Eficácia de um protocolo de higiene bucal com utilização de solução de clorexidina a 0,12% na prevenção de pneumonias associadas à ventilação mecânica (PAVM) e os efeitos sobre a microbiota da mucosa bucal de pacientes internados em unidades de terapia intensiva

A presente investigação teve como objetivo avaliar a prática de cirurgiões dentistas em uma unidade de terapia intensiva (UTI) de um hospital militar, o estabelecimento de um protocolo de higiene oral e os seus efeitos sobre a redução de pneumonias associadas à ventilação mecânica (PAVM). As percepções da equipe da UTI sobre as atividades dos cirurgiões dentistas também foram avaliadas por meio de um questionário. O perfil de colonização microbiana da mucosa oral antes e depois do estabelecimento das medidas de higiene oral também foi avaliado tanto por diluição e plaqueamento em meios de cultura microbiológicos seletivos e enriquecidos e através da amplificação pelo método de PCR e eletroforese em gel desnaturante em gradiente (DGGE), subsequente ao sequenciamento dos amplicons. A carga microbiana foi avaliada após a contagem de placas de agar e através da amplificação por PCR em tempo real (qPCR) do gene rrs nas amostras. O protocolo de higiene oral, realizado pelos cirurgiões dentistas, foi capaz de reduzir a incidência de PAVM (p <0,05). O questionário revelou que a modificação da halitose foi percebida por 93,33% dos participantes. A redução da ocorrência das úlceras orais e dos lábios durante a internação dos pacientes foi observada por 80% da equipe da UTI. Foi observada a redução da produção das secreções nasais e bucais por 70% da equipe dos profissionais da UTI. Para 86,66% dos participantes a assistência aos pacientes tornou-se mais agradável após a instituição dos cuidados bucais. O protocolo, realizado com a utilização de solução 0,12% de clorexidina, não foi capaz de evitar a colonização da mucosa oral por patógenos microbianos usualmente encontrados no ambiente hospitalar tais como os bastonetes Gram-negativos entéricos e não fermentadores, nem foi capaz de eliminá-los quando tais micro-organismos já se encontravam presentes antes dos procedimentos de higiene bucal. Alguns Bastonetes Gram-positivos (Lactobacillus sp e corinebactérias) e Staphylococcus epidermidis permaneceram após a realização dos procedimentos. O protocolo de higiene oral permitiu a redução da carga microbiana na mucosa oral de 50% dos pacientes considerando-se o método de contagem microbiana e para 35% dos pacientes pela avaliação dos números de cópias de genes rrs através de qPCR. Em conclusão, o protocolo de higiene oral desenvolvido pelos cirurgiões dentistas foi capaz de reduzir a incidência de PAV na UTI, embora não tenha sido capaz de prevenir a colonização da mucosa oral por supostos patógenos microbianos. O protocolo de higiene oral com a participação ativa dos cirurgiões dentistas foi bem aceito pelos profissionais da UTI e foi capaz de melhorar a qualidade da assistência aos pacientes críticos.

Determinação do perfil fenotípico e genotípico de amostras de Staphylococus aureus resistentes à meticilina (MRSA) e sensíveis a antibióticos não ß-lactâmicos em cinco hospitais no município do Rio de Janeiro

