A study on evaluation of prescription pattern of drugs in upper respiratory tract infections in children at a tertiary care hospital

Background: Acute respiratory tract infections (ARTIs) are a major burden to child health in developing countries like India. Preschool children have 4–8 episodes of the upper respiratory tract infection (URTI) per year on average, while school-aged children experience 2–6 episodes per year. They are the most prevalent reason for visits to the outpatient section of a hospital and general practice. Aim and Objective: The aim of this study was to evaluate the prescribing patterns in patients aged 1–18 years with URTIs. Materials and Methods: A prospective study conducted in the department of pharmacology at a tertiary health care center. Two hundred and fifty patients with URTI visiting pediatric and ENT department of tertiary health care center during December 2014–June 2015 were studied. Data included detailed history, physical examination, investigations, antimicrobial treatment given, and other treatment given were noted. This data was gathered from the records of Pediatric and ENT department. Statistical tests were used to analyze the data. Results: The most common clinical presentation was fever and cough. The common diagnosis noted in the study were non-specific URTI, tonsillitis, and sinusitis. Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Amoxicillin-clavulanic acid and cephalosporins were the common antibitoics prescribed. Beta-hemolytic streptococci were the common microbe isolated among the patients tested to know the etiology. Conclusion: Antipyretics (99.6%) and antibiotics (52%) were the frequently prescribed drugs among the patients. Antibiotics were prescribed in most of the non-specific URTI and pharyngitis which is a matter of concern.

Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Abstract Background Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time. Objectives We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil. Methods In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher's exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant. Results The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years. Conclusion No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

Saliva sampling methods. Cariogenic streptococci count using two different methods of saliva collection in children / Recuento de estreptococos cariogénicos a partir de dos métodos de obtención de saliva en niños

ABSTRACT The aim of this study is to compare the efficacy of two methods for collecting saliva samples from infants under 2 years of age for cariogenic streptococci (CS) count. Two collection methods were applied in 11 infants. In Method (A), saliva samples were collected by swabbing the inner cheek mucosa and floor of the mouth in figure of eight motions with a sterile cotton swab until it was soaked. In method (B), saliva samples were collected by aspiration of 1 ml of saliva with a sterile plastic syringe on the floor of the mouth, after stimulation with glove. The samples were cultured in modified Gold's broth (MSMG), and on trypticase, yeast extract, sucrose, cystine and bacitracin culture medium (TYSCB). In method (A), the swab with the sample was unloaded in situ on TYSCB and placed in PBS medium for transport. Then, 100 μl of the eluate was seeded in MSMG. In method (B) 100 μl were seeded in TYSCB and 100 μl in MSMG. Both culture media were incubated under capnophilic conditions for 48 hours at 37 °C. Colony forming units (CFU/ml) were counted by calibrated operators (kappa = 0.75). The presence of cariogenic streptococci (CS) (Streptococcus mutans-Streptococcus sobrinus) was determined by qPCR in the samples collected by both methods. The CFU/ml counts in MSMG differed significantly between methods (p = 0.021). In TYSCB, the recovery of CFU/ml was higher in method (A), without significant difference (p = 0.705). The molecular technique detected presence of CS, with no difference between collection methods. Collecting saliva samples by swabbing proved more effective in terms of recovery of microorganisms, and did not affect the detection of presence of CS by molecular techniques.

RESUMEN El objetivo de este estudio es comparar la eficacia de dos métodos de obtención de muestras salivales, en infantes menores de 2 años para el recuento de estreptococos cariogénicos (EC). Se aplicaron dos métodos de recolección en 11 infantes, el método (A), consistió en la recolección de muestras de saliva con hisopos de algodón estériles, realizando movimientos en ocho sobre la mucosa del carrillo y piso de boca, hasta embeber el hisopo. En el método (B) la recolección de las muestras se realizó por aspiración con jeringa plástica estéril en piso de boca hasta obtener 1 ml, luego de estimulación con guante. Las muestras fueron cultivadas en caldo de Gold modificado (MSMG) y medio de cultivo TYSCB (tripticasa, extracto de levadura, sacarosa, cistina y bacitracina). En (A), el hisopo con la muestra fue descargado in situ en TYSCB y colocado en medio de transporte PBS. 100 μl del eluato se sembró en MSMG. En (B) 100 μl fueron sembrados en TYSCB y 100 μl en MSMG. Ambos medios de cultivo fueron incubados en condiciones de capnofilia por 48 hs. a 37°C. El recuento de unidades formadoras de colonias (UFC/ml) se realizó por operadores calibrados (kappa= 0.75). La presencia de EC (Streptococcus mutans - Streptococcus sobrinus) fue determinada por qPCR en las muestras obtenidas por ambos métodos. Los resultados mostraron que los recuentos de UFC/ml en MSMG presentaron diferencias significativas entre ambos métodos (p=0.021) En TYSCB la recuperación de UFC/ml fue mayor en el método (A), sin observarse diferencias significativas (p=0.705). Se detectó la presencia de EC por técnica molecular, sin mostrar diferencias entre los métodos empleados. La recolección de muestra de saliva con hisopo presentó mayor eficacia en términos de recuperación de microorganismos, sin alterar la detección de presencia de EC por técnicas moleculares.

Perfil antibiótico de estreptococos del grupo viridans aislados de cavidad oral en individuos con uso prolongado de antibióticos / Antibiotic profile of viridans streptococci group isolated of oral cavity from patients with prolonged use of antibiotics

RESUMEN Los estreptococos del grupo viridans (EGV) son un grupo heterogéneo de bacterias saprófitas anaerobias facultativas que forman parte de la flora normal de cavidad oral. El incremento de la resistencia antibiótica de este grupo de bacterias cobra importancia en pacientes hospitalizados con terapia antibiótica prolongada, en los cuales estos microorganismos pueden ser sustituidos por bacterias multirresistentes. Objetivos: Determinar el porcentaje de cepas de EGV aisladas de cavidad oral resistentes a los antibióticos utilizados en el tratamiento de diversas patologías infecciosas hospitalarias. Material y Métodos: Estudio observacional descriptivo en el que se incluyeron 60 pacientes hospitalizados con historia de terapia antibiótica por más de 3 semanas. Las muestras se procesaron siguiendo protocolos estandarizados de recolección, aislamiento e identificación para EGV de cavidad oral y un protocolo de pruebas de sensibilidad antibiótica. Los resultados se muestran en tablas y gráficas de frecuencia. Resultados: La principal indicación para terapia antibiótica intrahospitalaria fue infección orofacial: 28,33%. La penicilina fue el antibiótico más utilizado ya sea en terapia única, combinada o múltiple en todos los pacientes. Se aislaron en total 108 cepas de EGV, con un promedio de 1,8 cepas por paciente. La especie predominantemente identificada fue S. mutans. El 96,3% de las cepas de EGV fue sensible a todos los antibióticos incluidos en el panel. Conclusiones: El uso de distintas combinaciones y modalidades de terapia antibiótica no tiene efecto en la susceptibilidad de EGV aislados de cavidad oral en pacientes hospitalizados, independiente de la duración del tratamiento.

