Impacto na epidemiologia da sepse tardia após a mudança do protocolo de antimicrobianos em uma UTIN de um serviço universitário

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Kisspeptina: efeito na maturação in vitro de ovócitos bovinos

This study aimed to evaluate different concentrations of kisspeptin, as well as the interaction of kisspeptin and FSH/LH in vitro maturation and oocyte competence in cattle. In Experiment 1 was determined the minimum concentration of Kisspeptin (Kp) to be used, and in Experiment 2 was evaluated its interection with FSH and LH. The oocytes were collected in a commercial slaughterhouse and only Grade I oocytes were utilized. The oocytes were cultured in TCM-199 medium with bicarbonate plus 10% FBS, sodium pyruvate (22μg/mL), amikacin (83mg/mL), FSH (0.5μg/mL), with different concentrations of Kp, the treatments were: FSH + 0M Kp-10; FSH + 10-7M Kp-10, FSH + 10-6M Kp-10; FSH + 10-5M Kp-10. In Experiment 2, was used better concentration of Kp found in Experiment 1, the following treatments: no hormones; FSH; FSH + Kp-10; FSH + LH; FSH, LH + Kp-10; Kp-10. The oocyte competence was determined by nuclear maturation, mitochondrial distribution, MitoTracker® Orange CMTMRos fluorescence intensity and DCF. The evaluation of nuclear maturation was made after 24 hours incubation and the oocytes were stained with DAPI to determine the nuclear stage (Germinal Vesicle-GV, Metaphase I-MI and Metaphase II-MII).The mitochondrial distribution was classified as peripheral/semiperipheral and diffuse in clusters/granules, evaluated after stained with the MitoTracker® Orange CMTMRos, and was also identified the intensity of it. To determine the intensity of ROS oocytes were stained with DCF. The statistical analysis was performed by SAS GLIMMIX PROC. In Experiment 1 oocytes matured only with the FSH reached a smaller nuclear maturation when compared to those who were matured with Kisspeptin at different concentrations (FSH:13/33; FSH + 10-7M Kp-10: 28/35; FSH + 10-6M Kp-10:30/34; FSH + 10-5M Kp-10:28/32; P=0,0001). There was no statistical difference in mitochondrial distribution between treatments (P>0.05). The fluorescence intensity of MitoTracker did not differ among treatments (P>0.05). The DCF fluorescence intensity was lower when the concentration of Kp was increased in the medium (FSH:12177726,1; FSH + 10-7M Kp-10:10945982,83; FSH + 10-6M Kp-10:9820536,53; FSH + 10-5M Kp-10:9147016,38; P<0,0001). Based in the Experiment 1 results, the concentration of Kp was determined in 10-7M. In Experiment 2 the mitochondrial distribution was different between treatments, because oocytes matured only with Kp or FSH+LH, reached a oocyte competence greater than those maturated with FSH only or without hormone addition (no hormones:66,66%; FSH:66,66%; FSH + Kp-10:75,86%; FSH + LH:91,17%; FSH, LH + Kp-10:82,85%; Kp-10:91,17%; P<0,05). The no hormones resulted in a lower nuclear maturation than the other treatments (no hormones: 5/18; FSH:18/32; FSH + Kp-10:22/29; FSH + LH:26/33; FSH, LH + Kp-10:26/34; Kp-10:25/34; P=0,0094). The fluorescence intensity of probes MitoTracker and DCF was lower when Kp was added to the maturation medium (no hormones:1228363/540069; FSH:2307984/1395751; FSH + Kp-10:1941890/1114948; FSH + LH:2502145/1722376; FSH, LH + Kp-10:2286173/1467782; Kp-10:1859411/979325 P<0,0001). So this is the first study that shows that Kisspeptin stimulates oocyte maturation without the presence of gonadotropins in the maturation medium.