Speciation of coagulase negative staphylococci (CoNS) isolated from various clinical specimens in a tertiary care hospital of southern Rajasthan

Background: Coagulase negative staphylococci (CoNS) are a group of staph bacteria, which generally exist as normal flora of human skin and the oral flora found on mucous membranes. CoNS in immunocompromised pa?ents can cause variety of infec?ons like bacteraemia, central nervous system shunt infec?on, intravascular catheter-related infec?ons, endocardi?s, surgical site infec?ons, urinary tract infec?ons, foreign body infec?on, endophthalmi?s, peritoni?s and wound, bone and joint infec?ons as well as infec?ons in neonates. These infec?ons are difficult to treat because of the risk factors and the drug resistant nature of the organisms.Objec?ve:To find out species wise distribu?on of Coagulase nega?ve Staphylococci (CoNS) in various relevant clinical samples in our ins?tute. Materials and Method:A total of 500 CoNS strains were isolated from relevant clinical specimens. CoNS strains were isolated from variety of clinical specimens. Strains were iden?fied as CoNS on the basis of colony morphology, gram stain, catalase test and coagulase test. Conven?onal methods were used for species iden?fica?on a?er confirming isolates as CoNS. Results:The most common source of CoNS isola?on was blood (34%), followed by respiratory secre?ons (24.4%), urine (16.8%), pus (13.4%), swabs (5.4%), bodily fluid (1.4%), and others (4.6%). S.epidermidis was most frequently isolated (30.6%), followed by S.hemoly?cus (25.4%), S.hominis (12.6%), S.capi?s (12%), S.lugdunensis (11.4%) and S.cohnii (08%). Conclusion : As CoNS have become major cause of nosocomial infec?ons, there is a need for rapid iden?fica?on and specia?on of CoNS with their an?bio?c suscep?bility for be?er management of these cases and to prevent emergence of drug resistance.

Infección por Staphylococcus lugdunensis: descripción de 44 casos / Staphylococcus lugdunensis infection: report of 44 cases

INTRODUCCIÓN: Staphylococcus lugdunensis, es un estafilococo coagulasa negativa (SCN) con características de virulencia y de sensibilidad antimicrobiana que lo hacen más parecido a Staphylococcus aureus que a otros SCN. OBJETIVOS: Conocer las características clínicomicrobiológicas de los aislados de S. lugdunensis identificados en nuestra institución. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo de los aislados de S. lugdunensis entre los años 2017 y 2019 en el Servicio de Microbiología del Hospital Universitario San Jorge de Huesca (España). Se revisaron las historias clínicas correspondientes a los pacientes con aislamiento de S. lugdunensis, considerándose las siguientes variables: edad, sexo, tipo de muestra, servicio de procedencia y enfermedad de base. La identificación bacteriana se realizó con MALDI-TOF VITEK MS (BioMérieux, Francia). Así mismo, se estudió su patrón de susceptibilidad antimicrobiana in vitro mediante microdilución en placa. RESULTADOS: Se obtuvieron 44 aislados de S. lugdunensis: 12 procedían de heridas, 10 fueron abscesos, 8 úlceras, 7 orinas, 4 frotis cutáneos, 2 exudados óticos, y 1 exudado vaginal. En relación con la enfermedad de base destacaron cinco pacientes con procesos tumorales y diez con diabetes mellitus. En 17 pacientes existían antecedentes de cirugía o traumatismo reciente. La mayoría de las cepas fueron sensibles a los antimicrobianos estudiados. En 19 de ellas se observó producción de β-lactamasa, dos fueron resistentes a macrólidos y tres a clindamicina. Todas las cepas fueron sensibles a oxacilina, gentamicina y cotrimoxazol. CONCLUSIONES: Aunque S. lugdunensis mantiene una buena sensibilidad a la mayoría de los antimicrobianos, su tendencia a producir abscesos y que exprese factores de virulencia más parecido a S. aureus que a otros SCN, hace necesaria una correcta identificación en el laboratorio con el fin de que su incidencia no quede subestimada.