ABSTRACT Viridans group streptococci (VGS) are a heterogeneous group of saprophytic facultative anaerobic bacteria that are part of the normal flora of the oral cavity. The increased resistance to multiple antibiotics in this group of bacteria becomes important in prolonged antibiotic therapies inpatient where these common microorganisms are replaced by multi-resistant bacteria. Objectives: To determine the percentage of VGS strains isolated from oral cavity resistant to antibiotics used in hospital infectious diseases. Material and methods: This is a descriptive cross-sectional study that included 60 hospitalized patients with a history of antibiotic therapy for more than 3 weeks. The samples were processed following standardized protocols for collection, isolation and identification of oral cavity VGS and a protocol of antibiotic susceptibility testing. The results are shown in tables and graphics of absolute and relative frequencies. Results: The main indication for antibiotic therapy was orofacial infection with a 28.33%. Penicillin was the antibiotic further used either in single, combined or multiple therapies in all patients. A total of 108 samples (1.8 per patient swabs) were collected. The predominantly identified specie was Streptococcus mutans. The 96.3% of all VGS strains were sensitive to all antibiotics included in the panel. Conclusion: Using different combinations and types of antibiotic therapy inpatient has no effect on the susceptibility of VGS isolated from oral cavity separate from treatment.

Spectrophotometric Analysis of Streptococcus mutans Growth and Biofilm Formation in Saliva and Histatin-5 Relate to pH and Viscosity

ABSTRACT Objective: To analyze the ability of saliva in controlling the growth and the biofilm formation of Streptococcus mutans (S. mutans) as well as the effect of histatin-5 anti-biofilm relate to pH and saliva viscosity. Material and Methods: The S. mutans biofilm assayed by crystal violet 1% and its growth measured by spectrophotometer. The saliva viscosity was analyzed by viscometer, and pH of saliva was measured by pH meter. Results: Based on the optical density values, growth of S. mutans in saliva ranged <300 CFU/mL (0.1 nm) at concentrations of 25%, 12.5% and 6.25% for 24 hours. Whereas at the 48 h and 72 h period of incubation shown an increase in growth of S. mutans ranged 300-600 CFU/mL (0.2-0.36 nm). The inhibitory biofilm formation of S. mutans in saliva was significantly higher at concentrations of 12.5% and 6.25% at 24 h incubation times on a moderate scale, whereas the histatin-5 was effective to inhibit S. mutans biofilm on the 50 and 25 ppm. The saliva possessed a higher inhibitory of biofilm S. mutans than histatin-5 and good level viscosity (0.91-0.92 cP). Conclusion: The saliva was able to control the growth of S. mutans, and histatin-5 can inhibit the biofilm formation S. mutans. Furthermore, the saliva was also able to respond to the pH change with good viscosity of saliva.

Characterization and distribution of viridans group streptococci isolated from infectious endophthalmitis and keratitis / Caracterização e distribuição de estreptococos do grupo viridans isolados de endoftalmite infecciosa e ceratite

ABSTRACT Purpose: The aims of this study were to characterize alpha-hemolytic streptococci among isolates from cases of infectious endophthalmitis and keratitis and to determine their distributions. Methods: The sample included 27 and 35 nonduplicated isolates of alpha-hemolytic streptococci recovered from patients with infectious endophthalmitis (2002-2013) and keratitis (2008-2013), respectively. Isolates were identified by the optochin susceptibility and bile solubility tests, using a biochemical identification system. The minimum inhibitory concentration was determined by the broth microdilution method. Molecular identification was performed by analyses of three constitutive genes and the complementary multilocus sequence. The molecular epidemiology of Streptococcus pneumoniae was investigated using multilocus sequence typing, and the presence of the capsular polysaccharide-encoding gene was assessed using conventional polymerase chain reaction. Outcomes were evaluated using the patients' medical records. Results: Phenotypic tests differentiated S. pneumoniae from other alpha-hemolytic streptococci, consistent with later molecular identifications. Streptococcus oralis was significantly prevalent among the endophthalmitis isolates, as was S. pneumoniae in the keratitis isolates. High levels of susceptibility to antibiotics were observed, including vancomycin, cephalosporins, and fluoroquinolones. High genetic variability was detected among the 19 S. pneumoniae strains, with 15 predicted to be encapsulated. The medical records of patients with infectious endophthalmitis were reviewed (n=15/27; 56%), and final visual acuity was assessed in 12 cases (44%). Many patients progressed to a final visual acuity state of "no light perception" (6/12; 50%), "light perception" (3/12; 25%), or "hand motion" (1/12; 8%). The medical records of patients with infectious keratitis were also reviewed (n=24/35; 69%), and final visual acuity was assessed in 18 cases (51%). Similarly, most patients progressed to a final visual acuity state of "no light perception" (6/18; 33%), "light perception" (1/18; 6%), or "hand motion" (6/18; 33%). Overall, the majority of patients progressed to a final visual acuity state of "no light perception" (12/30), "light perception" (4/30), or "hand motion" (7/30). Conclusions: The distribution of alpha-hemolytic streptococci in ocular infections suggested the presence of a species-specific tissue tropism. The prognoses of patients with ocular streptococcal infections were highly unfavorable, and antibiotic resistance did not contribute to the unfavorable clinical progressions and poor outcomes.

