Introduction Every tenth patient in Sweden is affected by nosocomial infections. Among these, urinary tract infection (UTI) is the most frequently occurring within the hospital environment. Nosocomial infections lead to increasing costs for care, more suffering among the patients, increasing use of antibiotics, and longer treatment spells. The Academic hospital have engaged all wards in the so called VRISS-project (“nosocomial infections must be stopped”) in order to reduce the number of nosocomial infections. Aim In connection to the VRISS-project new routines for removal of uretrahl catheters are introduced at ward 70E2 at the Academic hospital. The new routines imply that the catheter should be removed during the first post-op day. According to the old routines the catheter was to be removed no later than on the third post-op day. The authors of this study choose to investigate whether the new routines for uretrahl catheter removal have any effect on the occurrence of nosocomial UTI’s. Methods The study is a restrospective record study with quantitative, descriptive design. 411 journals from 2007 (188) and 2009 (223) have been reviewed. All patients that underwent knee or hip operations during January, February, March, and April 2007 and 2009 are included in the sample. Results The study shows that the new routines at ward 70E2 had some, but not full, influence on the share of patients with nosocomial UTI. Among women under 71 years of age and men older than 70 years, the number of days with uretrahl catheter and the share of patients with nosocomial UTI have decreased. However, among the younger men (<71 years) and the older women (>70 years) no effects of the new routines are detected. Conclusion To summarize it can be concluded that the routines for how to use uretrahl catheters at ward 70E2 work fairly well. However, the results also show that the number of days with uretrahl catheter and the share of patients with nosocomial UTI among risk patients, above all among the older women, are the same in spite of the new routines for removal of uretrahl catheters. Thus, strategies for detecting risk patients in an early stage can be improved upon. Such measures can reduce the risk for nosocomial UTI among these patients.

La utilización de los catéteres venosos centrales es esencial en las unidades de cuidados. Su uso, sin embargo, no está exento de riesgos, como la bacteriemia relacionada con catéter, con una morbimortalidad asociada significativa. Conociendo la importancia de la via endoluminal en la patogénesis de la bacteriemia por catéter, el objetivo de está tesis es observar la utilidad de un nuevo conector desinfectable que no requiere la utilización de agujas (Smartsite", Alaris Medicals Systems, San Diego, California 92121, USA).Descripción del conector desinfectableEl conector Smartsite" es un conector sin aguja que dispone de un émbolo silicona que permeabiliza la luz del conector al ser presionado. Este sistema puede ser fácilmente descontaminado mediante la fricción de una gasa impregnada en antiséptico antes de ser manipulado.Evaluación experimentalDiseñamos un nuevo modelo experimental que consistió en dos grupos de 25 botellas para hemocultivos aeróbicos (Bact Alert") en las que insertamos un catéter venoso periférico 18G (Venflon"). Estas botellas están provistas de un reactivo en el fondo que cambia de color al detectar el CO2 producido por el crecimiento de las bacterias. Para cerrar los catéteres utilizamos un conector desinfectable en el grupo estudio, mientras que en el grupo control se utilizó un tapón convencional. En cada grupo se mantuvieron 5 catéteres sin manipular durante toda la duración del estudio para validar la esterilidad del sistema. En el resto de catéteres, después del tercer día de inserción, la superficie del tapón o del conector desinfectable se contaminó diariamente con S aureus. Cinco horas después de la contaminación, se inyectó en cada catéter 1 centímetro cúbico de suero fisiológico estéril. Si se producia la positivización de las botellas, se procedía a la comparación del aislado con la cepa inicial.No hubo ninguna positivización en las cincuenta botellas durante los tres primeros días. Las botellas no manipuladas se mantuvieron estériles durante los 21 días que duró el estudio. El cincuenta por ciento de las botellas del grupo control se habían positivizado al quinto dia, respecto al onceavo dia en el grupo estudio. Al noveno dia de manipulación se habían positivizado el 100% de las botellas en el grupo control, mientras que en el grupo estudio el 40% de las botellas se mantenían estériles al finalizar el estudio después de 18 días de manipulación. Las curvas de supervivencia de ambos grupos mostraron una diferencia estadisticamente significativa (p<0.001).Evaluación clínicaSe realizó un ensayo clínico randomizado en una Unidad de Cuidados Intensivos polivalente de un Hospital Universitario de 420 camas. Los pacientes que necesitaron catéteres venosos centrales multilumen se distribuyeron aleatoriamente en dos grupos. Todos los catéteres fueron insertados y manipulados deacuerdo con las