Frecuencia de Bacilos Gram Negativos en la cavidad bucal de estudiantes de una Universidad de Asunción

Introducción: La cavidad bucal hospeda una gran cantidad de microorganismos, como los bacilos Gram negativos, y entre ellas, bacterias de gran importancia médica debido a su capacidad de producir enfermedades graves para el ser humano, especialmente en pacientes inmunodeprimidos. El objetivo de este trabajo fue determinar la presencia de Bacilos Gram Negativos y sus patrones de resistencia a antibióticos, en una población estudiantil de la ciudad de Asunción, en los años 2019 y 2020. Materiales y métodos: Se realizó un estudio observacional, descriptivo de corte transversal, donde se realizaron hisopados de la cavidad bucal a 35 alumnos de entre 18 a 24 años, de una universidad privada en la ciudad de Asunción. Se requirió consentimiento informado firmado por los participantes y fueron excluidos quienes tuvieron tratamientos antibióticos. Las muestras fueron obtenidas con un hisopo de algodón, posteriormente se colocaron en un medio de transporte para luego ser cultivadas en Agar MacConkey. El cultivo se realizó por 48 horas a 37° centígrados, luego se procedió a la identificación bacteriana. Por último, se realizó el antibiograma. Resultados: De los 35 alumnos se encontró una frecuencia de 48,57% de bacilos Gram negativos. Cepas de Klebsiella pneumoniae fueron las más frecuentes (35,29%). Se observó que las bacterias eran altamente resistentes a la Amoxicilina/Ácido Clavulánico. Conclusiones: La presencia de estos tipos de microorganismos puede ser peligrosa para la salud general de las personas, específicamente de los pacientes con algún tipo de inmunodepresión, debido a la gran la resistencia a antibióticos presentadas por algunas cepas.

Introduction: The oral cavity hosts a large number of microorganisms, such as Gram negative bacilli, and among them, bacteria of great medical importance due to their capacity to cause serious diseases for humans, especially in immunosuppressed patients. The objective of this work was to determine the presence of Gram Negative Bacilli and their patterns of resistance to antibiotics, in a student population of the city of Asunción, in the years 2019 and 2020. Materials and methods: An observational, descriptive cross-sectional study was carried out, where oral cavity swabs were made from 35 students between 18 and 24 years of age, from a private university in the city of Asunción. Informed consent signed by the participants was required and those who had antibiotic treatments were excluded. The samples were obtained with a cotton swab, later they were placed in a transport medium to later be cultured in MacConkey Agar. The culture was carried out for 48 hours at 37° Celsius, then the bacterial identification was carried out. Finally, the antibiogram was performed. Results: Of the 35 students, a frequency of 48,57% of Gram negative bacilli was found. Klebsiella pneumoniae strains were the most frequent (35.29%). The bacteria were found to be highly resistant to Amoxicillin/Clavulanic Acid. Conclusions: The presence of these types of microorganisms can be dangerous for the general health of people, specifically of patients with some type of immunosuppression, due to the great resistance to antibiotics presented by some strains.

Antimicrobial action, pH, and tissue dissolution capacity of 2,5% sodium hypochlorite gel and solution / Ação antimicrobiana, pH, e capacidade de dissolução tecidual de gel e solução de hipoclorito de sódio 2,5%

Objective: to evaluate antimicrobial action, pH, and tissue dissolution capacity of 2.5% sodium hypochlorite (NaOCl) gel and solution. Methods: The 2.5% NaOCl gel was produced from a colloidal base. The test groups included 2.5% NaOCl gel and solution and the control groups included gel base and distilled water. The antimicrobial activity was evaluated by the broth dilution technique against Enterococcus faecalis (ATCC 29212) at 15 and 30 seconds and at 1, 5, and 10 minutes. To evaluate tissue dissolution capacity, 30 pulp fragments of bovine incisors were weighed, 10 for each test group and 5 for each control group before and after exposure to the chemical auxiliaries. The final mass percentage of each fragment was calculated. The pH of the substances was measured in triplicate through a digital pH meter. Results: pH levels of 13.08 and 9.75 were observed for 2.5% NaOCl solution and gel, respectively. The antimicrobial action of 2.5% NaOCl was the same for both solution and gel, for all tested times. The 2.5% NaOCl solution group showed higher tissue dissolution capacity (Kruskal-Wallis and Student-Newman-Keuls tests P<0.0001). Conclusions: The type of medium, either solution or gel, containing 2.5% NaOCl did not influence the antimicrobial action at any of the tested times. However, 2.5% NaOCl gel did not present tissue dissolution capacity

