Biomedical subjects

A C Pignatari

Publications and source records attributed to A C Pignatari.

32 records · Page 2Linked to original sources

PubMedDate not supplied

Molecular typing of Candida albicans strains isolated from nosocomial candidemia.

Yeasts of the genus Candida have been recognized as important microorganisms responsible for nosocomial fungemia. Six blood-stream and two intravenous central catheter C. albicans strains were isolated from eight patients and studied by electrophoretic karyotyping of chromosomal DNA by pulsed-field gel electrophoresis. Seven chromosomal DNA profiles were identified. Two patients showed isolates with the same profile, suggesting nosocomial transmission. Karyotyping of C. albicans revealed an excellent discriminatory power among the isolates and may therefore be useful in the study of nosocomial candidemia.

Brazil↗

PubMedDate not supplied

Gastrointestinal translocation as a possible source of candidemia in an AIDS patient.

Apart from cryptococcosis and histoplasmosis, which are mycoses contained by T cell-mediated mechanisms of host defense, fungemia is rarely found in AIDS patients. The frequency of fungemia due to Candida spp. has been reported to be as low as 1%. We report a non-neutropenic AIDS patient who presented a candidemia which probably arose from her gastrointestinal tract.

AIDS-Related Opportunistic Infections↗

PubMedDate not supplied

Analysis of the clonal diversity of Staphylococcus aureus methicillin-resistant strains isolated at João Pessoa, state of Paraíba. Brazil.

To investigate the clonal diversity of Staphylococcus aureus strains isolated at João Pessoa, State of Paraíba, Brazil, digested genomic DNA were studied by pulsed-field gel electrophoresis (PFGE) in nine methicillin-resistant strains (MRSA) and three methicillin-sensitive strains (MSSA), selected among 67 isolates based on their antimicrobial susceptibility and epidemiology. The isolates were obtained between April and November 1992 from the Hospital of the Federal University of Paraíba, located in João Pessoa. Two MRAS isolates from the Oswaldo Cruz Hospital, São Paulo, Brazil, including an epidemic strain previously detected from different hospitals at the country were used as control. Five different patterns, were demonstrated by MRSA isolated in João Pessoa and these patterns were described in several epidemiologically unrelated hospitals in São Paulo. Our results suggest the interstate dissemination of a MRSA clone in João Pessoa which is similar to that described in other cities of Brazil.

Brazil↗

PubMedDate not supplied

[Evaluation of in vitro activity of new fluoroquinolones, cephalosporins and carbapenems against 569 gram-negative bacteria].

OBJECTIVE: Evaluation of the in vitro activity of new fluoroquinolones, cephalosporins and carbapenems against gram-negative bacteria. MATERIAL AND METHOD: A total of 569 clinical isolates were obtained from inpatients at São Paulo Hospital--UNIFESP/EPM in June and July of 1992. The species distribution was as follows: Enterobacter sp. (62), Escherichia coli (308), Klebsiella pneumoniae (27), Klebsiella sp. (9), Proteus mirabilis (23), Pseudomonas aeruginosa (88), Pseudomonas sp. (4), Serratia sp. (30) and other gram-negatives (7). Susceptibility tests were performed by broth microdilution. The antimicrobials agents tested were: ciprofloxacin, ofloxacin, levofloxacin, grepafloxacin, DU 6859-alpha, ceftazidime, cefepime, FK 037, imipenem, meropenem and biapenem. RESULTS: DU 6859-alpha showed the highest anti-microbial activity among the fluoroquinolones. It was two- to four-fold more active than ciprofloxacin against some species. The potency and antimicrobial spectrum were similar between the fourth-generation cephalosporins against Enterobacteriaceae, except for Enterobacter sp. strains which were more susceptible to cefepime than they were to cefetazidime or FK 037. When testing Pseudomonas aeruginosa, ceftazidime was slightly more active than the other cephalosporins. Against Enterobacteriaceae and Pseudomonas aeruginosa strains, meropenem was more active than imipenem or biapenem. In addition, the percentage of strains, susceptible to meropenem was higher than the percentage susceptible to the other cerbapenems against these species. CONCLUSION: The new antimicrobial agents demonstrated in vitro activity higher than that of agents commercially available. However, more studies are necessary to further evaluate the in vivo activity and the clinical benefit of these compounds.

