A Febre Reumática, complicação tardia de uma infecção de orofaringe causada pelo Streptococcus pyogenes (estreptococo -hemolítico do grupo A de Lancefield), tem como conseqüência a Cardiopatia Reumática, explicada pelo mimetismo molecular entre proteínas cardíacas humanas e a associação de proteínas e carboidratos da membrana do S. pyogenes. A profilaxia secundária com a PGB 1.200.000 UI IM propõe-se a evitar novos surtos, sendo administrada em intervalos de vinte e um dias nos países com alto índice de estreptococcia. A lesão valvar predispõe à Endocardite Infecciosa, que resulta de bacteriemias causadas por focos infecciosos de origem bucal em cerca de 40% dos casos. Os Streptococcus Viridans constituem o grupo mais comumente encontrado nas Endocardites Infecciosas, em especial os Streptococcus sanguinis e Streptococcus oralis. O efeito do uso crônico da PGB não foi estudado com especificidade para essa microbiota. Assim, foi avaliada, qualitativa e quantitativamente, a microbiota bucal de 100 pacientes, aos 7 e 21 dias, após profilaxia secundária para a Febre Reumática com a PGB 1.200.000 UI IM e comparada com a de 100 pacientes portadores de doença arterial coronariana sem antecedentes de Febre Reumática. As espécies avaliadas foram divididas em S. sanguinis, S. oralis e outras espécies de Streptococcus Viridans Foram coletadas amostras de saliva pela mastigação de goma de parafina e transportadas em meio VMGA II S. As culturas foram semeadas em ágar Columbia CNA com 5% de sangue desfibrinado puro de carneiro com acréscimo de penicilina G. e incubadas a 35ºC em estufa de CO2 por 72 horas. As colônias sugestivas de Streptococcus foram submetidas a testes bioquímicos para confirmação de gênero e espécie. A concentração inibitória mínima foi determinada pelo método Etest e interpretada segundo os padrões do Clinical and Laboratory Standards Institute. Não houve diferença quanto à presença do S. sanguinis nos grupos estudados (P=0,40). O S. oralis prevaleceu aos 7 dias de PGB em relação ao grupo controle (P=0,01). Quanto à identificação de outras espécies, houve maior número de cepas nos pacientes do grupo controle quando comparados aos do grupo de estudo aos 7 e 21 dias de PGB (P<0,001). Os números de UFC/ml de S. sanguinis, S. oralis e de outras espécies foram comparados entre os grupos e não houve diferença entre eles (P=0,96; P=0,60 e P=0,77; respectivamente). Quanto às CIM do S. sanguinis e do S. oralis, não houve diferença entre os grupos (P=0,79 e P=0,13; respectivamente). Todos os testes estatísticos foram realizados em um nível de significância de 5%. Concluiu-se que o S. oralis prevaleceu aos 7 dias de PGB 1.200.000 UI IM; os Streptococcus Viridans de outras espécies prevaleceram no grupo controle; o número de UFC/mL de saliva não diferiu nos grupos estudados, a susceptibilidade dos S. sanguinis e S. oralis à penicilina G não foi alterada pela ação da PGB 1.200.000 UI IM a cada 21 dias e, por fim, a PGB não provocou reações de hipersensibilidade em nenhum paciente do estudo / Rheumatic fever is the result of a Streptococcus pyogenes (group A -hemolytic Streptococcus) infection of the upper respiratory tract. Rheumatic heart disease is a rheumatic fever consequence and is elucidated by the molecular mimicry between human cardiac proteins and group A streptococcal proteins and carbohydrates association. The secondary prophylaxis with 1,200,000 U BPG every three weeks is used for prevention of recurrent rheumatic fever in developing countries. Valvar defects are a risk for infective endocarditis which is resulted of bacteriemia caused for oral infectious focuses in 40% of cases. Viridans streptococci are the predominant group recovered in infective endocarditis, specially Streptococcus sanguinis and Streptococcus oralis. The effect of chronic BPG wasnt studied with specificity to these pathogens yet. Therefore, the oral microbiota was evaluated, qualitatively and quantitatively, at 7 and 21 days after secondary prophylaxis with BPG to rheumatic fever (study group), in a hundred patients and in comparison to another hundred patients with coronary heart disease who never acquired rheumatic fever (control group). The species evaluated were divided in S. sanguinis, S. oralis and another Streptococcus species. It was collected samples of chewing-stimulated saliva (1ml) and transported in VMGA II S medium. The