Características epidemiológicas dos microrganismos resistentes presentes em reservatórios de uma Unidade de Terapia Intensiva

Exportado OPUSMade available in DSpace on 2019-08-13T18:49:17Z (GMT). No. of bitstreams: 1 qu_sia_souza_damasceno.pdf: 3049244 bytes, checksum: 857194d329dfc5c3b08277e1f6a7110f (MD5) Previous issue date: 20O ambiente ocupado por pacientes colonizados ou infectados pode se tornar contaminado porbactérias resistentes e constituir um reservatório secundário, favorecendo a transmissãocruzada. A identificação de potenciais reservatórios de microrganismos de importânciaepidemiológica no ambiente hospitalar constitui uma importante medida de prevenção da suadisseminação. Objetivou-se determinar as características epidemiológicas de microrganismosde importância clínica quando presentes nas superfícies, soluções, equipamentos ehemocultura de pacientes de uma Unidade de Terapia Intensiva de Belo Horizonte. Tratou-sede um estudo transversal, realizado entre julho e outubro de 2009. As amostras foram obtidasde soluções degermante e por swabs das superfícies (monitor de função cardíaca, ventiladormecânico, grade lateral da cama, torneira, mesa de cabeceira, estetoscópio e pia). As amostrasambientais sem diluições foram cultivadas em meios: Infuso de Cérebro e Coração (BHI),MacConkey e Agar Sabouraud a 37º por 48 horas. Os isolados bacterianos foramidentificados pela morfologia da colônia, coloração de Gram, teste de catalase e Kit API. Oteste de sensibilidade foi realizado com a utilização de antibiograma por disco de difusão parao imipenem, vancomicina, ceftriaxona e ciprofloxacina. Os isolados bacterianos com perfil deresistência aos antimicrobianos testados foram comparados às amostras de hemocultura peloteste repetitive extragenic palindromic sequences (rep-PCR) para análise de similaridade.As análises foram realizadas nos laboratórios de Ecologia e Fisiologia de Microrganismos ede Genética de Microrganismos da Universidade Federal de Minas Gerais. Verificou-seimportante contaminação de superfícies e equipamentos em UTI (P<0,004). Os estetoscópios,ventiladores mecânicos e torneiras apresentaram as maiores médias de contaminação. Nãohouve contaminação da solução degermante (PVP-I 10%). Nos estetoscópios da unidade deisolamento, registrou-se a presença de Enterococcus faecalis resistente à vancomicina,Staphylococcus aureus e Acinetobacter baumannii multirresistente. Entre o isolado deAcinetobacter baumannii multirresistente detectado no ventilador mecânico e uma amostra dehemocultura de paciente houve 80% de similaridade. Consideráveis percentuais desimilaridade (60-65% - IC: 85%), ainda foram observados entre outros isolados do ambiente ehemoculturas de pacientes. As similaridades entre os isolados bacterianos do ambiente epacientes reforçam a importância da vigilância epidemiológica quanto a possibilidade datransferência horizontal de patógenos. Conclui-se, que as superfícies inanimadasfrequentemente tocadas e equipamentos próximos ao paciente na UTI contaminam-se porbactérias resistentes, sugerindo relação clonal com isolados bacterianos de hemocultura depacientes. Assim, observa-se a necessidade de reforçar as medidas de controle, redução eprevenção da disseminação de microrganismos resistentes, além de dedicar maior atenção àdescontaminação de superfícies e equipamentos em UTI e à avaliação de sua eficácia,aspectos não analisados no estudo, mas de grande relevância nesse contexto.The environment placed by colonized or infected patient may become infected by pathogenicbacteria and constitute a secondary reservoir favoring the cross infection. The identification ofpotential reservoirs of epidemiological important microorganisms in the hospital environmentconstitutes an indispensable measure of prevention of its spread. This study aimed todetermine epidemiological characteristics of microorganisms of clinical importance whenpresent on surfaces, equipments and in solutions and patient blood culture from an Intensivecare Unit from Belo Horizonte. It was a cross-sectional study conducted from July to October2009. Samples were obtained from the degermant soap and by swabs of surfaces on cardiacmonitor, mechanical ventilator, bedside rail, faucet, bedside table, stethoscopes and sink.Concurrently to the environmental sample it was obtained routine culture from ICU adultpatients. Environment samples without dilution were cultured onto Brain Heart Infusion(BHI), MacConkey and Sabouraud Agar at 37º for 48h. The bacteria were identified bycolonial morphology, Gram stain, catalase and API Kit. The susceptibility test was performedby diffusion disc for imipenem, vacomycin, ceftriaxone and ciprofloxacin. The bacterialisolates from environment and routine cultures were compared by the repetitive extragenicpalindromic sequences (rep-PCR) test for similarity analysis. The analyses were performed atthe Ecology and Physiology of Microorganisms laboratory and Genetic of Microorganismslaboratory from Minas Gerais Federal University. It was verified an important contaminationof surfaces and equipment from UTI (P<0,004). The stethoscopes, mechanical ventilators andtap water showed the highest average of contamination. There wasnt contamination in thedegermant solution (PVP-I 10%). On the stethoscopes from the isolation unit were detectedVancomycin resistant Enterococcus faecalis, Staphylococcus aureus and multi-resistantAcinetobacter baumannii. Between one isolate of multi-resistant Acinetobacter baumanniidetected on the mechanical ventilator and a sample of blood culture patient there was 80% ofsimilarity. Considerable percentage of similarity (60-65% - IC: 85%) were, still, observedamong others bacterial isolates from the environment and patient blood cultures. Thesimilarities among environment bacterial isolates and samples of patients blood culturesreinforce the importance of epidemiological surveillance regarding the chance of pathogenshorizontal transference. In conclusion, inanimate surfaces frequently touched and equipmentsnear by the patients in ICU contaminated by resistant bacteria suggest clonal relatedness withbacterial isolates from patient blood culture. Thus it is necessary to reinforce measures ofcontrol, reduction and prevention of multi drug-resistant microorganisms spread. In additionto better attention to surfaces and equipment decontamination in ICU and efficacy assessment,aspects of great relevance in this context, not evaluated in this study

