Species distribution and antifungal susceptibility patterns of Candida spp. bloodstream isolates from a Brazilian tertiary care hospital

In this work, we collect data from surveys of bloodstream Candida isolates performed in Brazil from 1996 to 2004. Besides, we analyzed the species distribution of bloodstream Candida isolates together with potential risk factors for candidemia and the susceptibility profile of these isolates in patients from Hospital das Clinicas in Goiaonia city, Brazil. Blood samples were collected in the admission day and on every 7 days, in the intensive care unit (ICU) of a tertiary hospital. Candida isolates were identified by standard protocols that included germ tube formation, chlamydoconidia production on cornmeal agar and sugar fermentation and assimilation tests. Data of patients were recorded and analyzed according to age at the time of diagnosis, gender and presence of potential risk factors. Statistical analysis was used to determine if the time of hospital permanence increased Candida colonization in ICU patients' blood. The antifungal susceptibility testing was performed by broth microdilution method according to document NCCLS/CLSI M27-A2. Among the 345 blood samples cultured, candidemia was recovered in 33 patients, which were isolated 51.5% of Candida non-albicans. Fungemia was associated with long-term hospitalization. Fluconazole, itraconzole, voriconazole and amphotericin B exhibited a potent activity against all isolates of Candida. Voriconazole MICs were much low for all isolates tested. This work confirms data of increase of Candida non-albicans species in bloodstream in ICU and shows that voriconazole in vitro activity was higher than those of itraconazole, fluconazole and amphotericin B.

An approach of optimal sensitivity applied in the tertiary loop of the automatic generation control

This paper proposes an approach of optimal sensitivity applied in the tertiary loop of the automatic generation control. The approach is based on the theorem of non-linear perturbation. From an optimal operation point obtained by an optimal power flow a new optimal operation point is directly determined after a perturbation, i.e., without the necessity of an iterative process. This new optimal operation point satisfies the constraints of the problem for small perturbation in the loads. The participation factors and the voltage set point of the automatic voltage regulators (AVR) of the generators are determined by the technique of optimal sensitivity, considering the effects of the active power losses minimization and the network constraints. The participation factors and voltage set point of the generators are supplied directly to a computational program of dynamic simulation of the automatic generation control, named by power sensitivity mode. Test results are presented to show the good performance of this approach. (C) 2008 Elsevier B.V. All rights reserved.

Surveillance Programme for Healthcare Associated Infections in the State of São Paulo, Brazil. Implementation and the first three years' results

Governmental programmes should be developed to collect and analyse data on healthcare associated infections (HAIs). This study describes the healthcare setting and both the implementation and preliminary results of the Programme for Surveillance of Healthcare Associated Infections in the State of São Paulo (PSHAISP), Brazil, from 2004 to 2006. Characterisation of the healthcare settings was carried out using a national database. The PSHAISP was implemented using components for acute care hospitals (ACH) or long term care facilities (LTCF). The components for surveillance in ACHs were surgical unit, intensive care unit and high risk nursery. The infections included in the surveillance were surgical site infection in clean surgery, pneumonia, urinary tract infection and device-associated bloodstream infections. Regarding the LTCF component, pneumonia, scabies and gastroenteritis in all inpatients were reported. In the first year of the programme there were 457 participating healthcare settings, representing 51.1% of the hospitals registered in the national database. Data obtained in this study are the initial results and have already been used for education in both surveillance and the prevention of HAI. The results of the PSHAISP show that it is feasible to collect data from a large number of hospitals. This will assist the State of São Paulo in assessing the impact of interventions and in resource allocation. (C) 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

The aim of this study was to evaluate the incidence of and mortality due to meningitis and compare data according to microbiological diagnosis. This was a ten-year retrospective study conducted at a neonatal intensive care unit (NICU). Newborns with meningitis confirmed by positive CSF culture were included; those with congenital infection or malformations that made lumbar puncture impossible were excluded. The variables investigated were birth weight, gestational and postnatal age, procedures, hematological and CSF parameters, and complications. Parametric and non-parametric tests were used (statistical value p<0.05). The incidence of meningitis was 0.6% and mortality was 27%. of the 22 cases, 59% involved Gram-negative bacteria; 36% Gram-positive and 5% fungi. The groups did not differ in relation to birth weight, gestational and postnatal age, procedures or hematological and CSF parameters. Sepsis, convulsions and deaths were frequent in both groups, without statistical difference. Gram-negative cases showed abscesses and higher frequency of ventriculitis and hydrocephaly. Meningitis was infrequent, but presented high mortality and frequent complications.