recomendaciones del año 1996 de los CDC. Los catéteres del grupo estudio fueron equipados con el conector desinfectable, mientras los catéteres del grupo control se equiparon con llaves de tres pasos. A la retirada de los catéteres se procedió al cultivo de la punta del catéter y a dos hemocultivos periféricos. Se incluyeron 278 catéteres (139 en cada grupo de intervención), con una duración media de 9,9 días. No hubo diferencias en cuanto a las características de los enfermos ni de los catéteres de ambos grupos. La densidad de incidencia de BRC fue de 0.7/1000 días de catéter en el grupo estudio respecto a 5.0/1000 días en el grupo control (p=0.03). ConclusionesEl sistema de conexión desinfectable Smartsite" ha mostrado una mayor resistencia al paso de microorganismos hacia la luz del catéter que el tapón convencional, en el modelo experimental descrito.Añadir un conector desinfectable a las recomendaciones de la CDC reduce significativamente la incidencia de bacteriemia relacionada con catéter en catéteres venosos centrales insertados en pacientes críticos. / The use of venous catheters is essential in critical care units. Their use is not risk free, especially from catheter-related infections, which have a significant associated morbidity and mortality. Knowing the relevance of the endoluminal route in the pathogenesis of sepsis from catheters, the aim of these studies is to observe the security of a new needle-free disinfectable connector (Smartsite", Alaris Medicals Systems, San Diego, California 92121, USA) in experimental and clinical conditions.Description of the disinfectable connector.The Smartsite" connector is a needle-free device with a silicone valve, which becomes permeable when compressed by a syringe or any luer-type connector. The peculiarity of this system comes from the possibility of disinfect easily the external surface of the device by swabbing it with a gauze with antiseptic before handling.Experimental evaluationAn experimental trial was designed in which a laboratory model simulated the insertion of a peripheral venous catheter. This model consisted in two groups of 25 bottles of aerobic hemoculture (Bact Alert") into which an 18G peripheral venous catheter (Venflon") was inserted and closed with disinfectable needle-free connectors (study group) or conventional caps (control group). Five catheters from each group were left untouched to evaluate the sterility of the system without handling. In the remaining catheters, after the third day of insertion, the external surfaces of the disinfectable connectors and the caps were daily contaminated with S. Aureus. Five hours after each contamination, one cubic centimeter of sterile saline was injected. A sensor in the bottom of the bottle changed its colour if it was contaminated, detecting the CO2 produced by the growth of the bacteria. Once positive, the liquid in the bottle was examined to identify the microorganism. There was no infection in the fifty bottles in the first three days and there was no contamination in the 10 untouched models of the two groups of the study. Fifty per cent of the bottles were colonized in the fifth day in the control group and in the eleventh day in the study group. All control group bottles were colonized by the ninth day while 40% of the study group bottles were still sterile at the end of the study, after 18 days of handling. The survival curves of both groups show a significant difference (p<0.001).Clinical evaluation.A randomized controlled trial was performed in a polyvalent Intensive Care Unit to assess the efficacy of the disinfectable needle-free connector in the prophylaxis of catheter-related bloodstream infection. Patients who needed multilumen central venous catheters were assigned at random to study or control group. All catheters were inserted and manipulated according with the CDC'96 recommendations. Catheters of patients of the study group were equipped with disinfectable needle-free connectors whereas catheters of patients of control group catheters were equipped with three-way stopcocks.Two hundred forty three patients were included, with a total of 278 central venous catheters (139 in each study group). The mean insertion length of catheters was 9.9 days. Both groups were statistically comparable regarding patients and catheters characteristics. Incidence rate of catheter-related bloodstream was 0.7/1000 days of catheter use in the study group, in comparison with 5.0/1000 days of catheter use in the control group (p = 0.03). The multivariate logistic regression analysis identified age, obesity, number of days in ICU and the use of three-way stopcock as independent risk factors for catheter-related bloodstream. Conclusion. The needle-free disinfectable Smartsite connector has shown more resistance to the pass of microorganisms to catheter lumen than conventional caps in the extreme conditions of the described experimental model.To add a disinfectable needle-free connector to the CDC recommendations reduces significantly the incidence of catheter-related bloodstream in central venous catheters inserted in critically ill patients.