Staphylococcus aureus resistente à meticilina (MRSA) é um dos principais microrganismos envolvidos nas Infecções relacionadas à Assistência à Saúde (IrAS). Porém, um clone de MRSA, o CA-MRSA, emergiu na comunidade e atualmente vem sendo agente de IrAS. O objetivo desta dissertação é avaliar fenotípica e genotipicamente 111 amostras de Staphylococcus aureus resistentes à meticilina e sensíveis a antibióticos não ß-lactâmicos de pacientes atendidos em cinco hospitais no município do Rio de Janeiro. Utilizando os critérios padronizados pelo CLSI 2012, foram determinadas as susceptibilidades a 11 antimicrobianos pelo método de disco difusão em ágar e concentração inibitória mínima para vancomicina e oxacilina pelo método da microdiluição em caldo. A multirresistência (resistência a 3 ou mais antimicrobianos não ß-lactâmicos) foi observada em 31,5% das amostras, sendo que 53,2% apresentaram resistência ao antimicrobiano clindamicina, uma das opções para o tratamento empírico das infecções de pele/tecidos moles. 86,4% apresentaram concentração inibitória mínima (CIM) para vancomicina ≥ 1,0 g/mL ou seja, elevado percentual de amostras associadas ao fenômeno MIC creep, o qual está associado ao insucesso na terapia antimicrobiana anti-MRSA. Não foi observado até o momento nenhuma amostra com CIM ≥ 4cg/mL para vancomicina, entretanto, já há resistência à linezolida em quatro hospitais do estudo. A tipificação do SCCmec nos permitiu classificar 4,5% das amostras em HA-MRSA e 86,5% em CA-MRSA, nas quais a resistência heterogênea típica à oxacilina foi observada em 57,2%. A toxina de Panton-Valentine (PVL) foi identificada pela metodologia de PCR em 28% das amostras com genótipo CA-MRSA. Os fatores de riscos clássicos, da literatura, relacionados à infecção por HA-MRSA foram também observados nos pacientes com infecção por CA-MRSA portadoras de SCCmec IV e V. No intuito de verificar a existência de similaridades genéticas ou a presença de clone predominante entre as amostras dos cinco hospitais, foi realizada a técnica de eletroforese em gel sob campo pulsado (PFGE) e observou-se diversidade genética assim como a presença de amostras com padrões similares aos clones OSPC (18,5%) e USA400. Não foram encontradas amostras com padrões de eletroforese similares aos clones USA300, USA800 e CEB. É essencial a vigilância da resistência aos antimicrobianos não ß-lactâmicos no CA-MRSA, em especial à vancomicina. A mudança na epidemiologia deste microrganismo vem impactando os padrões característicos dos genótipos limitando os critérios de diferenciação entre eles. Neste contexto, as técnicas moleculares atuam como excelentes ferramentas de caracterização. O conhecimento do patógeno auxilia na elaboração e implementação de medidas preventivas, contribuindo para o controle da doença tanto no ambiente hospitalar quanto na comunidade.

Achromobacter xylosoxidans na fibrose cística: infecção crônica e disseminação clonal

A mortalidade na Fibrose Cística (FC) é decorrente de infecções pulmonares causadas comumente por: Pseudomonas aeruginosa, Staphylococcus aureus e espécies do Complexo Burkholderia cepacia (CBc). Mais recentemente, tem sido observada a emergência de BGN-NF raros, como Achromobacter xylosoxidans, porém, sua prevalência, potencial de transmissão e significado clínico são desconhecidos. O objetivo deste trabalho foi verificar a ocorrência de colonização crônica por A. xylosoxidans e avaliar a possibilidade de transmissão cruzada entre os pacientes acompanhados em dois centros de referência na cidade do Rio de Janeiro. Foram incluídos 39 pacientes com FC, com pelo menos uma cultura positiva para o gênero Achromobacter spp., em um total de 897 analisadas, do período de janeiro de 2003 a dezembro de 2008. A frequência de isolamento de Achromobacter spp. nas culturas analisadas foi de 14,5% (130 em 897 culturas). A maioria (n=122; 93,8%) foi identificada como A. xylosoxidans por testes fenotípicos e pelo sequenciamento do gene rrs que codifica o 16S rRNA. A análise do polimorfismo genético dos isolados de A. xylosoxidans pela técnica de PFGE, mostrou 22 grupos clonais. Destes, sete foram compartilhados entre pacientes distintos sugerindo transmissão cruzada. Apenas o clone G foi amplamente disseminado entre 56,4% dos pacientes estudados, sugerindo a possibilidade de um surto. Os 15 clones restantes constituíram-se em clones exclusivos por pacientes. Os cinco pacientes colonizados cronicamente por A. xylosoxidans mostraram a prevalência de clones únicos. Até o momento, este é o primeiro caso da ocorrência de surto por A. xylosoxidans em pacientes com Fibrose Cística. A. xylosoxidans é um microrganismo que vem se destacando em frequência e como um possível patógeno pulmonar nesses pacientes. Entretanto, até o momento os dados são insuficientes para avaliar a sua contribuição para a evolução da doença pulmonar. Estudos que busquem elucidar as características de A. xylosoxidans que o permitem colonizar persistentemente o pulmão dos pacientes com FC, bem como seu potencial de virulência, são necessários.