BACKGROUND: Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) with virulence and antibiotic sensitivity characteristics which makes it more similar to Staphylococcus aureus than other CNS. AIM: To know the microbiological and clinical characteristics of S. lugdunensis isolates identified from our health sector. METHODS: A retrospective study of S. lugdunensis isolates was carried out between 2017 and 2019 in the Microbiology Service of the San Jorge University Hospital in Huesca (Spain). The clinical records of patients with S. lugdunensis isolation were reviewed, considering the following factors: age, sex, sample type, service and underlying disease. Bacterial identification was performed using MALDI-TOF VITEK MS (BioMérieux, France). The pattern of antibiotic susceptibility was studied by means of plate microdilution. RESULTS: 44 isolates of S. lugdunensis were obtained: 12 corresponded to wounds, 10 were abscesses, 8 ulcers, 7 urine samples, 4 skin smears, 2 otic exudates, and 1 vaginal exudate. Regarding the underlying disease, five patients had a tumor processes and ten had diabetes mellitus. In 17 patients there was a history of recent surgery or trauma. Most of the strains were susceptible to the antibiotics studied. Production of beta-lactamase was observed in 19 of them, two were resistant to macrolides and three to clindamycin. None of the isolates were resistant to oxacillin, gentamicin or cotrimoxazole. CONCLUSIONS: Although S. lugdunensis maintains a good sensitivity to most antibiotics, its tendency to produce abscesses and that it expresses virulence factors more similar to S. aureus than to other CNS requires a correct identification in the laboratory so that its incidence is not underestimated.

Evaluation of Pathogens Causing Urinary Tract Infection and Their Sensitivity Pattern

Background: UTI constitute a major public health problem in India accounting 2nd most common infection next to respiratory tract infection. They are responsible for increasing treatment cost and significant morbidity.Aim:-To determine the incidence of UTI, evaluation of pathogens responsible and their antimicrobial susceptibility pattern in the population.Methods:Urine samples were collected from 300 patients attending the OPD Patna medical college, Patna during the period of 18 months (January 2017 to June 2018) Antimicrobial sensitivity testing was done for the bacterial isolates present in the sample by Kirby- Bauer disc diffusion method. Only those samples were taken into consideration which develops count equal to or greater than 1*105CFU/ml as indicated by Kass.Results:Out of 300 samples collected 146 (48.66%)) yielded bacterial growth. Out of 146 culture isolates E.Coli was the most common pathogen followed by klebsiella, CoNS and staphylococcus. Antibiotic sensitivity was performed on all the isolates. It was observed that highest sensitivity was 49.31% to amikacin, gentamycin (45.89%), nitrofurantoin (38.35%) meropenem (27.39%).Conclusions:It was observed that high grade of resistance to ampicillin, cotrimoxazole, ciprofloxacin, cefuroxime, chloramphenicol, cefotaxime, cefazolin, amoxicillin + clavulanic acid and gentamycin is present as a result of misuse or improper use of antibiotic in the community. Hence urine culture is necessary for the diagnostic screening of UTI before the treatment.

Antibiotic resistance patterns of methicillin-resistant coagulase negative staphylococci isolated from blood cultures at a university hospital in Turkey

Aims@#Recent reports indicate that many coagulase-negative staphylococci (CoNS) strains are resistant to most antimicrobials used against staphylococcal infections. This study was aimed to determine the species distribution of the CoNS isolates in Lokman Hekim Ankara Hospital and determine their antimicrobial resistance characteristics.@*Methodology and results@#The study was conducted at Lokman Hekim University Ankara Hospital between February 2020 and August 2021. The 154 blood cultures included in the study were incubated in the BACTEC FX40 automated blood culture device. Identification and antimicrobial susceptibility tests of the samples with positive catalase tests were performed with the BD Phoenix Automated Microbiology Sensitivity System. The statistical significance level was accepted as p<0.05. Nineteen different types of methicillin-resistant coagulase-negative staphylococci (MRCoNS) isolated from different age groups were identified. Vancomycin resistance was observed in 20 samples (13%). Trimethoprim-sulfamethoxazole (TMP-SMX) resistance was seen in 44 of 152 samples (28.6%), linezolid resistance in 15 of 143 samples (10.5%) and daptomycin resistance in 16 of 146 blood samples (11%).@*Conclusion, significance and impact of study@#In our investigation, there has been a striking rise in the prevalence of vancomycin, TMP-SMX, linezolid and daptomycin resistance among infections with the MRCoNS. Identifying and classifying multidrug resistance on MRCoNS requires reliable epidemiological data to be collected and compared between healthcare facilities in different countries. The research finding reported in this paper will contribute to the determination of alternative antibiotics for treating MRCoNS.

Staphylococcus coagulasa negativos como causantes de endocarditis en un recién nacido pretérmino / Neonatal coagulase negative Staphylococcus as a cause of endocarditis / Staphylococcus coagulase negativa como causa de endocardite em recém-nascido prematuro

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.

Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.

Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.

