This is the first study comparing current therapeutic options for infections due to carbapenem-resistant Acinetobacter. The most important finding of the present study is that ampicillin/sulbactam appears to be more efficacious than polymyxins, which was an independent factor associated with mortality during treatment.

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Emergence of carbapenem-resistant Escherichia coli producing CMY-2-type AmpC b-lactamase in Brazil Carbapenem-resistant Escherichia coli isolates have not been described to date in South America. However, the emergence of Shigella flexneri and Klebsiella pneumoniae isolates producing CMY-2type plasmid-mediated AmpC was recently reported in Argentina (Radice et al., 2007; Rapoport et al., 2008). Here, we report the emergence of carbapenemresistant E. coli producing CMY-2-type AmpC b-lactamase in Brazil, confirming that CMY-2-producing strains have already become established in Latin America.

Mycobacterium haemophilum is a slow-growing nontuberculous mycobacterium that can cause disease in both immunocompetent and immunocompromised patients. The most common clinical presentations of infection are the appearance of suppurative and ulcerated skin nodules. For the diagnosis, samples collected from suspected cases must be processed under the appropriate conditions, because M. haemophilum requires lower incubation temperatures and iron supplementation in order to grow in culture. In this case report, we describe the occurrence of skin lesions in a kidney transplant recipient, caused by M. haemophilum, associated with acupuncture treatment. The diagnosis was established by direct smear and culture of material aspirated from cutaneous lesions. Species identification was achieved by characterization of the growth requirements and by partial sequencing of the hsp65 gene. The patient was successfully treated with clarithromycin and ciprofloxacin for 12 months. Considering that the number of patients receiving acupuncture treatment is widely increasing, the implications of this potential complication should be recognized, particularly in immunosuppressed patients.

Brazil is the largest country in Latin America, with a population of 146 million people. The socioeconomic development and the distribution of population and health services varies widely within the country. There are approximately 1.2 million hospital admissions per month, 80% of them paid by a government healthcare program that follows the diagnosis-related groups (DRGs) model. The Ministry of Health has been trying to establish a nationwide nosocomial infection control program since 1983. Most Brazilian hospitals now have some kind of infection control activity, but only a few of them have complete programs. Infrastructural deficiencies, the scarcity of well-trained healthcare workers, and the widespread occurrence of multiresistant Staphylococcus aureus and gram-negative bacteria are some of the challenges faced by Brazilian hospitals in the control of nosocomial infection.

Objective: The goal of this study was to evaluate the infection control measures actually implemented by dental surgeons during dental practice, as patients and professionals are exposed to high biological risk in dental care environments. Method: 614 questionnaires (90.69%) were answered by professionals registered in updating or in post-graduate courses in the Municipality of São Paulo. Results: Out of surveyed professionals 30.62% admitted that surface protection barriers were not used, whereas 34.17% were using non ideal or outdated pre-disinfection practices. The autoclave was used by 69.38% of participants, although 33.80% were not monitoring control of the sterilization cycles. Chemical and biological indicators were not used simultaneously by 83.21% of respondents and were not employed on a daily or weekly basis by at least 81.75%. Dubious methods of sterilization were cited by 44.77%. Occupational accidents caused by cutting and piercing objects were reported by 47.88%; however, the biologic risk was underestimated by 74.15% of the professionals who suffered the accidents. Irritant solutions were used as an antiseptic agent by 18.55%. Conclusions: Infection control measures reported by dental surgeons during their practices are defi cient. It is necessary to educate, raise awareness of professionals, and promote constant updating courses on procedures which aim at improving safety of dental care.

Objective: Identifying predictors of infection or colonization with resistant microorganisms. Methods: A quantitative study of prospective cohort was carried out. A descriptive analysis was performed in order to know the population of the study and a discriminant analysis was performed to identify the predictors. Results: In this study were included 85 patients with infections caused by resistant microorganisms: carbapenem-resistant Pseudomonas aeruginosas (24.7%); carbapenem-resistant Acinetobacter (21.2%); methicillin-resistant Staphylococcus aureus (25.9%), vancomycin-resistant Enterococcus spp (17.6%) and carbapenem-resistant Klebsiella pneumonia (10.6%). The discriminant analysis identified transfers from other hospitals and hospitalization in intensive care unit as predictors for the occurrence of infections by the following groups: S. aureus resistant to methicillin, Acinetobacter resistant to carbapenems and K. pneumoniae resistant to carbapenems. None of the studied variables was discriminant for vancomycin-resistant Enterococcus spp. and carbapenem-resistant P. aeruginosas. Conclusion: The predictors found were: ICU hospitalization and transfers from other hospitals. ResumoObjetivo: Identificar os fatores preditores de infecção ou colonização por micro-organismos resistentes. Métodos: Foi realizado estudo quantitativo de coorte prospectivo. Foram realizadas a análise descritiva, para conhecimento da população do estudo, e a análise discriminante, para identificação dos fatores preditores. Resultados: Foram incluídos 85 pacientes com infecções por micro-organismos resistentes: Pseudomonas aeruginosas resistente aos carbapenêmicos (24,7%), Acinetobacter resistente aos carbapenêmicos (21,2%), Staphylococcus aureus resistente à meticilina (25,9%), Enterococcus spp. resistente à vancomicina (17,6%) e Klebsiella pneumoniae resistente aos carbapenêmicos (10,6%). A análise discriminante identificou transferências de outros hospitais e internação na Unidade de Terapia Intensiva como fatores preditores para ocorrência de infecção pelos grupos S. aureus resistente à meticilina, Acinetobacter resistente aos carbapenêmicos e K. pneumoniae resistente aos carbapenêmicos. Nenhuma das variáveis estudadas foi discriminante para Enterococcus spp. resistente à vancomicina e P. aeruginosas resistente aos carbapenêmico. Conclusão: Os fatores preditores encontrados foram: internação na UTI e a transferências de outros hospitais.