Mortality related to candidemia and risk factors associated with non-candida albicans

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Epidemiologia molecular de um surto de bacteriemia por Enterobacter cloacae e Enterobacter agglomerans ocorrido na região de Campinas, São Paulo, Brasil

A total of 73 isolates (57 Enterobacter cloacae and 16 Enterobacter agglomerans), recovered during an outbreak of bacteremia in the Campinas area, São Paulo, Brazil, were studied. Of these isolates, 61 were from parenteral nutrition solutions, 9 from blood cultures, 2 from a sealed bottle of parenteral nutrition solution, and one was of unknown origin. Of the 57 E. cloacae isolates, 54 were biotype 26, two were biotype 66 and one was non-typable. Of 39 E. cloacae isolates submitted to ribotyping, 87.2% showed the same banding pattern after cleavage with EcoRI and BamHI. No important differences were observed in the antimicrobial susceptibility patterns among E. cloacae isolates exhibiting the same biotype, serotype and ribotype. All E. agglomerans isolates, irrespective of their origin, showed same patterns when cleaved with EcoRI and BamHI. The results of this investigation suggest an intrinsic contamination of parenteral nutrition solutions and incriminate these products as a vehicle of infection in this outbreak.Foram estudadas um total de 73 cepas (57 de E. cloacae e 16 E. agglomerans), isoladas durante um surto de bacteriemia ocorrido na região de Campinas, S. Paulo. Entre estas cepas, 61 foram isoladas de solução de nutrição parenteral, 9 de sangue, 2 de bolsa fechada de solução de nutrição parenteral e uma era de origem desconhecida. Entre as 57 cepas de E. cloacae, a maioria das cepas foram do biotipo 26/sorotipo O3 (39 cepas) e do biotipo 26/OR (13). Entre as 39 cepas de E. cloacae ribotipadas, 87,2% apresentaram o mesmo padrão de bandas com EcoRI e BamHI. Cepas de E. cloacae pertencentes ao mesmo biotipo, sorotipo e ribotipo não apresentaram diferenças significativas em relação ao padrão de sensibilidade aos agentes antimicrobianos. Todas as cepas de E. agglomerans, independente da origem, pertenciam ao mesmo ribotipo após a clivagem com EcoRI e BamHI. Os resultados obtidos sugerem uma contaminação intrínseca das soluções de nutrição parenteral, incriminando-as como o veículo de transmissão dos agentes etiológicos do surto

LEAN nas emergências: atuação na superlotação da unidade de emergência referenciada do hospital de clínicas da Unicamp / LEAN in emergencies: acting on overcrowding in the emergency referral unit of the clinical hospital at Unicamp

O Hospital de Clínicas (HC) da Universidade Estadual de Campinas (UNICAMP) foi contemplado com o Programa Lean nas Emergências pelo PROADI/SUS com o intuito de ações para reduzir a superlotação do serviço de emergência. Por meio deste programa foram realizadas diversas frentes de melhoria com relação à gestão de indicadores e aos fluxos dos pacientes. Na finalização do projeto foi elaborado um A3 sobre ações na Redução da Superlotação da Unidade de Emergência Referenciada (UER). Ações que estão em implementação desde então com o apoio da Alta Gestão do HC.

Consenso em criptococose - 2008

Univ Sao Paulo, Fac Med, Div Clin Mol Infecciosas, Hosp Clin, Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Med, Sao Paulo, BrazilUniv Estadual Campinas, Hosp Clin, Inst Infectol Emilio Ribas, Campinas, SP, BrazilFundacao Oswaldo Cruz, Dept Microbiol Immunol & Parasitol, Inst Pesquisa Clin Evandro Chagas, Rio De Janeiro, BrazilUniv Fed Parana, Fac Med, Dept Saude Comunitaria, BR-80060000 Curitiba, Parana, BrazilUniv Fed Rio Grande do Sul, Fac Med, Dept Clin Med, Porto Alegre, RS, BrazilUniv Estadual Campinas, Fac Ciencias Med, Dept Clin Med, Sao Paulo, BrazilInst Doencas Trop Natan Portela, Teresina, PI, BrazilUniv Sao Paulo, Fac Med, Dept Mol Infecciosas & Parasitarias, Sao Paulo, BrazilUniv Estadual Campinas, Fac Ciencias Med, Dept Clin Med, Campinas, SP, BrazilUniv Fed Uberlandia, Fac Med, BR-38400 Uberlandia, MG, BrazilFac Med Triangulo Mineiro, Dept Clin Med, Uberaba, MG, BrazilInst Infectol Emilio Ribas, Sao Paulo, BrazilUniv Estadual Sao Paulo, Fac Med Botucatu, Dept Doencas Trop & Diagnost Imagem, Sao Paulo, BrazilUniv Sao Paulo, Fac Med Ribeirao Preto, Dept Clin Med, Ribeirao Preto, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Med, Sao Paulo, BrazilWeb of Scienc

