Características epidemiológicas de la Osteomielitis aguda en niños internados en un hospital infeccioso de referencia

Introducción: La osteomielitis aguda es una infección del hueso que afecta principalmente a los niños y tiene generalmente diseminación hematógena, a veces asociada a un trauma. En la etiología influyen factores, como la edad, el estado inmunológico y las enfermedades concomitantes. En la mayoría de los casos, el principal agente etiológico es Staphylococcus aureus. Es importante el diagnóstico oportuno para evitar secuelas a mediano o largo plazo. Objetivo: Describir las características epidemiológicas de un grupo de pacientes con osteomielitis aguda. Métodos: Se realizó la revisión retrospectiva de los expedientes clínicos de pacientes egresados del servicio de pediatría del Instituto de Medicina Tropical, entre enero de 2016 y diciembre de 2020, con diagnóstico de osteomielitis aguda. Resultados: Los varones con osteomielitis corresponden al 67,8% del total de 59 casos registrados, en cuanto a los signos y síntomas, el dolor, la tumefacción y la impotencia funcional fueron predominantes, la fiebre se documentó en 49 (83,1%) pacientes, se registró antecedentes de cirugía en 37 (62,7%) de los pacientes y complicaciones en 42 (71,2%) de los pacientes, la complicación más frecuente fue osteomielitis crónica El sitio anatómico más frecuente fueron los miembros inferiores. El tratamiento empírico fue realizado con cefalosporinas de 3G en 72,9% de los pacientes, ya sea solo o combinado con clindamicina o vancomicina, un paciente con aislamiento de M. tuberculosis recibió tratamiento HRZE. Se aisló algún germen 44 pacientes (74,5%), el microorganismo predominante fue Staphylococcus aureus en 81,8 %, la mitad (52,3%) correspondieron a SAMR Se encontró una alta resistencia a oxacilina del 55,8% y un solo paciente resistente a clindamicina (2,2%). Conclusión Los hallazgos fueron similares a los reportados en la literatura en cuanto a etiología, sitio anatómico afectado y cobertura antibiótica.

Introduction: Acute osteomyelitis is a bone infection that mainly affects children and generally has hematogenous spread, sometimes associated with trauma. The etiology is influenced by factors such as age, immune status, and comorbidities. In most cases, the main etiologic agent is Staphylococcus aureus. Timely diagnosis is important to avoid sequelae in the medium or long term. Objective: To describe the epidemiological characteristics of a group of patients with acute osteomyelitis. Methods: A retrospective review of the clinical records of patients discharged from the pediatric service of the Institute of Tropical Medicine was carried out between January 2016 and December 2020, with a diagnosis of acute osteomyelitis. Results: Men with osteomyelitis correspond to 67.8% of the total of 59 registered cases, in terms of signs and symptoms, pain, swelling and functional impotence were predominant, fever was documented in 49 (83.1%) patients, a history of surgery was recorded in 37 (62.7%) of the patients and complications in 42 (71.2%) of the patients, the most frequent complication was chronic osteomyelitis The most frequent anatomical site was the lower limbs. Empirical treatment was performed with 3G cephalosporins in 72.9% of the patients, either alone or in combination with clindamycin or vancomycin. One patient with M. tuberculosis isolation received HRZE treatment. Some germ was isolated in 44 patients (74.5%), the predominant microorganism was Staphylococcus aureus in 81.8%, half (52.3%) corresponded to MRSA. A high resistance to oxacillin of 55.8% and a only patient resistant to clindamycin (2.2%). Conclusion The findings were similar to those reported in the literature in terms of etiology, affected anatomical site, and antibiotic coverage.

Caracterización molecular de genes de virulencia (lmb, bca y rib) y de resistencia a macrólidos (ermB, ermTR y mefA) en aislamientos clínicos de Streptococcus agalactiae / Molecular characterization of virulence (lmb, bca and rib) and macrolid resistance genes (ermB, ermTR and mefA) in clinical isolates of Streptococcus agalactiae

RESUMEN El objetivo del estudio fue identificar molecularmente los genes de virulencia y resistencia a macrólidos en aislamientos clínicos de Streptococcus agalactiae (EGB), recuperados en 2019 a partir de secreción vaginal (n=9) y orina (n=22), en dos establecimientos de salud de Lima. La identificación y susceptibilidad antimicrobiana se determinaron por el sistema automatizado Vitek® 2, se confirmó la identificación fenotípicamente; la resistencia a macrólidos por el método D-test; la identificación de genes de virulencia (lmb, bca y rib) y de resistencia a macrólidos (ermB, ermTR y mefA) por reacción en cadena de la polimerasa (PCR). El fenotipo y genotipo de resistencia a macrólidos predominante fue cMLSb (12/31) y ermB (11/31), y el gen de virulencia más frecuente fue lmb (23/31). Todos fueron sensibles a penicilina, ampicilina y vancomicina. Estos hallazgos muestran la necesidad de implementar estudios de epidemiología molecular que permitan un adecuado conocimiento y seguimiento de EGB en el Perú.

ABSTRACT The aim of the study was to molecularly identify virulence and macrolide resistance genes in clinical isolates of Streptococcus agalactiae (GBS), recovered in 2019 from vaginal discharge (n=9) and urine (n=22), from two health facilities in Lima. Identification and antimicrobial susceptibility were determined by the Vitek® 2 automated system, identification was confirmed phenotypically; macrolide resistance was determined by the D-test method. Identification of virulence genes (lmb, bca and rib) and macrolide resistance genes (ermB, ermTR and mefA) was carried out by polymerase chain reaction (PCR). The predominant macrolide resistance phenotype and genotype were cMLSb (12/31) and ermB (11/31); the most frequent virulence gene was lmb (23/31). All were sensitive to penicillin, ampicillin and vancomycin. These findings show the need to implement molecular epidemiology studies that allow adequate knowledge and follow-up of GBS in Peru.