Infecciones intrahospitalarias por estafilococo coagulasa negativo en una unidad de neonatología / Coagulase negative streptococci nosocomial infections at a neonatal intensive care unit / Infecções intra-hospitalares por estafilococo coagulasa negativa numa unidade de neonatologia

Introducción: la sepsis tardía por estafilococo coagulasa negativo (SCoN) es una causa común de morbimortalidad en la unidad neonatal. Los SCoN son los microorganismos más frecuentemente involucrados con aproximadamente el 50% de los casos. El objetivo de este estudio es analizar la incidencia y las características de los neonatos portadores de sepsis tardía por SCoN. Materiales y métodos: se realizó un estudio descriptivo, longitudinal, retrospectivo. Se utilizaron las bases de datos del laboratorio de microbiología del hospital y las historias clínicas electrónicas para obtener la información. El período de estudio analizado fueron los años 2018 y 2019 en la unidad de cuidados intensivos e intermedios de recién nacidos del Centro Hospitalario Pereira Rossell. Resultados: obtuvimos una incidencia de 2,5% de los ingresos a cuidados intensivos e intermedios (25 pacientes). La edad gestacional al nacer fue de 28 semanas (25,0-35,0) y la mediana del peso fue de 1.070 g (730,0-2.365,0). La media de edad gestacional posmenstrual al momento del diagnóstico fue de 32,92±7,921 semanas. Por sospecha de sepsis precoz, 17 pacientes habían recibido un curso de antibióticos previo. El signo clínico más frecuentemente observado fue el deterioro del estado general, en 11 pacientes, seguido de distensión abdominal en 6 y fiebre en 5. Dentro de los SCoN, el más frecuentemente aislado fue el Staphylococcus epidermidis (13 pacientes); 22 pacientes recibieron tratamiento, 18 de ellos con vancomicina-meropenem y 4 con monoterapia con vancomicina. Conclusión: estos patógenos representan una causa importante de morbimortalidad en la unidad neonatal, particularmente en pacientes que presentan mayor gravedad y mayor necesidad de soporte vital. Se necesitan pautas claras de interpretación del rol de estos microorganismos y de abordaje de pacientes con riesgo de sepsis tardía, incluyendo el tratamiento antibiótico empírico.

Introduction: Coagulase Negative Staphylococci (CoNS) late onset sepsis is a common cause of morbidity and mortality in the neonatal intensive care unit (NICU). CoNS are the most frequently isolated microorganisms and total 50% of cases. The objective of this study is to analyze the incidence and characteristics of newborns carriers of late onset CoNS. Materials and methods: we performed a descriptive, retrospective, longitudinal study. Data was obtained from the hospital's microbiology laboratory database and electronic medical records. Patients included were those admitted to NICU during the period between 2018 and 2019. Results: we obtained an incidence of 2.5% of patients admitted to the NICU (25 patients). Median gestational age at birth was 28 weeks 25.0-35.0 and median birth weight was 1.070 g 730.0-2365.0. Mean gestational age at the time of diagnosis was 32.92±7.921 weeks. 17 patients had received an antibiotics course at birth because of early onset sepsis suspicion. The most frequently observed clinical symptom was deterioration of general condition, 11 patients, followed by abdominal distention in 6 and fever in 5. Among CoNS, the most frequently isolated pathogen was Staphylococcus epidermidis (13 patients). 22 patients received treatment, 18 a combination of vancomycin and meropenem and 4 received vancomycin monotherapy. Conclusion: these pathogens are a common cause of morbidity and mortality in the newborn intensive care unit, particularly in patients with more serious conditions and in those who require more advanced life support measures. Clearer interpretation of their role is needed as well as to determine a proper approach to patients at risk of late onset sepsis, including empiric antibiotic treatment.