Investigation on bacterial flora of farmed freshwater prawn (Macrobrachium rosenbergii de Man) in Bangladesh

Total bacterial load in the haemolymph of freshwater prawn Macrobrachium rosenbergii varied from 6.2x10⁴ to 1.9x10⁷ CFU/ml whereas in the hepatopancreas, bacterial load varied from 1.9x10³ to 2.9x10⁵ CFU/g. The total bacterial load in the pond water varied from 2.6x10² to 4.1x10⁵ CFU/ml. The isolated bacterial genera in the haemolymph and the hepatopancreas of prawn were Streptococcus, Acinetobacter, Micrococcus, Aeromonas, Vibrio, Flavobacterium, Staphylococcus and Pseudomonas, whereas the detected bacterial genera in pond water were Micrococcus, Streptococcus, Vibrio, Flavobacterium, Staphylococcus, Pseudomonas and Aeromonas. Among the detected genera, Vibrio and Staphylococcus were found to be dominant genera in the haemolymph of the sampled prawn throughout the study period whereas Staphylococcus and Pseudomonas were dominant in pond water.

Incidence of ulcer disease in African catfish (Clarias gariepinus Burchell) and trial for its chemotherapy

Young Clarias gariepinus cultured in an artificial tank were severely affected by an ulcer type of disease where 77% fish died within 5 weeks. From the lesions and kidney of affected fish Aeromonas, Pseudomonas, Flavobacterium, Micrococcus and Staphylococcus were isolated where Aeromonas was observed as the dominant bacteria. Among them, an A. hydrophila isolate AGK 34 was detected as a pathogen by the experimental challenge test. In order to find out a suitable remedial measure of the disease, four different chemotherapeutants were applied to the affected fish in 6 different ways under laboratory condition. Affected fish were recovered from the disease in different treatments. But the best result was obtained by a successive bath in 1-2% NaCl and subsequent oral treatment with commercial oxytetracycline at a dose of 75 mg/kg body weight of fish.

Microbiological quality of some iced fishes of Imphal market, Manipur

Imphal is the main marketing centre of fish in Manipur. As fish production of the state is not sufficient to meet the demands, about 120 metric tons of iced fishes are annually brought from other states and sold in this market. Microbiological quality of iced Wallago attu, Labeo rohita, L. gonius and Aorichthy aor in respect of total fungal count (TFC), total plate count of bacteria (TPC), Most Probable Number (MPN) of coliforms, Streptococci, Staphylococcus, Salmonella and Escherichia coli in four tissues (skin, muscle, gill and intestine) were analysed. In all cases, the counts were highest in the gills and lowest in the muscles. The values of TFC, TPC, coliforms, Streptococci and Staphylococci were 0-10³/g 10(sup)6-10⁸/g, 2-α/g, 10-10⁵/g, 10-10⁵/g respectively. E. coli and Salmonella were not detected in any of the samples while the ice used in the preservation contained 10⁵-10⁷ of TPC per gram. The microbiological qualities of the iced fishes of Imphal market were adjudged poor. The extremely high counts of bacteria might be due to (1) poor quality and left over fishes being packed, (2) contact with contaminated ice and (3) repeated thawing and freezing during the process of marketing and transportation.

Antibacterial effect of the Indian squid, Loligo duvauceli (d'Orbigny), ink

The ink of the Indian squid Loligo duvauceli (d'Orbigny) was tested for antibacterial activity. The antibacterial effect of bacteria present in the ink gland was also tested. Only one type of bacteria was found to be present in the ink gland of squid and was identified as Photobacterium leiognathi. Among the various forms of ink extracts, the precipitated and freeze-dried ink showed more pronounced antibacterial effect against Gram-negative bacteria, Salmonella, spp. Escherichia coli, Vibrio cholerae, V. parahaemolyticus and Pseudoinonas spp., and a less pronounced effect against Gram-positive bacteria, Staphylococcus spp. and Micrococcus spp., P. leiognathi did not inhibit any of the above bacteria. The antibacterial activity was associated with the compounds of the ink.

