Nocardia Farcinica Infectionafter Total Knee Arthroplasty:a Case Report / 现代检验医学杂志

Infection is a catastrophiccomplication in total knee arthroplasty.Reported a case of Nocardiafarcinica infection which appeared after application of cemented total knee replacement.A 64-year-old male patient was admitted to hospital 1 months after knee surgery,with a 2-week history of pain,swelling,and restricted mobility.As no improvement could be a-chieved after synovectomy and antibiotherapy,the prosthesis were removed from him.Although improvement could not be a-chieved in the knee of the patient at the end of 10-month therapy,the case has still being followed-up.

Detecção e caracterização de elementos conjugativos integrativos em bactérias isoladas de amostras ambientais / Detection and characterization of integrative conjugative elements in bacteria isolated from environmental samples

O reconhecimento da resistência antimicrobiana como um fenômeno emergente em saúde pública, tem constituído um problema em nível mundial. O abuso na utilização de antibióticos na medicina humana e veterinária, e na agricultura, tem originado incremento na diversidade de micro-organismos resistentes, refletindo em falha terapêutica. Os mecanismos de resistência a antibióticos em micro-organismos são mediados principalmente por genes adquiridos de DNA exógeno. A dinâmica da transferência horizontal é realizada por meio de elementos genéticos móveis que carregam genes de resistência. A ampla distribuição deste tipo de estruturas, como o elemento SXT, isolado inicialmente em V. cholerae, tem contribuído para a disseminação de complexos específicos clonais em determinadas áreas geográficas. Este estudo pioneiro no Brasil pesquisou a presença de elementos SXT, em espécies bacterianas do grupo das gama proteobactérias em espécies ambientais, determinou suas características estruturais e funcionais, incluindo genes de resistência a antibióticos, bem como a sensibilidade aos antibióticos dentre os isolados bacterianos que os abrigam. O resultado foi a classificação de 43 elementos SXT obtidos no Brasil, através da comparação com aqueles descritos na literatura. Dentre os elementos SXT obtidos, quatro são albergados por Morganella morganii, fato inédito na literatura. O conhecimento da evolução bacteriana constitui importante ferramenta para estabelecer estratégias eficazes de controle e tratamento de infecções, sem aumentar a pressão seletiva sobre os micro-organismos, bem como instrumento preciso e de grande importância para subsidiar estudos epidemiológicos.

Recognition of antimicrobial resistance as an emerging phenomenon in public health has been a problem worldwide. The abuse in the use of antibiotics in human and veterinary medicine, and agriculture, has caused an increase in the diversity of resistant microorganisms, reflecting in treatment failure. The mechanisms of antibiotic resistance in microorganisms are primarily mediated by genes acquired from exogenous DNA. The dynamics of the horizontal transfer is performed by mobile genetic elements which carry resistance genes. The wide distribution of these structures, such as the SXT element originally isolated from V. cholerae, has contributed to the spread of specific clonal complexes in certain geographical areas. This pioneering study in Brazil researched the presence of SXT elements in the group of bacterial species in environmental gamma-proteobacteria species, determined their structural and functional characteristics, including genes for resistance to antibiotics and the antibiotic susceptibility among bacterial isolates that harbor them. The result was the classification of 43 SXT elements found in Brazil, by comparison with those found in the literature. Among the SXT elements found, four are sheltered by Morganella morganii, unprecedented in the literature. Knowledge of bacterial evolution is an important to establish effective strategies to control and treat infections without increasing the selective pressure on microorganisms, as well as a precise instrument and very important tool to support epidemiological studies.

SXT constin among Vibrio cholerae isolates from a tertiary care hospital.

Background & objectives: The SXT element, also known as ‘constin’ (conjugable, self transmissible, integrating element) is an integrating conjugative element (ICE) in Vibrio cholerae discovered in the chromosome of epidemic V. cholerae O139 strain MO10 (SXTMO10) which arose in late 1992 in Chennai, India. SXT related ICEs have become widespread and currently, most if not all Asian V. cholerae clinical isolates contain SXT related ICEs. The present study attempts to determine the presence of SXT Int gene in V. cholerae recovered between 2005 to 2007 in a tertiary care hospital, demonstrate its conjugal nature and also detect co-presence and co-transfer of plasmids in representative isolates. Methods: This prospective study was done on 116 V. cholerae isolates [114- O1 (107 ogawa and 7 inaba) and 2 - Non O1 Non O139 V. cholerae] from watery stools between 2005 to 2007 recovered from equal number of patients. PCR was carried out using SXT Int specific primers that produced a 592 bp internal fragment of SXT element, and rifampicin resistant strain of E.coli K-12 was used as recipient in conjugation experiments to study transfer of SXT, as also co-transfer of resistance to tetracycline, erythromycin, and nalidixic acid. Antibiotic susceptibility was performed against various antibiotics. Results: Of the 116 isolates, 110 (94.8%) were positive for SXT element by PCR. It was demonstrated in 94.7 per cent of the O1, and 100 per cent of non O1 non O139 V. cholerae. All 2005 isolates, 25 per cent of 2006 isolates and 96.6 per cent of 2007 isolates were positive for SXT. Thirty two drug resistance patterns were observed and the 2007 isolates showed resistance to as many as eight antibiotics. The resistance of SXT positive isolates was higher than those of SXT negative and the typical drug resistance pattern corresponding to SXTET and SXTMO10 was shown by only one V. cholerae O1 isolate. Successful conjugal transfer of SXT was seen in 31 (88.6%) of the 35 isolates studied without any co-transfer while, presence of plasmids was observed in two of the 31 donor V. cholerae studied. Interpretation & Conclusions: The demonstration of SXT element and its successful horizontal transfer in V. cholerae isolates studied emphasizes the need for its detection to monitor antibiotic resistance and dissemination in V. cholerae.

