No abstract

Analysis of the clinical significance of CoNS isolated from hemocultures and the precise detection of oxacillin resistance represent decisive factors for the correct choice of antibiotic therapy. Although vancomycin constitutes the normal treatment in most Brazilian hospitals, reduction in its use is recommended.

Platelet Concentrates (PCs) are the blood components with the highest rate of bacterial contamination, and coagulase-negative staphylococci (CoNS) are the most frequently isolated contaminants. This study investigated the biofilm formation of 16 contaminated units out of 691 PCs tested by phenotypic and genotypic methods. Adhesion in Borosilicate Tube (ABT) and Congo Red Agar (CRA) tests were used to assess the presence of biofilm. The presence of icaADC genes was assessed by means of the Polymerase Chain Reaction (PCR) technique. With Vitek(r)2, Staphylococcus haemolyticus was considered the most prevalent CoNS (31.25%). The CRA characterized 43.8% as probable biofilm producers, and for the ABT test, 37.5%. The icaADC genes were identified in seven samples by the PCR. The ABT technique showed 85.7% sensitivity and 100% specificity when compared to the reference method (PCR), and presented strong agreement (k = 0.8). This study shows that species identified as PCs contaminants are considered inhabitants of the normal skin flora and they might become important pathogens. The results also lead to the recommendation of ABT use in laboratory routine for detecting biofilm in CoNS contaminants of PCs.

The objective ofthis study was to characterize the prevalence and susceptibility profile ofStaphylococcus aureus isolates at University Hospital ofSanta Maria, through data collection at the Laboratory ofClinical Analysis, during April to June 2009. Were requested 3270 cultures and 1123 (34%) were positive. The prevalence of S. aureus in relation to positive cultures was 89 (7,93%). It was found that these strains, 33% were resistant to oxacillin and 34.45% showed resistance related erm gene. High sensitivity to trimethoprim-sulfamethoxazole (72/80%) was detected for the automation and no strain showed resistance to vancomycin. Therefore, the prevalence of S. aureus and oxacillin resistance at HUSM were lower than observed in other tertiary hospitals in Brazil.

The Streptococcus agalactiae colonization prevalence and its susceptibility to antimicrobials in pregnant women at University Hospital of Santa Maria (HUSM) were evaluated from June to December 2009. The vaginal-rectal material was inoculated into tubes containing Todd-Hewitt broth with subsequent subculture on blood agar. The GBS identification was made through presumptive tests, confirmed by serological test and its susceptibility was evaluated. The occurrence ofGBS maternal-fetal transmission in the colonized pregnant women was researched. The GBS colonization was 11.11%. All strains were susceptible to penicillin, ampicillin, and vancomycin. Two strains (50%) were intermediate to clindamycin and one (25%) intermediate to erythromycin. A newborn whose mother was colonized had early-onset neonatal infection by GBS. By this, it is very important the research about the colonization by GBS in all pregnant women from 35 to 37 weeks of gestation and the use of intrapartum antibiotic prophylaxis for colonized pregnant women.Descriptors: Streptococcus agalactiae; Prevalence; Pregnant women; Newborns; Microbial Sensitivity Tests. RESUMOAvaliou-se a prevalência de colonização pelo Streptococcus agalactiae e o seu perfil de sensibilidade frente aos antimicrobianos em gestantes no Hospital Universitário de Santa Maria (HUSM), de junho a dezembro de 2009. O material vaginal-retal foi inoculado em tubos contendo caldo Todd-Hewitt com posterior subcultura em ágar sangue. A identificação do EGB foi realizada através de testes presuntivos, confirmadas por teste sorológico e avaliado seu perfil de sensibilidade. Pesquisou-se ocorrência de transmissão materno-fetal do EGB nas gestantes colonizadas. A prevalência de colonização foi de 11,11%. Todas as cepas foram sensíveis à penicilina, ampicilina e vancomicina. Duas cepas (50%) foram intermediárias à clindamicina e uma (25%) intermediária à eritromicina. Um recém-nascido de mãe colonizada teve infecção neonatal de início precoce por EGB. Confirma-se a importância da pesquisa de colonização por EGB em todas as gestantes entre 35ª e 37ª semana de gestação e uso de quimioprofilaxia intraparto nas gestantes colonizadas.