samples were cultured in pure and with penicillin G 5% sheep blood Columbia ágar (CNA), incubated for 72 hours in an atmosphere containing 5% CO2 at 35ºC. The strains that were suggestive to Streptococcus were identified by biochemical tests to confirm bacteria species and genus. Minimal inhibitory concentration was determined by Etest method and interpreted in accordance to Clinical and Laboratory Standards Institute. The results showed that there was no difference in S. sanguinis presence in all groups (P=0.40). S. oralis prevailed in 7 days BPG group in comparison to control group (P=0.01). The control group showed the highest number of others species in comparison to 7 and 21 days BPG (P<0.001). CFU/ml numbers of S. sanguinis, S. oralis and other species strains were compared in 7 and 21 days BPG to control group and there was no difference among themselves (P=0.96, P=0.60 and P=0.77; respectively). There was no difference in S. sanguinis and S. oralis MICs among the study and control groups (P=0.79 and P=0.13). All statistic tests were done at 5% significance level. It was concluded that S. oralis prevailed in 7 days BPG group in comparison to control group; other species of Viridans streptococci prevailed in control group. The number of CFU/mL did not differ in both studied groups; the penicillin susceptibility of S. sanguinis and S. oralis did not change by BPG every three weeks and, by the end, it was not observed hypersensitivity reactions to penicillin in neither of the patients of this study

Microorganismos da cavidade oral têm sido admitidos como causadores de doenças sistêmicas com reconhecido mecanismo de disseminação via corrente sangüínea. Diferentes fatores, incluindo a presença da doença periodontal, têm influência no risco de bacteremia oral, podendo ocasionar endocardite infecciosa por Streptococcus viridans. Sendo assim, a manutenção da saúde bucal adquire elevado grau de importância em gestantes portadoras de doença valvar reumática, em que o risco de endocardite infecciosa é eminente. A escassez científica fez deste tema o objetivo deste estudo: investigar a condição clínica periodontal de gestantes portadoras de cardiopatia valvar, identificando agentes periodontopatógenos nas amostras coletadas de saliva, sulco/bolsa periodontal, Para tanto, foram estudadas 52 gestantes cardiopatas (GC) e 70 gestantes não-cardiopatas (GNC). A condição periodontal foi avaliada empregando-se profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), linha esmalte cemento/margem gengival (LEC/MG), índice de sangramento (IS) e índice de placa bacteriana (IP). As seguintes médias foram obtidas para os parâmetros periodontais avaliados: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). Não houve diferença entre os grupos para o NCI (p= 0,612). A presença da Porphyromonas gingivalis na saliva foi maior (p= 0,007) no GNC, porém não houve diferença nas amostras de sulco/bolsa periodontal. / Microorganisms of the oral cavity are known to cause systemic diseases, spread through sanguine current. Different factors, including the presence of periodontal disease, influencing the risk of oral bacteremia could cause infectious endocarditis for Streptococcus viridans. Nevertheless, the maintenance of the oral health is extremely important in pregnant women with rheumatic valvar disease, in which the risk of infectious endocarditis is eminent. The aim of this study was to investigate the clinical periodontal condition of pregnant women with valvar disease and to identify the presence of Porphyromonas gingivalis in saliva and subgingival samples. For these purposes, we studied 52 pregnant with valvar disease (GC) and 70 healthy pregnant women (GNC). The following periodontal parameters were evaluated: probing depth (PCS), clinical attachment level (NCI), gingival margin location (LEC/MG), bleeding on probing (IS) and plaque index (IP). The following mean periodontal parameters were obtained: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). There was no statistical difference for NCI among the groups. There was no difference between periodontal clinical conditions in pregnant women with valvar disease and healthy pregnant women. The presence of the Porphyromonas gingivalis in saliva samples of healthy pregnant women is statistically higher than in pregnant woman with valvar disease; however, there was no difference in periodontal samples