Sepse tardia para Staphylococcus coagulase negativa (SCoN) é uma causa comum de morbidade e mortalidade na unidade neonatal. SCoNs são os microrganismos mais frequentemente envolvidos e representam aproximadamente 50% dos casos. O objetivo deste estudo é analisar a incidência e as características de neonatos com sepse tardia por SCoN. Materiais e métodos: foi realizado um estudo descritivo, longitudinal e retrospectivo. Usamos os bancos de dados do laboratório de microbiologia e prontuários médicos eletrônicos de nosso hospital para obter as informações. O período de estudo analisado foi de 2018 e 2019 na unidade de terapia intensiva e intermediária para recém-nascidos do Centro Hospitalar Pereira Rossell. Resultados: obtivemos uma incidência de 2,5% de internações em Terapia Intensiva e Intermediária (25 pacientes). A idade gestacional ao nascer foi de 28 semanas 25,0-35,0 e o peso médio foi de 1070g 730,0-2365,0. A média da idade gestacional pós-menstrual no momento do diagnóstico foi de 32,92 ± 7,921 semanas. 17 pacientes haviam recebido um curso anterior de antibióticos por suspeita de sepse precoce. O sinal clínico mais frequentemente observado foi deterioração do estado geral em 11 pacientes, seguido por distensão abdominal em 6 e febre em 5. Dentre os SCoN, o mais isolado foi o Staphylococcus Epidermidis (13 pacientes). 22 pacientes receberam tratamento, 18 deles com Vancomicina-Meropenem e 4 com Vancomicina em monoterapia. Conclusão: esses patógenos representam uma importante causa de morbimortalidade na unidade neonatal, principalmente em pacientes com maior gravidade e maior necessidade de suporte de vida. Orientações claras são necessárias para interpretar o papel desses microrganismos e para abordar pacientes com risco de sepse tardia, incluindo tratamento com antibióticos.

Aortic Root Replacement for Destructive Endocarditis - Clinic and Microbiology

Abstract Introduction: Destructive aortic root endocarditis is associated with high mortality rates. The objective of this article was to characterize the clinical and microbiological profiles of these patients, especially concerning an already implanted aortic valve prosthesis. We also focused on prognostic factors. Methods: Eighty patients underwent aortic root replacement due to destructive endocarditis from 1999 to 2018 in our institution. We analyzed their pre, intra, and postoperative data, outcomes, and predictors of mortality. Results: Thirty-one patients had native valve endocarditis (NVE), eight patients had early-onset prosthetic valve endocarditis (PVE), and 41 patients had late-onset PVE. Streptococcus was found in 19.4% of NVE cases and no PVE case. Coagulase-negative Staphylococcus was responsible for 62.5% of the cases of early-onset PVE. Thirty-four (42.5%) patients had received inappropriate antibiotics before admission. No microorganism was associated with higher risk of mortality. Aortoventricular dehiscence was identified as an independent risk factor of mortality along with PVE, concomitant bypass surgery, and delayed diagnosis. The incidence of postoperative complications was similar in all three groups. Rates of long-term survival (P=0.044) and freedom from the composite endpoint (P=0.024) defined as death, stroke, aortic valve reinfection, and aortic valve reoperation were the lowest within the NVE group and the highest among the PVE patients. Conclusion: In endocarditis, prolonged diagnostics, inadequate antimicrobial treatment, and late surgery led to destructive local complications and worsened the prognosis. PVE is associated with higher mortality than NVE.

Prevalence and effect of intramammary infection due to coagulase-negative staphylococcal (CNS) species in somatic cell counts in milk from Holstein dairy cows in Boyaca, Colombia / Prevalencia y efecto de la infección intramamaria debida a especies de estafilococos coagulasa negativo (ECN) en el conteo de células somáticas en leche de vacas Holstein en Boyacá, Colombia

ABSTRACT Mastitis is one of the most important illnesses in specialized dairy herds worldwide due to the effects on production and animal health. The types caused by CNS has a special importance in a production where the main pathogens are controlled. The objective of the present work is to determine the prevalence of CNS in a dairy herd in Boyaca and also quantify the effects of every species of CNS in SCC. 40 cows were selected and sampled during 6 months, CMT was performed, and results from 1 to trace were sampled. The routine bacteriological test was also performed for CNS identification, and the isolating of CNS was performed through rpoB gene identification and through the type of strain using the pulse gel electrophoresis procedure. Out of 960 samples, 619 were positive for CNS growth. The most prevalent species were Staphylococcus epidermidis, S. chromogenes, S. sciuri, S. simulaans, S. haemolyticus and S. capitis. The results that were found here are similar to the results observed in different parts of the world, which confirms that they are pathogens that must be constantly evaluated because they can go unnoticed in routine controls, especially in those farms where major pathogens are not a serious problem. The results determined in this study demonstrate that CNS generates a slight increase in somatic cells.