RESUMO Objetivo: O objetivo deste estudo foi caracterizar os estreptococos alfa-hemolíticos isolados de endoftalmite infecciosa e ceratite e determinar sua distribuição. Métodos: A amostra incluiu 27 e 35 isolados não-duplicados de estreptococos alfa-hemolíticos recuperados de pacientes com endoftalmite infecciosa (2002-2013) e ceratite (2008-2013), respectivamente. Os isolados foram identificados pelos testes de suscetibilidade à optoquina e bile solubilidade, utilizando um sistema de identificação bioquímica. A concentração inibitória mínima foi determinada pelo método de microdiluição em caldo. A identificação molecular foi realizada pela análise de três genes constitutivos e análise complementar de sequências multilocus. A epidemiologia molecular do Streptococcus pneumoniae foi investigada por tipagem de sequência multilocus, e a presença do gene codificador do polissacarídeo capsular foi avaliada por reação em cadeia da polymerase convencional. Os resultados foram avaliados utilizando os prontuários médicos dos pacientes. Resultados: Os testes fenotípicos diferenciaram S. pneumoniae dos outros estreptococos alpha-hemolíticos, consistentes com identificações moleculares posteriores. S. oralis foi significativamente prevalente entre os isolados de endoftalmite, assim como S. pneumoniae nos isolados de ceratite. Foram observados altos níveis de suscetibilidade a antibióticos, incluindo vancomicina, cefalosporinas e fluoroquinolonas. Alta variabilidade genética foi detectada entre as 19 cepas de S. pneumoniae, com 15 previstas para serem encapsuladas. Os prontuários médicos dos pacientes com endoftalmite infecciosa foram revisados (n=15/27; 56%), e a acuidade visual final foi avaliada em 12 casos (44%). Muitos pacientes evoluiram para um estado final de acuidade visual de "sem percepção luminosa" (6/12; 50%), "percepção luminosa" (3/12; 25%) ou "movimentos de mãos" (1/12; 8%). Também foram revisados os prontuários médicos dos pacientes com ceratite infecciosa (n=24/35; 69%), e a acuidade visual final foi avaliada em 18 casos (51%). Da mesma foram, a maioria dos pacientes evoluiu para um estado final de acuidade visual de "sem percepção luminosa" (6/18; 33%), "percepção luminosa" (1/18; 6%) ou "movimentos de mãos" (6/18; 33%). No geral, a maioria dos pacientes evoluiu para um estado final de acuidade visual de "sem percepção luminosa" (12/30), "percepção luminosa" (4/30) ou "movimentos de mãos" (7/30). Conclusões: A distribuição de estreptococos alfa-hemolíticos nas infecções oculares sugeriu a presença de um tropismo de tecido específico da espécie. Os prognósticos dos pacientes com infeções oculares por estreptococos foram altamente desfavoráveis e a resistência a antibióticos contribuiu não para as progressões clínicas des­favoráveis e os maus resultados.

Morbilidad de Faringitis Aguda Estreptocócica en el Dispensario del Seguro Social Campesino Llimpe Grande Enero - Junio 2019 / Acute Streptococcal Pharyingitis Morbidity in the Llimpe Grande Peasant Social Security Dispensary January - June 2019

La faringitis bacteriana es una enfermedad infectocontagiosa que históricamente ha afectado al ser humano durante cualquier etapa de su vida, resultando un área de estudió de importancia para la salud pública.Esta investigaciónpresenta el reporte epidemiológico de morbilidad de Faringitis Aguda Estreptocócica (FAE) atendidos en el dispensario del Seguro Social Campesino Llimpe Grande durante los meses de enero a julio del año 2019. Esto se logró, en dos fases apartir de la revisión de 2538 registros de morbilidad atendidos en el periodo de estudio, correlacionando los caracteres diagnósticos clínicos con la resolución de casos posterior a la indicación del tratamiento con terapia de antibióticos, información levantada a partir del 10% de historias clínicas, corroborando la misma con la población médica (n=9).La información fue analizada en Excel para la determinación de intervalos de confianza apoyado en estadística descriptiva.La FAE en el caso de Ecuador se asocia ala época húmeda, con prevalencia hacia el sexo femenino (Rm=0,2) para el periodo en estudio. Sintomatología:úvula inflamada enrojecida, petequias suaves, náuseas, dolor abdominal degarganta. Los casos se presentan en todas las edades con predominio en el grupo de 18 a 64 años. El 100% de los casos respondieron a la terapia de antibióticos solo un 1,14% no respondió a la antibioterapia por abandonar en forma tempranael mismo.Aún quedan preguntas por responder, por lo que hacemos un llamado a la comunidad científica en general a realizar acciones tendentes a optimizar los registros FAE, robusteciendo a futuro los reporte epidemiológico(AU)

Bacterial pharyngitis is an infectious disease that has historically affected humans during any stage of their life, resulting in an area of study of importance for public health. This research presents the epidemiological report of morbidity of Acute Streptococcal Pharyngitis (AED) treated at the Llimpe Grande Peasant Social Security dispensary during the months of January to July 2019. This was a chieved, in two phases, from there view of 2538 morbidity records attended in the study period, correlating the clinical diagnostic characteristics with there solution of cases after the indication of treat ment with antibiotic therapy, information gathered from the 10% of medical records, corroborating the same with the medical population (n = 9). The information was analyzed in Excel for the determination of confidence intervals supported by descriptive statistics. FAE in the case of Ecuador is associated with the wetseason, with a prevalence tow ards the female sex (Rm = 0.2) for the period understudy. Symptoms: red swollenuvula, mildpetechiae, nausea, abdominal sorethroat. Cases occur in all ages with a predominance in the 18 to 64 age group. 100% of the cases responded to antibiotictherapy, only 1.14% did not respond to antibiotic therapy dueto abandoning it early. There are still questions to be answered, so we call on the scientific community in general to take action saimed at optimizing AED records, streng the ning the epidemiological reports in the future(AU)

Evaluation of microbial contamination and efficacy of antimicrobial agents in disinfection of handicapped patients' toothbrushes

This study aimed to evaluate the contamination of toothbrushes usedby patients with disabilities, by microbial culture and cariogenic biofilm formation,and to explore two methods of disinfection. Methods: Experimental procedures were divided into three stages, with the same interval between each stage. In the first stage, the patients brushed their teeth, rinsed them with water, and their toothbrushes were sprayed with sterilized tap water. In the second and third stages, the steps were similar to those of Stage I, except the toothbrushes were sprayed with 0.12% chlorhexidine and 0.05% cetylpyridinium chloride solutions, respectively. At the end of each stage, the toothbrush bristles were cultured in bacitracin sucrose broth (CaSaB) medium. Data were analyzed through Friedman's nonparametric test (5% significance level). Results: In Stage I, mutans group streptococci (MS) were present in 30 toothbrushes (76.9%), and the number of colonies/biofilms ranged from 0 to +100. In Stage II, no MS colonization was observed. In Stage III, only 10.2% of the toothbrushes were contaminated with MS, and the number of colonies/biofilms ranged from 1 to 31. Conclusion: Bristles of toothbrushes used by patients with disabilities became contaminated with MS after a single brushing. The 0.12% chlorhexidine solution eliminated all microorganisms from the bristles of the toothbrushes used by the patients. Both 0.12% gluconate chlorhexidine and 0.05% cetylpyridinium chloride spray solutions can effectively be used for toothbrush disinfection to reduce contamination.