Comparative evaluation of susceptibility testing methods for colistin and polymyxin B on isolates of Enterobacteriaceae / 中华检验医学杂志

Objective:To provide a promising and optimal laboratory susceptibility-testing method for the clinical usage of antibiotic (polymyxin), four susceptibility-testing methods were performed and the broth microdilution (BMD) was chosen as the gold standard.Methods:A total number of eighty-eight nonduplicate clinical Enterobacteriaceae specimes were collected from January to December of 2019 in the First Affiliated Hospital, Fujian Medical University. Among the clinical specimens, of which six strains were positive for mcr-1. The minimal inhibitory concentration (MIC) of polymyxin of the clinical specimens were examined by the following methods: (1) broth microdilution, (2) colistin broth disk elution, (3) Vitek-2?, (4)BD PhoenixTM,(5)commercial broth microdilution. With BMD as reference, essential agreement (EA), categorical agreement(CA), very major error(VME) and major error (ME) of polymyxins for different methods were analyzed. The Kappa-consistency testing, paired Chi-square testing and the Spearman-rank correlation testing were used to analyze the consistency between the four antimicrobial susceptibility testing methods and the gold standard.Results:Taking broth microdilution as reference, the EA of colistin broth disk elution, Vitek-2?, BD PhoenixTM, commercial broth microdilution were 94.32% (83/88), 92.05% (81/88), 90.90% (80/88), and 96.59%(85/88), respectively. The CA of all the four methods were 100% (88/88). No VME and ME were recorded for four methods. Moreover, the consistency between four susceptibility testing methods and the gold standard is acceptable (Kappa values=1, P<0.001, McNemar test P=1 and r>0.5, P<0.05). Conclusions:In the present work, four susceptibility testing methods all met the standards recommended jointly by the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing, of which the performance of the commercial broth microdilution and CBDE fared relatively well. Thus, these four methods could be routinely used in clinical microbiology laboratory of our hospital for colistin and polymyxin B susceptibility testing.

Sensibilidad in vitro de cepas chilenas de Cryptococcus neoformans de origen clínico / In vitro susceptibility of Chilean Cryptococcus neoformans strains of clinical source

Resumen Introducción: Las infecciones por levaduras del género Cryptococcus afectan principalmente a pacientes con déficit de la inmunidad mediada por células. Han sido escasos los estudios de sensibilidad realizados para este género en Chile. Objetivos: Determinar la sensibilidad in vitro de Cryptococcus sp a antifúngicos de uso habitual y evaluar la concordancia esencial entre sensibilidad determinada por microdilución en caldo y por difusión en agar con tiras comerciales. Materiales y Método: Estudio descriptivo de 21 cepas aisladas desde liquido céfalo-raquídeo y sangre. Las CIM50 y CIM90 para fluconazol, voriconazol y anfotericina B se determinaron por microdilución en caldo (Sensititre Yeast One®) y por difusión en agar con tiras comerciales (MIC Test Strips). Resultados: Todas las cepas correspondieron a C. neoformans. Los rangos de CIM50 y CIM90 para cada antifúngico estudiado fueron amplios por ambos métodos. La concordancia esencial entre microdilución y difusión en agar con tiras comerciales fue de 24, 62 y 29% para fluconazol, voriconazol y anfotericina B, respectivamente. Conclusiones: La prueba de Sensititre Yeast One® y la de difusión en agar con tiras comerciales, MIC Test Strips, tienen una pobre concordancia esencial para fluconazol y anfotericina B.

Abstract Background: Cryptococcus yeast infections primarily affect immunocompromised patients. There have been few susceptibility studies conducted for this genus in Chile. Aims: To determine the in vitro susceptibility to commonly used antifungals and evaluate the concordance between susceptibility determined by microdilution in broth and commercially available strips. Methods: Descriptive study of 21 Cryptococcus strains, isolated from cerebrospinal fluid and blood. The MIC50 and MIC90 for fluconazole, voriconazole and amphotericin B was determined by broth microdilution (Sensititre Yeast One®) and by commercial drug sensitivity strips (MIC Test Strips). Results: All strains corresponded to C. neoformans. The ranges of MIC50 and MIC90 for each antifungal studied were wide by both methods. The essential agreement between Sensititre Yeast One test and strips was 24, 62 and 29% for fluconazole, voriconazole and amphotericin B, respectively. Conclusions: The Sensititre Yeast One test and MIC Test Strips exhibited poor essential concordance, especially for fluconazole and amphotericin B.

Clinical Evaluation of QMAC-dRAST for Direct and Rapid Antimicrobial Susceptibility Test with Gram-Positive Cocci from Positive Blood Culture Bottles / 대한임상미생물학회지

BACKGROUND: Timely intervention in the treatment of bloodstream infection is important for prescription of appropriate antimicrobials. With prompt determination of the antimicrobial susceptibility of a causative agent, rapid antimicrobial susceptibility test (AST) can help select the appropriate antimicrobial therapy. This clinical study is for evaluation of the clinical performance of the QMAC-dRAST for rapid AST directly from positive blood culture (PBC)s with Gram-positive cocci. METHODS: A total of 115 PBC samples with Gram-positive organisms (76 Staphylococcus spp. and 39 Enterococcus spp.) were evaluated by the QMAC-dRAST system, and their pure culture isolates were evaluated by the MicroScan WalkAway (Beckman Coulter, USA) as the comparative AST system. Thirteen antimicrobial agents were included, and the agreement and discrepancy rates of the QMAC-dRAST system (Quantamatrix Inc., Republic of Korea) compared to the MicroScan WalkAway were calculated. To resolve discrepancies, the broth microdilution method was performed. RESULTS: The QMAC-dRAST system exhibited a categorical agreement rate of 94.9% (1,126/1,187) and an essential agreement rate of 98.3% (1,167/1,187). The QMAC-dRAST system yielded very major (false-susceptible) errors at 1.0% (5/485), major (false-resistant) errors at 1.3% (9/693), and minor errors at 4.0% (47/1,187) compared to the MicroScan WalkAway. The QMAC-dRAST system significantly eliminated 30 hours of total turnaround time by combination of direct inoculation of PBC and an image-based approach. CONCLUSION: The results of the QMAC-dRAST system were highly accurate. Thereby, the QMAC-dRAST may provide essential information to accelerate therapeutic decisions for earlier and adequate antibiotic treatment and patient management in clinical settings.

