectivamente. Ao final do período de avaliação, os três grupos tratados apresentaram diferença estatística significativa da área da ferida em relação ao grupo controle e o grupo que recebeu a FVE do tecido adiposo apresentou o menor tempo de cicatrização da ferida