La maladie rénale peut se manifester avec différents types de pathologies buccales pouvant augmenter les risques de bactériémie. Bien que l’endocardite infectieuse soit une condition rare chez les patients atteints de maladie rénale, elle peut toutefois être retrouvée suite à des infections nosocomiales. Dans le passé, une antibiothérapie prophylactique était prescrite aux patients hémodialysés pour les protéger de l’endocardite infectieuse et de l’infection de l’accès d’hémodialyse. Aujourd’hui, cette recommandation est révolue. Afin de contrer les risques de bactériémie transitoire, une attention particulière doit être apportée aux soins d’hygiène orale à la maison. Le but de l’étude est d’évaluer l’efficacité de deux méthodes d’enseignement d’hygiène orale chez les patients atteints de maladie rénale. Objectifs de recherche Les trois objectifs de recherche sont a) d’évaluer les connaissances des parents de patients atteints de maladies rénales sur l’endocardite infectieuse et le lien avec la santé buccodentaire; b) d’évaluer la perception des parents par rapport à la santé buccodentaire de leur enfant et leurs habitudes d’hygiène orale; et c) de comparer l’influence de deux méthodes d’hygiène orale sur l’indice de plaque chez les enfants atteints de maladies rénales. Hypothèses Les deux hypothèses de recherche sont que a) les parents d’enfants atteints de maladies rénales connaissent et adhèrent aux recommandations émises par l’American Heart Association; et que b) l’amélioration de l’indice de plaque chez les patients atteints de maladies rénales est plus grande pour le groupe recevant des instructions par le matériel audiovisuel par rapport à ceux qui les reçoivent par le néphrologue. Méthodologie Suite à l’obtention d’un certificat d’éthique à la recherche du Centre Hospitalier Universitaire Sainte-Justine, 37 des 38 sujets recrutés âgés entre 6 et 16 ans (19 filles et 18 garçons) ont participé à cette étude transversale. Suite à la signature d’un consentement éclairé, les sujets sont assignés par randomisation à l’un des deux groupes d’instructions d’hygiène orale, soit celui sans instructions spécifiques (groupe 1) ou par matériel audiovisuel (groupe 2). Un questionnaire portant sur les connaissances des parents en rapport avec la santé buccodentaire est remis aux parents. Un indice de plaque initial est noté avant l’application des instructions d’hygiène orale reçues. Un indice de plaque final mis en évidence à l’aide de pastilles révélatrices est documenté avec des photographies intra-orales et mesuré par deux observateurs, testés pour la fiabilité intra et inter-observateurs. Résultats Les analyses statistiques ne démontrent aucune différence significative entre les deux groupes d’instructions d’hygiène orale. Les variables à l’étude (âge, sexe, suivi dentaire, fréquence des soins à la maison, connaissances et motivation) ne montrent aucune influence significative sur la qualité de l’hygiène orale des sujets. Seul l’indice de plaque initial est inversement relié à la perception des parents face à la santé buccodentaire de leur enfant : plus le relevé de plaque est bas, plus la santé buccodentaire est perçue comme bonne. Conclusion Selon les résultats de notre étude, il n’existe pas de différence statistiquement significative entre les deux méthodes d’instructions d’hygiène orale. Néanmoins, les deux techniques permettent de diminuer significativement l’indice de plaque chez les enfants atteints de maladies rénales et de conscientiser cette population à l’importance du maintien d’une bonne santé buccodentaire. / Renal diseases are known to cause oral changes that can increase the risk of developping a bacteraemia. Even if infective endocarditis is a rare condition in patients with renal disease, it is associated with nosocomial infections. In the past, antimicrobial therapy was recommended for haemodialysis patients to prevent infective endocarditis and indwelling venous catheter-related infections. The administration of prophylactic antibiotics is no longer supported, given the lack of evidence concerning this approach. To prevent patients from developing a transitory bacteraemia, home oral care has to be improved. The goal of this study is to assess the efficacy of two oral health instruction methods in children with renal disease. Objectives The objectives of this study are to