Bacterial quality and depuration of the green mussel Perna viridis from natural beds

Green mussel (Perna viridis) and sea water from their natural beds on the coastal areas of Porto Novo were studied between April and August 1996 for their bacterial quality. Water samples from the beds were also analysed for their physico-chemical parameters. The total bacterial count of mussels from natural beds as well as bed waters ranged 10³ organisms per gram of mussel meat suspension and per milliliter of sea water. The faecal coliforms were found to be within the permissible limits. Pathogenic bacteria such as Salmonella spp., Streptococcus spp. and Staphylococcus spp. were absent. The variations in pH, temperature, salinity and dissolved oxygen of the seawater samples were insignificant. The mussels were subjected to depuration by different methods among which chlorination was found to be most effective.

Survival of Staphylococci on frozen fish

Using Staphylococcus aureus as the test culture it has been shown that cell injury occurs in two phases during freezing and storage at temperatures below freezing. Certain constituents of fish muscle appear to protect the cells during both phases of injury. The survival of bacteria on fish muscle is not influenced by the rate at which the fish muscle was frozen prior to inoculation. There was no significant difference between growth of bacteria on quick frozen and slow frozen fish muscle after thawing. However there appeared to be a slight tendency for the lag phase of growth to be extended on thawed quick frozen fish muscle when compared with thawed slow frozen muscle.

A survey of process hygiene in the Sri Lankan prawn industry. 2. The hygiene status of personnel

Of 262 personnel tested, 137 (52%) were found to be positive for Staphylococcus aureus. Among individual companies the prevalence of S. aureus ranged from 92% (Company No. 1) to 22% (Company No. 2). Although five companies provided a sanitiser hand-dip, this was found to be ineffective for the control of S. aureus. Provision of hand-washing facilities, of protective clothing and of toilet facilities was found to be inadequate for an export food industry.

An anionic antimicrobial peptide from toad Bombina maxima

Amphibian skin is a rich resource of antimicrobial peptides like maximins and maximins H from toad Bombina maxima. A novel cDNA clone encoding a precursor protein that comprises maximin 3 and a novel peptide. named maximin H5. was isolated from a skin cDNA library of B. maxima. The predicted primary structure of maximin H5 is ILGPVLGLVSDTLDDVLGIL-NH2,. Containing three aspartate residues and no basic amino acid residues. maximin H5 is characterized by an anionic property. Different from cationic maximin H peptides. only Gram-positive strain Staphylococcus aureus was sensitive to maximin H5. while the other bacteria] and fungal strains tested ere resistant to it. The presence of metal ions. like Zn2+ and Mg2+, did not increase its antimicrobial potency. Maximin H5 represents the first example of potential anionic antimicrobial peptides from amphibians, The results provide the first evidence that. together kith cationic antimicrobial peptides. anionic antimicrobial peptides may also exist naturally as part of the innate defense system. (C), 2002 Elsevier Science (USA). All rights reserved.

Incidence of ulcer type of disease in wild fishes of Bangladesh

Disease occurred in wild fish species investigated in different water bodies like canals, ditches, beel, haor, flood plain in 17 districts of Dhaka division. Haemorrhagic lesions were observed on the body surface of affected fishes. Incidence of the disease in the investigated water bodies ranged from 0 to 100%. In total 19 fish species were found to be affected and prevalence of infection ranged from 0.0 to 100.0%. Channa punctatus and Puntius ticto were severely affected in all locations. Percentage of infection in these fishes ranged from 0.0 to 100.0. The highest infection was observed in Netrokona, Kishoreganj, and Mymensingh districts. Bacterial genera isolated from the lesions of these affected fishes were Aeromonas, Pseudomonas, Flavobacterium, Micrococcus, and Staphylococcus. Among these isolates Aeromonas was the dominant. Abundance of Aeromonas in the lesions among the investigated bacteria ranged from 75 to 90%. Five identified Aero monas lrydrophila were examined for their pathogenicity and were able to infect the experimental fish, silver barb (Puntius gonionotus). The pathogen Aeromonas hydrophila was thus considered to have an association with the outbreak of ulcer type of disease in the investigated fish species.