Objetivo: avaliar a ação antimicrobiana, pH e capacidade de dissolução tecidual promovida por hipoclorito de sódio (NaOCl) 2,5%, nas formas líquida e gel. Métodos: O gel de NaOCl 2,5% foi produzido a partir de base coloidal. Os grupos testes foram NaOCl 2,5% gel e solução e os grupos controle incluíram a base gel e água destilada. A ação antimicrobiana foi avaliada por meio de método de diluição em caldo, frente a Enterococcus faecalis (ATCC 29212) após 15 e 30 segundos, e também a 1, 5 e 10 minutos. Para o teste de diluição tecidual, 35 fragmentos de polpa bovina (sendo 10 para cada grupo teste e 5 para o grupo controle) foram pesadas antes e após a exposição aos auxiliares químicos. O percentual de massa final de cada fragmento foi calculada. O pH dos auxiliares químicos foi medido em pHmetro digital, em triplicata. Resultados: Valores de pH iguais a 13,08 e 9,75 foram observados para solução e para o gel de NaOCl, respectivamente. A ação antimicrobiana do NaOCl foi a mesma para o gel e a solução, em todos os períodos testados. Maior capacidade de dissolução tecidual foi obtida no grupo onde se utilizou a solução de NaOCl 2,5% (Testes de Kruskal-Wallis e Student-Newman-Keuls, P<0,0001). Conclusões: A apresentação na forma de gel ou de líquido do NaOCl 2,5% não modificou a ação antimicrobiana em qualquer um dos períodos testados. Porém, o gel de NaOCl 2,5% não demonstrou capacidade de dissolução tecidual.

Bacterial culture of bile from patients with obstructive jaundice and antibiotic sensitivity / 中国内镜杂志

Objective To investigate the characteristics of microbial isolates and the positive rate from bile cultures taken from obstructive jaundice patients, then compare the antimicrobial sensitivities to guide the rational choice and use of antibiotics. Methods Bile cultures from 322 patients from January 2012 to April 2016 were reviewed. Specimens were obtained from patients that were diagnosed obstructive jaundice. The bile specimens were examined for pathogenic respectively. At the same time, the empirical antibiotics of the 322 cases prior to operation were also analyzed. Results Bile culture was positive in 246 among322 cases, the positive culture rate was 76.40%. A total of 267 pathogens were isolated in bile culture: 208 Gram-negative bacteria, 48 Gram-positive bacteria and 11 fungus. The most common pathogens in all were Escherichia coli (208 strains, 53.18%), Enterococcus faecium (28 strains, 10.49%), Klebsiella pneumoniae (27 strains, 10.11%). The most sensitive antibiotics against Gram-negative bacteria were imipenem and meropenem (with susceptibility rate for 98.08%, respectively). The more sensitive antibiotics against Gram-negative bacteria were efoperazone/sulbactam, amikacin, piperacillin/tazobactam (susceptibility 92.31%, 88.46% and 85.58%). The lowest susceptibility rate of Gram-negative to twelve kings of antimicrobial agents were levofloxacin, andaztreonam (susceptibility 29.81%, 28.37%). The most sensitive antibiotics against Gram-positive bacteria were linezolid, teicoplanin and vancomycin(with susceptibility rate for 100.00%, respectively). The more sensitive antibiotics against Gram-positive bacteria was chloromycrtin (susceptibility 88.89%). The lower susceptibility rate of Gram-positive were levofloxacin (susceptibility 25.00%). 281 cases of patients before surgery empirical use of antimicrobial drugs. Monotherapy was used in 219 cases. The main drug was levofloxacin (86/219), the second was cefoperazone/sulbactam (70/219). The dual therapy was used in 62 cases, the mainly was cefoperazone/sulbactam plus ornidazole or metrornidazole(27/62), the second was levofloxacin plus ornidazole or metrornidazole (12/62). Conclusions Gram negative bacteria were the predominant bile pathogens found in patients with obstructive jaundice. And the most prominent Gram-negative pathogens were Escherichia coli. The sensitive rates of cefoperazone/sulbactam, amikacin and piperacillin/tazobactam were higher, which could be used as the preferred antimicrobial agents. Imipenem and meropenem should remain the last alternative when all other therapies fail or serious infection; The empirical antibiotics's pertinence was not very suitable, levofloxacin's resistance rates in obstructive jaundice was higher. It should be avoided to choose during empirical antimicrobial therapy.