RESUMEN La mastitis es una de las enfermedades más importantes en los rebaños lecheros especializados alrededor de todo el mundo debido a los efectos sobre la producción y la salud animal. Los tipos ocasionados por estafilococos coagualasa negativo (ECN) tienen una importancia especial en una producción en la que los principales patógenos están controlados. El objetivo del presente trabajo es determinar la prevalência del ECN en un hato lechero en Boyacá y cuantificar los efectos de cada especie de ECN en el conteo de células somáticas (CCS). Se seleccionaron 40 vacas y se tomaron muestras durante 6 meses, se realizó california mastitis test (CMT) y se tomaron muestras de los resultados desde 1 hasta donde hubo trazas. También se realizó la prueba bacteriológica de rutina para la identificación del ECN y el aislamiento del ECN se realizó mediante la identificación del gen rpoB y del tipo de cepa, usando el procedimiento de electroforesis en gel de pulso. De 960 muestras, 619 fueron positivas para el crecimiento del ECN. Las especies más prevalentes fueron Staphylococcus epidermidis, S. chromogenes, S. sciuri, S. simulans, S. haemolyticus y S. capitis. Los resultados encontrados aquí son similares a resultados en diferentes partes del mundo, lo que confirma que son patógenos que deben ser evaluados constantemente porque pueden pasar desapercibidos en los controles de rutina, especialmente en aquellas fincas donde los patógenos mayores no son un problema grave. Los resultados determinados en este estudio demuestran que el SNC genera un ligero aumento de células somáticas.

Microbiological evaluation of pasty and soft ice cream / Avaliação microbiológica de sorvetes pastosos e expressos / Evaluación microbiológica de helados pastosos y suaves

Ice cream is susceptible to contamination by handling and bad hygiene conditions during both the storage process and the fractioning for sale, and once contaminated, it can cause diseases. The purpose of this survey was to evaluate the microbiological quality of ice cream sold in bulk, of pasty and soft types, offered for consuming. Thirty samples of pasty ice cream sold in bulk, and thirty samples of soft ice cream were analyzed through the counting of thermotolerant coliforms, coagulase-positive Staphylococcus spp., and searching for the presence of Salmonella spp. During the study, a total of ten (33%) samples of pasty ice cream and five (16%) samples of soft ice cream were found to be beyond the limits established by the Brazilian law. Salmonella spp. was found in four samples (6.7%). These results are an alert for the need of greater attention to the microbiological quality of ice cream in order to ensure the safety of its consumers.(AU)

Os sorvetes são suscetíveis à contaminação pela manipulação e más condições higiênicas durante o processamento, armazenamento e do fracionamento para venda, uma vez contaminados podem causar doenças. O objetivo deste estudo foi avaliar a qualidade microbiológica de sorvetes, vendidos a granel, pastosos e expressos, oferecidos para consumo. Trinta amostras de sorvete pastoso, vendido a granel, e trinta amostras de sorvete expresso foram analisadas realizando-se contagem de coliformes termotolerantes, Staphylococcus spp. coagulase-positiva e pesquisando-se a presença de Salmonella spp. Foram detectadas dez (33%) amostras de sorvete pastoso e cinco (16%) amostras de sorvete expresso fora dos limites estabelecidos pela legislação brasileira. Salmonella spp. foi encontrado em quatro amostras (6,7%). Esses resultados alertam para a necessidade de uma maior atenção à qualidade microbiológica dos sorvetes, a fim de garantir a segurança do consumidor.(AU)

Los helados son susceptibles a la contaminación por manipulación y malas condiciones higiénicas durante el procesamiento, almacenamiento y fraccionamiento para venta, una vez contaminados pueden causar enfermedades. El objetivo de este estudio ha sido evaluar la calidad microbiológica de helados vendidos a granel, pastosos y suaves, ofrecidos para el consumo. Se analizaron treinta muestras de helados pastosos vendidos a granel, y treinta muestras de helados suaves, realizándose el conteo de coliformes termotolerantes, Staphylococcus spp. coagulase positiva e investigándose la presencia de Salmonella spp. Se detectaron diez (33%) muestras de helado pastoso y cinco (16%) muestras de helado blando fuera de los límites establecidos por la legislación brasileña. Salmonella spp. se encontró en cuatro muestras (6,7%). Esos resultados destacan la necesidad de una mayor atención a la calidad microbiológica de los helados, con el fin de garantizar la seguridad del consumidor.(AU)

Phenotypic Characterization and Antibiotic Susceptibility Profile of Coagulase Positive Staphylococci from The External Surfaces of Hospital Cockroaches (Periplaneta americana)

