ABSTRACT
Objective:To investigate the differences in microbiological examination results between alcohol abuse and no alcohol abuse in adult ICU patients and the association between alcohol abuse and these differences.Methods:The adult patients with microbiological examination results were selected from the MIMIC-Ⅲ database and divided into two groups according to whether they had alcohol abuse. The two groups were matched by propensity score, and the similarities and differences in microbiological examination results were evaluated between the two groups after matching. The measurement data of non normal distribution were expressed by M ( Q1, Q3). Wilcoxon rank sum test was used for the comparison of the two groups, and the comparison of counting data was used χ 2 test or Fisher exact probability method. Results:After matching, the alcohol abuse patients were more likely to use mechanical ventilation (47.06% (1 379/2 930) vs. 52.66% (1 543/2 930), χ 2=18.14, P<0.001), had a higher positive rate in sputum samples (44.30% (400/903) vs. 49.41% (501/1 014), χ 2=4.81, P=0.028) and had a lower positive rate in other samples (26.85% (653/2 432) vs. 21.67% (541/2 496), χ 2=17.69, P<0.001). In blood samples, the percentage of Gram-negative bacteria was lower in the alcohol abuse group (26.87% (126/469) vs. 17.25% (74/429), χ 2=11.42, P<0.001), while the percentage of Gram-positive bacteria was higher (78.46% (368/469) vs. 86.01% (369/429), χ 2=8.17, P=0.004). The percentage of patients with Pseudomonas aeruginosa (3.75% (110/2 930) vs. 2.08% (61/2 930), χ 2=13.88, P<0.001) and Enterococcus sp. (8.19% (240/2 930) vs. 6.45% (189/2 930), χ 2=6.29, P=0.012) was lower in the alcohol abuse group. However, there was a higher percentage of patients with methicillin-resistant Staphylococcus aureus (2.32% (68/2 930) vs. 3.28% (96/2 930), χ 2=4.57, P=0.032) and Haemophilus influenzae (1.30% (38/2 930) vs. 2.01% (59/2930), χ 2=4.19, P=0.041) in the alcohol abuse group. For Staphylococcus aureus (61.10% (322/527) and 52.66% (267/507), χ 2=7.16, P=0.007) and Enterococcus sp. (75.83% (160/211) and 63.64% (56/88), χ 2=4.02, P=0.045), the alcohol abuse group had a lower resistance to levofloxacin; for Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae, the alcohol abuse group had a lower resistance to cephalosporins (all P<0.05). Conclusions:In adult ICU, alcohol abuse might increase the risks of using mechanical ventilation, and patients with alcohol abuse might be more prone to have respiratory tract infections. Alcohol abuse patients with blood infections were less likely to be infected with Gram-negative bacteria, but had a higher probability of Gram-positive bacteria infection. What is more, Alcohol abuse might increase the risks of infections with Haemophilus influenzae and methicillin-resistant Staphylococcus aureus. In alcohol abuse patients, the infection of Staphylococcus aureus, Enterococcus sp., Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae was less resistant to many antibiotics than that in no alcohol abuse patients.
ABSTRACT
El Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-AC) emergió en Uruguay en el año 2001 y desde ese momento se ha establecido como agente de múltiples enfermedades infecciosas de la infancia. Algunas formas clínicas de presentación más frecuentes, como las infecciones superficiales, no ofrecen habitualmente dificultades diagnósticas. Otras menos frecuentes, como los abscesos de localización profunda, son formas menos conocidas donde el diagnóstico no es sencillo y existe riesgo de tratamiento tardío lo cual contribuye a una mayor carga de morbimortalidad por este agente. En este trabajo se comunican cuatro casos clínicos de abscesos profundos por SAMR-AC, en pacientes hospitalizados en los años 2009- 2011 en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell. Se presentan tres casos de abscesos musculares, dos de ellos retroperitoneales, y un caso de abscesos hepáticos, forma de presentación infrecuente pero típica de este agente. Se destacan en esta serie las dificultades para el diagnóstico temprano por lo inespecífico de la presentación clínica, el apoyo fundamental de la imagenología en la confirmación diagnóstica, la necesidad de tratamiento antimicrobiano prolongado y del drenaje adecuado del material colectado importante en la identificación microbiológica del agente implicado...
Subject(s)
Humans , Adolescent , Female , Child, Preschool , Child , Abdominal Abscess/diagnosis , Abdominal Abscess/therapy , Liver Abscess/diagnosis , Liver Abscess/therapy , Community-Acquired Infections , Methicillin-Resistant Staphylococcus aureus , Pyomyositis/diagnosis , Pyomyositis/therapy , Anti-Bacterial Agents/therapeutic use , Child, HospitalizedABSTRACT
A formação de biofilmes é considerada uma vantagem que alguns Staphylococcus aureus isolados de mastite bovina possuem, facilitando a permanência dos mesmos no úbere. Isto requer a adesão das bactérias no epitélio mamário com proliferação e formação de multicamadas de células envolvidas por uma matriz polimérica conhecida como exopolissacarídeo. O objetivo deste estudo foi avaliar a produção de biofilmes das estirpes de S. aureus isoladas de casos mastite subclínica bovina. Estudou-se 94 estirpes de S. aureus obtidas do leite de vacas com mastite subclínica oriundas de duas propriedades rurais no estado de São Paulo. Essas estirpes foram caracterizadas quanto a produção de biofilmes pelos testes de aderência em microplacas e pela presença dos genes icaA e icaD responsáveis pela produção do polissacarídeo de adesão intercelular. Os resultados obtidos revelaram que no teste de aderência em placas, 98,9% das estirpes produziram biofilme e a presença dos genes icaA e icaD foi encontrada em 95,7% das estirpes de S. aureus. Bactérias produtoras de biofilmes no epitélio mamário diminuem a efetividade dos antimicrobianos, por isso a detecção de S. aureus produtoras de biofilmes têm importância no entendimento da patogenia desse agente, além de permitir uma melhor adoção de medidas de prevenção e controle.
Biofilm formation is considered an advantage for Staphylococcus aureus mastitis isolates, facilitating bacterial persistence in the udder. It requires attachment to mammary epithelium, proliferation and accumulation of cells in multilayers and enclosing in a polymeric matrix known as exopolysaccharide. The objective of this study was to evaluate the ability of Staphylococcus aureus isolated from bovine subclinical mastitis for formation of biofilms. A total of 94 Staphylococcus aureus strains obtained from milk samples of cows suffering from subclinical mastitis in dairy herds on two properties in the state of São Paulo were evaluated. These strains were characterized by in vitro biofilm formation, and by the presence of icaA and icaD genes which are responsible for intercellular adhesion. The results revealed that 98.9% of the isolates produced biofilm in vitro by adherence in sterile 96-well "U" bottom polystyrene tissue culture plates; 95.7% of the isolates possessed the icaA and icaD genes. These bacterial isolates biofilm producers may impair eradication of chronic mastitis, rendering antibiotherapy less effective. The detection of biofilm forming ability in mastitis isolates may provide useful information for more adequate therapeutic regimen and for preventive actions in the control of those bacterial isolates in bovine herds.