Estudo clinico-epidemiologico das infecções fungicas em receptores de transplante de medula ossea no Hospital das Clinicas na Universidade Estadual de Campinas

Orientador: Maria Luiza Moretti-BranchiniTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Receptores de transplante de medula óssea constituem uma população de alto risco para ocorrência de infecções fúngicas invasivas (IFI). O conhecimento das características epidemiológicas locais é fundamental para a defInição das estratégias de prevenção. Foi feito um estudo retrospectivo que envolveu 115 pacientes, 91 receptores de enxerto alogênico e 24 receptores de enxerto autólogo, nos quais foram detectadas 15 (13,0%) IFI, 8 (53,3%) delas com identificação microbiológica do patógeno. As fungemias (n=8; 53,3%) e as sinusites (n=4; 26,7%) foram as localizações mais freqüentes. Cinco (62,5%) infecções foram causadas por espécies de Candida e 2 (25,0%) foram causadas por Fusarium sp. Dentre as espécies de Candida, 60,0% eram não-albicans. Cinqüenta e dois (45,2%) pacientes apresentaram colonização fúngica; receptores de enxerto alogênico apresentaram maior proporção (52,7%) de colonização do que receptores de enxerto autólogo (16,7%) (p=O,003). O fator de risco independente para ocorrência de IFI nos receptores de enxerto alogênico, identificado por regressão logística multivariada, foi neutropenia prolongada (p<0,001; OR=I,17 [IC95%=1,04-1,24]), enquanto que a não realização de irradiação corporal total no condicionamento agiu como fator independente de proteção ao desenvolvimento de IFI (P=O,021; OR=0,16 [IC95%=0,03-0,76). Através de análise de regressão logística multivariada, encontramos que mucosite prolongada foi fator de risco independente para ocorrência de colonização fúngica entre os receptores de enxerto alogênico (P=O,014; OR=I,l1 [IC95%=1,02-1,21]). A mortalidade atribuível à IFI foi 20,0%. Não houve diferença na sobrevida entre pacientes com ou sem IFI (P=0,173)Abstract: Bone marrow transplant (BMT) recipients are at high risk for developing invasive fungal infections. Deep and prolonged immunosupression have been associated conditions to increase the number of invasive fungal infections in this population. The study of the local and specific epidemiology of these immunosuppressive patients has been an important issue for the treatment and application of preventive measures to reduce the risk of infections. The aim of this study was to evaluate the epidemiology of fungal infections in patients hospitalized in the BMT unit of the Hospital das Clínicas-UNICAMP. Diagnose of invasive fungal infections were made according to the EORTCINIAID criteria. One hundred and fifteen BMT patients, 91 allogenic and 24 autologous recipients were evaluated. Fifteen invasive fungal infections were detected and 8 (53.3%) had microbiological identification of the pathogens. Fungemia (n=8) and sinusitis (n=4) were the most prevalent funga! infections in our study. Five (62.5%) invasive fungal infections were caused by Candida spp. (C. parapsilosis=3) and two (25.0%) by Fusarium sp. Fifty-two (45.2%) patients had fungal colonization. Fungal colonization was more frequent in allogeneic BMT recipients (52.7%) than in autologous recipients (16.7%) (p=O.003). Independent risk factors for invasive fungal infections in allogeneic recipients, identified by multivariate analysis, were prolonged neutropenia (p<0.001) and total body irradiation in the conditioning regimen (P=O.021).The attributable mortality due to fungal infection was 20.0%. There was no difference in survival between patients with or without deep fungal infections (P=O.173)DoutoradoClinica MedicaDoutor em Clínica Médic

Seguimento clinico e laboratorial de 404 individuos com sorologia positiva para sifilis