A study to phenotypically characterize and determine the antibiogram of coagulase positive Staphylococci (CoPS) from the external surfaces of hospital cockroaches (Periplaneta americana) was conducted using standard microbiological methods. Out of the 50 cockroaches collected from various hospitals in Uyo, sixty-two percent (n = 31) had coagulase positive Staphylococci which consisted of Staphylococcus aureus (44.0 %; n = 22) and Staphylococcus intermedius (18.0 %; n = 9). The CoPS isolates showed 100% resistance to Penicillin, Tetracycline, Clindamycin and 80.6% sensitivity to Amoxicillin-clavulanate. The CoPS showed multiple antibiotic resistances to ≥ 3 antibiotics, with 60 % exhibiting resistance to 6 antibiotics. Out of the 80 % (n = 31) of the multidrug resistant CoPS that were sensitive to Amoxicillin-clavulanate, none of them showed production of beta lactamase. The cockroaches bore multiple antibiotic resistant CoPS on their external surfaces and their contact can initiate contamination of patients' food. Pest control measures in hospital are hereby recommended to minimize cockroach related infections

Effect of donor-derived infection on clinical prognosis of kidney transplant recipients / 器官移植

Objective To evaluate the effect of donor-derived infection (DDI) on clinical prognosis of kidney transplant recipients. Methods Clinical data of 82 donors from donation after citizen's death and 148 kidney transplant recipients were retrospectively analyzed. According to the culture results of the lavage fluid of donor kidney, all recipients were divided into the lavage fluid culture of donor kidney positive group (positive group, n=92) and lavage fluid culture of donor kidney negative group (negative group, n=56). All recipients were assigned into the DDI group (n=19) and non-DDI group (n=129) according to whether they developed DDI or not. The distribution and composition ratio of positive strains in the lavage fluid of donor kidney were analyzed. The incidence of postoperative infection and other complications was assessed in the recipients. Perioperative conditions of the recipients were statistically compared between the DDI and non-DDI groups. The treatment efficacy and clinical prognosis of DDI recipients were evaluated. Results Among 148 recipients, 92 obtained positive culture results in the lavage fluid of donor kidney. A total of 131 pathogenic strains were isolated, including 41.2% (54/131) of Gram-positive cocci, 48.9% (64/131) of Gram-negative bacilli and 9.9%(13/131) of fungi. Among 148 recipients, 52 cases were infected. And 45% (41/92) and 20% (11/56) of the recipients were infected in the positive and negative group, respectively. Statistical significance was noted between two groups (P=0.002). Surgical site was the most common infection site in 52 infected recipients, followed by the urinary system. Nineteen recipients developed DDI with an incidence rate of 12.8% and fatality of 16%. Compared with the non-DDI recipients, DDI recipients had significantly higher graft loss rate and fatality, and longer postoperative hospital stay (all P < 0.05). Eight cases presented with carbapenem-resistant Klebsiella pneumoniae (CRKP) infection, after treatment with tigecycline and/or polymyxin and carbapenems, 3 cases died, and 3 underwent kidney graft resection. In the other 8 recipients with CRKP infection, 2 cases were treated with ceftazidime-avibactam (CAZ-AVI) alone, 3 treated with CAZ-AVI combined with carbapenems, and 3 initially treated with tigecycline combined with carbapenems followed by CAZ-AVI for salvage treatment. After corresponding treatment, the recipients achieved long-term survival. Conclusions DDI may lead to severe complications, while early specific antibacterial treatment plays a positive role.

Dosificación empírica de vancomicina en neonatos: relación entre recomendación de dosis iniciales y relación área bajo la curva en 24 h/concentración inhibitoria mínima / Empiric vancomycin dosing in neonates: relationship between initial dose and 24 h area under the curve/minimum inhibitory concentration ratio

Resumen Introducción: Vancomicina es un antimicrobiano ampliamente utilizado para infecciones por Staphylococcus coagulasa negativa en neonatos; sin embargo, no existe claridad sobre la dosis empírica que asegure su eficacia terapéutica. Objetivo: Evaluar la relación entre las dosis iniciales de vancomicina utilizadas en una Unidad de Cuidado Intensivo Neonatal (UCIN) con la eventualidad de alcanzar el objetivo terapéutico de área bajo la curva sobre concentración inhibitoria mínima (ABC/CIM) mayor a 400 µg/h/mL. Materiales y Método: Estudio descriptivo y retrospectivo, realizado entre febrero 2016 y marzo 2018. Se incluyeron neonatos en tratamiento con vancomicina por sospecha/confirmación de infección por cocáceas grampositivas y medición de concentraciones plasmáticas de vancomicina al inicio del tratamiento. La probabilidad de alcanzar el objetivo terapéutico se evaluó mediante re-muestreo de valores de ABC y CIM. Resultados: Se incluyeron 38 pacientes con 49 concentraciones plasmáticas de vancomicina. Los aislados microbiológicos se confirmaron en 94,7% de los pacientes (n = 36). Los valores de ABC/CIM en dos grupos (según niveles valle de vancomicina < 10 µg/mL y ≥ 10 µg/mL), fueron de una mediana de 327 (IQ 25-75 = 174-395) y 494 (IQ 25-75 = 318-631), respectivamente (p = 0,035). Las dosis empíricas utilizadas logran logran un objetivo terapéutico (ABC/CIM > 400) de sólo 47,7% considerando CIMs en nuestra institución. Conclusiones: Teniendo en cuenta las sensibilidades institucionales, no es posible asegurar alcanzar ABC/CIM > 400 µg/h/mL. Se debe seguir investigando para replantear las actuales estrategias de dosificación y así determinar la más apropiada para neonatos.