Objetivo: O presente estudo teve como objetivo avaliar a contaminação de escovas de dente utilizadas por pacientes especiais, por meio de cultura microbiana e formação de biofilme cariogênico, explorando dois métodos de desinfecção. Métodos: O estudo foi dividido em três estágios, com o mesmo intervalo de tempo entre cada estágio. No primeiro estágio, os pacientes escovaram os dentes e enxaguaram com água, em seguida, suas escovas foram borrifadas com água destilada. No segundo e terceiro estágios, as etapas foram semelhantes às do estágio I, exceto que as escovas de dente foram borrifadas com soluções de clorexidina 0,12% e cloreto de cetilpiridínio 0,05%, respectivamente. Ao final de cada etapa, as cerdas das escovas de dente foram cultivadas em meio de Caldo Sacarose Bacitracina (CaSaB). Os dados foram analisados por meio do teste não paramétrico de Friedman (nível de significância de 5%). Resultados: No estágio I, os estreptococos do grupo mutans (EM) estavam presentes em 30 escovas de dente (76,9%), e o número de colônias / biofilmes variou de 0 a +100. No estágio II, nenhuma colonização por MS foi observada. No estágio III, apenas 10,2% das escovas de dente estavam contaminadas com MS, e o número de colônias / biofilmes variou de 1 a 31. Conclusão: As cerdas das escovas de dente utilizadas por pacientes especiais contaminaram-se com EM após uma única escovação. A solução de clorexidina 0,12% eliminou todos os microrganismos das cerdas das escovas de dente utilizadas pelos pacientes. Ambas as soluções em spray (gluconatode clorexidina 0,12% e cloreto de cetilpiridínio 0,05%) podem ser utilizadas com eficácia para desinfecção das escovas de dente para reduzir a contaminação.

jptsd123 / 口腔疾病防治

@#Esophageal cancer is one of the most lethal digestive system cancers, and its pathogenic factors have always been the focus of research. Recently, it has been found that microorganisms and their metabolites in the esophagus may also represent one of the pathogenic factors. Because of their continuity in anatomical structure, the oral cavity and esophagus have a certain correlation in terms of the composition of flora. In recent years, many scholars have studied the relationship between oral microorganisms and esophageal cancer to monitor changes in oral microorganisms as well as to diagnose and treat esophageal cancer more effectively. In this paper, the research status of oral microorganisms and esophageal cancer was reviewed. The Results of the literature review show that the diversity of bacteria in the esophagus is affected by oral flora in terms of the occurrence and development of esophageal cancer. Among these bacteria, the periodontal red complex, which includes Porphyromonas gingivalis, forsythia and Treponema dentata, as well as common oral microorganisms, such as Streptococcus viridis and Fusobacterium nucleatum, are all related to the occurrence and development of esophageal cancer to a certain extent. At present, there are few studies on the mechanism of microorganisms and esophageal cancer, but scholars have found that lipopolysaccharides and endotoxins, the products of Gram-negative bacteria in the esophagus, may participate in the innate immune response of the host, and the relevant mechanism of action needs further study in order to find new targets for monitoring and treatment.

Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization / Prevalência de colonização retovaginal por estreptococo do grupo B em gestantes de programa de atendimento pré-natal de instituição de saúde

ABSTRACT Objective To evaluate the prevalence of group B Streptococci in pregnant women of a corporate health program, as well as the epidemiological correlations. Methods This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. Results A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients' age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B Streptococcus (prevalence of 23.3%; 95%CI: 18.7-28.5). Conclusion Considering the high prevalence of group B Streptococcus in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.

RESUMO Objetivo Identificar a prevalência de estreptococo do grupo B entre gestantes que frequentaram um programa de saúde corporativa, bem como as correlações com a colonização positiva. Métodos Estudo retrospectivo dos prontuários do pré-natal de um hospital privado em São Paulo, no período de 2015 a 2016. Foram excluídas as mulheres que abandonaram o programa ou apresentavam dados incompletos nos prontuários. As variáveis quantitativas foram descritas por média, desvios padrão, mediana, valores mínimos e máximos. A paridade e a condição socioeconômica foram descritos por frequência absoluta e percentagens. Utilizamos modelos de regressão logística no programa (SPSS) para analisar as correlações de variáveis de acordo com a cultura retovaginal, considerando IC95% e valores de p. As variáveis foram idade, número de gestações, peso ganho na gestação e idade gestacional no parto. Resultados Foram incluídos 347 prontuários e, após a aplicação dos critérios de exclusão, 287 prontuários compuseram a amostra final. A idade dos pacientes variou entre 17 e 44 anos. A média de idade foi de 30,6 anos, e 67 pacientes tiveram resultado positivo para o estreptococo do grupo B (prevalência de 23,3%; IC95%: 18,7-28,5). Conclusão Considerando a alta prevalência de estreptococos do grupo B em nosso serviço, existem evidências de que a estratégia de antibiótico profilaxia baseada na cultura retovaginal é custo-efetiva.

