Measures to prevent surgical site infections: what surgeons (should) do.

BACKGROUND: The present study was designed to evaluate surgeons' strategies and adherence to preventive measures against surgical site infections (SSIs). MATERIALS AND METHODS: All surgeons participating in a prospective Swiss multicentric surveillance program for SSIs received a questionnaire developed from the 2008 National (United Kingdom) Institute for Health and Clinical Excellence (NICE) clinical guidelines on prevention and treatment of SSIs. We focused on perioperative management and surgical technique in hernia surgery, cholecystectomy, appendectomy, and colon surgery (COL). RESULTS: Forty-five of 50 surgeons contacted (90%) responded. Smoking cessation and nutritional screening are regularly propagated by 1/3 and 1/2 of surgeons, respectively. Thirty-eight percent practice bowel preparation before COL. Preoperative hair removal is routinely (90%) performed in the operating room with electric clippers. About 50% administer antibiotic prophylaxis within 30 min before incision. Intra-abdominal drains are common after COL (43%). Two thirds of respondents apply nonocclusive wound dressings that are manipulated after hand disinfection (87%). Dressings are usually changed on postoperative day (POD) 2 (75%), and wounds remain undressed on POD 2-3 or 4-5 (36% each). CONCLUSIONS: Surgeons' strategies to prevent SSIs still differ widely. The adherence to the current NICE guidelines is low for many procedures regardless of the available level of evidence. Further research should provide convincing data in order to justify standardization of perioperative management.

Potential impact of environmental bacteriophages in spreading antibiotic resistance genes

The idea that bacteriophage transduction plays a role in the horizontal transfer of antibiotic resistance genes is gaining momentum. Such transduction might be vital in horizontal transfer from environmental to human bodyassociated biomes and here we review many lines of evidence supporting this notion. It is well accepted that bacteriophages are the most abundant entities in most environments, where they have been shown to be quite persistent. This fact, together with the ability of many phages to infect bacteria belonging to different taxa, makes them suitable vehicles for gene transfer. Metagenomic studies confirm that substantial percentages of the bacteriophage particles present in most environments contain bacterial genes, including mobile genetic elements and antibiotic resistance genes. When specific genes of resistance to antibiotics are detected by real-time PCR in the bacteriophage populations of different environments, only tenfold lower numbers of these genes are observed, compared with those found in the corresponding bacterial populations. In addition, the antibiotic resistance genes from these bacteriophages are functional and generate resistance to the bacteria when these genes are transfected. Finally, reports about the transduction of antibiotic resistance genes are on the increase.

The role of Serratia marcescens porins in antibiotic resistance

The outer membrane permeability of Serratia marcescens was studied by comparing porin-deficient mutants with their parental strains. Omp1-deficient strains were selected by moxalactam resistance, whereas mutants lacking the Omp2 porin were obtained by experimental infection with the SMP2 phage, whose primary receptor is the Omp2 porin. The role of porins was demonstrated in quinolone accumulation assays, where semi-quantitative differences in accumulation were observed. Permeability coefficients to cephaloridine of Omp1 mutants were determined and compared with those of the parental strain. The clinical isolates S. marcescens HCPR1 and 866 showed 30- to 200-fold reduced permeability coefficients when Omp1 porin was absent

The role of Serratia marcescens porins in antibiotic resistance

The outer membrane permeability of Serratia marcescens was studied by comparing porin-deficient mutants with their parental strains. Omp1-deficient strains were selected by moxalactam resistance, whereas mutants lacking the Omp2 porin were obtained by experimental infection with the SMP2 phage, whose primary receptor is the Omp2 porin. The role of porins was demonstrated in quinolone accumulation assays, where semi-quantitative differences in accumulation were observed. Permeability coefficients to cephaloridine of Omp1 mutants were determined and compared with those of the parental strain. The clinical isolates S. marcescens HCPR1 and 866 showed 30- to 200-fold reduced permeability coefficients when Omp1 porin was absent

The role of Serratia marcescens porins in antibiotic resistance

The outer membrane permeability of Serratia marcescens was studied by comparing porin-deficient mutants with their parental strains. Omp1-deficient strains were selected by moxalactam resistance, whereas mutants lacking the Omp2 porin were obtained by experimental infection with the SMP2 phage, whose primary receptor is the Omp2 porin. The role of porins was demonstrated in quinolone accumulation assays, where semi-quantitative differences in accumulation were observed. Permeability coefficients to cephaloridine of Omp1 mutants were determined and compared with those of the parental strain. The clinical isolates S. marcescens HCPR1 and 866 showed 30- to 200-fold reduced permeability coefficients when Omp1 porin was absent