Antifungal activity of the essential oil of cymbopogon citratus (DC) stapf: an in vitro study

Aim. to evaluate the antifungal potential of the essential oil of cymbopogon citratus by determining the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration (MFC) for candida albicans (ATCC 90029), candida albicans (CBS 562), candida tropicalis (ATCC 705) and candida tropicalis strains (CBS 94), as well as to analyze the possible mechanism of action of the oil through the addition of sorbitol to the culture medium. methods. for the MIC determination, inocula were previously adjusted through spectrophotometry and 100µL were added to the wells of plates already containing the culture medium and 100µL of the serial dilutions of the oil, incubating them in aerobiosis for 24 hours, with subsequent staining by 1 percent TCT. for the MFC, 50µL of the supernatant from the MIC assay wells were dripped onto petri dishes and incubated in aerobiosis for 24 hours. tests were performed in triplicate and data analysed by descriptive statistics. results. It was determined that the MIC for C. albicans was 125 µg/mL while MIC for C. tropicalis was 250 µg/mL, with the essential oil presenting fungicidal effect for both analyzed yeasts. conclusion. the essential oil of cymbopogon citratus does not act at the cellular wall level and demonstrated an antimicrobial effect on candida albicans and candida tropicalis, therefore acting as a fungicide.

Análisis del uso de antibióticos en antibiogramas de urocultivos realizados por un laboratorio clínico de la región centro-occidental de Colombia / Analysis of the use of antibiotics in antibiograms of urine carried out by a clinical laboratory of the central-western region of Colombia

Resumen Introducción: Los antibióticos son moléculas bactericidas/bacteriostáticas que controlan infecciones bacterianas, su uso incorrecto favorece multirresistencia o falla terapéutica en el caso de cepas bacterianas naturalmente resistentes, generando así un riesgo para la salud. Objetivo: Analizar el uso de antibióticos en antibiogramas de urocultivos realizados por un laboratorio clínico (región centro-occidental, Colombia). Materiales y métodos: Estudio descriptivo-retrospectivo. Se tomaron datos de urocultivos y antibiogramas realizados entre abril de 2014 a junio de 2015 por un laboratorio clínico de la región centro-occidental de Colombia. Los datos obtenidos fueron confrontados con los protocolos descritos por el Instituto Nacional de Salud de Colombia. Resultados: Se analizaron 1815 reportes de urocultivos y antibiogramas, identificando 18 especies bacterianas. En el 22,3%(403) de casos se evaluaron y reportaron antibióticos sobre microorganismos naturalmente resistentes. Pseudomonas aeruginosa presentó mayor resistencia, el antibiótico con mayor resistencia fue ácido nalidíxico (66,7%). Conclusión: El estudio mostró que existe un problema en cuanto al manejo, reporte e interpretación de antibiogramas frente a microorganismos naturalmente resistentes, que podría favorecer el desarrollo de multirresistencia en microorganismos sensibles de la flora bacteriana. Una revisión de la bibliografía nacional e internacional, mostró reportes similares; ningún autor menciona resistencias intrínsecas, por lo que los datos de antibiótico resistencia serían sobreevaluados.

Abstract Introduction: Antibiotics are bactericidal/bacteriostatic molecules that control bacterial infections, its misuse favors multidrug or therapeutic failure in the case of naturally resistant bacterial strains, thus generating a health risk. Objective: To analyze the use of antibiotics in urine antibiograms carried out by a clinical laboratory (central-western region, Colombia). Materials and methods: A descriptive-retrospective study was made. Urine and antibiograms data were collected from April 2014 to June 2015 by a clinical laboratory in the central-western region of Colombia. The obtained data was confronted with the protocols described by the National Institute of Health of Colombia. Results: 1815 reports of urine and antibiograms were analyzed, identifying 18 bacterial species. In the 22.3% (403) of cases, antibiotics were evaluated and reported on naturally resistant microorganisms. Pseudomonas aeruginosa showed greater resistance and the antibiotic with the highest resistance was nalidixic acid (66.7%). Conclusion: The study showed that there is a problem in managing, reporting and interpreting antibiograms against naturally resistant microorganisms, which could favor the development of multidrug in sensitive microorganisms of bacterial flora. A review of national and international bibliography showed similar reports; however, no author mentions intrinsic resistances, so the data of antibiotic resistance would be over evaluated.

