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RESUMO Objetivo: Avaliar a atividade antibacteriana contra Staphylococcus aureus e Pseudomonas aeruginosa de dois revestimentos endotraqueais com nanopartículas e fotocatálise sob luz visível. Métodos: Testaram-se dois tipos de nanopartículas de titânio: anatase padrão (TiO2) e TiO2 nano-dopada (N-TiO2). As nanopartículas foram colocadas em superfície interna de segmentos de tubos endotraqueais comerciais, aplicadas sobre um filtro de acetato de celulose; os tubos endotraqueais controle foram deixados sem revestimento de nanopartículas. Em cada tubo endotraqueal foi inoculado um total de 150 unidades formadoras de colônia e, a seguir, estes foram expostos a uma fonte de luz fluorescente (3700 lux, comprimento de onda de 300 - 700nm) por 5, 10, 20, 40, 60 e 80 minutos. Contaram-se as Unidades Formadoras de Colônia após 24 horas de incubação a 37ºC. A inativação bacteriana foi calculada como a redução porcentual do crescimento bacteriano em comparação a tubos não expostos à luz. Resultados: Na ausência de luz, não se observou qualquer atividade antibacteriana relevante contra qualquer das cepas estudadas. Para P. aeruginosa, ambos os revestimentos tiveram inativação bacteriana mais elevada do que o controle em qualquer dos momentos de avaliação (p < 0,001), sendo que não se observaram diferenças entre o revestimento padrão e nano-dopado. Para S. aureus, a inativação foi maior que os controles, começando a partir de 5 minutos para nano-dopado (p = 0,018) e 10 minutos para o revestimento padrão (p = 0,014); a inativação com a forma nano-dopada foi maior do que com a forma padrão aos 20 minutos (p < 0,001), 40 minutos (p < 0,001) e 60 minutos (p < 0,001). Conclusões: O revestimento com nanopartículas de titânio comercial padrão e nano-dopado inibiu o crescimento bacteriano sob a luz fluorescente visível. o revestimento nano-dopado teve maior atividade antibacteriana contra S. aureus em comparação à atividade observada com o revestimento com anatase padrão. ABSTRACT Objective: The aim of this study was to assess the antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa of two nanoparticle endotracheal tube coatings with visible light-induced photocatalysis. Methods: Two types of titanium dioxide nanoparticles were tested: standard anatase (TiO2) and N-doped TiO2 (N-TiO2). Nanoparticles were placed on the internal surface of a segment of commercial endotracheal tubes, which were loaded on a cellulose acetate filter; control endotracheal tubes were left without a nanoparticle coating. A bacterial inoculum of 150 colony forming units was placed in the endotracheal tubes and then exposed to a fluorescent light source (3700 lux, 300-700 nm wavelength) for 5, 10, 20, 40, 60 and 80 minutes. Colony forming units were counted after 24 hours of incubation at 37°C. Bacterial inactivation was calculated as the percentage reduction of bacterial growth compared to endotracheal tubes not exposed to light. Results: In the absence of light, no relevant antibacterial activity was shown against neither strain. For P. aeruginosa, both coatings had a higher bacterial inactivation than controls at any time point (p < 0.001), and no difference was observed between TiO2 and N-TiO2. For S. aureus, inactivation was higher than for controls starting at 5 minutes for N-TiO2 (p = 0.018) and 10 minutes for TiO2 (p = 0.014); inactivation with N-TiO2 was higher than that with TiO2 at 20 minutes (p < 0.001), 40 minutes (p < 0.001) and 60 minutes (p < 0.001). Conclusions: Nanosized commercial and N-doped TiO2 inhibit bacterial growth under visible fluorescent light. N-TiO2 has higher antibacterial activity against S. aureus compared to TiO2.