Abstract Background: Vancomycin is used for treating coagulase-negative staphylococcus infections in neonates. However, concerns about the appropriate empirical dosing required for optimal efficacy, still remain. Aim: To assess the relationship between the initial doses of vancomycin used in a Neonatal Intensive Care Unit (NICU) with the possibility of achieving therapeutic target of AUC024h/MIC > 400 µg/h/mL. Methods: Retrospective and descriptive study carried out between February 2016 and March 2018. All neonates treated with vancomycin for suspected/proven Gram-positive infection and with at least one trough serum concentration level were included. Probability of target attainment (PTA) was evaluated through resampling of AUC and MIC values. Results: Final dataset included 38 patients and 49 trough vancomycin levels; 94.7% of these cases (n = 36) were confirmed Gram-positive infections. The median AUC/MIC values for the trough values vancomycin < 10 µg/mL group and for the ≥ 10 µg/mL group were 327 (IQR 174-395) and 494 (IQR 318-631) respectively (p = 0.035). Current empirical dosing strategy has a 47.7% PTA (AUC/MIC > 400) when taking institutional MICs into account. Conclusions: It is not possible to assure achieving a AUC/MIC > 400 µg/h/mL when considering institutional sensibilities. Current empiric dosing strategies should be reconsidered and further investigation needs to be done to help determine the appropriate empirical dosing required for optimal efficacy in neonates.

The challenges of neonatal sepsis management / Os desafios no manejo da sepse neonatal

Abstract Objectives To present current evidence on the etiology, risk factors, diagnosis, and management of early and late neonatal sepsis. Source of data Non-systematic review of the Medline (PubMed), Scopus, Web of Science, Cochrane, and Google Scholar databases regarding the following terms: neonatal sepsis, early neonatal sepsis, late neonatal sepsis, empirical antibiotic therapy, sepsis calculator, vancomycin, newborn, preterm newborn. Data synthesis Neonatal sepsis is a frequent cause of neonatal morbidity and mortality. Its diagnosis is difficult. Continuous observation of the patient is critical to diagnostic suspicion. When neonatal sepsis is suspected, bacteriological tests should be collected. Vancomycin should not be routinely using in the empirical antibiotic regimen in late neonatal sepsis, and the main protective mechanisms against neonatal sepsis are handwashing and the use of breast milk. Conclusions Newborns constitute a group that is more vulnerable to sepsis. Knowledge of risk factors and etiological agents allows a better approach to the newborn with sepsis.

Resumo Objetivos Apresentar evidências atuais na etiologia, fatores de risco, diagnóstico e manejo da sepse neonatal precoce e tardia. Fontes de dados Revisão não sistemática feita nas bases de dados Medline (PubMed), Scopus, Web of Science, Cochrane, Google Scholar sobre os temas sepse neonatal, sepse neonatal precoce, sepse neonatal tardia, antibioticoterapia empírica, sepsis calculator, vancomicina, recém-nascido, recém-nascido pré-termo. Síntese de dados A sepse neonatal é uma causa frequente de morbimortalidade neonatal. O seu diagnóstico é difícil. A observação contínua do paciente é fundamental para uma suspeição diagnóstica. Ao se suspeitar de sepse neonatal devem-se coletar exames bacteriológicos. Não usar, rotineiramente, vancomicina no esquema empírico de antibiótico na sepse neonatal tardia. Os principais mecanismos protetores da sepse neonatal são a lavagem de mãos e o uso do leite materno. Conclusões Os recém-nascidos constituem um grupo mais vulnerável à sepse. O conhecimento dos fatores de risco e dos agentes etiológicos permite uma melhor abordagem do recém-nascido séptico.