Background: With the increasing survival rate of early preterm infants and the extensive use of invasive health care procedures, the nosocomial infection rate is on the rise in the past decade in the neonatal intensive care unit (NICU). The patients in NICU are a unique and highly vulnerable population, including preterm infants and infants requiring surgery. Nosocomial infection (NI) is associated with the majority of infectious complications of infants, resulting in morbidity and mortality. Close surveillance, accurate measurement, and promotion of full awareness of the risk factors of infection are essential to nosocomial infection control. Previous research had pointed out some factors related to the NI in other countries, and further research is still much needed to reveal the incidence of NI and further analyze the risk factors in China. Objectives: The objectives of this study were to assess incidence and epidemiologic profile of nosocomial infection in NICU of China, and to identify the main risk factors of nosocomial infections. Methods: This was a retrospective cohort with a nested case control study. All data were collected from the database of the medical records of all the patients who were admitted to the Guangzhou Women and Children’s Medical Center (N=1653) during December 2009 to May 2012.Infection rate, infection density and central line-associated bloodstream infection rate were estimated. Stepwise regression model yielded adjusted odds ratio (OR) of potential risk factors for NI. Results: The infection rate in NICU during the study period was 6.2 episodes per 100 patients (6.0-6.4 episodes per 100 patients). Infection density was 4.2 episodes per 1000 patient-days each year (95%CI=3.4-5.0 episodes per 1000 patient-days). The infection rate of ventilation-related pneumonia was 3.4 episodes per 1000 Mechanical Ventilation (MV) days. (95%CI= 3.2-3.5 episodes per MV patient-days).Central line-associated bloodstream infection rate was 5.4 episodes per 1000 central line days (95%CI= 5.1-5.6episodes per central line days). Overall, infants with gestational age >32weeks, longer duration of receipt of parenteral nutrition and longer duration of receipt of probiotics were significantly less likely to have NI (adjusted ORs= 0.35, 0.94 and 0.88, respectively). Congenital malformation, multiple birth, receipt of vein or arterial catheter, receipt of surgical operation and gastric tube feeding were significantly more likely to have NI(adjusted ORs=4.43,3.24 and 3.88, respectively). And longer duration of using prophylactic antibiotic was significantly more likely to have NI (adjusted OR=1.13). Conclusion: Our study provided information to the prevention strategies of nosocomial infections and improvement of health care service.We described the nosocomial infection rate, infection density and device-related infection rate, seasonal distribution, the type of infection and the pathogens identified to reveal the profile of nosocomial infection of NICU in Guangzhou, China.Andwe identified the association between intrinsic factors of infants and health care procedures with NI. Multicenter prospective study can be conducted in the future to investigate the specific risk factors on different birth weight or gestational age in China. / published_or_final_version / Public Health / Master / Master of Public Health

Following an outbreak of multi-resistant Haemophilus influenzae type b (Hib)infections in a tuberculosis hospital, this study was undertaken to determine carriage of Hib in 2 paediatric wards; to characterise all isolates of Hib, determine their antimicrobial susceptibility profile and the antibody response of the children to a conjugate vaccine. Prior to and one month after immunisation, oro- and nasopharyngeal swab specimens as well as venous blood were collected from each child. Isolates were tested for /3-lactamase and chloramphenicol acetyltransferase (CAT)production, their MIC's determined by the agar dilution method and characterisation of Hib isolates was performed by biotyping and analysis of outer membrane protein (OMP) profiles. An ELISA was also developed to determine serum antibody levels to polyribosyl-ribitol-phosphate (PRP), the capsular polysaccharide of Hib. The study population comprised a total of 135 children who had been hospitalised for treatment for tuberculosis. The patients were aged 4 months to 14 years with a median of 37,5 months. During the study period, none of the children developed invasive Hib disease. The overall carriage rate of Hib increased from 38% (51/135) before immunisation to 62% (84/135) after immunisation (P 0,15 /ig/ml. After immunisation, 34%(45) of patients increased their antibody levels to > 1,0 /xg/ml. There was no statistical difference between the mean antibody concentrations of patients who were colonised by Hib and those who were not (p = 0,58). The vaccine did not reduce carriage of Hib in this study population of children being treated for tuberculosis and the immune response to the vaccine was not optimal. Production of /3-lactamase and the prevalence of rifampicin resistance has implications for treatment and chemoprophylaxis in this population. OMP analysis showed a diversity of types. Multi-resistant strains causing invasive disease had the same OMP type as some multiresistant strains which colonised the children. / Thesis (M.Med.Sc.)-University of Natal, Durban, 1996.