assess the knowledge on infective endocarditis and its link to the oral health of parents with children who present with renal disease; to evaluate the perception of parents in relation with their child’s oral health and their dental behaviour and finally to compare the impact of the oral health instruction methods on the plaque index of children with renal disease. Hypothesis The two hypotheses of this study are a) parents of children suffering from renal diseases know and respect the guidelines published by the American Heart Association and b) that the improvement of the plaque index is better in the group who receives oral health instructions from the audio-visual material compared to the one receiving instructions from the nephrologist. Methods An ethic’s certification was obtained from the Centre Hospitalier Universitaire Sainte-Justine for children. Of the 38 recruited patients, 37 patients (19 girls, 18 boys) ranging in age from 6 to 16 years participated in this transversal study. Consent was obtained prior to randomised assignment to either oral hygiene delivered by means of an audio-visual aid (groupe 1) or by a nephrologist (group 2). A questionnaire investigating parental knowledge on renal disease linked with oral health was administered. An initial plaque index was taken before applying oral health instructions. A final plaque index using disclosing tablets was measured by two observers tested for intra and inter-reliability through intra-oral pictures. Results The statistical analyses do not show any significant differences between the two oral health instruction groups. No significant relation was found between oral health status and age, gender, dental follow up, frequency of home dental hygiene and motivation. The only significant relationship found was as parents perception of their child’s oral health increases, the initial plaque index decreases. Conclusion The results indicate that even if there is no statistically significant difference between the two methods of oral health instruction, both techniques are capable of reducing the plaque index of children suffering from renal disease.

L'endocardite infectieuse (EI) est une complication rare mais gravissime de la bactériémie à Staphylococcus aureus. Bien que certains facteurs de risque liés à l'hôte aient été décrits, l'implication de facteurs bactériens dans la survenue de l'EI est encore inconnue. Ces travaux de thèse ont visé à chercher tout élément bactérien associé à l'EI. Les facteurs phénotypiques décrits ou supposés comme potentiellement impliqués dans l'EI ont été testés. En parallèle, les profils génotypiques des souches obtenus par puces ADN ont été analysés par différents outils statistiques. L'analyse statistique univariée n'a montré aucune différence significative entre souches d'EI et souches de bactériémie, suggérant un processus complexe et multifactoriel. En effet, l'analyse discriminante en composante principale appliquée sur les données de puces ADN a permis de mettre en évidence une distinction entre les deux groupes de souches, confirmée sur une collection indépendante de souches. De plus, une fonction linéaire simplifiée, basée sur seulement 8 marqueurs génétiques, a permis d'obtenir des performances similaires, sur la collection de souches initiale ainsi que la collection indépendante de validation. En dernier lieu, les souches d'EI et de bactériémie ont été comparées à partir de séquences du génome complet (n = 40 (20 EI, 20 bactériémies)). L'analyse statistique par analyse discriminante en composante principale réalisée sur ces données génomiques confirme une distinction possible entre les deux groupes de souches. Au total, ces travaux de thèse apportent la preuve de concept que les facteurs bactériens sont impliqués dans la survenue de l'EI au cours de bactériémie à S. aureus / Infective endocarditis (IE) is a severe condition complicating 10-25% of Staphylococcus aureus bacteremia. Although host-related IE risk factors have been identified, the involvement of bacterial features in IE complication is still unclear. This PhD work aimed to characterize strictly defined IE and bacteremia isolates and searched for discriminant features. Phenotypic traits previously reported or hypothesized to be involved in staphylococcal IE pathogenesis were tested. In parallel, the genotypic profiles of all isolates, obtained by