Efeito antimicrobiano e modulador do óleo essencial extraído da casca de frutos da Hymenaea courbaril L / Antimicrobial effect and modulator of essential oil extracted from the fruits peel of Hymenaea courbaril L

O Jatobá (Hymenaea courbaril L.) possui um amplo histórico de utilização, seus frutos são compostos por óleos essenciais, taninos, substâncias amargas, matérias resinosas e pécticas, amido e açúcares, O objetivo deste estudo foi avaliar a atividade antimicrobiana e moduladora do óleo essencial extraído da casca de frutos da Hymenaea courbaril L, (OEHc) sobre cepas de S, aureus oxacilina sensíveis (OSSA) de referência, Para a avaliação da atividade antimicrobiana foram determinadas as Concentrações Inibitória (CIM) e Letal Mínimas (CLM) do OEHc e o efeito do tempo de exposição a concentrações do OEHc, o efeito modulador do OEHc sobre antibióticos de uso clínico foi avaliado pelo teste de difusão em ágar modificado, OEHc inibiu o crescimento das cepas de S, aureus ATCC 6538P (CIM = CLM = 0,28% v/v) e S, aureus ATCC 14458 (CIM = 0,28% v/v, CLM = 0,56% v/v), A CLM do OEHc foi capaz de inviabilizar as cepas OSSA testadas em 8 horas (S, aureus ATCC 6538P) e 24 horas (S, aureus ATCC 14458) e a CIM inibiu o crescimento de S, aureus ATCC 14458 até 48h de exposição, A ação moduladora do OEHc na atividade de antibióticos de uso clínico variou com o ATM e com a cepa testada, Os resultados encontrados mostram que o OEHc possui uma boa atividade antimicrobiana sobre a espécie Gram-positivo S, aureus, revelando seu efeito modulador sinérgico quando associado a antibióticos de uso clínico, demonstrando ser o OEHc um forte candidato para o desenvolvimento de fármacos com atividade antimicrobiana...

Jatobá (Hymenaea courbaril L.) has an extensive history of use, its fruits are composed of essential oils, tannins, bitter substances, resinous and pectic materials, starch and sugars. The objective of this study was to evaluate antimicrobial activity and effect of essential oil extracted from the rind of fruits of Hymenaea courbaril l. (OEHc) about reference strains of S. aureus oxacillin susceptible (OSSA). For the evaluation of antimicrobial activity were determined Inhibitory (MIC) and Lethal (CLM) Minimum Concentrations from OEHc and the effect of time of exposure to concentrations of OEHc, OEHc modulator effect on antibiotics of clinical use was assessed by modified agar diffusion test. OEHc inhibited the growth of S. aureus strains ATCC 6538P (CIM = CLM = 0,28% v/v) and S. aureus ATCC 14458 (CIM = 0,28% v/v; CLM = 0,56% v/v). The CLM from OEHc was able to derail the OSSA strains tested in 8 hours (S. aureus ATCC 6538P) and 24 hours (S. aureus ATCC 14458) and the CIM inhibited the growth of S. aureus ATCC 14458 until 48 hours of exposure. The modulatory action of the antibiotic activity of OEHc clinical use ranged with the ATM and with the strain tested. The results show that the OEHc has a good antimicrobial activity on the species Gram-positive S. aureus, revealing its synergistic modulator effect when associated with antibiotics of clinical use, demonstrating the OEHc a strong candidate for the development of drugs with antimicrobial activity...