Perfil microbiológico de infecciones urinarias asociadas a cateterismo permanente en el Hospital de Talca / Microbiological profile of urinary infections associated to permanent catheterization at Hospital de Talca

Urinary tract infection associated to permanent catheterization is the most frequent infection associated to health care. Antibiotic resistance is an increasing problem, thus it is important to know the local pathogenic agents, their resistance and sensibility profiles to use an optimal treatment. OBJECTIVES: Describe the resistance and sensibility profiles in the most frequent microorganisms in urinary tract infections associated to permanent catheterization at the Internal Medicine Service of Hospital Regional de Talca. METHODS: We studied the antibiotic resistance and sensitivity of each microorganism isolated from urinary samples from patients with the antecedent of permanent urinary catheterization at the Internal Medicine Service of Hospital Regional de Talca since January 2013 to December 2016, according to the records at the Cross Infection Unit of this center. OUTCOMES: We collected 69 cases, there were 14 of them with two agents. The highest incidence of urinary tract infections associated to permanent urinary catheterization was at 2014, while the lowest at 2015. The most frequent agents detected were K. pneumoniae (34%), E. coli (20%), P. aeruginosa (20%) and A. baumannii (5%), holding a similar tendency in each year. We found 23 strains of Enterobacteriaceae producing Extended-spectrum ß- Lactamases. In general we found that Carbapenems and Amikacin had the best sensitivity while Nitrofurantoin and Ciprofloxacin had the highest resistance

Concentração inibitória mínima e concentração bactericida mínima de extratos hidroalcoólicos das folhas de Myracrodruon urundeuva All. e Qualea grandiflora Mart. sobre Streptococcus mutans e Lactobacillus casei / Minimum inhibitory concentration and minimum bactericidal concentration of hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves on Streptococcus mutans and Lactobacillus casei

A cárie dentária é uma doença bucal de alta prevalência e impactante em países em desenvolvimento. É causada pela presença de biofilme dentário rico em bactérias acidogênicas e acidúricas, como Streptococcus mutans e Lactobacillus casei. Neste sentido, a fitoterapia tem sido aplicada na odontologia devido ao seu conhecido efeito antimicrobiano, tendo potencial para prevenir doenças como a cárie dentária. Portanto, o presente estudo tem como objetivo testar o potencial antimicrobiano de extratos bruto e etanólico das folhas de Myracrodruon urundeuva (M. urundeuva.) e Qualea grandiflora (Q. grandiflora) sobre S.mutans e L. casei. Para tal, determinaram-se a Concentração Inibitória Mínima (CIM) e a Concentração Bactericida Mínima (CBM). A CIM foi definida como a menor concentração do agente antimicrobiano capaz de inibir 100% o crescimento microbiano (absorbância) em relação aos controles negativos. Para a CBM, alíquotas foram removidas dos poços que não apresentaram nenhuma absorbância (viabilidade, concentrações CIM) e semeadas em placas de ágar BHI, incubadas por 24 h a 37°C em estufa de CO2 5%. A CBM foi determinada considerando a menor concentração dos extratos capaz de impedir o crescimento bacteriano visível. Cepas de S. mutans (ATCC 21175) e L. casei (ATTC 334) foram ativadas em BHI e caldo Rogosa, respectivamente. A CIM foi determinada pela técnica de diluição em microplacas de 96 poços (100 l de extrato + 80 l BHI/Rogosa + 20 l da bactéria diluída em BHI/Rogosa equivalente a 5x105 UFC/mL), as quais foram incubadas por 24 h (S. mutans) e 48 h (L. casei) a 37°C em estufa de CO2 5%. Os extratos de M. urundeuva e Q. grandiflora inicialmente foram diluídos em BHI/Rogosa variando as concentrações entre 2 mg/ml a 0,00012207 mg/ml e os mesmos extratos diluídos em álcool foram avaliados nas concentrações entre 20 mg/ml a 0,00244 mg/ml para S. mutans e L. casei. Não foi possível determinar a CIM e a CBM para os extratos diluídos no BHI/Rogosa. Foram utilizados como controle positivo a clorexidina e como controles negativos BHI/Rogosa com e sem álcool a 5%. As CIMs (CBMs) da M. urundeuva e Q. grandiflora, diluídas em álcool, e clorexidina contra S. mutans foram 2,5 mg/ml (2,5 mg/ml), 5,0 mg/ml (--) e 0,00468 mg/ml (0,00937 mg/ml), respectivamente. Em relação ao L. casei, as CIMs (CBMs) da M. urundeuva e Q. grandiflora, diluídas em álcool, e da clorexidina foram 0,156 mg/ml (0,312 mg/ml), 0,156 0,625 mg/ml (0,312 0,625mg/ml) e 0,00468 mg/ml (0,3 mg/ml), respectivamente. Como conclusão, nosso estudo mostrou que L. casei (ATTC 334) é mais susceptível aos extratos que S. mutans (ATCC 21175) e o extrato M. urundeuva apresenta melhor efeito antimicrobiano que a Q. grandiflora em S. mutans (ATCC 21175), porém os dois extratos apresentam efeito similar sobre L. casei (ATTC 334) e ambos foram inferiores à CHX.(AU)

Dental caries is an oral disease of high prevalence and impact in developing countries. It is caused by the presence of a dental biofilm rich in acidogenic and aciduric bacteria, such as Streptococcus mutans and Lactobacillus casei. Accordingly, phytotherapy has been applied in dentistry due to its known antimicrobial effect, having potential to prevent diseases such as dental caries. Therefore, the present study aims to test the antimicrobial potential of crude and ethanolic extracts of Myracrodruon urundeuva (M. urundeuva) and Qualea grandiflora (Q. grandiflora) leaves on S. mutans and L. casei. For this, the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) were determined. MIC was defined as the lowest concentration of the antimicrobial agent capable of inhibiting 100% the microbial growth in comparison to the negative controls. For MBC, aliquots were removed from the wells that did not show any absorbance (viability, concentrations than MIC) and seeded on BHI agar plates, incubated for 24 h at 37°C and 5% CO2. The MBC was determined considering the lowest concentration of extracts capable of preventing visible bacterial growth. Strains of S. mutans (ATCC 21175) and L. casei (ATTC 334) were activated in BHI and Rogosa broth. MIC was determined by the dilution technique in 96-wells microplates (100 l of extract + 80 l BHI/ Rogosa + 20 l of bacterium diluted in BHI/Rogosa equivalent to 5x105 CFU/ml), which were incubated for 24 h (S. mutans) and 48 h (L. casei) at 37°C and 5% CO2. The extracts were firstly diluted in BHI/Rogosa varying the concentrations between 2 mg/mL and 0.00012207 mg/ml; the same extracts were also diluted in alcohol at concentrations ranging from 20 mg/ml to 0.00244 mg/ml and both tested against S. mutans and L. casei. It was not possible to determine the MIC and MBC for the extracts diluted in BHI/Rogosa. Chlorhexidine was used as positive control, while BHI/Rogosa with or without 5% alcohol were used as negative controls. The MICs (MBCs) of M. urundeuva and Q. grandiflora diluted in alcohol, and clorexidine against S. mutans were 2.5 mg/ml (2.5 mg/ml), 5.0 mg/ml (--) and 0.00468 mg/ml (0.00937 mg/ml), respectively. In respect to L. casei, the MICs (MBCs) of M. urundeuva and Q. grandiflora, diluted in alcohol, and chlorhexidine were 0.156 mg/ml (0.312 mg/ml), 0.156 0.625 mg/ml (0.312 0.625 mg/ml) and 0.00468 mg/ml (0.3 mg/ml), respectively. In conclusion, our study showed that L. casei (ATTC 334) is more susceptible than S. mutans (ATCC 21175) to the extracts and the extract of M. urundeuva has a better antimicrobial effect than Q. grandiflora against S. mutans (ATCC 21175), but both extracts have similar effect on L. casei (ATTC 334) and they were inferior to CHX.(AU)

Distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015: results from a multicenter, retrospective study / 中华血液学杂志

Objective@#To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment.@*Methods@#Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed.@*Results@#The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) .@*Conclusions@#Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.

Caracterização de leveduras isoladas da corrente sanguínea em pacientes atendidos em hospitais públicos do município de Salvador, Bahia, Brasil / Characterization of yeasts isolated from the bloodstream in patients attended at public hospitals in the city of Salvador, Bahia, Brazil

Infecções de corrente sanguínea (ICS) por leveduras são um grave problema de saúde pública. O conhecimento sobre as ICS deve ser regionalizado e este estudo descreve essas características quanto a ocorrência das espécies e o perfil de sensibilidade ao fluconazol pelo método de Disco Difusão como também, utilizando Vitek2 para determinar a concentração inibitória mínima (CIM) em isolados obtidos de pacientes atendidos em hospitais públicos de Salvador/BA...

Bloods tream infections (BSI) yeast are a major public health problem. Knowledge about the ICS should be regionalized and this study describes these characteristics and the occurrence of species and the sensitivity profile to fluconazole by disk diffusion method but also using Vitek2 to determine the minimum inhibitory concentration (MIC) in isolates from patients treated in public hospitals in Salvador / BA...

Influencia de concentrações subinibitórias de agentes antimicrobianos sobre a fisiologia e genética de S. mutans / Influence of subinhibitory concentrations of antimicrobial agents on the physiology and genetics of S. mutans

Streptococcus mutans é conhecido por sua capacidade de aderir, colonizar e formar biofilme nas superfícies dentárias. Para sobreviver na cavidade bucal, S. mutans coordena a expressão de vários genes em resposta aos fatores ambientais, como na presença de agentes antimicrobianos. Os objetivos deste estudo foram: 1) avaliar a influência de concentrações subinibitórias (sub-MIC) de fluoreto de sódio (NaF) e digluconato de clorexidina (Chx) sobre o crescimento planctônico; 2) avaliar a influência desses antimicrobianos em concentrações sub-MIC na formação de biofilme das cepas de S. mutans; 3) avaliar a expressão dos genes covR e vicR de cepas de S. mutans expostas aos sub-MIC de Chx e NaF. Cepas de S. mutans padrão (ATCC 25175 e UA159) e isolada de criança com cárie precoce da infância (3FV2) foram reativadas em BHI caldo e expostas a Chx e NaF para determinação da MIC e MBC. A partir desses valores, curvas de crescimento foram obtidas para as cepas de S. mutans expostas a concentrações sub-MIC de Chx (0,25 x MIC a 0,75 x MIC) e NaF (0,125 x MIC a 0,75 x MIC). Ensaios de biofilme foram realizados para as cepas de S. mutans expostas ou não aos sub-MIC dos agentes antimicrobianos (0,25 x MIC; 0,5 x MIC e 0,75 x MIC). A expressão dos genes covR e vicR foram avaliadas por PCR quantitativo para as cepas de S. mutans em condições planctônicas expostas a 0,125/0,25/0,5 x MIC de NaF e Chx. Os dados obtidos foram submetidos à análise estatística considerando p≤0,05. Os resultados mostraram que subMIC de Chx e de NaF afetaram o crescimento planctônico das cepas de S. mutans, de maneira dose-dependente. Sub-MIC de Chx afetou somente a formação de biofilme de 3VF2 e valores de NaF acima de 0,5 x MIC causaram redução do crescimento do biofilme para todas as cepas testadas, de maneira dose-dependente, com exceção da cepa ATCC 25175, que foi afetada igualmente por todas as concentrações avaliadas. Concentrações sub-MIC gradativas de Chx induziram a expressão crescente do gene vicR das cepas avaliadas. Quando NaF e Chx foram associados, o gene covR teve sua expressão reduzida quando expostas a 0,5 x MIC. Conclui-se que concentrações sub-MICs de NaF acima de 0,5 x MIC causaram redução do crescimento planctônico e em biofilme das cepas de S. mutans. Concentrações sub-MIC de Chx induzem a expressão de vicR podendo favorecer a formação de biofilme pelas cepas de S. mutans(AU)