microarray, were analyzed. No significant difference was observed between IE and bacteremia strains, regarding either phenotypic or genotypic univariate analyses, suggesting a multifactorial process. However, the discriminant analysis of principal components (DAPC), applied on microarray data, segregated IE and bacteremia isolates. The performance of this model was confirmed with an independent collection of IE and bacteremia isolates. Finally, a simple linear discriminant function based on a subset of 8 genetic markers retained valuable performance both in study collection and in the independent validation collection. At last, IE and bacteremia isolates were compared based on whole genome sequence data from a subset of 40 isolates. When applied to this dataset, DAPC confirmed a possible segregation between the two groups of isolates. All in all, this PhD work provides the proof of concept that bacterial characteristics may contribute to the occurrence of IE in patients with S. aureus bacteremia

Microorganismos da cavidade oral têm sido admitidos como causadores de doenças sistêmicas com reconhecido mecanismo de disseminação via corrente sangüínea. Diferentes fatores, incluindo a presença da doença periodontal, têm influência no risco de bacteremia oral, podendo ocasionar endocardite infecciosa por Streptococcus viridans. Sendo assim, a manutenção da saúde bucal adquire elevado grau de importância em gestantes portadoras de doença valvar reumática, em que o risco de endocardite infecciosa é eminente. A escassez científica fez deste tema o objetivo deste estudo: investigar a condição clínica periodontal de gestantes portadoras de cardiopatia valvar, identificando agentes periodontopatógenos nas amostras coletadas de saliva, sulco/bolsa periodontal, Para tanto, foram estudadas 52 gestantes cardiopatas (GC) e 70 gestantes não-cardiopatas (GNC). A condição periodontal foi avaliada empregando-se profundidade clínica de sondagem (PCS), nível clínico de inserção (NCI), linha esmalte cemento/margem gengival (LEC/MG), índice de sangramento (IS) e índice de placa bacteriana (IP). As seguintes médias foram obtidas para os parâmetros periodontais avaliados: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). Não houve diferença entre os grupos para o NCI (p= 0,612). A presença da Porphyromonas gingivalis na saliva foi maior (p= 0,007) no GNC, porém não houve diferença nas amostras de sulco/bolsa periodontal. / Microorganisms of the oral cavity are known to cause systemic diseases, spread through sanguine current. Different factors, including the presence of periodontal disease, influencing the risk of oral bacteremia could cause infectious endocarditis for Streptococcus viridans. Nevertheless, the maintenance of the oral health is extremely important in pregnant women with rheumatic valvar disease, in which the risk of infectious endocarditis is eminent. The aim of this study was to investigate the clinical periodontal condition of pregnant women with valvar disease and to identify the presence of Porphyromonas gingivalis in saliva and subgingival samples. For these purposes, we studied 52 pregnant with valvar disease (GC) and 70 healthy pregnant women (GNC). The following periodontal parameters were evaluated: probing depth (PCS), clinical attachment level (NCI), gingival margin location (LEC/MG), bleeding on probing (IS) and plaque index (IP). The following mean periodontal parameters were obtained: PCS: 1.52 (GC) e 1.45 (GNC); NCI: 1.13 (GC) e 1.02 (GNC); LEC/MG: 0.41 (GC) e 0.40 (GNC); IS: 7.34 (GC) e 6.27 (GNC) e IP: 12.19 (GC) e 13.48 (GNC). There was no statistical difference for NCI among the groups. There was no difference between periodontal clinical conditions in pregnant women with valvar disease and healthy pregnant women. The presence of the Porphyromonas gingivalis in saliva samples of healthy pregnant women is statistically higher than in pregnant woman with valvar disease; however, there was no difference in periodontal samples