Thesis (M.A.)--Northern Kentucky University, 2007. / Made available through ProQuest. Publication number: AAT 1445357. ProQuest document ID: 1372026871. Includes bibliographical references (p. 27-28)

Thesis (Ph. D.)--University of Technology, Sydney, 2004. / Bibliographic references: leaves 174-199.

Thesis (Ph.D.)--University of Western Australia, 2003.

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, 2008. / Submitted by Ângela Christina (angelchris@bce.unb.br) on 2009-05-05T20:46:16Z No. of bitstreams: 1 2008_GustavoBalduinoLeite_reduzida.pdf: 1263249 bytes, checksum: c55f741f929e8ef09635062edaafb6dc (MD5) / Approved for entry into archive by Guimaraes Jacqueline(jacqueline.guimaraes@bce.unb.br) on 2009-05-06T15:48:42Z (GMT) No. of bitstreams: 1 2008_GustavoBalduinoLeite_reduzida.pdf: 1263249 bytes, checksum: c55f741f929e8ef09635062edaafb6dc (MD5) / Made available in DSpace on 2009-05-06T15:48:42Z (GMT). No. of bitstreams: 1 2008_GustavoBalduinoLeite_reduzida.pdf: 1263249 bytes, checksum: c55f741f929e8ef09635062edaafb6dc (MD5) Previous issue date: 2008-10 / Staphylococcus aureus é um patógeno associado a altas taxas de mortalidade e morbidade, capaz de produzir infecções em diversos tecidos do corpo humano. Sua capacidade em adquirir resistência à antibióticos e de sobreviver em diferentes condições ambientais o torna um perigoso agente infeccioso no ambiente hospitalar. O objetivo deste estudo foi realizar um levantamento da ocorrência de indivíduos portadores assintomáticos de S. aureus suscetíveis (MSSA) ou resistente a meticilina (MRSA) no âmbito do Hospital Universitário de Brasília (HUB) e na comunidade e, o desenvolvimento de procedimentos moleculares para identificação de MSSA e de MRSA. No total foram coletadas 327 amostras nasais e sub-ungueais de profissionais e alunos vinculados ao HUB. Essas amostras foram divididas em três grupos: Alunos (medicina, enfermagem e odontologia), Equipe Médica (enfermeiros, auxiliares e técnicos de enfermagem e médicos) e Técnicos (funcionários que não possuem contato com pacientes). Também foram coletadas 48 amostras de pacientes previamente identificadas como MRSA pelo HUB e 136 amostras de indivíduos sem contato com o ambiente hospitalar (comunidade). Todas as amostras foram submetidas a crescimento em meios de cultura seletivos e diferenciais e testadas quanto a produção de coagulase para a identificação de S. aureus. Os isolados foram então submetidos ao teste de susceptibilidade à oxacilina e vancomicina. Os isolados de comunidade e de pacientes foram submetidos a ensaios de PCR para confirmação dos resultados bioquímicos através de iniciadores específicos para os genes que codificam proteína A, coagulase e nuclease termoestável, específicos de S. aureus, e mecA, presente em MRSA. A porcentagem de portadores de S. aureus encontrada na comunidade foi de 17,64%, e nos grupos relacionados ao ambiente hospitalar de 56,02%, sendo que: Alunos 69,64%; Equipe Médica 47,54% e Técnicos 51,02%. A diferença de portadores de cada grupo e o grupo comunidade foi significativa (P 0,001), o que indica que indivíduos sem contato com o ambiente hospitalar possui menos tendência de estar colonizado por S. aureus. Em relação a MRSA, a porcentagem de portadores na comunidade foi de 1,47%, e entre os indivíduos relacionados ao ambiente hospitalar 37,95%. Nos alunos a freqüência foi de 53,57%, equipe médica 22,95% e técnicos 38,77%. Dentro do grupo técnicos destaca-se os funcionários da lavanderia, onde 52,2% foram caracterizados como portadores de MRSA. A diferença dos grupos associados ao hospital e o grupo comunidade foi significativa (P 0,001). Apenas dois isolados de pacientes não confirmaram a caracterização prévia, sendo considerados Staphylococcus coagulase negativo resistente à oxacilina. Todos os isolados de comunidade e pacientes identificadas como Staphylococcus aureus e como MRSA nos testes bioquímicos também foram positivos nos ensaios de PCR. Os três isolados de pacientes caracterizadas como Staphylococcus coagulase negativo resistente à oxacilina foram positivos apenas na amplificação do gene mecA, confirmando os resultados nos testes bioquímicos. Nenhuma amostra apresentou resistência à vancomicina. Nossos resultados sugerem uma alta freqüência de portadores de MRSA