Streptococcus mutans is known for its ability to adhere, colonize and form biofilm on dental surfaces. To survive in the oral cavity, S. mutans coordinates the expression of several genes in response to environmental factors, such as in the presence of antimicrobial agents. The objectives of this study were: 1); to evaluate the influence of subinhibitory concentrations (sub-MIC) of chlorhexidine (Chx) and sodium fluoride (NaF) on planktonic growth 2) to evaluate the influence of sub-MIC of these agents on biofilm formation of S. mutans strains; 3) to evaluate the expression of the covR and vicR genes of S. mutans strains exposed to sub-MIC of Chx and NaF. Standard strains of S. mutans (ATCC 25175 or UA159) and clinical strain isolated from child with caries (3FV2) were reactivated in BHI broth and exposed to Chx and NaF for determination of MIC and MBC. From these values, growth curves were obtained for S. mutans strains exposed to sub-MIC concentrations of Chx (0.25 x MIC to 0.75 x MIC) and NaF (0.125 x MIC to 0.75 x MIC). Biofilm assays were performed for S. mutans strains exposed or not to the sub-MIC of antimicrobial agents (0.25, 0.5 and 0.75 x MIC). Expression of covR and vicR genes were evaluated by quantitative PCR for strains of S. mutans under plankton conditions exposed to 0.125 / 0.25 / 0.5 x MIC of NaF and Chx. The data were submitted to statistical analysis considering p≤0.05. The results showed that Chx and NaF sub-MIC affected planktonic growth of S. mutans strains in a dose-dependent manner. Sub-MIC of Chx only affect the biofilm formation for ATCC 25175, and, NaF values above 0.5 x MIC caused reduction of the biofilm growth for all tested strains, in a dose-dependent manner, except for ATCC 25175, which was also affected by all concentrations evaluated. Gradual sub-MIC concentrations of Chx induced increasing expression of the vicR gene of the strains evaluated. When NaF and Chx were related, the covR gene had its expression reduced when exposed to 0.5xMIC. It is concluded that sub-MICs concentrations of NaF above 0.5 x MIC caused reduction of planktonic and biofilm growth of S. mutans strains. Sub-MICs concentrations of Chx induce vicR expression and may favor biofilm formation by S. mutans strains(AU)

Drug resistance and risk factors of hospital-acquired pneumonia caused by imipenem-resistant Acinetobacter baumannii / 中华临床感染病杂志

Objective To investigate the drug resistance and risk factors of hospital-acquired pneumonia (HAP) induced by imipenem-resistant Acinetobacter baumannii.Methods Clinical data on 114 patients with Acinetobacter baumannii-related HAPs admitted in Wujiang First People' s Hospital in Suzhou during January 2013 and December 2014 were retrospectively analyzed.According to the results of drug sensitivity test,patients were divided into imipenem-resistant group and non imipenem-resistant group.Drug resistance to 20 commonly used antibiotics was observed in two groups,and multivariate Logistic regression analysis was performed to identify the risk factors of imipenem-resistant Acinetobacter baumannii infection.Results Among 114 strains ofAcinetobacter baumannii,66 strains (57.89％) were imipenem-resistant and 48 strains (42.11％) were non-imipenem-resistant.The resistance rates to β-lactams,quinolones and aminoglycosides were significantly higher in imipenem-resistant group than those in non-imipenem-resistant group (P ＜ 0.01),and no tigecycline-resistant strain was found in both groups.Univariate analysis showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score ≥ 15,plasma level of albumin ≤ 25 g/L,intensive care unit (ICU) stay,indwelling gastric tube,deep venous catheterization,establishment of artificial airway,mechanical ventilation time ≥ 7 d,use of broad-spectrum antibiotics ≥ 14 d and combined use of antibiotics were risk factors of imipenem-resistant Acinetobacter baumannii related HAP (x2 =13.06,6.86,25.40,15.09,17.87,21.46,17.94,6.91 and 10.10,P ＜0.01).Multivariate Logistic regression analysis revealed that establishment of artificial airway [OR =72.014,95％ confidetial interval (CI):19.566-265.061,P ＜ 0.01],and use of broad-spectrum antibiotics ≥ 14 d (OR =3.892,95％ CI:1.092-13.879,P ＜ 0.05) were independent risk factors of imipenem-resistant Acinetobacter baumannii related HAP.Conclusion Imipenem-resistant Acinetobacter baumannii strains are highly resistant to most antibiotics.Strict control of invasive procedures and long-term combined use of antibiotics may reduce the occurrence of imipenem-resistant Acinetobacter baumannii related HAPs.

Endophthalmitis isolates and antibiotic sensitivities: A 8-year review of culture proven cases / 中华实验眼科杂志

Background Endophthalmitis is a serious,sight-threatening condition.Identifying the causative microorganisms is very important for available treatment of endophthalmitis.Objective This survey was to analyze the spectrum of organisms causing culture-proven endophthalmitis and their sensitivities to commonly antimicrobial agents.Methods Medical data of patients with culture-proven endophthalmitis at Zhongshan Ophthalmic Center from January 2003 through December 2010 were respectively reviewed.The outcomes included intravitreal isolates and antibiotic sensitivities were analyzed.Results Four hundred and sixty-nine strains of organisms were isolated from 447 eyes of 447 patients with infective endophthalmitis,including 22 eyes of polymicrobial infection.In the organisms,gram-positive organisms were 241 (51.4％),fungi were 125 (26.7％) and gram-negative organisms were 103 (22.0％).The most common organisms were Staphylococcus epidermidis in 29.4％,Aspergillus in 7.7％ and Pseudomonas aeruginosa in 5.3％.In this group of infective patients,the most common clinic settings were posttraumatic endophthalmitis (72.7％),and then were postoperative endophthalmitis (10.5％),endogenous endophthalmitis (9.8％) and keratitis (6.9％).Most gram-positive organism and gram-negative organism were sensitive to levofloxacin and cefoperazone.The susceptibility rate of gram-positive organism to chloromycetin was increased in 2007-2010 years compared with 2003-2006 years (x2=5.398,P＜0.05).The susceptibility rate to ciprofloxacin of gram-negative organisms declined (x2 =5.398,P ＜ 0.05),but that to rifampicin increased in the duration of 2007-2010 compared with 2003-2006 (x2 =4.500,P ＜ 0.05).Conclusions Gram-positive organisms are the most commonly causative organisms of endophthalmitis.Most bacterial organisms are sensitive to levofloxacin and cefoperazone.Local data of culturing and susceptibility test offers a guideline for the treatment of infectious endophthalmitis.

