The objective of this study was to evaluate clinical characteristics, etiology, and resistance to antimicrobial agents, among patients with ventilator-associated pneumonia (VAP). A case study vs. patients control under mechanical ventilation and hospitalized into clinical-surgical adults ICU of HC-UFU was performed from March/2005 to March/2006. Patients under ventilation for over 48 h were included in the study including 84 with diagnosis of VAP, and 191 without VAP (control group). Laboratory diagnosis was carried out through quantitative microbiological evaluation of tracheal aspirate. The identification of pathogens was performed by classical microbiological tests, and the antibiotics sensitivity spectrum was determined through the CLSI technique. VAP incidence rate over 1,000 days of ventilation was 24.59. The mean (+/- SD) duration of mechanical ventilation prior to VAP diagnosis was 23.2 +/- 17.2 days. By multivariate analysis the risk factors predisposing for VAP were: mechanical ventilation time and mechanical ventilation > seven days, tracheostomy and use of > or = three antibiotics. Mortality rate was high (32.1 %) but lower than that of the control group (46.5%). Major pathogens were identified in most of patients (95.2%) and included: Pseudomonas aeruginosa (29%), Staphylococcus aureus (26%), Enterobacter/Klebsiella/Serratia (19%) and Acinetobacter spp. (18%), with expressive frequencies of P. aeruginosa (52%), S. aureus (65.4%) and Enterobacteriaceae (43.7%) resistant to imipenem, oxacillin and 3/4 generation cephalosporins, respectively. In conclusion, our observation showed VAPs caused by multiresistant microorganisms, the prescription of > or = three antibiotics, and mortality with unacceptably high rates. The practice of de-escalation therapy appears to be urgently needed in order to improve the situation.

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The aims of this study were to determine endemic and epidemic infection due to Gram-negative bacilli, risk factors associated with colonization and infection by these organisms and the resistance phenotypes (ESBL, AmpC) in neonates admitted in a High Risk Nursery. The study was conducted during a 21 month period and included: a prospective study to evaluate the neonates with hospital infection and the use of third-generation cephalosporins; a case-control study to determine the risk factors associated with colonization/infection. Rectal and oropharynx cultures were also performed in four opportunities (September and November 2001, February and August 2002). The isolates for which the resistance of ceftazidime was 2 µg/mL were suspected of producing ESBL or AmpC β-lactamases. The incidence of infection by Gram-negative bacilli was 2.4% (89/ 3.708 neonates), and sepsis (35.9%) and conjunctivitis (31.4%) were the most common infections. The endemic infections were more prevalent (73.9%) and usually associated with Enterobacteriaceae (95.5%), being these organisms also related to colonization, corresponding mainly to isolates of Enterobacter spp. and Klebsiella spp. Two outbreaks of Pseudomonas aeruginosa (n=10) and Acinetobacter baumannii (n=11) were identified during the survey. Univariate analysis showed that risk factors for Gram-negative bacilli infection considered significant included: the length of stay before infection/colonization, exposure to antimicrobial agents, mechanical ventilation, central venous catheters, parenteral nutrition and surgery. The majority of resistance to ceftazidime among Enterobacteriaceae isolates (80.9%) was from ESBL phenotype. Administration of thirdgeneration cephalosporins (ceftriaxone) led to the emergence of these multiresistant Gram-negative bacilli in the neonatal unit.

Experimental model in the qualitative and quantitative assessment of non-Helicobacter gastric microflora 3 -ORIGINAL ARTICLE Experimental model in the qualitative and quantitative assessment of nonHelicobacter gastric microflora under proton pump inhibitors action¹Modelo experimental na avaliação qualitativa e quantitativa da microflora gástrica não-Helicobacter sob ação de inibidores de bomba de próton ABSTRACT Purpose: To evaluate models of gastric material collection from Wistar rats with and without using proton pump inhibitors(PPIs). Methods: Twenty-four rats underwent intraperitoneal omeprazol treatment, and other 12 received similar treatment with 0.9% saline. All animals underwent collection of gastric material samples, after stomach removal, by either biopsies, or aspirates, or swabs. Samples were bacteriologically processed in order to identify species and strains. Values are described as natural logarithm of colony former units per mL [Ln(CFU/mL)]. Kruskal-Wallis and Mann-Whitney nonparametric tests were used, and p<0.05 was set as statistically significant. Results: Significant difference was not seen for Ln (UFC/mL) values among the three methods of collection irrespective of using or not omeprazol. Also, significant difference was not seen in Ln (UFC/mL) values when comparing a method with each others, either using omeprazol or placebo. A significant increase of bacteria strains occurred when PPI was used, and this was seen on the three ways of collection, mainly in biopsy and swab. Conclusion: No difference occurred among the three methods of collecting bacteria samples from stomachs of rats, either when using placebo or omeprazol. A remarkable change is seen on animals bacterial microflora when PPIs are used, and bacteria are better identified when swab and biopsy are used. Key words: Proton Pumps. Models, Animal. Rats, Wistar. RESUMO Objetivo: Avaliar modelos de coleta de material gástrico de ratos da linhagem Wistar, com e sem o uso de inibidores de bomba de próton (IBPs). Métodos: 24 ratos foram submetidos a tratamento com omeprazol intraperitoneal e 12 outros ratos receberam tratamento semelhante com solução salina a 0,9%. Os animais foram submetidos a coleta de amostras de material gástrico, após retirada do estômago, utilizando-se de biópsias, aspirados ou swabs. Os materiais obtidos foram processados bacteriologicamente para identificação de espécimes quanto ao gênero. Os valores são descritos em logaritmo natural das unidades formadoras de colônias por mL [Ln(UFC/mL)]. Utilizou-se os testes não-paramétricos de KruskalWallis e Mann-Whitney, considerando-se p<0,05 como estatisticamente significativo. Resultados: Não se observou diferença significativa da quantidade de Ln(UFC/mL) entre os três métodos de coleta, independente do uso de omeprazol. Também não se observou diferença significativa de Ln(UFC/mL) ao comparar-se os métodos individualmente entre si nas condições de uso de omeprazol ou placebo. Houve aumento significativo da variedade de gêneros de bactérias com o uso de IBP, nos 3 mét...

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