A Febre Reumática, complicação tardia de uma infecção de orofaringe causada pelo Streptococcus pyogenes (estreptococo -hemolítico do grupo A de Lancefield), tem como conseqüência a Cardiopatia Reumática, explicada pelo mimetismo molecular entre proteínas cardíacas humanas e a associação de proteínas e carboidratos da membrana do S. pyogenes. A profilaxia secundária com a PGB 1.200.000 UI IM propõe-se a evitar novos surtos, sendo administrada em intervalos de vinte e um dias nos países com alto índice de estreptococcia. A lesão valvar predispõe à Endocardite Infecciosa, que resulta de bacteriemias causadas por focos infecciosos de origem bucal em cerca de 40% dos casos. Os Streptococcus Viridans constituem o grupo mais comumente encontrado nas Endocardites Infecciosas, em especial os Streptococcus sanguinis e Streptococcus oralis. O efeito do uso crônico da PGB não foi estudado com especificidade para essa microbiota. Assim, foi avaliada, qualitativa e quantitativamente, a microbiota bucal de 100 pacientes, aos 7 e 21 dias, após profilaxia secundária para a Febre Reumática com a PGB 1.200.000 UI IM e comparada com a de 100 pacientes portadores de doença arterial coronariana sem antecedentes de Febre Reumática. As espécies avaliadas foram divididas em S. sanguinis, S. oralis e outras espécies de Streptococcus Viridans Foram coletadas amostras de saliva pela mastigação de goma de parafina e transportadas em meio VMGA II S. As culturas foram semeadas em ágar Columbia CNA com 5% de sangue desfibrinado puro de carneiro com acréscimo de penicilina G. e incubadas a 35ºC em estufa de CO2 por 72 horas. As colônias sugestivas de Streptococcus foram submetidas a testes bioquímicos para confirmação de gênero e espécie. A concentração inibitória mínima foi determinada pelo método Etest e interpretada segundo os padrões do Clinical and Laboratory Standards Institute. Não houve diferença quanto à presença do S. sanguinis nos grupos estudados (P=0,40). O S. oralis prevaleceu aos 7 dias de PGB em relação ao grupo controle (P=0,01). Quanto à identificação de outras espécies, houve maior número de cepas nos pacientes do grupo controle quando comparados aos do grupo de estudo aos 7 e 21 dias de PGB (P<0,001). Os números de UFC/ml de S. sanguinis, S. oralis e de outras espécies foram comparados entre os grupos e não houve diferença entre eles (P=0,96; P=0,60 e P=0,77; respectivamente). Quanto às CIM do S. sanguinis e do S. oralis, não houve diferença entre os grupos (P=0,79 e P=0,13; respectivamente). Todos os testes estatísticos foram realizados em um nível de significância de 5%. Concluiu-se que o S. oralis prevaleceu aos 7 dias de PGB 1.200.000 UI IM; os Streptococcus Viridans de outras espécies prevaleceram no grupo controle; o número de UFC/mL de saliva não diferiu nos grupos estudados, a susceptibilidade dos S. sanguinis e S. oralis à penicilina G não foi alterada pela ação da PGB 1.200.000 UI IM a cada 21 dias e, por fim, a PGB não provocou reações de hipersensibilidade em nenhum paciente do estudo / Rheumatic fever is the result of a Streptococcus pyogenes (group A -hemolytic Streptococcus) infection of the upper respiratory tract. Rheumatic heart disease is a rheumatic fever consequence and is elucidated by the molecular mimicry between human cardiac proteins and group A streptococcal proteins and carbohydrates association. The secondary prophylaxis with 1,200,000 U BPG every three weeks is used for prevention of recurrent rheumatic fever in developing countries. Valvar defects are a risk for infective endocarditis which is resulted of bacteriemia caused for oral infectious focuses in 40% of cases. Viridans streptococci are the predominant group recovered in infective endocarditis, specially Streptococcus sanguinis and Streptococcus oralis. The effect of chronic BPG wasnt studied with specificity to these pathogens yet. Therefore, the oral microbiota was evaluated, qualitatively and quantitatively, at 7 and 21 days after secondary prophylaxis with BPG to rheumatic fever (study group), in a hundred patients and in comparison to another hundred patients with coronary heart disease who never acquired rheumatic fever (control group). The species evaluated were divided in S. sanguinis, S. oralis and another Streptococcus species. It was collected samples of chewing-stimulated saliva (1ml) and transported in VMGA II S medium. The samples were cultured in pure and with penicillin G 5% sheep blood Columbia ágar (CNA), incubated for 72 hours in an atmosphere containing 5% CO2 at 35ºC. The strains that were suggestive to Streptococcus were identified by biochemical tests to confirm bacteria species and genus. Minimal inhibitory concentration was determined by Etest method and interpreted in accordance to Clinical and