Efficacy and safety of oral fosfomycin trometamol for the treatment of lower urinary tract infections caused by multi drug resistant bacteria：an open-label, uncontrolled, multicenter study / 中华泌尿外科杂志

Objective To assess the efficacy and safety of oral fosfomycin trometamal in patients with lower urinary tract infections ( UTIs) caused by multi drug resistant ( MDR) bacteria in the clinical setting in China.Methods Multicenter study was conducted from January 2011 to December 2011 in 12 hospitals in China.Three hundred and fifty-six patients with non-fever lower UTls were treated by fosfomycin trometamal 3 g once daily.Three hundred and fifty cases with complete data were further evaluated .One hundred and twenty ( 34.3%) were male and 230 ( 65.7%) were female.The average age was ( 49.9 ± 16.6) years.Depending of the results of urine culture at the first visit ,142 patients with E.coli, Klebsiella pneumonia, proteus, Staphylococcus aureus, Staphylococcus epidermidis and entercocous were analyzed.The susceptibility of MDR bacteria to fosfomycin trometamol were calculated . The clinical efficacy , bacteriological efficacy of fosfomycin trometamol to these patients was evaluated .Results For the gram-negative bacteria detected by culture , among the E.coli, Klebsiella pneumonia and proteus, 50%(52/104) were Extended-Spectrum β-lactamases producing organisms . For the gram-positive bacteria ( n =38 ) detected by culture, methicillin-resistant staphylococcus accounts for 55%(11/20) of all the Staphylococcus and the other gram-positive bacteria were Enterococcus ( n=18 ) .Higher susceptibility rates to fosfomycin trometamol were observed among MDR bacteria (85.7%) and the clinical effective rate and bacteriological effective rate of fosfomycin trometamol were 96.4%( 53/55 ) and 87.5%( 42/48 ) , respectively .The incidence of drug-related adverse events (AEs) was 5.6%(20/356).The most common AE was diarrhea. No drug-related serious adverse events were found .Conclusions The distributions of uropathogens in China are complicated. The detection rate of MDR uropathogens is high . The dosing regimen of fosfomycin trometamal 3 g once daily is effective and tolerable for the patients with lower UTIs caused by MDR bacteria . It may represent good options for the empiric therapy for the patients with lower UTIs .

Atividade biológica da jurema-preta (Mimosa tenuiflora (Wild) Poir. ) sobre Staphylococcus aureus isolado de casos de mastite bovina / Biological Activity of jurema preta (Mimosa tenuiflora (Wild) Poiret) on Staphylococcus aureus isolated of mastitis cattle

O objetivo deste estudo foi avaliar a sensibilidade do Staphylococcus aureus ao extrato da jurema-preta (Mimosa tenuiflora (Wild) Poir.). Foram isoladas 25 cepas de S. aureus de amostras de leite de vacas com histórico de mastite clínica e subclínica, submetidas ao teste de atividade antimicrobiana do extrato de M. tenuiflora. Os testes de sensibilidade in vitro foram realizados utilizando o método de difusão em meio sólido. Em seguida foram inoculados 50 μL do extrato nas seguintes diluições 1:1; 1:2; 1:4; 1:8; 1:16; 1:32; 1:64; 1:128; 1:256; 1:512. As placas foram incubadas a 37 °C, por um período de 24 a 48 h. Os ensaios foram realizados em triplicata. Observou-se halos de inibição entre 6 e 25 mm de diâmetro. O percentual de sensibilidade das amostras testadas foi distribuido em: 1:1 a 1:32 (100 por cento); 1:64 (92 por cento); 1: 128 (72 por cento); 1:256 (28 por cento); 1:512 (0 por cento). O estudo da M. tenuiflora sobre as amostras de S. aureus testadas demonstrou que a planta tem ação antimicrobiana.

The aim of this study was to evaluate the sensitivity of the S.aureus to the extract of Mimosa tenuiflora (Wild) Poir. (jurema-preta). Twenty five strains of S. aureus were isolated from milk samples with description of clinical and subclinical mastitis and submitted to antimicrobial activity test of the M. tenuiflora extract. The sensitivity in vitro tests were carried out using the agar difusion method (well diffusion method). After that, 50μL of the extract were inoculated in the following dilutions: 1:1; 1:2; 1:4; 1:8; 1:16; 1:32; 1:64; 1:128; 1:256; 1:512. The plates were incubated at 37 ºC during 24 and 48 h. The tests were made in triplicate. Halos of inhibition were observed between 6 and 25 mm of diameter. The percentage of sensitivity of the tested samples was distributed in: 1:1 to 1:32 (100 percent), 1:64 (92 percent); 1: 128 (72 percent); 1:256 (28 percent); 1:512 (0 percent). The study of M. tenuiflora on the tested S. aureus samples it demonstrated that the plant has antimicrobial action.