no ambiente hospitalar, contrariamente ao observado na comunidade. O número de portadores de MRSA entre alunos e funcionários da lavanderia levanta a questão do possível papel que estes indivíduos podem estar desempenhando na disseminação dessas cepas resistentes pelo hospital, no entanto essa pergunta só poderá ser respondida através de estudos específicos. Os ensaios moleculares demonstraram o potencial dessa metodologia no diagnóstico rápido de infecções por MRSA, o que possibilita não só um tratamento mais eficiente como uma redução na disseminação dessas cepas. / _________________________________________________________________ ABSTRACT / Staphylococcus aureus is a pathogen associated with high rates of mortality and morbidity, capable of producing infections in various tissues of the human body. His ability to acquire resistance to antibiotics makes it a dangerous infectious agent in the hospital environment. The purpose of this work was to survey the incidence of asymptomatic carriers of S. aureus resistant (MRSA) and susceptive (MSSA) to methicillin in the University Hospital of Brasília (HUB), and the development of procedures for molecular identification of MSSA and MSRA strains. In total 327 samples were collected nasal and sub-nail of individuals related to the HUB. These samples were divided into three groups: students (medicine, nursing and dentistry), medical staff (nurses, nursing assistants and doctors) and the Technical Group (employees who do not have contact with patients). Were also collected 48 samples from patients previously identified as MRSA by HUB and 136 samples from individuals without contact with the hospital environment (community). All samples were inoculated into the culture medium and Baird Parker, and colonies with phenotypic characteristics of S. aureus were tested for fermentation of mannitol and coagulation of rabbit’s plasma to confirm the identification. Samples confirmed as S. aureus were then subjected to the test of susceptibility to oxacillin and vancomycin. Samples from community and patients were also subjected to PCR confirmation of the biochemical results through DNA fragment amplification using specific primers for genes that encodes protein A, coagulase and the thermal-stable nuclease, all specific to S. aureus, and mecA, which is present in MRSA. The rate of S. aureus carriers found in the community was 17.64%, and the total of groups related to the hospital was 56.02%, of which: Students 69.64%; Technicians 51.02% and Medical Staff 47.54%. The difference in carriers of each group and in the community group was significant (P 0001), which indicates that individuals without contact with the hospital have fewer chances to be colonized by S. aureus. For MRSA, the rate of carriers in the community was 1.47%, and among individuals related to the hospital was 37.95%, while in the Students group the rate was 53.57%, in the Medical Staff group was 22.95% and in the Technicians group was 38.77%. Inside the Technicians group, 52,2% of the workers in hospital’s laundry were colonized with MRSA. The difference between the groups associated with the hospital and the community group was significant (P 0001). Only two samples of patients did not confirm the prior characterization made by HUB and was considered Staphylococcus coagulase negative oxacillin resistant. All samples of community and patients identified as Staphylococcus aureus and MRSA in biochemical tests were also positive in the PCR test. The three samples of patients characterized as Staphylococcus coagulase negative oxacillin resistant was positive only for the amplification of the mecA gene, confirming the results in biochemical tests. No sample proved resistant to vancomycin. Our results suggest a high rate of MRSA carriers among hospital workers and students. The number of MRSA carriers among students and worker of the laundry raise the question about the rule of these individuals over the dissemination of MRSA through the hospital wards. Further studies focused on that matter would be necessary to answer this question. The molecular experiments showed the potential of this methodology on a fast diagnosis of MRSA infections, what would not just help the treatment, but should avoid the disseminations of those clones.