The role of Serratia marcescens porins in antibiotic resistance

The outer membrane permeability of Serratia marcescens was studied by comparing porin-deficient mutants with their parental strains. Omp1-deficient strains were selected by moxalactam resistance, whereas mutants lacking the Omp2 porin were obtained by experimental infection with the SMP2 phage, whose primary receptor is the Omp2 porin. The role of porins was demonstrated in quinolone accumulation assays, where semi-quantitative differences in accumulation were observed. Permeability coefficients to cephaloridine of Omp1 mutants were determined and compared with those of the parental strain. The clinical isolates S. marcescens HCPR1 and 866 showed 30- to 200-fold reduced permeability coefficients when Omp1 porin was absent

Impact of antibiotic resistance on chemotherapy for pneumococcal infections

Over the past three decades, penicillin-resistant pneumococci have emerged worldwide. In addition, penicillin-resistant strains have also decreased susceptibility to other β-lactams (including cephalosporins) and these strains are often resistant to other antibiotic groups, making the treatment options much more difficult. Nevertheless, the present in vitro definitions of resistance to penicillin and cephalosporins in pneumococci could not be appropriated for all types of pneumococcal infections. Thus, current levels of resistance to penicillin and cephalosporin seem to have little, if any, clinical relevance in nonmeningeal infections (e.g., pneumonia or bacteremia). On the contrary, numerous clinical failures have been reported in patients with pneumococcal meningitis caused by strains with MICs ≥ 0.12 μg/ml, and penicillin should never be used in pneumococcal meningitis except when the strain is known to be fully susceptible to this drug. Today, therapy for pneumococcal meningitis should mainly be selected on the basis of susceptibility to cephalosporins, and most patients may currently be treated with high-dose cefotaxime (±) vancomycin, depending on the levels of resistance in the patient's geographic area. In this review, we present a practical approach, based on current levels of antibiotic resistance, for treating the most prevalent pneumococcal infections. However, it should be emphasized that the most appropriate antibiotic therapy for infections caused by resistant pneumococci remains controversial, and comparative, randomized studies are urgently needed to clarify the best antibiotic therapy for these infections

Conservação pós-colheita de frutos de araçá-vermelho em função do estádio de maturação e temperatura de armazenamento

O presente trabalho objetivou estudar os efeitos do estádio de maturação e temperatura de armazenamento sobre a fisiologia de araçá-vermelho. Frutos colhidos nos estádios de maturação verde (coloração vermelha da epiderme < 20%) e maduro (coloração vermelha da epiderme > 50%) foram armazenados nas temperaturas de 0; 5; 10; 20 e 30ºC (UR de 85-90%) para a quantificação das taxas respiratórias e alterações na coloração da epiderme (L='lightness' e hº=ângulo 'hue'). Houve aumento substancial na taxa respiratória com o aumento na temperatura de armazenamento de 0 a 30ºC, com Q10 @ 2,7. Frutos colhidos no estádio de maturação verde apresentaram, em relação a frutos colhidos no estádio maduro, sensível redução na qualidade, caracterizada pelo menor teor de sólidos solúveis e maior acidez, porém melhor retenção de firmeza e de coloração da epiderme (com menor alteração na coloração de verde para vermelho), especialmente quando armazenados a 0ºC, e menor incidência de podridões. Frutos de araçá-vermelho devem ser colhidos no estádio maduro e imediatamente armazenados a temperaturas próximas de 0ºC, visando a prolongar a sua conservação, já que apresentam elevadas taxas respiratórias e rápido amadurecimento à temperatura ambiente (20ºC).

Preservação da qualidade pós-colheita de araçá-vermelho através do tratamento com 1-metilciclopropeno e do acondicionamento em embalagens plásticas, sob refrigeração

O objetivo deste trabalho foi estudar o padrão respiratório e de produção de etileno, e os efeitos do tratamento com diferentes doses de 1-metilciclopropeno (1-MCP) e do acondicionamento em diferentes embalagens plásticas, associado à refrigeração, na preservação da qualidade pós-colheita de araçá-vermelho. Os frutos apresentaram comportamento climatérico de respiração e produção de etileno. Frutos tratados com doses crescentes de 1-MCP (0; 100; 300; 600 e 1.200 nL L-1) e armazenados a 10±1C/90±5% UR, durante 10 dias, apresentaram retardo substancial no amadurecimento, através da preservação da textura e inibição na mudança de cor da epiderme. Frutos acondicionados com diferentes filmes (polietileno de baixa densidade, policloreto de vinila e à base de náilon) apresentaram, em termos gerais, melhor preservação da textura e menores mudanças na cor da epiderme e perdas de massa fresca, durante armazenamento refrigerado (5C e 10C). Os resultados demonstram que os frutos de araçá-vermelho apresentam elevada perecibilidade, caracterizada pelas elevadas taxas respiratórias e de produção de etileno, sendo mais bem preservados quando refrigerados, e tratados com 1-MCP ou acondicionados em embalagens plásticas.

