Caption: Scanning electron microscope image of A. baumannii, with maps of its genome (outer circle) and alien island sequences (inner circle – red).
Credit: Courtesy of J.Carr/CDC; T.Gianoulis and D.Massa/Yale

Comunidade internacional divulga alerta para infecções resistentes a remédios

Normalmente encontrada no solo e na água, uma perigosa e resistente bactéria se alastra por hospitais de todo o mundo, inclusive do Brasil, alertaram especialistas em doenças infecciosas em artigo publicado esta semana na revista médica “The Lancet”. De acordo com os médicos, a Acinetobacter baumannii seria ainda mais ameaçadora do que a MRSA (uma variante muito resistente de Staphylococcus aureus) e a Clostridium difficile: ela já responde por pelo menos 30% das infecções hospitalares resistentes a drogas.

— Há um crescente aumento de infecções por A baumannii em vários hospitais em todo o mundo — afirmou, em entrevista à Reuters, Matthew Falagas, da Universidade de Tufts, em Boston, e do Instituo Alfa de Ciências Biomédicas, na Grécia, co-autor do artigo ao lado de Drosos Karageorgopoulos. — E são infecções muito difíceis de tratar porque as bactérias são resistentes à maioria dos medicamentos disponíveis.

Brasil já registrou casos de infecção

Especialistas em infecção hospitalar no Brasil já estão cientes da ameaça da bactéria e de sua presença em centros de saúde no país há algum tempo.

— Do mesmo modo que em outros países, não somente as Staphylococcus aureus resistentes à meticilina, conhecidos como MRSA, têm preocupado nossa comunidade médicocientífica.

Surtos de infecções hospitalares causadas por A. baumannii, sensíveis somente ao antibiótico colistina, têm sido descritos, há alguns anos, no Brasil — diz Agnes Marie Sá Figueiredo, diretora do Instituto de Microbiologia da Universidade Federal do Rio de Janeiro (UFRJ).

De acordo com o artigo da “Lancet”, o papel da A. baumannii em graves infecções diagnosticadas em pacientes criticamente doentes é cada vez mais claro. “Esse patógeno está associado a surtos de infecção muito difíceis de serem controlados”, destaca o texto.

Alguns médicos estão lançando mão de uma classe de antibióticos conhecidos como polimixinas para combater a infecção.

Essas drogas não são usadas há 20 anos para esta finalidade, em parte por causa dos efeitos colaterais que apresentam, entre eles problemas renais. “Isso significa que os médicos precisam de novas drogas para combater a bactéria”, sustentou Falagas. “Mas a melhor arma para deter o avanço da A. baumannii ainda é lavar bem as mãos. Essa é a medida mais importante de prevenção para os que trabalham em hospitais.” Mas não apenas. A limpeza das instalações hospitalares e dos equipamentos utilizados é ainda mais importante, sustentam especialistas em infecções resistentes.

A A. baumannii compartilha muitas das piores características da MRSA e da Clostridium difficile, como a sobrevivência em superfícies secas e a resistência à maioria dos desinfetantes. A A. baumannii sobrevive na poeira e até na roupa de cama por meses.

Ela também pode ser transportada na pele de pessoas saudáveis. Tudo isso torna muito difícil a erradicação da bactéria depois que ela se instala em alguma instituição, explicam os especialistas, e revelam a importância da limpeza rigorosa na prevenção.

A A. baumannii provoca infecções sangüíneas e pneumonia, entre outros problemas.

Especialistas dizem que a bactéria não representa uma ameaça às pessoas saudáveis e que mesmo para as linhagens mais resistentes ainda existem drogas eficazes. No entanto, dizem, a questão é preocupante.

Schools in Several States Report Staph Infections, and Deaths Raise the Alarm

Bill Crandall for The New York Times

The nurse, Jenny Jones, and the principal, William Gregory, at a Maryland high school where there were staph infections.