Evaluación de sensibilidad antibiótica en urocultivos de pacientes en primer nivel de atención en salud de Pereira / Using an antibiotic sensitivity assay on urine cultures from patients attending general practice healthcare institutions in Pereira

Objetivos: Las Infecciones de vías urinarias son una causa de consulta muy frecuente en primer nivel de atención en salud. Describir los gérmenes más frecuentemente aislados y los patrones de resistencia a los antibióticos en urocultivos y antibiogramas de pacientes de primer nivel de atención de Pereira. Materiales y Métodos: Estudio descriptivo observacional de corte transversal, en una población de 131 608 afiliados al Sistema General de Seguridad Social en Salud entre el 1 de enero de 2010 y 7 de abril de 2011 evaluando las bacterias aisladas en urocultivos procesados con más de 100 000 Unidades Formadoras de Colonias y resultados de sensibilidad y resistencia de antibiogramas. La resistencia se evaluó bajo parametros de Clinical and Laboratory Standards Institute mediante método manual de difusión de disco Kirby-Bauer con sensidiscos Beckton Dickinson Diagnostics. Resultados: Se realizaron 5 226 urocultivos, de los cuales 1 058 mostraron crecimiento de uropatógenos. Un total de 792 (74,9 %) cultivos reportó el crecimiento de más de 105 UFC, Los microorganismos más frecuentemente aislados fueronEscherichia coli(67,2 %),Klebsiella sp(19,2 %) yEnterococcus sp(7,8 %).Escherichia colimostró sensibilidad alta para amoxicilina/clavulanato (100 %), nitrofurantoina (94,8 %), ceftriaxona (86,3 %), ciprofloxacina (71,0 %) y resistencia elevada para ampicilina (54,7 %), amoxicilina (50,0 %), trimetoprimsulfametoxazole (43,8 %) y cefalotina (42,8 %). Conclusiones: Nitrofurantoina puede ser la mejor opción terapéutica en primera línea de manejo en infecciones de vías urinarias bajas y ciprofloxacina para pielonefritis debido a su efectividad y poca resistencia en primer nivel de atención en Pereira.

Objectives: Describing the bacteria most frequently isolated from and antibiotic resistance patterns in urine cultures taken from patients attending general practice healthcare institutions in Pereira as urinary tract infections are a frequent cause for primary healthcare attention. Materials and Methods: A descriptive cross-sectional observational study of 131,608 members of the health social security system was carried out between January 1st 2010 and April 7th 2011;the bacteria isolated from urine cultures having more than 105 colony-forming units (CFU) were assessed, as were the sensitivity and antibacterial agents’ resistance results. Resistance was evaluated in line with Clinical and Laboratory Standards Institute (CLSI) parameters by means of the Kirby-Bauer disk diffusion manual method with Beckton Dickinson diagnostic disks. Results: 5,226 urine cultures were analysed, 1,058 of which showed uropathogengrowth. Bacterial growth was reported in 792 cultures (74.9 %), having more than 105 CFU. The most frequently isolated microorganisms were Escherichia coli (67.2 %), Klebsiella sp (19.2 %) and Enterococcus sp (7.8 %).Escherichia colishowed high sensitivity to amoxicillin / clavulanate (100 %), nitrofurantoin (94.8 %), ceftriaxone (86.3 %), ciprofloxacin (71.0 %) and high resistance to ampicillin (54.7 %), amoxicillin (50.0 %), trimethoprim-sulfamethoxazole (43.8 %) and cephalothin (42.8 %). Conclusions: Nitrofurantoin may be the best therapeutic option in first-line management of lower urinary tract infection and ciprofloxacin for pyelonephritis due to its effectiveness and low resistance as seen in primary healthcare practice in Pereira.

Clinical implication of peri-operative urine bacterial examination in upper urinary tract stone / 中华泌尿外科杂志

Objective To analyze the bacterial distribution and resistance in upper urinary tract stone patients, then choose suitable antibiotics and reduce infectious complications accordingly.Methods Middle flow urine, infectious stone and the end of kidney drainage tube were taken for culture in 148 patients who underwent percutaneous nephrolithotomy between January 2009 to September 2010. Antibiotics were used according to the culture results and the complications secondary to infection were analyzed. Results Urinary pathogens presented in 38 (25.7%) patients before operation.There were 112 strains of bacteria. The predominant strains included: Escherichia coli (17 cases,11.5%), Staphylococcus epidermidis (4 cases) and Proteus mirabillis (4 cases). Escherichia coli and Proteus mirabillis were common in stone culture. Staphylococcus epidermidis (5 cases),Pseudomonas aeruginosa (5 cases) and Staphylococcus haemolytcus (5 cases) were found in renal drainage tube culture which were positive in 25 patients. Imipenem, cefepime, vacomycin, nitrofurinton were sensitive and commonly used antibiotics. Forty-one patients (27.7 %) had fever postoperatively, including 10 positive for middle urine culture and 9 positive for drainage tube culture. One infective shock was diagnosed postoperatively. Conclusions Gram-negative bacilli are predominant in the upper urinary tract stone patients preoperatively. Gram-positive ones are common postoperatively.Suitable antibiotics, based on middle flow urine culture, could reduce urinary infective complications.