Potential impact of environmental bacteriophages in spreading antibiotic resistance genes

The idea that bacteriophage transduction plays a role in the horizontal transfer of antibiotic resistance genes is gaining momentum. Such transduction might be vital in horizontal transfer from environmental to human body-associated biomes and here we review many lines of evidence supporting this notion. It is well accepted that bacteriophages are the most abundant entities in most environments, where they have been shown to be quite persistent. This fact, together with the ability of many phages to infect bacteria belonging to different taxa, makes them suitable vehicles for gene transfer. Metagenomic studies confirm that substantial percentages of the bacteriophage particles present in most environments contain bacterial genes, including mobile genetic elements and antibiotic resistance genes. When specific genes of resistance to antibiotics are detected by real-time PCR in the bacteriophage populations of different environments, only tenfold lower numbers of these genes are observed, compared with those found in the corresponding bacterial populations. In addition, the antibiotic resistance genes from these bacteriophages are functional and generate resistance to the bacteria when these genes are transfected. Finally, reports about the transduction of antibiotic resistance genes are on the increase.

Tratamentos pré-germinativos em sementes de araçá-boi (Eugenia stipitata)

O araçá-boi (Eugenia stipitata) é uma fruteira nativa com grande potencial agroindustrial. Suas sementes são intolerantes ao dessecamento e apresentam dormência, o que dificulta sua propagação. O objetivo do trabalho foi analisar as características de germinação das sementes de araçá-boi submetidas a diferentes tratamentos pré-germinativos: retirada parcial do tegumento, lixiviação e fracionamento. A germinação das sementes intactas e com retirada parcial do tegumento foi realizada em dois ambientes: casa de vegetação e viveiro telado com sombrite de 50%. Para a lixiviação, as sementes foram colocadas em balde e submetidas à lixiviação, em água corrente, por até 90 dias, com intervalos de 10 dias. O fracionamento das sementes foi realizado de acordo com a posição da zona meristemática de protrusão da raiz e parte aérea (fracionamento transversal e longitudinal). A retirada parcial do tegumento das sementes de araçá-boi diminui o tempo médio de germinação de 91 para 48 dias, com 100% de emergência. As sementes de araçá-boi mantidas submersas em água corrente por até 50 dias mantêm a viabilidade e o vigor. As frações de sementes que apresentam a protuberância meristemática formam plântulas normais, com as mesmas características de germinação das sementes intactas, porém os diferentes tipos de fracionamento não aceleraram nem uniformizaram a germinação das sementes.

Caracterização fisico-química e sensorial de geleia de mamão com araçá-boi

Foram elaboradas quatro formulações de geleia com as seguintes proporções de mamão (Carica papaya) (M) e araçá-boi (Eugenia stipitata) (AB): F1 (70% M: 30% AB), F2 (60% M: 40% AB), F3 (40%M : 60% AB) e F4 (30% M : 70% AB). Todas as formulações apresentaram proporção final de polpa e açúcar de 1:1, com 0,5% de pectina e teor de 65% de sólidos solúveis. As geleias foram analisadas quanto às características físico-químicas e sensoriais (teste de aceitação e preferência). O teste de aceitação foi realizado por 50 consumidores, por meio de escala hedônica de 7 pontos, avaliando-se os atributos: aparência, cor, aroma, sabor e textura. A acidez titulável variou entre 0,77 e 1,72 g de ácido cítrico100 g-1, estando dentro da faixa de acidez determinada para diferentes geleias de frutas. O teor de açúcares redutores foi mais elevado na formulação F4. As formulações apresentaram índice de aceitação acima de 90% para os atributos aparência, cor, aroma e textura. As formulações F1 e F2, com menores concentrações de araçá-boi, apresentaram maior aceitação para os atributos sensoriais cor e sabor. Entretanto, a formulação F1 apresentou elevada intenção de compra e foi considerada pelo mapa de preferência interno a mais aceita para todos os atributos avaliados, sendo, portanto, a mais adequada para a industrialização e consumo.