Actividad antimicrobiana de adhesivo ortodóntico con nanopartículas de plata sobre Streptococcus mutans / Antimicrobial activity of orthodontic adhesive with silver nanoparticles on Mutans streptococci / Atividade antimicrobiana de adesivo ortodôntico com nanopartículas de prata sobre streptococcus mutans

La aparatología fija usada en ortodoncia dificulta una adecuada higiene bucal, en estas condiciones el de-sarrollo de lesiones cariosas puede ser una complicación, uno de los principales agentes etiológicos involu-crados es Streptococcus mutans. La nanotecnología con plata tiene una aplicación preventiva importante en biomateriales dentales. Objetivo: Se determinó la actividad antimicrobiana sobre Streptococcus mutans de nanopartículas de plata (AgNPs) incluidas en adhesivos ortodónticos a diferentes concentraciones. Materia-les y métodos: En 20 cajas Petri con Streptococcus mutans inoculada en agar Müller-Hinton suplementado con 5% de sangre, se colocaron 6 discos de papel, 4 embe-bidos con AgNPs incluidas en un adhesivo orto-dóntico a concentraciones de 25, 75, 125 y 175 ppm, y 2 discos controles con clorhexidina al 0.12% y agua destilada. Se determinó la capacidad antimicrobiana en función de promedios de halos de inhibición a las 48 horas de incubación, en comparación con la escala de Duraffourd y la clorhexidina 0.12%. Resultados: A 25 ppm no existió capacidad antibacteriana, a 75 ppm el 50% alcanzó sensibilidad límite, pero el 100% de las muestras a 125 y 175 ppm consiguieron sensibilidad límite, sin embargo, la clorhexidina al 0,12% presentó mayor sensibilidad entre media 60% y sumamente sensible 40%. Conclusión: Las nanopartículas de plata con tamaño inferior a 100 nm, incluidas a 125 y 175 ppm en adhesivos de ortodoncia poseen actividad anti-microbiana sobre Streptococcus mutans, sin embargo, en el tiempo de estudio no alcanzan la sensibilidad de la clorhexidina al 0.12%.

The fixed appliances used in orthodontics make proper oral hygiene difficult, in these conditions the develop-ment of carious lesions can be a complication, one of the main etiologic agents involved is Mutans streptococci. It was determined that silver nanotechnology has an important preventive application in dental biomaterials. Objective: Antimicrobial activity on Mutans streptococci of silver nanoparticles (AgNPs) included in orthodon-tic adhesives at different concentrations. Materials and methods: In 20 Petri dishes with Mutans streptococci inoculated in Müller-Hinton agar supplemented with 5% blood, 6 paper discs were placed, 4 soaked up with AgNPs included in an orthodontic adhesive at concentrations of 25, 75, 125 and 175 ppm, and 2 control discs with 0.12% chlorhexidine and distilled water. Antimicrobial capacity was determined based on averages of inhibition halos at 48 hours of incubation, compared to the Duraffourd scale and 0.12% chlorhexidine. Results:At 25 ppm there was no antibacterial capacity, at 75 ppm 50% reached limit sensitivity, but 100% of the sam-ples at 125 and 175 ppm achieved limit sensitivity, however, chlorhexidine 0.12% showed higher sensitivity be-tween average 60% and highly sensitive 40%. Conclusión: Silver nanoparticles smaller than 100 nm, included at 125 and 175 ppm in orthodontic adhessives, have antimicrobial activity on Strptococcus mutans, however, when studying, they don't reach the sensitivity of chlorhexidine at 0.12%.

Os aparelhos fixos utilizados em ortodontia dificultam uma higiene bucal adequada, nessas condições o desenvolvimento de lesões cariosas pode ser uma complicação, um dos principais agentes etiológicos envol-vidos é o Streptococcus mutans. A nanotecnologia com partículas de prata tem uma importante aplicação pre-ventiva em biomateriais dentários. Objetivo: Determinou-se a atividade antimicrobiana das nanopartículas de prata (AgNPs) incluídas em adesivos ortodônticos em diferentes concentrações sobre Streptococcus mutans. Materiais e métodos: Em 20 placas de Petri com Streptococcus mutans inoculadas em ágar Müller-Hinton suplementado com 5% do sangue, foram colocados 6 discos de papel, 4 ensopados com AgNPs incluídos em um adesivo ortodôntico nas concentrações de 25, 75, 125 e 175 ppm e 2 discos de controle com 0,12% de clorexidina e água destilada. O efeito antimicrobiano foi determinado com base nas médias de halos de inibição às 48 horas de incubação, em comparação com a escala de Duraffourd e com clorexidina a 0,12%. Resultados: A 25 ppm não havia capacidade antibacteriana, a 75 ppm 50% atingiram a sensibilidade limite, mas 100% das amostras a 125 e 175 ppm atingiram a sensibilidade limite, no entanto, 0,12% de clorexidina apresentou maior sensibilidade entre 60% em média e 40% altamente sensíveis. Conclusão: Nanopartículas de prata menores que 100 nm, incluídas em 125 e 175 ppm em adesivos ortodônticos, têm atividade antimi-crobiana em Streptococcus mutans, no entanto, no tempo

Determinación de la adquisición del Streptococcus grupo mutans en un grupo de niños uruguayos de hasta 36 meses de edad Estudio piloto / Determinação da aquisição do grupo Streptococcus mutans em um grupo de crianças uruguaias até 36 meses de idade. Estudo piloto / Determination of the acquisition of Mutans Streptococci in a group of Uruguayan children up to 36 months of age. Pilot study

Resumen: Introducción: La boca del recién nacido se contamina inmediatamente con microorganismos maternos. Caufield determinó la colonización con SGM para niños americanos a los 26 meses de edad. Estudios latinoamericanos la ubican entre los 14,9-18 meses. Objetivos: -Identificar el momento de adquisición y colonización del SGM en una población de niños uruguayos y relacionarlo con factores del niño y maternos. Establecer el tiempo necesario para la recolección de la muestra y estudio de su pérdida. Método: Estudio observacional, longitudinal prospectivo, de 83 pares madre-hijo de un policlínico de Montevideo. De 83 pares examinados, 20 completaron el estudio. Se incluyeron niños de 0-9 meses, con/sin dientes y primera toma salival negativa para SGM. Resultados: Edad promedio de adquisición del SGM 16,4 meses (±4,13) y colonización 18,6 meses (±3,80) de edad. La pérdida de la muestra fue 71,42%. Conclusiones: La colonización resultó similar a la encontrada por Florio (Brasil), observándose diferencias significativas con Caufield (EEUU).