Orientador: Luiz Jacintho da SilvaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Para avaliar a indicação da punção liquórica em indivíduos as sintomáticos doadores de sangue com exame sorológico de triagem para sífilis reagente (Venereal Disease Research Laboratory (VDRL) e Treponema pallidum Hemagglutination Test (TPHA)), foi realizado um estudo prospectivo no período de maio de 1991 a maio de 1994, com 404 indivíduos: 289 (71,5%) doadores de sangue com sorologia positiva para sífilis, 73 (18,1%) pacientes com sífilis em atividade e 42 (10,4%) indivíduos as sintomáticos com VDRL reagente detectados em um serviço de endoscopia digestiva. Trezentos e vinte e sete (80,9%) indivíduos eram do sexo masculino. A média de idade foi igual a 36 anOs (mínimo=18; máximo=70; DP=l1,4). Tratamento anterior para sífilis foi relatado por 247 (61,1 %) indivíduos; em 183 (74,1%) deles, a droga referida foi penicilina benzatina. Foi realizada punção lombar em 207 (51,2%) indivíduos. Dentre os doadores, 115 (90.6%) tinham contagem de células no LCR dentro dos padrões de normalidade, enquanto 26 (45,6%) pacientes ambulatoriais tinham celularidade aumentada (p < 0,01). O valor preditivo negativo do VDRL em relação ao encontro de pleocitose foi de 0,92 e o valor preditivo negativo do VDRL para a ocorrência de hiperproteinorraquia foi de 0,83 entre os doadores. Com base nos valores preditivos negativos do VDRL-SGE para as alterações liquóricas, concluímos que indivíduos assintomáticos portadores de sorologia para sífilis reagente com título 1:4 poderiam prescindir da punção lombarAbstract: In order to evaluate the necessity of the lumbarpuncture in asymptomatic blood donors with a positive serologic test for syphilis (Venereal Disease Research Laboratory (VDRL) and Treponema pallidum Hemagglutination Test (TPHA», a prospective study was carried out between may, 1991 and may, 1994. Four hundred and four individuals were evaluated, 289 (71.5%) ofthem blood donors, 73 (18.1 %) patients with clinica! syphilis and 42 (10.4%) asymptomatic patients with positive serologic test for syphilis that underwent a diagnostic procedure. In the study, 327 (80.9%) patients were males. The mean age was 36 years (range 18-70 yrs; SD= 11.4). Most of the patients had had a previous treatment for syphilis, and in 183 (74.1 %) the drug used was benzatine penicillin. Two hundred and seven (51.2%) patients underwent lumbar puncture. Among the blood donors, 115 (90.6%) had normal cerebrospinal fluid (CSF) cell counts, but 26 (45.6%) ambulatory patients had pleocytosis (p<0.01). The negative predictive value of the VDRL in the blood for the CSF pleocytosis was 0.92, and for high protein levels in CSF was 0.83 among the blood donors. Based on the negative predictive values of the VDRL in the blood for the CSF abnormalities, we can conclude that asymptomatic people with positive syphilis serologic test with titles lesser than 1:4 could do without any lumbar punctureMestradoClinica MedicaMestre em Clinica Medic

Identification of fungal pathogens by visible microarray system in combination with isothermal gene amplification

The increasing incidence of infectious diseases caused by fungi in immunocompromised patients has encouraged researchers to develop rapid and accurate diagnosis methods. Identification of the causative fungal species is critical in deciding the appropriate treatment, but it is not easy to get satisfactory results due to the difficulty of fungal cultivation and morphological identification from clinical samples. In this study, we established a microarray system that can identify 42 species from 24 genera of clinically important fungal pathogens by using a chemical color reaction in the detection process. The array uses the internal transcribed spacer region of the rRNA gene for identification of fungal DNA at the species level. The specificity of this array was tested against a total of 355 target and nontarget fungal species. The fungal detection was succeeded directly from 103 CFU/ml for whole blood samples, and 50 fg DNA per 1 ml of serum samples indicating that the array system we established is sensitive to identify infecting fungi from clinical sample. Furthermore, we conducted isothermal amplification in place of PCR amplification and labeling. The successful identification with PCR-amplified as well as isothermally amplified target genes demonstrated that our microarray system is an efficient and robust method for identifying a variety of fungal species in a sample1781126sem informaçã

Isolation And Drug Susceptibility Of Candida Parapsilosis Sensu Lato And Other Species Of C-parapsilosis Complex From Patients With Blood Stream Infections And Proposal Of A Novel Lamp Identification Method For The Species

Candida parapsilosis complex (CPC) is the third Candida species isolated in blood cultures of patients from our Hospital, following C. albicans and C. tropicalis. From 2006 to 2010, the median annual distribution of CPC was 8 cases/year. Records of 36 patients were reviewed. CPC were 31 (86.1 %) C. parapsilosis; 4 (11.1 %) C. orthopsilosis; and 1 (2.8 %) C. metapsilosis. Clinical characteristics were central venous catheter, 34 (94.4 %); parental nutrition, 25 (70 %); surgery, 27 (57.9 %); prior bacteremia, 20 (51.3 %); malignancy, 18 (50 %). General mortality was 47.2 %. Death was higher in immunosuppressed patients (17 vs. 11; p = 0.003). Three out four (75 %) patients with C. orthopsilosis and 14 out 31 (45.2 %) with C. parapsilosis died (p = 0.558). Thirty-nine individual isolates were tested for susceptibility to seven antifungal drugs, with MICs values showing susceptibility to all of them. Two isolates, one C. orthopsilosis and one C. parapsilosis, had fluconazole MIC = 4 mu g/mL. Differentiation among CPC has implication in caring for patients with invasive candidiasis since there are differences in virulence, pathogenicity and drug susceptibility. A method targeting the topoisomerase II gene based on loop-mediated isothermal amplification (LAMP) was developed. LAMP emerges as a promising tool for the identification of fungal species due to the high sensitivity and specificity. LAMP can be performed at the point-of-care, being no necessary the use of expensive equipment. In our study, the method was successful comparing to the DNA sequencing and proved to be a reliable and fast assay to distinguish the three species of CPC.1791-25362Ethical Committee of the School of Medical Sciences of the University of CampinasJICA (Japan International Cooperation Agency