Anti-Infective Agents↗

PubMedDate not supplied

[Sensitivity pattern of 117 clinical isolates of Staphylococcus aureus from 12 hospitals].

OBJECTIVE: To evaluate the antimicrobial susceptibility pattern of oxacillin susceptible (OSSA) and resistant Staphylococcus aureus (ORSA) isolates to other antimicrobial agents that can be used for the treatment of staphylococcal infections. MATERIAL AND METHOD: We evaluated 117 clinical S. aureus isolates from several São Paulo hospitals. Clinical isolates from Campinas, SP and from João Pessoa, PB, were also included. The in vitro susceptibility testing was performed by broth microdilution as described by the National Committee for Clinical Laboratory Standards (NCCLS). The minimum inhibitory concentration (MIC) was evaluated for 24 antimicrobial agents, including beta-lactams, fluoroquinolones, aminoglycosides, glycopeptides, macrolides, lincosamides and streptogramins. Both commercially available and experimental drugs were included in the study. Cross-resistance among fluoroquinolones was evaluated by susceptibility testing 24 isolates to 10 fluoroquinolones. RESULTS: The antimicrobial agents that showed the highest in vitro activity were the glycopeptides, the streptogramin RP-59.500, and the mupirocin (100% susceptibility). Eighty-seven percent of the OSSA and only 38% of the ORSA isolates were susceptible to ciprofloxacin (MIC50 0.25 microgram/mL and > 4 micrograms/mL, respectively). Cross-resistance among fluoroquinolones were noted even for the experimental drugs. Two fluoroquinolones remained active against ciprofloxacin-resistant isolates, clinafloxacin and WIN-57.273. However, the ciprofloxacin-resistant isolates had MICs eight-to 64-fold higher than the ciprofloxacin-susceptible isolates, suggesting that the MICs may continue to increase when these fluoroquinolones become commercially available. CONCLUSION: Our results showed a high rate of antimicrobial resistance among S. aureus from the Brazilian hospitals. Very few drugs can still be used for the treatment of staphylococcal infections.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Effect of nosocomial bacteremia caused by oxacillin-resistant Staphylococcus aureus on mortality and length of hospitalization].

OBJECTIVES: To identify the attributed mortality rate of bloodstream hospital infection by Staphylococcus aureus resistant to methicillin (MRSA) and its effect on length of hospital stay. DESIGN: Case-control study. SETTING: Hospital São Paulo da Universidade Federal de São Paulo, a 660-bed, tertiary-care teaching hospital in São Paulo, Brazil. PATIENTS: Seventy one adults patients with hospital-acquired MRSA bacteremia diagnosed between January 1, 1991, and September 30, 1992, and 71 MRSA-free controls were matched by the following criteria: age, sex, underlying disease, surgical procedure, same risk time and admission date. RESULTS: The incidence of patients with hospital sepsis by MRSA accounted for 73.22% of the patients with hospital bloodstream infection by Staphylococcus aureus. The mortality rate of the cases was 56.33 (40/71) and 11.26 (8/71) of the controls. The attributable mortality rate was 45.07% (OR = 17.0; IC 95% = 3.58-202.26; p = 0.000001). The length of hospital stay median time was of 32.55 days for the cases and 29.75 for the controls (p = 0.32). CONCLUSION: A high level of sepsis by MRSA was observed in all the Staphylococcus aureus bacteremia. The bloodstream hospital infection by MRSA itself does provide a high level of mortality independently from the patients base disease, without however, increasing their hospital length of stay.

Adult↗

PubMedDate not supplied

E test: a novel technique for antimicrobial susceptibility testing.

We describe the applicability of the E test (AB Biodisk Solna, Sweden), a new method for determining minimum inhibitory concentrations of antimicrobial agents against bacteria. This report is based on the literature review and on our own experience using the E test for susceptibility testing of the Xanthomonas maltophilia, Streptococcus pneumoniae and Streptococcus viridans group against eight different drugs.