Resumo: Introdução: A boca do recém-nascido é imediatamente contaminada por microrganismos maternos. Caufield determinou a colonização com SGM para crianças americanas aos 26 meses de idade. Estudos latino-americanos o situam entre 14,9-18 meses. Objetivos: -Identificar o momento de aquisição e colonização do SGM em uma população de crianças uruguaias e relacioná-lo com fatores da criança e da mãe. Estabeleça o tempo necessário para coletar a amostra e estudar sua perda. Método: Estudo observacional, longitudinal prospectivo, de 83 pares mãe-filho da uma policlínica de Montevidéu. Dos 83 pares examinados, 20 completaram o estudo. Foram incluídas crianças de 0-9 meses com / sem dentes e primeira amostra salivar negativa para SGM. Resultados: Idade média de aquisição do SGM 16,4 meses (± 4,13) e colonização 18,6 meses (± 3,80) de idade. A perda estabelecida da amostra foi 71,42%. Conclusões: A colonização foi semelhante aos de Florio (Brasil), observando diferenças significativas com Caufield (EUA)

Abstract: Introduction: The newborn's mouth is immediately contaminated with maternal microorganisms at birth. Caufield determined that the average age of colonization with Mutants streptococci (MS) for American children was 26 months old. Latin American studies indicate that it occurs at an age between 14.9 and 18 months old. Objectives: To identify the time of MS acquisition and colonization in a population of Uruguayan children and to relate it with various child and maternal factors. To establish the time needed to collect the sample and its loss. Methods: Observational, longitudinal prospective study, of 83 mother-child pairs from a medical center in Montevideo. From the 83 pairs examined, 20 completed the study. Children between 0-9 months old, with/without teeth, whose first saliva sample was negative for MS, were included. Results: The mean age of MS acquisition was 16.4 months (± 4.13), and colonization occurred at 18.6 months (± 3.80) of age. The sample loss was 71.42%. Conclusions: The colonization found was similar to that found by Florio (Brazil) but showed significant differences with Caufield's results (USA).

Modeling the Growth of Bacteria Streptococcus sobrinus Using Exponential Regression

Abstract Objective: To build an exponential regression model based on parameter estimation. Material and Methods: We developed a simple mathematical model to simulate the growth of bacteria and the exponential growth is often used to model population growth as such cell growth while the exponential decay is portraying a declining or decreases in the size of the population. An exponential regression method was used to fit the data and estimate growth parameter values Streptococcus sobrinus using statistical software SPSS version 20. Results: Based on the results of the parameter estimates, which is constant are 83.039 and b1 is 0.005 while R-square is 0.952. According to the R-Square results obtained, the model is good and appropriate. Conclusion: The model can be used to find the potential biological parameters, which may be able to predict the treatment outcome. This study helps researchers to understand the specific growth rate(s), which can be used to best grow the organism.

A study of the prevalence of group B streptococci in the third trimester of pregnancy

Background: Group B Streptococci (GBS) is an important cause of early onset neonatal sepsis and the maternal colonization of this organism is a key factor in the occurrence of GBS associated morbidity and mortality in the newborns. Timely recognition of its presence in the genital tract of a pregnant women and intrapartum antibiotic prophylaxis can significantly bring down the burden of the disease in neonates. A cross sectional study was conducted on  antenatal women during 35-37weeks of gestation to evaluate the prevalence of Group B Streptococci in third trimester of pregnancy and explore the feasibility of including GBS screening in the routine antenatal investigation protocol.Methods: 200 antenatal women satisfying the exclusion/inclusion criteria were recruited for the study. Vaginal and perianal swabs were collected using sterile swab sticks and inoculated using the specified media. Beta hemolysis and typical colonies were looked for under microscope. Positive cases were subjected to intrapartum antibiotic prophylaxis and the neonates were observed for 72 hours to look for any signs of sepsis.Results: It was found that 2% of the women screened were positive for GBS .While none of the newborns of the 4 positive cases showed any signs of sepsis.Conclusions: Prophylactic intrapartum prophylaxis against GBS has shown to decrease the chances of neonatal sepsis but more detailed and robust studies are required before incorporating routine screening in our antenatal care system.

Validation of an adherence assay to detect group mutans streptococci in saliva samples / Validación del Test de adherencia para el recuento de estreptococcos del grupo mutans en muestras de saliva

The aim of the present study was to validate and establish a cut off point and the predictive value of an adhesion test (AA-MSMG), as a microbiological method for evaluating cariogenic risk. The study is based on a variant (20% sucrose) of a selective medium descripted by Gold et al. (MSMG). This method differentiates mutans group streptococci (MGS) by exacerbating the production of insoluble extracellular polysaccharide which gives adhesion to surfaces such as glass, plastic and dental enamel. Caries assessment according to ICDAS was conducted in 154 patients (aged >21 years) who were attended at Preventive and Community Dentistry Department, School of Dentistry, University of Buenos Aires, Argentina, between August 2017 to August 2018. The study population was assigned to groups according to the presence/ absence of caries lesions: Group A: ICDAS lesion code = 0 (L=0) on all dental surfaces (n=23); and Group B: L>1 (n=131). After mouth-rinsing with distilled water, saliva samples were collected with fasting and hygiene protocol, and sent immediately to the Microbiological Diagnosis Laboratory, Microbiology Department, School of Dentistry, University of Buenos Aires. Samples were homogenized and serially diluted to the tenth. 100 pl of the dilutions were cultured in 25 cm² sterile plastic flasks containing 9.9 ml of modified selective medium described by Gold (MSMG-selective and differential medium). Cultures were incubated in an anaerobic atmosphere at 36 ± 1°C for 48 hours. The supernatants were eluted and the samples washed with sterile distilled water. Colony forming unit counts were performed by calibrated researchers (Kappa >0.75) using a stereoscopic microscope at 50X. Mutans group streptococci (MGS) counts ranged from 1x10(4) to 1x10(5) CFU/ml in group A, and were higher than 1x10(6) CFU/ml in Group B. Statically analysis of results (ROC) showed that the AAMSMG has a satisfactory predictive value (91%) and established a cutoff point in 1.68x10(5) UFC / ml. This would indicate that individuals whose MGS saliva counts are higher than the cutoff value would be 5 times more likely to develop dental caries. Adherence assay could be a useful microbiological predictor of caries risk.