Laboratory Standards Institute. The results showed that there was no difference in S. sanguinis presence in all groups (P=0.40). S. oralis prevailed in 7 days BPG group in comparison to control group (P=0.01). The control group showed the highest number of others species in comparison to 7 and 21 days BPG (P<0.001). CFU/ml numbers of S. sanguinis, S. oralis and other species strains were compared in 7 and 21 days BPG to control group and there was no difference among themselves (P=0.96, P=0.60 and P=0.77; respectively). There was no difference in S. sanguinis and S. oralis MICs among the study and control groups (P=0.79 and P=0.13). All statistic tests were done at 5% significance level. It was concluded that S. oralis prevailed in 7 days BPG group in comparison to control group; other species of Viridans streptococci prevailed in control group. The number of CFU/mL did not differ in both studied groups; the penicillin susceptibility of S. sanguinis and S. oralis did not change by BPG every three weeks and, by the end, it was not observed hypersensitivity reactions to penicillin in neither of the patients of this study

O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

O objetivo desse estudo foi avaliar os efeitos da administração prévia de antibiótico na incidência de complicações infecciosas em procedimentos de estimulação cardíaca artificial. Os pacientes foram selecionados em um estudo duplo-cego e randomizado (1:1). Grupo I Cefazolina (1,0g dose única) versus grupo II placebo. O comitê de segurança interrompeu o estudo após a inclusão de 649 pacientes devido à diferença entre os grupos (group I 314; grupo II 335 pacientes) em favor do uso de antibiótico: 2 infectados (0,63%) versus 11 infectados no grupo placebo (3,28%); p=0,016. Marcadores identificados por análise univariada: não uso de antibiótico; procedimentos de implantes (versus trocas); hematoma pós-operatório e duração do procedimento. O não uso de antibiótico e hematoma pós-operatório foram significantes em análise multivariada / The objective of this study was to evaluate the effects of the previous venous antibiotic administration in the incidence of infectious complications in cardiac stimulation surgical procedures. Patients were selected in a double blind, randomized (1:1) trial. Group I Cefazolin (1,0g one dose) versus group II placebo. The security committee interrupted the trial after inclusion of 649 patients due to differences between groups (group I 314; group II 335 patients) in favor of the antibiotic arm: 2 infected patients (0,63%) versus 11 infected patients in the placebo arm (3,28%); p=0,016. Markers identified by univariate analysis: non-use of preventive antibiotic; implant procedures (versus replacement); post-operative haematoma and procedure duration. The non-use of antibiotic and the post-operative haematoma were independent predictors of infection in multivariate analysis

Made available in DSpace on 2014-07-22T13:16:48Z (GMT). No. of bitstreams: 2 Regina Elizabeth Müller.pdf: 4161979 bytes, checksum: 5df884fdb04b617145c35c1741e9b502 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira. Rio de Janeiro, RJ, Brasil. / Introdução: A cardiopatia reumática persiste como a principal doença cardiovascular adquirida em crianças e adultos jovens em todo o mundo, sendo responsável por altas taxas de morbimortalidade e evoluindo com frequência para a necessidade de cirurgia cardíaca valvar em pacientes na fase aguda ou crônica da doença. Objetivo: Estimar os fatores associados e o tempo desde o diagnóstico até a cirurgia cardíaca valvar em crianças e adolescentes portadores de cardiopatia reumática, em um centro cardiológico de referência terciária no Rio de Janeiro. Material e Métodos: estudo observacional longitudinal de base hospitalar, utilizando metodologia de análise de sobrevivência, para estimativa do tempo até a cirurgia, e modelo de regressão de Cox, para avaliar as razões de risco associadas segundo as covariáveis. A coorte foi composta por pacientes com 3 a 20 anos, cadastrados no Instituto Nacional de Cardiologia no Rio de Janeiro entre julho de 1986 e junho de 2006 e acompanhados até setembro de 2011. O diagnóstico da lesão valvar foi confirmado pelo exame Doppler-ecocardiográfico. As covariáveis, avaliadas no início do acompanhamento, foram reunidas em três dimensões: sociodemográfica (sexo, grupo etário, cor