Drug Resistance, Microbial↗

PubMedDate not supplied

[Epidemiology of bacteremias at a university hospital].

The epidemiological aspects of bacteremias were determined in a university hospital, according to service, age, sex and place of acquisition (nosocomial or community-acquired). From August 1985 through July 1986 the incidence rate of bacteremias at the Sao Paulo Hospital was 21.7/1000 admissions. Such a high rate is probably related to the characteristics of the patients admitted to the hospital. The incidence was higher in the extremes of age and was similar in either sex. Approximately 60% of the bacteremias were nosocomial including 9.1% that were present at admission in patients transferred from other hospitals. The most frequent isolated pathogen was S. aureus. The most important source of bacteremia was the respiratory tract followed by the gastrointestinal and urinary tracts.

Adolescent↗

PubMedDate not supplied

Nosocomial and community acquired bacteremia: variables associated with outcomes.

Bacteremia is related to high morbidity and lethality. The present investigation was conducted to evaluate the variables associated with outcomes of bacteremia at a University Hospital in São Paulo, Brazil. Patients with bacteremia were identified through positive blood cultures performed at the microbiology laboratory between August 1985 and July 1986. Their charts were reviewed and the following variables were considered: age, sex, presence of underlying disease, where was the bacteremia acquired, source of infection, presence of shock and appropriateness of antimicrobial therapy. In the period of the study, there were 362 cases of bacteremia out of 16,636 admissions to the hospital. The lethality rate was 33.4%, six times higher than the mortality rate for non-bacteremic patients. Age greater than 40 years, presence of severe underlying disease, nosocomial acquisition, respiratory tract as the source of bacteremia, presence of shock and, being infected with Pseudomonas sp were significantly associated with fatal outcome. Appropriate antimicrobial therapy reduced the incidence of shock and improved survival of patients with bacteremia. This study provides information on outcome of patients with bacteremia at a University Hospital in Brazil and, settles the variables associated with poor outcome in these patients.

Adolescent↗

PubMedDate not supplied

[Cryptococcal meningitis in pregnancy. Review of the literature. Report of 2 cases].

Two cases of neurocryptococcosis were diagnosed during pregnancy in São Paulo (Brazil). Amphotericin B was used in the second trimester in one patient. The other, received amphotericin B during the first trimester of pregnancy and 5-fluorocytosine was added in the second trimester. In both, the pregnancy was uneventful and the fetus suffered no damage. The therapy used to treat pregnant women with cryptococcal meningitis is commented. The newborn follow-up is discussed. A review of the literature concerning neurocryptococcosis during pregnancy is presented.

Adult↗

PubMedDate not supplied

[Analysis of the program of control of the use of antimicrobials at the Hospital São Paulo--Escola Paulista de Medicina].

BACKGROUND AND OBJECTIVE: Antimicrobial agents represent a group of drugs that are frequently used in hospitals. Approximately, 50% of hospitalized patients receive at least one antimicrobial drug during the hospitalization period. However, half of these drugs are prescribed incorrectly. The objective of this paper was to analyse the antimicrobial control program that has been used at Escola Paulista de Medicina since 1989. CASUISTIC & METHODS: The prescription of eleven controlled antibiotics should be done in a special form. Any requisition of a controlled antibiotic was evaluated, within 24 hours, by an infection diseases specialist who was hired exclusively for this function. RESULTS: During 1989, 5,573 controlled antimicrobials were requested by the hospital staff, and 17.6% of them were considered inadequate and were refused. Such a percentage was high considering that our institution is a university hospital where the antibiotic usage should be more precise and adequate. We also should take into account that the indication of only 11 antimicrobial drugs were evaluated. CONCLUSION: The results allow us to conclude that each hospital should have not only a policy on antimicrobial usage but also an effective program of control of these drugs.