El objetivo del presente estudio fue validar, establecer el punto de corte y valor predictivo de una técnica microbiológica para evaluar el nivel de estreptococos del grupo mutans en saliva. La técnica consiste en un test de adherencia que emplea un medio selectivo modificado (20% sacarosa) descripto por Gold et al. (TA-MSMG). Este método permite diferenciar a los estreptococos del grupo mutans (SGM) exacerbando la producción del polisacárido extracelular insoluble que le confiere adhesión a superficies como vidrio, plástico y esmalte dental. De acuerdo con los criterios de ICDAS se sembraron 154 salivas de pacientes mayores de edad, que asistieron al Servicio de Odontología Preventiva y Comunitaria de la Facultad de Odontología de la Universidad de Buenos Aires entre los meses de agosto de los años 2017 y 2018. La población estudiada fue asignada a dos grupos según la presencia / ausencia de lesiones de caries: Grupo A: código de lesión ICDAS = 0 (L = 0) en todas las superficies dentales (n = 23); y Grupo B: L> 1 (n = 131). Después de realizar un enjuague bucal con agua destilada, las muestras de saliva se recogieron según protocolo (ayuno de 4 horas y suspensión de higiene dental de 12 hs). Las muestras se remitieron de inmediato al Laboratorio de Diagnóstico Microbiológico, Departamento de Microbiología de la Facultad de Odontología, Universidad de Buenos Aires. Para su procesamiento, las muestras fueron homogeneizadas y diluidas al décimo. Se cultivaron 100 pl de las diluciones en botellas de plástico estériles de 25 cm² que contenían 9,9 ml de medio de Gold modificado (MSMG-20% sacarosa). Los cultivos se incubaron en atmósfera anaeróbica a 36 ± 1°C durante 48 horas. El sobrenadante se eluyó y las muestras se lavaron con agua destilada estéril. Los recuentos de unidades formadoras de colonias SGMfueron realizados por investigadores calibrados (Kappa >0.75) utilizando un microscopio estereoscópico a 50X. Los recuentos de SGM presentaron una variación entre 1x10(4)y 1x10(5) UFC/ml en el grupo A, mientras que en el Grupo B fueron superiores a 1x10(6) UFC/ml. El análisis estadístico de los resultados determinó una curva ROC que establece para el TA-MSMG un valor predictivo del 91% y un punto de corte en 1.68x10(5) UFC SGM / ml. Esto indicaría que los individuos cuyos recuentos en saliva de SGM sean superiores al valor de corte, tendrían 5 veces más posibilidades de desarrollar caries (5:1). Este método podría ser un instrumento útil al momento de evaluar (indicador microbiológico) el riesgo cariogénico del paciente.

Antibiotic susceptibility pattern of group B streptococcal isolates from maternal genital tract

Background: Group B streptococcus (GBS) is one of the important cause of early onset neonatal sepsis in developed countries leading to increased neonatal morbidity and mortality. Penicillin and Ampicillin are the drugs of choice for prevention of GBS infections. Antibiotic resistance amongst GBS isolates is an emerging health problem affecting neonates. Hence, this study was performed to determine the antibiotic susceptibility pattern of Group B Streptococcus (GBS) in a population of pregnant women.Methods: A prospective study was done to screen pregnant women for vaginal and rectal GBS colonization during their regular visits to antenatal clinic. Todd-Hewitt broth, an enrichment medium for GBS was used for isolation. The antibiotic susceptibility pattern of the isolates were studied.  Results: A total of 300 pregnant women were screened for GBS colonization. GBS colonization rate in our study was 2.3%. The antibiotic susceptibility pattern of the isolates revealed that none of the isolates were resistant to penicillin or clindamycin, while resistance was noted to erythromycin (14.3%) and   tetracycline (71.4%).Conclusions: GBS continues to remain sensitive to Penicillin which is the drug of choice for prevention and treatment of GBS.  Consistent surveillance of antibiotic sensitivity pattern of GBS as well as for other organisms implicated in new born sepsis and maternal infections is required to formulate guidelines for prevention and treatment.

Detection and characterization of Streptococcus downei, a rare bacterial species of mutans streptococci from caries-active patients

Background: The oral bacteria, mutans streptococci (MS), are an etiological agent of dental caries. Of MS, Streptococcus downei are rarely isolated bacteria. Aim: The aim of this study was to isolate and characterize S. downei from caries-active subjects. Materials and Methods: In all, 65 dental plaque samples were collected from dental caries-active subjects. All the isolates were further identified and characterized using 16S rDNA sequencing, biochemical tests, antibiogram, and minimum inhibitory concentration (MIC). Results: Five isolates have been identified as S. downei using 16S rDNA sequencing. Phylogenetic analysis showed that S. downei was closely related to S. sobrinus. The biotype traits of these five isolates were IV (n = 3), V (n = 1), and variants (n = 2). The study proposed one new biotype, classified as biotype VIII for the variant strain. The antibiogram tests revealed that all the strains of S. downei were susceptible to all the antibiotics used in the study with higher sensitivity to penicillin and ampicillin. The MIC of ampicillin and erythromycin against S. downei was 0.047 and 0.39 μg/mL, respectively. Conclusion: The study reports the prevalence of S. downei in caries-active subjects and recommends further investigations to determine its role in the disease.

Endocarditis infecciosa nativa en pediatría: enfoque clínico cardiológico / Native valve infective endocarditis in children: From the focus of clinical cardiology

Objetivos: Analizar las características demográficas, clínicas, microbiológicas, evolución y factores de riesgo de morbimortalidad asociados a la endocarditis de válvula nativa (EIN) en pacientes (p) pediátricos. Población y métodos: Se evaluaron 176 p con EIN, divididos en grupo I: <3meses (27p) y grupo II: >3meses (149p). Resultados: Grupo I: el 66% tenía corazón sano. El microorganismo más frecuente fue Staphylococcus aureus (44,4%). Afectación derecha (77,8%-p<0,0001). Evento principal: infección no controlada (INC) (52%, p=0,0009) y asociada a Candida (p<0,00001). Se indicó tratamiento quirúrgico a 10 p (37%). Mortalidad 29,6%(8p). Grupo II: el 57% presentaba cardiopatía previa. Microorganismos prevalentes: S.aureus (49,1%) y estreptococos del grupo viridans (22,5%). Hubo compromiso predominantemente izquierdo (p=0,001). Eventos: embolias sistémicas (36,2%-p=0,01), perforación valvular (51%-p=0,0005), insuficiencia cardíaca (26%-p=0,03) e INC (21,5%). La embolia sistémica se asoció a S.aureus (p=0,01). El 36,2% requirió cirugía. Mortalidad 6,7% (10p). En el análisis univariado la mortalidad se asoció a edad <3meses (p=0,0003), INC (p=0,002) y S.aureus (p=0,03). En el multivariado la mortalidad se relacionó a edad < 3meses (OR:7,50 ­IC95%:1,77­31,69) y a INC (OR:4,2-IC95%:1,16­15,29). Conclusiones: La EN se presentó en pacientes con corazón sano en el 50% de los casos. El microorganismo más frecuente fue S.aureus. En los <3 meses la infección no controlada fue la complicación más frecuente asociada a Candida, con afectación predominante de cavidades derechas. Los >3meses tuvieron mayor prevalencia de perforación valvular izquierda asociada a embolias sistémicas e insuficiencia cardíaca. El 35% de los p requirió cirugía. Los predictores de mortalidad fueron la edad <3meses y la INC.