By IAN URBINA

The New York Times

SANDY SPRING, Md., Oct. 18 — When the football players here at Sherwood High School were not getting the message about washing their uniforms and using only their own jerseys, the school nurse paid a surprise visit to the locker room. She brought along a baseball bat.

“Don’t make me use this,” the nurse, Jenny Jones, said, pointing out that seven players on the team had already contracted a deadly drug-resistant strain of bacteria this year. “Start washing your hands,” she said. “I mean it.”

School officials around the country have been scrambling this week to scrub locker rooms, reassure parents and impress upon students the importance of good hygiene. The heightened alarm comes in response to a federal report indicating that the bacteria, methicillin-resistant Staphylococcus aureus, or MRSA, are responsible for more deaths in the United States each year than AIDS.

MRSA (pronounced MEER-suh) is a strain of staph bacteria that does not respond to penicillin or related antibiotics, though it can be treated with other drugs. The infection can be spread by sharing items, like a towel or a piece of sports equipment that has been used by an infected person, or through skin-to-skin contact with an open wound.

On Wednesday and Thursday, scores of schools were closed and events were canceled in Connecticut, Maryland, North Carolina, Ohio and Virginia as cleaning crews disinfected buses, lockers and classrooms. More closings are planned on Friday.

School officials in Mississippi, New Hampshire and Virginia reported student deaths within the past two weeks from the bacteria, while officials in at least four other states reported cases of students being infected.

The federal report, written by doctors at the Centers for Disease Control and Prevention, found that nearly 19,000 people had died in the United States in 2005 after an invasive MRSA infection. The study also suggested that such infections might be twice as common as previously thought.

This week, health officials began reporting a growing number of cases in schools, gyms and day care centers, and not just in nursing homes and hospitals, as has often been the case in the past.

Nicole Coffin, a spokeswoman at the centers, said that while the results of the study are striking, it is important to realize that about 85 percent of the infections reported from the bacteria were in health care settings.

“MRSA in the community is typically a mild skin infection that rarely becomes life-threatening,” she said, adding that even when it does become more severe, the death rates for this type of infection are low.

Here in Sandy Spring, students seem to be getting the message that they need to take extra care.

“I think they’re taking it seriously now,” William Gregory, the principal at Sherwood High School, said of members of the football team. “She is pretty emphatic,” he said, pointing to Ms. Jones. “But the students are also seeing the reports of deaths, and that has reminded them.”

He added that as he visits locker rooms now, the tell-tale stench is gone from athletes’ uniforms, and students are calling him and the nurse diligently when cuts do not seem to be healing.

Elsewhere in the state, more than two dozen staph infections have been reported by four Anne Arundel County high schools over the past three weeks. County officials sent letters to parents explaining that crews have been scrubbing schools with hospital-grade disinfectant.

Ashton Bonds was one of the rare cases of a death from MRSA contracted outside a health care facility. Mr. Bonds, a 17-year-old football player from Staunton River High School in Moneta, Va., died Monday from the bacteria.

“He put up a fight,” said Veronica Bonds, Ashton’s mother. “He was strong. I just think he was just tired, too.”

In response to the death, students throughout the county protested what they called unsanitary conditions in their school buildings.

Although school officials have observed that the bacteria mostly affect student athletes, cases have been reported in children of elementary school age as well.

“I worry about her getting sick anyway, but I don’t want her to catch something that will make her very, very ill,” said Kelli Stammen about her 2-year-old daughter, who attends city-sponsored recreation and library classes in Grove City, Ohio, where a 17-year-old high school student was put in intensive care unit in September with a staph infection.

The C.D.C. study found that 27 percent of all invasive MRSA infections originated in hospitals, while 58 percent began outside of a hospital but in patients with some recent exposure to the health care system.

The remaining 15 percent of invasive MRSA cases originated in the community without any apparent health care risk factor.

Bob Driehaus contributed reporting from Cincinnati.