Emergence Of Extended-spectrum β-lactamase Producing Enterobacter Spp. In Patients With Bacteremia In A Tertiary Hospital In Southern Brazil

Background Extended-spectrum β-lactamases (ESBLs) are increasingly prevalent in Enterobacter spp., posing a challenge to the treatment of infections caused by this microorganism. The purpose of this retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with bacteremia caused by ESBL and non ESBL-producing Enterobacter spp. in a tertiary hospital over the period 2004-2008. Methods The presence of blaCTX-M, blaTEM, blaSHV, and blaPER genes was detected by polymerase chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by pulsed-field gel electrophoresis (PFGE). Results Enterobacter spp. was identified in 205 of 4907 of the patients who had positive blood cultures during hospitalization. Of those cases, 41 (20%) were ESBL-producing Enterobacter spp. Nosocomial pneumonia was the main source of bacteremia caused by ESBL-producing Enterobacter spp. The presence of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2 (23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While Enterobacter aerogenes strains showed mainly a clonal profile, Enterobacter cloacae strains were polyclonal. Conclusion Although no difference in clinical outcomes was observed between patients with infections by ESBL-producing and non-ESBL-producing strains, the detection of ESBL in Enterobacter spp. resulted in the change of antimicrobials in 75% of cases, having important implications in the decision-making regarding adequate antimicrobial therapy. © 2012 Elsevier España, S.L. All rights reserved.3228792Sanders, Jr.W.E., Sanders, C.C., Enterobacter spp.: Pathogens poised to flourish at the turn of the century (1997) Clin Microbiol Rev, 10, pp. 220-241Ho, P.L., Shek, R.H., Chow, K.H., Lai, W.M., Detection and characterization of extended-spectrum beta-lactamases among bloodstream isolates of Enterobacter spp. in Hong Kong, 2000-2002 (2005) J Antimicrob Chemother, 55, pp. 326-332Thomson, K.S., Extended-spectrum-β-lactamase, AmpC, and carbapenemase issues (2010) J Clin Microbiol, 48, pp. 1019-1025Rodríguez-Baño, J., Picón, E., Gijón, P., Hernández, J.R., Cisneros, J.M., Peña, C., Risk factors and prognosis of nosocomial bloodstream infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli (2010) J Clin Microbiol, 48, pp. 1726-1731Schwaber, M.J., Carmeli, Y., Mortality and delay in effective therapy associated with extended-spectrum beta-lactamase production in Enterobacteriaceae bacteraemia: A systematic review and meta-analysis (2007) J Antimicrob Chemother, 60, pp. 913-920Tumbarello, M., Spanu, T., Di Bidino, R., Marchetti, M., Ruggeri, M., Trecarichi, E.M., Costs of bloodstream infections caused by Escherichia coli and influence of extended-spectrum-beta-lactamase production and inadequate initial antibiotic therapy (2010) Antimicrob Agents Chemother, 54, pp. 4085-4091Cheong, H.S., Ko, K.S., Kang, C.I., Chung, D.R., Peck, K.R., Song, J.H., Clinical significance of infections caused by extended-spectrum b-lactamase-producing Enterobacteriaceae Blood isolates with inducible AmpC b-lactamase (2012) Microbial Drug Resist, 18, pp. 446-452Towne, T.G., Lewis, J.S., Herrera, M., Wickes, B., Jorgensen, J.H., Detection of SHVtype extended-spectrum beta-lactamase in Enterobacter isolates (2010) J Clin Microbiol, 48, pp. 298-299(2011) Susceptibility TestingTwenty-First Informational Supplement M100-S21, , Clinical and Laboratory Standards Institute. 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Assoc Physicians India, 51, pp. 669-672Marchaim, D., Gottesman, T., Schwartz, O., Korem, M., Maor, Y., Rahav, G., National multicenter study of predictors and outcomes of bacteremia upon hospital admission caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (2010) Antimicrob Agents Chemother, 54, pp. 5099-5104Pai, H., Hong, J.Y., Byeon, J.H., Kim, Y.K., Lee, H.J., High prevalence of extended-spectrum beta-lactamase-producing strains among blood isolates of Enterobacter spp collected in a tertiary hospital during an 8-year period and their antimicrobial susceptibility patterns (2004) Antimicrob Agents Chemother, 48, pp. 3159-3161García-Hernández, A., García-Vázquez, E., Gómez-Gómez, J., Canteras, M., Hernandez-Torres, A., Ruiz-Gomes, J., Predictor factors of ESBL versus non-ESBL Escherichia coli bacteraemia and influence of resistance on the mortality of the patients (2010) Med Clin (Barc), 136, pp. 56-60Marcos, M., Iñurrieta, A., Soriano, A., Martínez, J.A., Almela, M., Marco, F., Effect of antimicrobial therapy on mortality in 377 episodes of Enterobacter spp bacteraemia (2008) J Antimicrob Chemother, 62, pp. 397-403Bonnet, R., Dutour, C., Sampaio, J.L.M., Chanal, C., Sirot, D., Labia, R., Novel cefotaximase (CTX-M-16) with increased catalytic efficiency due to substitution Asp-240→Gly (2001) Antimicrob Agents Chemother, 45, pp. 2269-227

Um programa sobre promoção da saúde do adulto para trabalhadores em saúde Un programa sobre promoción de la salud del adulto para trabajadores en salud A program about adult health promotion for health workers

O objetivo desse trabalho é avaliar uma metodologia alternativa de educação em saúde do adulto desenvolvida entre trabalhadores em saúde. A avaliação foi feita através da pergunta orientadadora: O que significou para você o Curso de Saúde do adulto? A análise consistiu em destacar dos depoimentos as afirmações que mais se repetiam, e agrupá-las em sete categorias: 01. Aprender coisas novas; 02. Aprender para orientar as pessoas que freqüentam a Unidade Básica de Saúde; 03. Interação com os colegas; 04. Sentir-se valorizando profissionalmente; 05. Preocupação com os filhos; 06. Melhorar estilo de vida; 07. Sugestões. Os resultados remetem aos pressupostos apresentados na introdução do trabalho, bem como os do modelo epidemiológico proposto por BLUM4.<br>El objetivo de este trabajo es avaluar una metodologia alternativa de educación en salud del adulto desarrollada entre trabajadores de salud. La avaluación fué hecha a través de la pregunta orientadora: ¿Lo que ha significado para Ud. el curso Salud del Adulto? La análisis se ha constituído para destacar de las deposiciones, las afirmaciones que más se repetian, y agrupadas en siete categorias: 01. Aprender cosas nuevas; 02. Aprender para orientar las personas que frecuentan las Unidades Básicas de Salud; 03. Interacción entre los colegas; 04. Sentirse valorado en la profesión; 05. Preocupación con los hijos; 06. Mejor estilo de vida; 07. Sugestiones. Los resultados remeten a los presupuestos presentados en la introducción del trabajo así como los el modelo epidemiológico propuesto por BLUM4.<br>The porpoise of this work is to evaluate an alternative methodology of education in adult health care undertaken with health care workers. The evaluation was made by the directional question: what did the Adult Health Course mean to you? The analysis consisted of detecting in the responses, the affirmatives that were respective and grouping them in seven categories: 01. Learning new things; 02. Learning to orient people who goes to the basic Health Unit; 03. Interaction with colleagues; 04. Feeling professionally appraned; 05. Worrisome with sons; 06. Improving way of life; 07. Suggestions. The results to the presuppositions presented in the introduction of the article, as well as, with the Epidemiological Model proposed by BLUM4