Supplemental Digital Content is available in the text., Objective: Ventilator-associated event surveillance was introduced in the National Healthcare Safety Network in 2013, replacing surveillance for ventilator-associated pneumonia in adult inpatient locations. We determined incidence rates and characteristics of ventilator-associated events reported to the National Healthcare Safety Network. Design, Setting, and Patients: We analyzed data reported from U.S. healthcare facilities for ventilator-associated events that occurred in 2014, the first year during which ventilator-associated event surveillance definitions were stable. We used negative binomial regression modeling to identify healthcare facility and inpatient location characteristics associated with ventilator-associated events. We calculated ventilator-associated event incidence rates, rate distributions, and ventilator utilization ratios in critical care and noncritical care locations and described event characteristics. Measurements and Main Results: A total of 1,824 healthcare facilities reported 32,772 location months of ventilator-associated event surveillance data to the National Healthcare Safety Network in 2014. Critical care unit pooled mean ventilator-associated event incidence rates ranged from 2.00 to 11.79 per 1,000 ventilator days, whereas noncritical care unit rates ranged from 0 to 14.86 per 1,000 ventilator days. The pooled mean proportion of ventilator-associated events defined as infection-related varied from 15.38% to 47.62% in critical care units. Pooled mean ventilator utilization ratios in critical care units ranged from 0.24 to 0.47. Conclusions: We found substantial variability in ventilator-associated event incidence, proportions of ventilator-associated events characterized as infection-related, and ventilator utilization within and among location types. More work is needed to understand the preventable fraction of ventilator-associated events and identify patient care strategies that reduce ventilator-associated events.

Human soluble triggering receptor expressed on myeloid cells (sTREM -1) is a glycoprotein of the immunoglobulin superfamily. In normal lung tissue, sTREM -1 is selectively expressed in lung alveolar macrophages specialized for pathogen clearance and is up-regulated in the presence of bacteria and fungi. The aim of this study was to assess sTREM -1 levels in serum and lungs of patients with ventilator associated pneumonia (VAP) and to evaluate its potential diagnostic role. The study cohort included 31 patients meeting the criteria for VAP, including clinical, microbiological, radiological and laboratory findings in patients on mechanical ventilation for more than 48 hours and with Clinical Pulmonary Infection Score (CPIS) >6. Serum and lung levels of sTREM -1 were obtained and tested for differences. The samples were analyzed using ELI SA technique and the values were expressed in pg/mL. The samples for lung sTREM -1 were obtained from direct bronchial lavage fluid and serum samples from peripheral blood. Differences were tested by Mann Whitney U test with p, Humani topljivi okidački receptor izražen na mijeloidnim stanicama (sTREM -1) je glikoprotein iz superporodice imunoglobulina. U normalnom plućnom tkivu sTREM -1 je selektivno izražen na makrofazima plućnih alveola, koji su specijalizirani za uklanjanje patogena, te podliježe regulaciji naviše u prisutnosti bakterija i gljiva. Cilj ove studije bio je procijeniti razine sTREM -1 u serumu i plućima bolesnika s upalom pluća povezanom s uređajem za umjetno disanje (VAP), kao i njegovu moguću dijagnostičku vrijednost. Ispitivanje je obuhvatilo 31 bolesnika koji su zadovoljavali kriterije za VAP, uključujući kliničke, mikrobiološke, radiološke i laboratorijske nalaze bolesnika priključenih na mehaničku ventilaciju kroz više od 48 sati i sa zbirom CPIS (Clinical Pulmonary Infection Score) većim od 6. Izmjerene su serumske i plućne razine sTREM -1 i izračunate razlike među njima. Uzorci su analizirani pomoću tehnike ELI SA, a vrijednosti su izražene u pg/mL. Uzorci za procjenu sTREM -1 u plućima dobiveni su direktnom bronhijalnom lavažom, a uzorci seruma iz periferne krvi. Razlike su testirane Mann Whitneyevim U testom uz razinu značajnosti P

Background: This study evaluates the bacterial pathogens of Ventilator-associated pneumonia (VAP) in a tertiary referral hospital. Methods: A total of 109 bacterial pathogens from 91 adult patients with VAP, who were admitted to the medical intensive care unit from January 2008 to December 2009, were examined. Clinical characteristics, bacterial pathogens, and resistance profiles were analyzed. Results: Staphylococcus aureus (44%) was the most frequently isolated. Acinetobacter baumanii (30%), Pseudomonas aeruginosa (12%), Stenotrophomonas maltophilia (7%), Klebsiella pneumoniae (6%), and Serratia marcescens (2%) were isolated from the transtracheal aspirates or bronchoalveolar lavage in patients with VAP. There was no significant difference of bacterial pathogens between early and late onset VAP. All isolated S. aureus were methicillin resistant S. aureus; the imipenem resistance rate of A. baumanii was 69%. Conclusion: The two most frequent pathogens of VAP were S. aureus and A. baumanii. There were no pathogenic differences between early and late onset VAP.