A infecção do trato urinário (ITU) é considerada uma das doenças mais comuns de origem bacteriana. Objetivou-se determinar a prevalência de ITU em pacientes atendidos no Hospital Universitário de Santa Maria, o agente mais isolado, a incidência entre os sexos e a faixa etária mais acometida. Realizou-se um estudo retrospectivo das uroculturas solicitadas no HUSM, no período de 2007 à 2010, as quais foram cultivadas no setor de Microbiologia do Laboratório de Análises Clínicas. Dos 34.898 exames solicitados, 6.190 (17,74%) foram positivos. O sexo feminino apresentou o maior percentual de positividade (72,94%) e a faixa etária feminina mais acometida foi entre 14 a 40 anos (37,6%) e a masculina entre 41 a 64 anos (10,6%). O microrganismo prevalente foi a Escherichia coli com 31,9%. A partir deste estudo pôde-se verificar que os bacilos gram-negativos (BGN) foram os patógenos prevalentes, além disso, ocorreu um significativo número de isolados de Candida sp.

CONTEXT: Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT: A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive) developed in blood cultures performed on the day of death (seventh day), and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day). The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria. RESUMO CONTEXTO:A síndrome da pele escaldada estafilocócica é uma doença esfoliativa de pele. São raros os relatos desta síndrome causada por Staphylococcus aureus resistente à meticilina em neonatos, mas, quando presentes, exigem diagnóstico e tratamento rápidos para diminuir a morbidade e mortalidade. RELATO DE CASO: Uma menina recém-nascida prematura, pesando 1.520 g ao nascimento, com idade gestacional de 29 semanas e 4 dias, desenvolveu síndrome da pele escaldada estafilocócica no quinto dia de vida. As culturas de sangue coletadas no primeiro e quarto dias foram negativas, mas houve desenvolvimento de Pseudomonas aeruginosa e Enterococcus sp. (vancomicina sensível) na hemocultura realizada no dia do óbito (sétimo dia) e Pseudomonas aeruginosa e Serratia marcescens foram identificadas nas culturas de secreção da nasofaringe, nádega e da secreção abdominal. Na cultura do coto umbilical (sétimo dia), além desses dois bacilos Gram-negativos, foi isolado o Staphylococcus aureus resistente à meticilina. O diagnóstico da síndrome da pele escaldada estafilocócica foi baseado em critério clínico.

RESUMOIntrodução: Devido à sepse bacteriana associada à transfusão de concentrados plaquetários (CPs) ter sérias consequências clínicas para os pacientes, alguns procedimentos têm sido incorporados na preparação e no controle de qualidade dos componentes sanguíneos para reduzir o risco da contaminação bacteriana. Este artigo descreve a prevalência da contaminação bacteriana dos CPs que foram transfundidos, o espectro bacteriano detectado com seu perfil de sensibilidade aos antimicrobianos e as reações transfusionais nos receptores. Métodos: Um total de 292 CPs (278 randômicos e 14 por aférese), proveniente do Hemocentro do Estado do Rio Grande do Sul (HEMORGS) de Santa Maria foi testado. As quantidades de 100µL e 200µL foram coletadas da porção tubular da bolsa de plaquetas e semeadas utilizando dois tipos de metodologias. Resultados: Em cinco unidades(1,7%; 5/292) foram isoladas bactérias pela metodologia qualitativa e apenas uma pela quantitativa. Staphylococcus epidermidis foi o microrganismo identificado em todas as amostras. Dois pacientes apresentaram sepse associada à transfusão com desfecho fatal. Conclusões: A contaminação bacteriana pelas transfusões de CPs constitui-se num importante problema de saúde pública devido a sua associação com altas taxas de morbidade e mortalidade. Neste estudo, somente microrganismos gram-positivos foram isolados sendo que nenhuma amostra obtida por aférese apresentou contaminação. Palavras-chaves: Concentrados plaquetários. Contaminação bacteriana. Sepse. Staphylococcus epidermidis. ABSTRACTIntroduction: Bacterial sepsis associated with the transfusion of platelet concentrates (PCs) results in serious clinical implications for patients. Given these implications, certain procedures have been integrated into the preparation and quality control of blood components to reduce the risk of bacterial contamination. This article describes the prevalence of bacterial contamination on transfused PCs, the bacterial spectrum detected and their antimicrobial susceptibility profile and transfusion reactions in receptors. Methods: A total of 292 PCs (278 random and 14 per apheresis) from the Blood Center of the State of Rio Grande do Sul (HEMORGS), located in the city of Santa Maria, were tested. Quantities of 100µL and 200µL were collected from platelet bag tubing and seeded using two methodologies. Results: Using the qualitative methodology, bacteria were isolated in five units (1.7%; 5/292), while only one was isolated using the quantitative methodology. Staphylococcus epidermidis was the microorganism identified in all samples. Two patients died of transfusion-related sepsis. Conclusions: Bacterial contamination due to PC transfusion is considered a major public health problem due to its association with high rates of morbidity and mortality. In this study only gram-positive microorganisms were isolated and none of the samples obtained by apheresis presented contamination.