Detecção molecular e resistência a antimicrobianos no grupo V. fluvialis - V. furnissii / Molecular detection and antimicrobial resistance in group V. fluvialis - V. furnissii

Vibrio fluvialis é um microorganismo que provoca a gastroenterite muito semelhante à cólera, mas também há relatos de casos extra-intestinais como sepse, ferida, peritonite e celulite hemorrágica e encefalite. Acredita-se que a infecção por esse microorganismo esteja vinculada ao consumo de peixes crus ou mal cozidos contaminados e / ou frutos do mar. A identificação dessa bactéria por métodos fenotípicos continua a ser um problema devido à sua grande semelhança com Aeromonas hydrophila e V.furnissii; por isso, a utilização de uma ferramenta de diferenciação entre essas espécies é importante. Nas últimas décadas, o aumento da resistência aos antimicrobianos tem sido um fator preocupante, porque ela interfere na escolha dos medicamentos para o tratamento eficaz e há uma necessidade de rápida produção de novos antibióticos. Ambientes costeiros e estuários estão em perigo de serem contaminados por esgoto, que pode conter drogas que agem de forma seletiva, permitindo o desenvolvimento de resistência aos antimicrobianos. Vários estudos demonstraram que estirpes clínicas de V. fluvialis são resistentes a múltiplas drogas. Objetivos - Desenvolver um marcador molecular baseado no 16S rDNA capaz de detectar o grupo V. fluvialis-V. furnissii, e avaliar a susceptibilidade a antibióticos destas espécies, principalmente a partir de amostras ambientais. Métodos - Após a elaboração dos iniciadores a partir do alinhamento das espécies do gênero Vibrio, foram utilizadas cepas identificadas fenotipicamente como V. fluvialis e de V. furnissii para a sua detecção molecular. O perfil de susceptibilidade a antibióticos pelo método da disco-difusão foi realizada, assim como a investigação molecular da presença do elemento SXT e de seus genes de resistência a antimicrobianos. Resultados: Com a utilização dos iniciadores desenvolvidos foi possível confirmar corretamente as espécies. Observou-se alta porcentagem de resistência a ampicilina e cefalotina, sendo que 65,9por cento...

Vibrio fluvialis is a microorganism that causes gastroenteritis very similar to cholera, however there are also reports of extraintestinal cases as sepse, skin wounds, peritonitis and hemorrhagic cellulitis and cerebritis. It is believed that infection by this organism is linked to the consumption of raw or undercooked contaminated fish and / or seafood. Identification of this bacteria by phenotypic methods remains a problem due to its great similarity with Aeromonas hydrophila and V.furnissii, therefore the use of a tool to differentiate these species is important. In recent decades, increasing antimicrobial resistance has been a concerning factor because it interferes in the choice of drugs for effective treatment and there is a need for rapid production of new antibiotics. Coastal and estuarine environments are in danger of being contaminated by sewage, which may contain drugs that will act selectively, allowing the development of antimicrobial resistance. Several studies have demonstrated that clinical strains of V. fluvialis are resistant to multiple drugs. Objectives - To develop a 16S rDNA - molecular marker able to detect the group V. fluvialis-V.furnissii, and to evaluate the antibiotic susceptibility of this species mainly from environmental samples. Methods - After the development of primers from alignment of the genus Vibrio strains phenotypically identified as V. fluvialis and V. furnissii were used for their molecular identification. The profile of antibiotic susceptibility was performed by the disk diffusion method, and the molecular investigation of the presence of the SXT element and their antimicrobial resistance genes. Results - The primers developed were able to confirm correctly the species. A high percentage of resistance to ampicillin and cephalothin was observed, V. fluvialis and V. furnissii showed resistance to at least two of the antibiotics used, 65.9 per cent and 43.24 per cent respectively. Only in one strain of...