Patrones de resistencia antimicrobiana en uropatógenos gramnegativos aislados de pacientes ambulatorios y hospitalizados Cartagena, 2005-2008 / Antimicrobial resistance pattern for gram-negative uropathogens isolated from hospitalised patients and outpatients in Cartagena, 2005-2008

Objetivo Determinar el patrón de resistencia antimicrobiana de bacterias patógenas asociadas a infecciones urinarias en pacientes ambulatorios y hospitalizados. Métodos Se realizó un estudio descriptivo entre febrero de 2005 y noviembre de 2008 en el Laboratorio Clínico de la Universidad de San Buenaventura, Cartagena. La susceptibilidad antimicrobiana fue evaluada con el método de difusión en agar empleado la técnica de Kirby Bauer aplicando procedimientos normalizados. Resultados Del total de muestras de orina analizadas (1 384) durante el período de estudio, 32,9 por ciento (455) fueron urocultivos positivos, la mayoría de éstos (81,4 por ciento) provenían de mujeres. Los agentes bacterianos más frecuentes fueron Escherichia. coli (60,1 por ciento), Klebsiella pneumoniae (6,9 por ciento), Pseudomonas aeruginosa (6,6 por ciento), Proteus mirabilis (5,4 por ciento) y Acinetobacter baumannii (1,4 por ciento). Los aislamientos gramnegativos mostraron una alta resistencia a la ampicilina (84,3100 por ciento), amoxacilina/ácido clavulánico (66,5 80,0 por ciento) y ciprofloxacina (40,057,9 por ciento). Conclusión Las bacterias gramnegativas fueron los principales agentes asociados a infecciones urinarias en esta población siendo E. coli el aislamiento más frecuente. La interpretación de los perfiles de susceptibilidad encontrados permite considerar como prudente la administración empírica de cefalosporinas de tercera generación como tratamiento inicial de las infecciones urinarias en esta población.

Objective Determining the microbial aetiology spectrum and antibiotic resistance pattern of uropathogens causing urinary tract infections in hospitalised patients and outpatients. Methods A descriptive study was carried out between February 2005 and November 2008 at the San Buenaventura University's Clinical Laboratory in Cartagena. Antibiotic sensitivity was determined by the Kirby Bauer method. Results Out of the total specimens (1,384) analysed over the four-year study period, 455 of the urine samples (32.9 percent) were culture positive, most (81.4 percent) having come from females. The bacterium isolated most frequently was Escherichia coli (60.1 percent) followed by Klebsiella pneumoniae (6.9 percent), Pseudomonas aeruginosa (6.6 percent), Proteus mirabilis (5.4 percent) and Acinetobacter baumannii (1.4 percent). The Gram-negative isolates displayed a high level of resistance to ampicillin (range 84.3100 percent), amoxicillin/clavulanic acid (range 66.580 percent) and ciprofloxacin (range 4057.9 percent). Conclusion Gram-negative bacteria were responsible for urinary tract infections in the patients involved in this study. The most commonly isolated bacteria were E. coli. Empirical administration of a third-generation cephalosporin for initial treatment of urinary tract infections in this population appears prudent from the perspective of antimicrobial susceptibility.

Application of ATP-TCA in chemotherapy of human cardia cancer / 肿瘤研究与临床

Objective To investigate the drug sensitivity of cardia tumors in vitro by ATP-TCA, and to provide basis of clinic chemotherapy. Methods 42 cardia tumors were tested by ATP-TCA to determine and assess the drug sensitivity of 8 common chemotherapeutics. Correlation analysis was done between the clinical classification and the drug sensitivity. Results The drug sensitivity had significant difference among cardia tumors. From high to low, it was ADM>MMC>PTX> 5-Fu>HCT =VP16>CDDP>IFO, Sensitive degree were 50.00 %, 35.45 %, 31.25 %, 23.53 %, 10.53 %, 10.53 %, 7.69 %, 5 %. Sensitivity of the same drug in different pathologic stages had no significant difference. Conclusion ATP-TCA can play a guiding role in individual chemotherapy for human cardia cancer.

Investigation on indicators of clinical therapeutic effect of choamydiae infection in the gential tract / 国际检验医学杂志

tep immunochromatographic method accounted for 96.4%.Conclusion Both RT-PCR and step immuno chromatographic method can not be used as means of short-term therapeutic effect evaluation.

Macrolide resistance and molecular mechanisms in Mycoplasma pneumoniae / 中华检验医学杂志

Objective To investigate status of macrolide resistance and determine molecular mechanisms in Mycoplasma pneumoniae.Nethods All of 370 throat swab specimens were cultured to isolate Mycoplasma pneumoniae.Mycoplasma pneumoniae isolates were identified by nested PCR for specific 16SrRNA gene.Antibiotic susceptibility test was done to identify acrolide resistant strains.23SrRNA gene wag amplified by nested PCR followed by direct automatic sequencing method.The DNA sequences were compared to the sequence of Mycoplasma pneumoniae M129(accession no.X68422)to find molecular mechanisms of drug resistance.Results Fifty clinical strains were isolated from 370 specimens.Of 50 strains.4 strains were susceptible to macrulide,46 strains were macrolide resistant with the percentage of 92%.MICs of resistant strains to erythromycin.Azithromycin and josamycin were elevated.The sequence of 23SrRNA gene in 4 Susceptible strains and the reference strain FH was identical to Mycoplagma pneumoniae gene in GenBank.46 resistant strains arbored a point mutation respectively,among them,40 strains had all A to G transition at position 2063.1 strain had an A to C transition at position 2063,the other five strains showed an A to G transition at position 2064.Conclusions Macrolide resistance in Mycoplasma pneumoniae iS very serious health conceru.The point mutation in 23SrRNA.Xpecailly predominant position 2063 mutation contributed to the macrolide resistance in Mycoplagma pneumoniae.The MICs of resistant strains to erythromycin,azithromycin and iosamycin are much higher than Mycoplasma pneumoniae reference strain FH.