Objectives: To analyze demographic, clinical, and microbiological, outcome, and morbidity and mortality risk factors associated with native valve endocarditis (NVE) in pediatric patients (p). Population and methods: 176 p with NVE were evaluated and divided into group I: <3 months (27p) and group II: >3 months (149p). Results: Group I: 66% had a healthy heart. The most common microorganism was Staphylococcus aureus (44.4%). Right-sided involvement (77.8%-p<0.0001). Main event: Uncontrolled infection (UCI) (52%, p-0.0009) and association with Candida (p<0.00001). Surgical treatment was indicated in 10 p (37%). Mortality was 29.6% (8p). Group II: 57% had previous heart disease. Prevalent microorganisms: S. aureus (49.1%) and viridans group streptococci ( (22.5%). Left-sided involvement predominated (p-0.001). Events: systemic embolism (36.2%-p-0.01), valve perforation (51%-p-0.0005), heart failure (26%-p-0.03), and UCI (21.5%). Systemic embolism was associated with S. aureus infection (p-0.01). 36.2% required surgery. Mortality was 6.7% (10p). In univariate analysis, mortality was associated with age <3 months (p-0.0003), UCI (p-0.002), and S. aureus infection (p-0.03). In multivariate analysis, mortality was related to age <3 months (OR:7.50 ­ 95% CI:1.77­31.69) and UCI (OR:4.2 -95% CI:1.16­15.29). Conclusions: NVE was observed in patients with a healthy heart in 50% of cases. The most common microorganism found was S. aureus. In the <3 months group, uncontrolled infection was the most common complication associated with Candida, predominantly affecting the right side. The >3 months group had a higher prevalence of left-valve perforation associated with systemic embolism and heart failure. 35% of p required surgery. Predictors of mortality were age <3 months and UC (AU)

Identificación y sensibilidad a los antimicrobianos de aislados de estreptococos del grupo viridans provenientes de pacientes internados en un hospital universitario de la ciudad de Buenos Aires / Identification and antibiotic susceptibility of viridans group streptococci isolates recovered from patients hospitalized at a teaching hospital in Buenos Aires City

Los estreptococos del grupo viridans (EGV) son agentes causales de infecciones localizadas e invasivas. Dada la gravedad de las infecciones producidas por EGV sumada a las escasas comunicaciones actuales en nuestro país, los objetivos de este trabajo fueron la identificación y el estudio de la sensibilidad a los antibióticos de aislados caracterizados como EGV, recuperados de pacientes internados, para actualizar el conocimiento sobre el perfil de resistencia y la epidemiología de las infecciones ocasionadas por EGV. Se recuperaron 132 aislados de EGV en el Hospital de Clínicas «José de San Martín¼ en el período 2011-2015. La identificación se realizó mediante pruebas convencionales y espectrometría de masas (Matrix Assisted Laser Desorption Ionization - Time of Flight Mass Spectrometry). El grupo Streptococcus anginosus fue el más frecuente (42%) seguido por el grupo Streptococcus mitis (33%). Dentro del grupo S. mitis se excluyó a Streptococcus pneumoniae. El 100% de los aislados fue sensible a ertapenem, linezolid y vancomicina; el 96,9% a cef-triaxona y cefepima. Se encontró un 25,8% de resistencia a penicilina (I+R) fundamentalmente en aislados de grupo S. mitis. La resistencia a tetraciclina fue del 27,2% y solo 2/132 aislados fueron resistentes a levofloxacina. Los valores de CIM de gentamicina oscilaron entre 0,5 y 32 -og/ml. El 17,4% de los aislados presentó resistencia a eritromicina sin diferencia significativa en la distribución de fenotipos M y MLS. Los resultados muestran la importancia de la vigilancia continua de las infecciones producidas por estos microorganismos con el fin de generar aportes para la elección de la terapia antibiótica adecuada.

Members of the viridans group streptococci (VGS) are the cause of local and invasive infections. Due to the severity of these infections and taking into account that reports regarding epidemiological aspects are scarce, the aims of this work were the identification and the study of the antibiotic susceptibility profiles of the isolates recovered from patients that were hospitalized in order to find out about the resistance level and the epidemiology of infections in which VGS are involved. A hundred and thirty two isolates identified as VGS were isolated at Hospital de Clínicas «José de San Martín¼ during the period 2011-2015. The identification was performed by biochemical test and mass spectrometry by Matrix Assisted Laser Desorption Ionization -Time of Flight Mass Spectrometry. Streptococcus anginosus group was prevalent (42%) followed by Streptococcus mitis group (33%). In the latter, isolates of Streptococcus pneumoniae were excluded. All the VGS isolates were susceptible to ertapenem, meropenem, linezolid and vancomycin; 25.8% were resistant (I+R) to penicillin, being prevalent in the S. mitis group. Regarding ceftriaxone and cefepime 96.9% of the isolates were susceptible. Only two isolates were resistant to levofloxacin, 27.2% to tetracycline and it was not found high level resistance to gentamycin (MIC range 0.5-32 µg/ml). Resistance to erythromycin was 17.4% with no significant difference between M and MLS phenotypes. The most active antibiotics were in addition to ceftriaxone and cefepime, vancomycin, ertapenem, meropenem and linezolid. These results highlight the importance of the continuous surveillance of the infections caused by VGS in order to predict a correct antibiotic therapy.

Bacterial Endocarditis Caused by Abiotrophia defectiva in a Healthy Adult: A Case Report with Literature Review / 대한임상미생물학회지

Infective endocarditis caused by Abiotrophia defectiva is rarely encountered. A 67-year-old male transferred from a local hospital presented with severe dyspnea and pulmonary edema. Preoperative transthoracic echocardiography revealed severe mitral regurgitation with large vegetation. Blood cultures grew A. defectiva, a gram positive, nutritionally deficient streptococcus variant. Emergent mitral valve replacement through right thoracotomy was performed, and after completing six weeks of antibiotic combination therapy (vancomycin, ampicillin, and gentamicin), the patient recovered fully. Because of the need for prompt surgical treatment and long-term antibiotic therapy and lack of laboratory experience with the organism, physicians and laboratory workers should pay close attention to the possibility of A. defectiva infective endocarditis when gram positive cocci are detected in blood cultures.