RESUMO OBJETIVO: Medir o tempo de esvaziamento gástrico de uma dieta semi-sólida em indivíduos com megaesôfago chagásico, em comparação com um grupo controle não-chagásico. MÉTODO: O tempo necessário para o esvaziamento gástrico de uma dieta semi-sólida foi avaliada por meio de ultrassonografia, em 28 pacientes com megaesôfago Chagásico (graus I, II, e III) e comparado com o de um grupo de controle (n = 15). Após medida do diâmetro antral em jejum, 400mL de uma dieta semi-sólida foram administradas e medidas consecutivas foram realizadas a cada 30min. RESULTADOS: A duração da disfagia foi significativamente menor nos pacientes com megaesôfago grau I do que naqueles com graus II ou III. O tempo de esvaziamento gástrico foi significativamente aumentado no grupo megaesôfago em comparação com o grupo de controle. As médias de áreas antrais medidas em jejum e após a distensão antral máxima não diferiram entre os grupos megaesôfago e controle. CONCLUSÃO: O tempo de esvaziamento gástrico de uma dieta semi-sólida foi significativamente maior em pacientes com megaesôfago chagásico que nos controles. O atraso não depende da extensão da dilatação do megaesôfago ou da duração clínica da disfagia.

OBJECTIVE: To measure the time to gastric emptying of a semi-solid diet in individuals with Chagasic megaesophagus, in comparison with a non-Chagasic control group. METHOD: The time to gastric emptying of a semi-solid diet was assessed via ultrasonography in 28 patients with Chagasic megaesophagus (grades I, II, and III) and compared to that of a control group (n = 15). After measurement of antral diameter under fasting conditions, 400mL of a semi-solid diet were administered and consecutive measurements were performed every 30 min. RESULTS: The duration of dysphagia was significantly lower in patients with megaesophagus grade I than in those with grades II or III. The time to gastric emptying was significantly increased in the megaesophagus group compared to the control group. The means of antral areas measured under fasting conditions and after maximal antral distension did not differ between the megaesophagus and control groups. CONCLUSION: The time to gastric emptying of a semi-solid diet was significantly greater in patients with Chagasic megaesophagus than in controls. The delay did not depend on the extent of dilatation of the megaesophagus or the duration of dysphagia.

INTRODUCTION: Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature. OBJECTIVES AND METHODS: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. RESULTS: Most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%), Acinetobacter baumannii (21%) e Pseudomonas aeruginosa (20%). Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii. CONCLUSION: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. RESULTS: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.

The aim of this study was to estimate the additional cost of treatment of a group of nosocomial infections in a tertiary public hospital. A retrospective observational cohort study was conducted by means of analyzing the medical records of 34 patients with infection after total knee arthroplasty, diagnosed in 2006 and 2007, who met the criteria for nosocomial infection according to the Centers for Disease Control and Prevention. To estimate the direct costs of treatment for these patients, the following data were gathered: length of hospital stay, laboratory tests, imaging examinations, and surgical procedures performed. Their costs were estimated from the minimum values according to the Brazilian Medical Association. The estimated cost of the antibiotics used was also obtained. The total length of stay in the ward was 976 days, at a cost of US$ 18,994.63, and, in the intensive care unit, it was 34 days at a cost of US$ 5,031.37. Forty-two debridement procedures were performed, at a cost of US$ 5,798.06, and 1965 tests (laboratory and imaging) were also performed, at a cost of US$ 15,359.25. US$ 20,845.01 was spent on antibiotics and US$ 1,735.16 on vacuum assisted closure therapy, microsurgical flaps, implant removal, spacer use, and surgical revision. The total additional cost of these cases of hospital infection in 2006 and 2007 was of US$ 91,843.75. Based on that, we demonstrate that the high cost of treatment for hospital infections emphasizes the importance of taking measures to prevent and control hospital infection.