Anti-Bacterial Agents↗

PubMedDate not supplied

[In vitro susceptibility testing of 446 clinical isolates of gram-positive bacteria to new quinolones, carbapenems and cephalosporins].

OBJECTIVE: To assess the in vitro susceptibility of gram-positive bacteria isolated in the São Paulo Hospital against five fluoroquinolones, three carbapenems and three cephalosporins. MATERIALS AND METHOD: Susceptibility was tested in 77 isolates of streptococci, 38 enterococci, 25 S. aureus and 91 S. epidermidis. The strains were isolated in the São Paulo Hospital in June and July of 1992. The susceptibility testing was performed by broth microdilution according to the procedure described by the national committee for Clinical Laboratory Standards (NCCLS). The antimicrobial agents tested were: ciprofloxacin, ofloxacin, levofloxacin, grepafloxacin (formerly OPC 17116), DU-6859, imipenem, meropenem, biapenem, ceftazidime, cefepime and FK-037. RESULTS: The best in vitro activity was demonstrated by the new fluoroquinolones, especially DU 6859. Among the commercially available compounds, the fluoroquinolones ciprofloxacin and ofloxacin (81% susceptibility) and the carbapenem imipenem (74% susceptible) were the most active compounds. The highest resistance rates were shown by enterococci and oxacillin-resistant staphylococci. CONCLUSIONS: The results of the present study showed that the in vitro activities of the new carbapenems are similar to that of imipenem and the fourth generation cephalosporins are more active than ceftazidime against gram-positive bacteria. In addition, the newer fluoroquinolones were four to sixteen-fold more active than that showed by the commercially available compounds of this class, especially against enterococci and oxacillin-resistant staphylococci. These results indicate that these newer fluoroquinolones should be further evaluated in clinical trials.

Carbapenems↗

PubMedDate not supplied

[Study of the susceptibility of Staphylococcus sp. and Enterococcus sp. to teicoplanin and vancomycin].

PURPOSE: The study was performed in order to evaluate the susceptibility of Enterococcus and Staphylococcus to teicoplanin and vancomycin. METHODS: 150 Enterococcus strains and 450 Staphylococcus strains (298 Staphylococcus aureus and 152 negative coagulase strains) isolated in three Brazilian hospitals were studied. The MICs were determined using teicoplanin and vancomycin E Test strips. The range of the antimicrobial concentration in each strip went from 256 mcg/mL to 0.016 mcg/mL. Diffusion tests using disks impregnated with 10 mcg of teicoplanin and 30 mcg of vancomycin were also performed. RESULTS: All the 298 Staphylococcus aureus strains were susceptible to the two antimicrobials. Three of the 152 negative coagulase strains presented intermediate susceptibility to teicoplanin (MICs between 8 and 16 mcg/mL). Four of the 150 Enterococcus strains presented intermediate susceptibility to vancomycin but were totally susceptible to teicoplanin. CONCLUSION: According to these results teicoplanin and vancomycin are good therapeutical options in the treatment of staphylococcal and enterococcal infections.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Clinical significance, epidemiology and microbiology of coagulase-negative staphylococcal nosocomial bacteremia at a teaching hospital].

Coagulase-negative staphylococci (CNS) are an important cause of nosocomial bacteremia and they are frequently considered as contaminants of blood-cultures. From October 1990 to September 1992, 300 positive blood-cultures for CNS at the Hospital São Paulo were studied and 141 CNS bacteremias were characterized as nosocomial bacteremias. Clinical and microbiological criteria were defined to differentiate between true CNS bacteremia and contaminated cultures. Only 20.6% of the CNS nosocomial bacteremia were considered as true bacteremia. Most of the CNS true nosocomial bacteremia were detected among newborns admitted to the neonatal intensive care unit; the presence of intravascular catheter and parenteral nutrition were significant findings. We did not detect significant difference between true nosocomial bacteremia and contaminated cultures regarding to resistance to oxacillin and SLIME production. The clinical criteria and the positivity of the blood-cultures up to 48 hours after incubation, utilized in our definitions, were useful parameters to characterize the CNS true nosocomial bacteremia.

Adolescent↗