Detection of P. aeruginosa harboring bla(CTX-M-2), bla(GES-1) and bla(GES-5), bla(IMP-1) and bla(SPM-1) causing infections in Brazilian tertiary-care hospital

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cogeneration for small users: case studies for Brazilian tertiary sector

In this paper we present technical and economic studies of cogeneration systems utilizing combustion engines and gas turbines, applied in two establishments of the tertiary sector, regarding Brazilian conditions (according to Silveria, 1994). In the first step cogeneration systems utilizing combustion engines associated to absorption refrigeration systems are studied, in which electricity and cold air for a university building rate produced. In the second step some possibilities of the use of the gas turbine in cogeneration systems for a hospital are shown. In this case, the exhaust gases are utilized for the production of steam in a heat recovery steam generator (HRSG) or cold water in an absorption refrigeration system (for air conditioning) for the hospital building. The dynamic increment of the energy demand of Brazilian tertiary sector in last years can increase the installation of these cogeneration system (in compact version) as well as strengthen the development of the decentralized energy generation in Brazil.

Burial history and porosity evolution of Brazilian upper Jurassic to tertiary sandstone reservoirs

The parameter time-depth index (TDI) is applied in this study to quantify empirically the influence of burial history on sandstone porosity evolution. The TDI, expressed in kilometers per million years of age, is defined as the area in the burial history diagram enclosed by the burial curve of the reservoir and the axes of the diagram. In practice, reservoir depths during burial history are integrated at regular time intervals of 1 m.y. The calculations exclude present-day bathymetry or paleobathymetry. Sandstone reservoirs from several sedimentary basins along the Brazilian continental margin (Santos, Campos, Espírito Santo, Cumuruxatiba, Recôncavo, Sergipe, Alagoas, and Potiguar) were analyzed to investigate the evolution of porosity against TDI. These Upper Jurassic to Tertiary sandstones lie in depths of 700 to 4900 m, and are hydrocarbon charged (oil or gas). Average porosities of most of these reservoirs were obtained from core analysis, and a few porosity data were taken from well log interpretations. Detrital constituents of the sandstones are mainly quartz, feldspar, and granitic/gneissic rock fragments. Sandstones were grouped into three main reservoir types, based on composition (detrital quartz content) and grain sorting: Type I (average quartz content <50%) are very coarse grained to conglomeratic, poorly to very poorly sorted lithic arkoses. Rock fragments are mainly granitic/gneissic and coarse grained. Type II (average quartz content ranging from 50% to 70%) are fine- to coarse-grained (pebbles absent or occurring in small percentages), moderately sorted arkoses. Type III (average quartz content >80%) are fine to coarse, moderately to poorly sorted quartz arenites or subarkoses. Plots of average porosity against depth show great dispersion in porosity values; such dispersion is mostly due to differences in the reservoir burial histories. However, plotting porosity values against the TDI for individual reservoir types produces well-defined trends. The decrease in porosity is less marked in Type III reservoirs, intermediate in Type II, and faster in Type I. Such plots suggest that it is possible to make relatively accurate porosity predictions based on reservoir TDI, texture, and composition,: within the constraints of reservoir depth/age and basin tectonics analyzed in this study.

Study of a fuel cell cogeneration system applied to a Brazilian tertiary sector

In this paper, a methodology for the study of a molten carbonate fuel cell cogeneration system and applied to a computer center building is developed. This system permits the recovery of waste heat, available between 600°C and 700°C, which can be used to the production of steam, hot and cold water, hot and cold air, depending on the recuperation equipment associated. Initially, some technical information about the most diffusing types of the fuel cell demonstration in the world are presented. In conclusion, the fuel cell cogeneration system may have an excellent opportunity to strengthen the decentralized energy production in the Brazilian tertiary sector.

Species distribution and susceptibility profile of Candida species in a Brazilian public tertiary hospital

Background. Species identification and antifungal susceptibility tests were carried out on 212 Candida isolates obtained from bloodstream infections, urinary tract infections and dialysis-associated peritonitis, from cases attended at a Brazilian public tertiary hospital from January 1998 to January 2005. Findings. Candida albicans represented 33% of the isolates, Candida parapsilosis 31.1%, Candida tropicalis 17.9%,Candida glabrata 11.8%, and others species 6.2%. In blood culture, C. parapsilosis was the most frequently encountered species (48%). The resistance levels to the antifungal azoles were relatively low for the several species, except for C. tropicalis and C. glabrata. Amphotericin B resistance was observed in 1 isolate of C. parapsilosis. Conclusions. The species distribution and antifungal susceptibility herein observed presented several epidemiological features common to other tertiary hospitals in Latin American countries. It also exhibited some peculiarity, such as a very high frequency of C. parapsilosis both in bloodstream infections and dialysis-associated peritonitis. C. albicans also occurred in an important number of case infections, in all evaluated clinical sources. C. glabrata presented a high proportion of resistant isolates. The data emphasize the necessity to carry out the correct species identification accompanied by the susceptibility tests in all tertiary hospitals. © 2010 Bagagli et al; licensee BioMed Central Ltd.