Submitted by Isaac Francisco de Souza Dias (isaac.souzadias@ufpe.br) on 2016-07-19T18:05:52Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE ANA MARIA PARAHYM PARA BIBLIOTECA.pdf: 1891461 bytes, checksum: 126d9a321e875b9bad2755b2b199b1cc (MD5) / Made available in DSpace on 2016-07-19T18:05:52Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) TESE ANA MARIA PARAHYM PARA BIBLIOTECA.pdf: 1891461 bytes, checksum: 126d9a321e875b9bad2755b2b199b1cc (MD5) Previous issue date: 2012-07-05 / CNPQ / Infecção fúngica nosocomial tem acarretado altos índices de mortalidade, sendo frequentes em pacientes de Unidades de Terapia Intensiva-UTI. No diagnóstico e tratamento, adequada conduta laboratorial através de exame direto e cultura torna-se indispensável. Ferramentas moleculares devem ser utilizadas como estratégia de identificação rápida e avaliação da similaridade genética entre os agentes etiológicos. Assim, o presente trabalho teve por finalidade diagnosticar Infecção fúngica nosocomial em pacientes de UTIs e detectar ocorrência destas infecções com mesma origem e perfil de sensibilidade antifúngica dos isolados. No período de março de 2008 a junho de 2011, foram coletadas 1.040 amostras clínicas, entre essas amostras de sangue, secreção traqueal, urina, vegetações cardíacas e líquido pleural, nas UTIs de quatro hospitais de Recife-PE, sendo isoladas 64 culturas incluindo Aspergillus flavus, Candida albicans, C. glabrata, C. guilliermondii, C. krusei, C. lusitaniae, C. parapsilosis, C. sake, C. tropicalis, Pseudozyma aphidis e Saprochaete capitata. A similaridade genética foi detectada através dos primers (GACA)4 e (GTG)5 em isolados de C. albicans, C. parapsilosis e C. tropicalis. A sensibilidade antifúngica de 38 isolados de Candida ao fluconazol mostrou resistência em 52,63%. Dos 13 isolados testados 76,9% foram resistentes ao voriconazol (4 de C. albicans e 6 de C. tropicalis). Resistência a anidulafungina não foi detectada em isolados de Candida, no entanto 8 isolados de C. parapsilosis e um de C. guilliermondii apresentaram concentrações inibitórias mínimas elevadas (2μg/mL). Os isolados de P. aphidis, S. capitata e A. flavus foram sensível ao voriconazol e dose-dependente ao fluconazol; sensível ao voriconazol, dosedependente ao fluconazol e resistente a anidulafungina; e sensível ao fluconazol, respectivamente. Todos os isolados testados foram sensíveis a anfotericina B. Ocorreu óbito em 39,7% dos pacientes. De acordo com nossos resultados concluímos que infecções fúngicas nosocomiais acometem pacientes de UTI, sendo C. albicans o agente etiológico mais frequente. / Nosocomial fungal infection has caused high mortality rates, being frequent in patients treated in the Intensive Care Unit-ICU. In the diagnosis and treatment, proper conduct to laboratory analyses and direct examination and culture becomes indispensable. Molecular biology should be used as a strategy for rapid identification of etiologic agents and evaluation of the genetic similarity between isolates. Thus, this study aimed to diagnose nosocomial fungal infection in ICUs patients and to detect the occurrence for these infections with the same origin and antifungal susceptibility profile of the isolates. From March 2008 to June 2011, 1.040 clinical samples were collected between these samples of blood, tracheal aspirates, urine, cardiac vegetations and pleural fluid, in the ICUs of four hospitals in Recife-PE, with a total of 64 cultures were isolated including Aspergillus flavus, Candida albicans, C. glabrata, C. guilliermondii, C. krusei, C. lusitaniae, C. parapsilosis, C. sake, C. tropicalis, Pseudozyma aphidis, and Saprochaete capitata. The genetic similarity was detected between