da pele, região de moradia e década do diagnóstico); clínica (apresentação clínica, classe funcional, número de surtos anteriores, profilaxia secundária, endocardite infecciosa e fibrilação atrial); e ecocardiográfica (lesão valvar por tipo e gravidade; diâmetro do átrio esquerdo, diâmetro sistólico do ventrículo esquerdo, função ventricular esquerda, hipertensão arterial pulmonar, e ruptura de cordoalha mitral). O banco de dados foi elaborado com o programa ACCESS 2000 e a análise estatística foi realizada pelo programa R versão 2.13.1. Foi considerado significativo o valor de - 0,05. Resultados: a coorte foi composta por 348 pacientes, 58% do sexo feminino, com idade mediana ao cadastro de 12,5 anos, e de 21,5 anos ao final do acompanhamento. O tempo médio de seguimento foi de 9,0 anos (2-21 anos). O evento cirurgia cardíaca ocorreu em 39% da amostra, com tempo mediano até a cirurgia de 22,3 anos. Na análise univariada todas as covariáveis das três dimensões (socioedemográfica, clínica e ecocardiográfica) apresentaram significância estatística e risco para realização de cirurgia cardíaca (hazard ratio>1), com exceção apenas da covariável região de moradia (p>0,5). Na análise multivariada, o modelo final incluiu as variáveis: década do diagnóstico, classe funcional, número de surtos anteriores, endocardite infecciosa, lesão valvar por tipo e gravidade, diâmetro do átrio esquerdo, diâmetro sistólico do ventrículo esquerdo e ruptura de cordoalha mitral. Conclusões: A realização da cirurgia cardíaca em pacientes com cardiopatia reumática está associada a fatores sociodemográficos, clínicos e ecocardiográficos. / Introduction: Rheumatic heart disease remains as the most common acquired heart disease in children and young adults all over the world, being responsible for high mortality and morbidity rates and often demanding valve surgery in the acute or chronic phase of the disease. Objective: To estimate the time from diagnosis until valve operation and the associated factors in children and young adults with rheumatic heart disease followed up in a tertiary center for cardiovascular care in Rio de Janeiro. Methods – It is a longitudinal observational study of a hospital based population, using survival analysis methodology for time estimation and Cox regression model for hazard risk evaluation of associated variables. Cohort was composed by 3 to 20 years old patients, registered in the National Institute of Cardiology (Instituto Nacional de Cardiologia), in Rio de Janeiro, between July 1986 and June 2006, and followed up until September 2011. Valve disease diagnosis was confirmed through Doppler echocardiography examination. Variables were evaluated at the patient´s first visit and separated in three dimensions: socio demographic (gender, age group, skin color, residence region, decade of diagnosis); clinic (disease status at presentation, functional class, number of previous rheumatic episodes, secondary prophylaxis, infectious endocarditis, atrial fibrillation); echocardiographic (valve lesion and severity, left atrium diameter, systolic left ventricle diameter, left ventricle function, pulmonary hypertension, rupture of mitral chordae). The database wasbased on the program ACCESS 2000 and statistical analysis was performed using the R Program version 2.13.1. For statistical analysis was considered as significant values for  value 0.05. Results – 348 patients were included in the cohort, 58% female. Median age at the register was 12.5 years, and 21.5 years at the end of follow up. Median follow-up time was 9.0 years (2 to 21 years). 39% underwent valve operation and the median time until surgery was 22.3 years. In the univariate analysis all the variables from the three dimensions (socio demographic, clinic and echocardiographic) presented statistical significance as hazard risk in predicting valve operation (hazard ratio>1), with only one exception, that was residence region (p>0.5). In the multivariate analysis the final model included the following variables: decade of diagnosis, functional class, number of anterior rheumatic episodes, infectious endocarditis, valve lesion and severity, left atrium diameter, systolic left ventricle diameter and rupture of mitral chordate. Conclusions: Valve surgery in patients with rheumatic heart disease is associated with socio demographic, clinic and echocardiographic factors.