The in vitro leishmanicidal activity of hexadecylphosphocholine (miltefosine) against four medically relevant Leishmania species of Brazil

The in vitro leishmanicidal activity of miltefosine® (Zentaris GmbH) was assessed against four medically relevant Leishmania species of Brazil: Leishmania (Leishmania) amazonensis, Leishmania (Viannia) braziliensis, Leishmania (Viannia) guyanensis and Leishmania (Leishmania) chagasi. The activity of miltefosine against these New World species was compared to its activity against the Old World strain, Leishmania (Leishmania) donovani, which is known to be sensitive to the effects of miltefosine. The IC50 and IC90 results suggested the New World species harboured similar in vitro susceptibilities to miltefosine; however, miltefosine was approximately 20 times more active against the Old World L. (L.) donovani than against the New World L. (L.) chagasi species. The selectivity index varied from 17.2-28.9 for the New World Leishmania species and up to 420.0 for L. (L.) donovani. The differences in susceptibility to miltefosine suggest that future clinical trials with this drug should include a laboratory pre-evaluation and a dose-defining step

The in vitro leishmanicidal activity of hexadecylphosphocholine (miltefosine) against four medically relevant leishmania species of Brasil

Submitted by Nuzia Santos ([email protected]) on 2014-10-24T11:54:08Z No. of bitstreams: 1 The in vitro leishmanicidal activity of hexadecylphosphocholine (miltefosine) against four medically relevant Leishmania species of Brazil.pdf: 267700 bytes, checksum: 68f580f77e828f3ea01793a63706fd36 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2014-10-24T12:10:36Z (GMT) No. of bitstreams: 1 The in vitro leishmanicidal activity of hexadecylphosphocholine (miltefosine) against four medically relevant Leishmania species of Brazil.pdf: 267700 bytes, checksum: 68f580f77e828f3ea01793a63706fd36 (MD5)Made available in DSpace on 2014-10-24T12:10:36Z (GMT). No. of bitstreams: 1 The in vitro leishmanicidal activity of hexadecylphosphocholine (miltefosine) against four medically relevant Leishmania species of Brazil.pdf: 267700 bytes, checksum: 68f580f77e828f3ea01793a63706fd36 (MD5) Previous issue date: 2011Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisas Clínicas. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisas Clínicas. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisas Clínicas. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Parasitologia Celular e Molecular. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisas Clínicas. Belo Horizonte, MG, Brasil.The in vitro leishmanicidal activity of miltefosine® (Zentaris GmbH) was assessed against four medically relevant Leishmania species of Brazil: Leishmania (Leishmania) amazonensis, Leishmania (Viannia) braziliensis, Leishmania (Viannia) guyanensis and Leishmania (Leishmania) chagasi. The activity of miltefosine against these New World species was compared to its activity against the Old World strain, Leishmania (Leishmania) donovani, which is known to be sensitive to the effects of miltefosine. The IC50 and IC90 results suggested the New World species harboured similar in vitro susceptibilities to miltefosine; however, miltefosine was approximately 20 times more active against the Old World L. (L.) donovani than against the New World L. (L.) chagasi species. The selectivity index varied from 17.2-28.9 for the New World Leishmania species and up to 420.0 for L. (L.) donovani. The differences in susceptibility to miltefosine suggest that future clinical trials with this drug should include a laboratory pre-evaluation and a dose-defining step