isolates of C. albicans, C. parapsilosis and C. tropicalis using the primers (GACA)4 and (GTG)5. The antifungal susceptibility of 38 Candida isolates showed resistance to fluconazole at 52.63%. Of 13 isolates tested 76.9% were resistant to voriconazole (4 of C. albicans and 6 of C. tropicalis). Anidulafungin resistance was not detected in Candida isolates; however 8 isolates of C. parapsilosis and one of C. guilliermondii showed elevated minimum inhibitory concentrations (2μg/mL). The isolates of P. aphidis, S. capitata and A. flavus were sensible to voriconazole and dependent dose to fluconazole, sensible to voriconazole, dose dependent dose to fluconazole and resistant to anidulafungin, and sensible to fluconazole, respectively. All isolates tested were sensible to amphotericin B. Death occurred in 39.7% of patients with nosocomial fungal infection, indicating the importance of early and accurate diagnosis. According to our results we conclude that nosocomial fungal infections affect patients in the ICU, and C. albicans is the most frequent etiologic agent.

Justificativa â A pneumonia hospitalar (PH) à causa de morbidade e mortalidade elevadas em pacientes hospitalizados. A terapia antimicrobiana empÃrica adequada e precoce pode salvar a vida de mais da metade dos pacientes com PH e deve ser baseada em padrÃes locais de sensibilidade a antimicrobianos. Praticamente todo tratamento de PH Ã, inicialmente, empÃrico. O objetivo deste trabalho à contribuir com o conhecimento do padrÃo regional de resistÃncia de microrganismos nesse contexto. Metodologia â Foram estudados 588 resultados de culturas de lavado bronco-alveolar (LBA) de pacientes internados em Fortaleza, processados na rotina de um laboratÃrio privado, no perÃodo de janeiro de 1996 a dezembro de 2001. Como resultado de pesquisa aos prontuÃrios mÃdicos desses pacientes, dois grupos foram criados: Grupo 1, com n=147, composto por pacientes com pneumonia hospitalar (PH) notificada segundo os critÃrios do Center for Disease Control and Prevention (CDC); Grupo 2, com n=382, pacientes com pneumonia nÃo-hospitalar (PNH). Utilizou-se a tÃcnica quantitativa de cultivo descrita nos trabalhos de Kahn e Jones (1987), Salata et al. (1987) e Carvalho (1997). IdentificaÃÃo e antibiogramas foram realizados no equipamento VITEK BioMerrieux, exceto para Streptococcus pneumoniae e Stenotrophomonas maltophilia cujos antibiogramas foram realizados pelo mÃtodo Kirby-Bauer e E-test respectivamente. Resultados â No Grupo 1, os cinco microrganismos mais freqÃentes foram Pseudomonas aeruginosa [56 casos (38,1%)], Staphylococcus aureus [24 casos (16,3%)], Klebsiella pneumoniae [12 casos (8,2%)], Acinetobacter spp [12 casos (8,2%)] e Serratia marcescens [10 casos (6,8%)]. No Grupo 2, encontraram-se, mais freqÃentemente, Pseudomonas aeruginosa [113 casos (29,6%)], Staphylococcus aureus [89 casos (23,3%)], Klebsiella pneumoniae [32 casos (8,4%)] e Acinetobacter spp [31 casos (8,1%)]. NÃo foi observada diferenÃa significativa entre os dois grupos para a etiologia. O mesmo ocorreu com o perfil de resistÃncia dos organismos, exceto para o Grupo 1 com S. aureus/oxacilina (p=0,027) e P. aeruginosa/piperacilina/tazobactam (p=0,003). No perfil de resistÃncia do conjunto total de amostras (n=751), destaca-se a de P. aeruginosa ao imipenem, de 40,8%; de Acinetobacter spp ao imipenem, de 10,0%; de Acinetobacter spp a Ampicilina/Sulbactam, de 44,3%; e de S. aureus a oxacilina, de 67,3%. O intervalo de tempo entre a data de internaÃÃo e a realizaÃÃo da cultura foi maior do que 7 dias em 60,18% dos casos. ConclusÃo - no trato respiratÃrio, o problema da multiresistÃncia bacteriana à evidente e preocupante com alta prevalÃncia de bacilos