Estudio de susceptibilidad a tigeciclina: Influencia del agar Mueller-Hinton en el método de difusión en agar y validación del método E-test® para Acinetobacter baumannii / In vitro evaluation of tygecicline: Influence of Mueller-Hinton agar in agar diffussion methods and validation of E-test® for Acinetobacter baumannii

Tigecycline is a glicylcicline with broad antimicrobial spectrum. Susceptibility testing to this drug for Acinetobacter is difficult in hospitals due to the utilization of the disk diffusion method. FDA break points have shown an unacceptable rate of errors (23 percent) for disk diffusion versus broth microdilution in American studies and overcall of resistance depending on the brand of Mueller Hinton agar used. Modifications to these FDA break points have been proposed, but there is not enough evidence yet. Data from a multicenter study from Chile allowed the evaluation of the characteristics of the agar used for susceptibility testing and the utility of E-test as an alternative MIC method for Acinetobacter. The Mueller Hinton agar brand is an important factor that affects disk diffusion method results. There is very good correlation between broth microdilution and E-test for the susceptibility category as well as for MIC determination. The intermedíate and resistant results obtained with disk diffusion method should be checked by using E-test.

Tigeciclina es una glicilciclina de amplio espectro antimicrobiano. La determinación de la susceptibilidad a este fármaco presenta dificultades en el laboratorio asistencial al utilizar la técnica de difusión por disco para Acinetobacter spp. Los puntos de corte -según la (FDA- han mostrado una tasa inaceptable de errores (23 por ciento) en comparación con el método de micro-dilución en caldo en estudios americanos, diversas evaluaciones demuestran que existe una sobreestimación de resistencia in vitro dependiendo de las características del agar Mueller Hinton utilizado. Se han propuesto modificaciones a los puntos de corte pero no se han oficializado por insuficientes evidencias. Los datos de un estudio multicéntrico realizado en Chile permitieron evaluar la influencia de las distintas marcas de medios de cultivo en el tamaño de los halos y la utilidad de la epsilometría (E-test®) como método CIM para Acinetobacter sp. La marca de agar Mueller Hinton y otros factores propios del medio dificultan la determinación de la susceptibilidad a tigeciclina utilizando difusión por disco. Existe muy buena correlación entre la micro-dilución en caldo y el E- test®, tanto para la categoría de susceptibilidad como para la CIM. Por esto, se sugiere que los resultados intermedios o resistentes obtenidos por difusión en agar para A. baumannii sean comprobados mediante el uso de E-test®.

Cultivation and drug sensitive test of bile bacteria in patients with bile duct diseases during endoscopic retrograde cholangiopancreatography / 中华消化内镜杂志

Objective To observe the bacterioflora of bile and it' s drugs sensitivity in patients with bile duct diseases to serve as a guidance in medication. Methods Bile of 156 cases of patients with biliary disease was collected and cultured respectively during endoscopic retrograde cholangiopancreatography (ER-CP) by deep cannulation and sucking out bile through the catheter. Forty eight blood samples among them were cultured simultaneously. Ten kinds of drug papers were used to investigate the bacterial sensitivity. The data were analysed statistically- Results Bacteria positive rate of these 156 bile samples was 62. 8% , including Gram - negative bacteria (81.6% ) and Gram - positive bacteria (18. 4% ). These bacteria consist of Pseudomonas aeruginosa (35. 1% ) , Escherichia coli(22. 8% ) , Streptococcus faecalis (16.7%) ,Entero bacilliaerogenes(7. 9% ) ,Klebsiella(7. 0% ) , Citrobacter(6. 1% ) ,Acinetobacler lwqffi(2. 6% ) and Staphylo-coccus aureus( 1. 7% ). The bacteria positive rate was only 4. 2% in the 48 blood samples. Drug sensitive rates of bacteria against 10 kinds of drugs were changed in recent years. The result indicated that the sensitive rates of bacteria were significantly higher in ciprofloxacin, fortum, cefoperazone, sulbactam + cefoperazone and cilastatin than those in ampicillin,azlocillin, cefazolin sodium, eefuroxime(P