Detection of SPM and IMP metallo-β-lactamases in clinical specimens of Pseudomonas aeruginosa from a Brazilian public tertiary hospital

Phenotypic and genotypic SPM and IMP metallo-β-lactamases (MBL) detection and also the determination of minimal inhibitory concentrations (MIC) to imipenem, meropenem and ceftazidime were evaluated in 47 multidrug-resistant Pseudomonas aeruginosa isolates from clinical specimens. Polymerase chain reaction detected 14 positive samples to either blaSPM or blaIMP genes, while the best phenotypic assay (ceftazidime substrate and mercaptopropionic acid inhibitor) detected 13 of these samples. Imipenem, meropenem and ceftazidime MICs were higher for MBL positive compared to MBL negative isolates. We describe here the SPM and IMP MBL findings in clinical specimens of P. aeruginosa from the University Hospital of Botucatu Medical School, São Paulo, Brazil, that reinforce local studies showing the high spreading of blaSPM and blaIMP genes among Brazilian clinical isolates. © 2011 Elsevier Editora Ltda.

A interface entre uma Unidade de internação infantil em Pronto Socorro de Hospital Universitário, com o Sistema de Saúde local e regional

Pós-graduação em Pediatria - FMB

Intraoperative Cardiac Arrest and Mortality in Trauma Patients. A 14-Yr Survey from a Brazilian Tertiary Teaching Hospital

Background: Little information on the factors influencing intraoperative cardiac arrest and its outcomes in trauma patients is available. This survey evaluated the associated factors and outcomes of intraoperative cardiac arrest in trauma patients in a Brazilian teaching hospital between 1996 and 2009.Methods: Cardiac arrest during anesthesia in trauma patients was identified from an anesthesia database. The data collected included patient demographics, ASA physical status classification, anesthesia provider information, type of surgery, surgical areas and outcome. All intraoperative cardiac arrests and deaths in trauma patients were reviewed and grouped by associated factors and also analyzed as totally anesthesia-related, partially anesthesia-related, totally surgery-related or totally trauma patient condition-related.Findings: Fifty-one cardiac arrests and 42 deaths occurred during anesthesia in trauma patients. They were associated with male patients (P<0.001) and young adults (18-35 years) (P = 0.04) with ASA physical status IV or V (P<0.001) undergoing gastroenterological or multiclinical surgeries (P<0.001). Motor vehicle crashes and violence were the main causes of trauma (P<0.001). Uncontrolled hemorrhage or head injury were the most significant associated factors of intraoperative cardiac arrest and mortality (P<0.001). All cardiac arrests and deaths reported were totally related to trauma patient condition.Conclusions: Intraoperative cardiac arrest and mortality incidence was highest in male trauma patients at a younger age with poor clinical condition, mainly related to uncontrolled hemorrhage and head injury, resulted from motor vehicle accidents and violence.

Tropical Healthcare Epidemiology: Weather Determinants of the Etiology of Bloodstream Infections in a Brazilian Hospital

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Nasopharyngeal carriage of Staphylococcus aureus among imprisoned males from Brazil without exposure to healthcare: risk factors and molecular characterization

Background: Previous studies report high prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) colonization among imprisoned populations. However, there are no data on that prevalence in Brazilian correctional institutions.Findings: We tested 302 male prisoners for nasopharyngeal colonization with Staphylococcus aureus from February 2009 through April 2010. The overall isolation rate of S. aureus was 16.5% (50/302). Men who had sex with men, users of inhalatory drugs and those with previous lung or skin diseases were more likely to be colonized with S. aureus. MRSA was isolated from 0.7% of subjects (2/302). The two Community-associated (CA)-MRSA belonged to ST5 but were unrelated based on the PFGE results. Both harbored SCCmec IV, and did not possess the Panton-Valentine Leukocidin gene.Conclusion: We found low prevalence of S. aureus and CA-MRSA among prisoners. MRSA isolates ST5 from two subjects harboured SCCmec IV and presented different PFGE patterns.

Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil

Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI). Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI) or local access infections (LAI). Our study aimed to provide a wide overview of HAT epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test) and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC), either temporary (RR = 13.35, 95% CI = 6.68-26.95) or permanent (RR = 2.10,95% CI = 1.09-4.13), as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day) were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units. (C) 2013 Elsevier Editora Ltda. All rights reserved.