gram-negativos multiresistentes, marcadamente P. aeruginosa e Acinetobacter spp., assim como elevada resistÃncia a oxacilina nas amostras de Staphylococcus aureus. O Grupo 2 nÃo possui caracterÃsticas de pneumonia comunitÃria (PC), provavelmente, porque o tempo entre a internaÃÃo e a realizaÃÃo da cultura foi longo o suficiente para permitir a colonizaÃÃo do trato respiratÃrio superior pela microflora do ambiente hospitalar. à possÃvel que o Grupo 2 seja constituÃdo por pacientes com pneumonia comunitÃria severa refratÃria à antibioticoterapia que necessita internaÃÃo, ou que tiveram vÃrias internaÃÃes anteriores, com conseqÃente colonizaÃÃo por microflora hospitalar. InvestigaÃÃes subseqÃentes devem conferir atenÃÃo especial a esse aspecto. Pode ser Ãtil, neste contexto, o emprego de tÃcnicas de Biologia Molecular para melhor caracterizaÃÃo dos microrganismos isolados / Hospital acquired pneumonia (HAP) is associated with high morbidity and mortality in hospitalized patients. Early, appropriate, and adequate empiric antibiotic therapy can save lives of more than half of all HAP patients and must be based on local data. This study will provide local patterns of antibiotic resistance. Practically all primary therapy of HAP is empiric and information from surveillance program of a given hospital is very important. We studied 588 Bronchoalveolar lavage cultures results from hospitalized patients performed in a private lab during a period of 6 years from 1996 to 2001. As a result of searching patientâs records, two groups were assigned: Group 1, n=147, patients with HAP notified by Nosocomial Infection Commission according to Center for Disease Control and Prevention-CDC; Group 2, n=382, patients with No-Nosocomial Pneumonia. Bacteriologic cultures were done quantitatively with a threshold of >= 105 according to Kahn and Jones (1987), Salataet al. (1987) and Carvalho (1997). Identification and susceptibility tests were performed on VITEK BioMerrieux except for Streptococcus pneumoniae and Stenotrophomonas maltophilia. In patients from Group 1, the five most frequent agents were: P. aeruginosa 56 cases (38,1%), S.aureus 24 (16,3%), K. pneumonia 12 (8,2%), Acinetobacter spp 12 (8,2%) and S. marcescens 10 (6,8%). Group 2 shows: P. aeruginosa 113 (29,6%), Staphylococcus aureus 89 (23,3%), Klebsiella pneumoniae 32 (8,4%), Acinetobacter spp 31 (8,1%) and Candida spp 20 (5,2%). There was no significant difference between resistance profile of isolates when distributed in two groups except S. aureus/Oxacilina (p=0,027), P.aeruginosa/Piperacilina/Tazobactam (p=0,003). The resistance profile in total (n=751) was: P. aeruginosa/Imipenem 40,8%, Acinetobacter spp/Imipenem 10,0%, Acinetobacter spp/AmpicilinaSulbactam 44,3% e S. aureus/Oxacilina 67,3%. The time between admission date and culture request was more than 7days in 60,18% in both groups. Conclusion: a) drug-resistance in lower respiratory tract infection(LRTI) is a serious concern mainly with high prevalence of multi-R gram-negative like P. aeruginosa and Acinetobacter with high resistance for Imipenem and other &#946;- IactÃmic and S. aureus with high resistance to Oxacilina. There was no significant difference between the two groups. Group 2 did not show characteristics of Community-Acquired Pneumoniae (CAP) maybe because of large intervals of time between admission and request of culture, or this kind of patient had either severe CAP with no response to prior multiple antimicrobial therapy or previous hospitalizations or even had recent hospitalization and consequent colonization. Forwards molecular studies should be performed on isolates to provide better characterization of lower respiratory tract pathogens.