A novel family of antimicrobial peptides from the skin of Amolops loloensis

While conducting experiments to investigate antimicrobial peptides of amphibians living in the Yunnan-Sichuan region of southwest China, a new family of antimicrobial peptides was identified from skin secretions of the rufous-spotted torrent frog, Amolops loloensis. Members of the new peptide family named amolopins are composed of 18 amino acids with a unique sequence, for example, NILSSIVNGINRALSFFG. By BLAST search, amolopins did no show similarity to any known peptides. Among the tested microorganisms, native and synthetic peptides only showed antimicrobial activities against Staphylococcus aureus ATCC2592 and Bacillus pumilus, no effects on other microorganisms. The CD spectroscopy showed that it adopted a structure of random combined with beta-sheet in water, Tris-HCl or Tris-HCl-SDS. Several cDNAs encoding amolopins were cloned from the skin cDNA library of A. loloensis. The precursors of amolopin are composed of 62 amino acid residues including predicted signal peptides, acidic propieces, and mature antimicrobial peptides. The preproregion of amolopin precursor comprises a hydrophobic signal peptide of 22 residues followed by an 18 residue acidic propiece which terminates by a typical prohormone processing signal Lys-Arg. The preproregions of precursors are very similar to other amphibian antimicrobial peptide precursors but the mature amolopins are different from other antimicrobial peptide families. The remarkable similarity of preproregions of precursors that give rise to very different antimicrobial peptides in distantly related frog species suggests that the corresponding genes form a multigene family originating from a common ancestor. (C) 2008 Elsevier Masson SAS. All rights reserved.

Novel cathelicidin-derived antimicrobial peptides from Equus asinus

In the present study, EA-CATH1 and EA-CATH2 were identified from a constructed lung cDNA library of donkey (Equus asinus) as members of cathelicidin-derived antimicrobial peptides, using a nested PCR-based cloning strategy. Composed of 25 and 26 residues, respectively, EA-CATH1 and EA-CATH2 are smaller than most other cathelicidins and have no sequence homology to other cathelicidins identified to date. Chemically synthesized EA-CATH1 exerted potent antimicrobial activity against most of the 32 strains of bacteria and fungi tested, especially the clinically isolated drug-resistant strains, and minimal inhibitory concentration values against Gram-positive bacteria were mostly in the range of 0.3-2.4 mu g center dot mL-1. EA-CATH1 showed an extraordinary serum stability and no haemolytic activity against human erythrocytes in a dose up to 20 mu g center dot mL-1. CD spectra showed that EA-CATH1 mainly adopts an alpha-helical conformation in a 50% trifluoroethanol/water solution, but a random coil in aqueous solution. Scanning electron microscope observations of Staphylococcus aureus (ATCC2592) treated with EA-CATH1 demonstrated that EA-CATH could cause rapid disruption of the bacterial membrane, and in turn lead to cell lysis. This might explain the much faster killing kinetics of EA-CATH1 than conventional antibiotics revealed by killing kinetics data. In the presence of CaCl2, EA-CATH1 exerted haemagglutination activity, which might potentiate an inhibition against the bacterial polyprotein interaction with the host erythrocyte surface, thereby possibly restricting bacterial colonization and spread.

Inhibition of seafood-borne bacteria in cooked mackerel (Rastrelliger kanagurta) fish meat by lactic acid bacteria

Antagonistic activity of lactic acid bacteria (LAB) namely Streptococcus faecalis, Pediococcus cerevisiae and Lactobacillus casei was tested against seafood-borne bacteria such as Staphylococcus aureus, Bacillus cereus, Escherichia coli, Clostridium perfringens and Listeria monocytogenes. Three lactic acid bacteria such as Streptococcus faecalis, Lactobacillus casei and Pediococcus cerevisiae were coated on cooked mackerel meat, individually and in combination against fish-borne bacteria. S. faecalis inhibited C. perfringens in individual coat by 3.7 log units as compared to control, whereas L. casei did not inhibit C. perfringens. P. cerevisiae inhibited S. aureus by 5 log units. L. casei, inhibited L. monocytogenes by 3.3 log units on the third day of storage as compared to control. On the other hand, S. aureus and B. cereus were inhibited on the third and second day by 4.9 log and 5.2 log units respectively. B. cereus, S. aureus, L. monocytogenes were the most sensitive to all three LAB. C. perfringens was the least inhibited among all the seafood-borne bacteria tried. Multiple LAB or LAB strains in combination showed much earlier inhibitory activity on seafood-borne bacteria than single LAB coat.