Species distribution and clinical profiles of coagulasenegative staphylococci (CoNS) isolated from blood cultures among paediatric patients in Hospital Kuala Lumpur

@#Introduction: Coagulase-negative staphylococci (CoNS) is often considered as a culture contaminants but it can potentially be pathogenic to patients with risk factors. A combination of species identification and clinical criteria has been suggested in determining true CoNS bacteraemia. Objectives: To identify the species distribution, antibiotic susceptibility patterns and clinical profiles of CoNS isolated from blood cultures among paediatric patients in Hospital Kuala Lumpur (HKL). Methods: This study involved CoNS isolation from blood cultures of paediatric in-patients of the Paediatric Institute HKL. Isolates were identified to species level using Analytical Profile Index Staph identification strips and antimicrobial susceptibility pattern following Kirby-Bauer Disc Diffusion method. The clinical profiles of patients were obtained from their medical records. Results: Eleven CoNS species were identified from 148 isolates. Staphylococcus epidermidis was the most frequent species isolated (67.6%). The majority of the isolates showed resistance to penicillin (85.8%); while 70.3% were methicillin-resistant (MR) CoNS, which demonstrated a significant association with true infection (p=0.021). Predictors for significant CoNS infection included thrombocytopaenia, presence of predisposing factors, nosocomial infection, blood collected from peripheral vein, and CoNS isolated from two consecutive blood cultures. The most common predisposing factors for the isolation of CoNS were the presence of peripheral (54.1%) and central venous catheters (35.1%). Conclusion: CoNS can cause significant bloodstream infections. The isolation of CoNS from blood cultures should be carefully interpreted by considering the predictive factors. Local data regarding predictive factors of patients with culture-positive CoNS, species distribution and antimicrobial susceptibility pattern are useful to determine the significance of blood culture results and care management of patients

Identification and characterization of methicillin-resistant Staphylococcus spp. isolated from surfaces near patients in an intensive care unit of a hospital in southeastern Brazil

Abstract INTRODUCTION: Contaminated hospital environments contribute to the transmission of microorganisms associated with healthcare. Contaminated surfaces handled by patients or healthcare professionals are a source of microorganism transmission by hand. Methicillin-resistant Staphylococcus bacteria are among the main agents responsible for increasing healthcare-associated infections in Brazil and worldwide. METHODS: The objective of this study was to screen and characterize methicillin-resistant Staphylococcus spp. on surfaces near patients in an intensive care unit. Microbiological samples, collected from ten beds in an intensive care unit with five sampling sites, were inoculated into a methicillin-resistant Staphylococcus aureus chromogenic medium. MALDI-TOF and PCR analyses were used to identify the bacteria. Antimicrobial susceptibility was determined using the disk diffusion test. The presence of the mecA gene was investigated using PCR. RESULTS: We observed that 44 out of the 50 sampling sites presented grown isolates in the methicillin-resistant Staphylococcus aureus medium. The incidence of isolated microorganisms on the right side rail, left side rail, tables, infusion pump keypad, and cardiac monitor were 18.8 %, 36.7 %, 10.9 %, 2.4 %, and 31 %, respectively. The 42 isolates included in this study were identified as coagulase-negative Staphylococcus. All of these microorganisms were multidrug-resistant and mecA gene-positive. CONCLUSIONS: This study identified the presence of methicillin-resistant coagulase-negative Staphylococcus on the beds of an intensive care unit, providing evidence for the necessity of assertive actions to decrease the risk of healthcare-associated infections at the site.

A clinical, radiological and etiological study of neonatal pneumonia

Background: Pneumonia contributes to between 7, 50,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year worldwide1. It is estimated that 3.9 million of the 10.8 million deaths in children annually worldwide occur in the first 28 days of life.2 Neonatal pneumonia can be preventable if it is diagnosed as early as possible. Early recognition and prompt management are essential for the better outcome.Aim and objective: To determine bacterial etiology of neonatal pneumonia and to study the risk factors associated with neonatal pneumonia.Methods: A prospective, descriptive study was conducted for the duration of one year from July 2014 to June 2015 in Pragna children's Hospital, a tertiary care centre, Hyderabad, Telangana, India. A total of 100 neonates were admitted in Pragna children's Hospital with the signs and symptoms of neonatal pneumonia. A detailed history was taken including age, obstetric history of the mother, detailed birth history including resuscitation details and gestational age assessment were evaluated.Results: Out of 100 cases, 39(39%) neonates were preterm babies and 61(61%) were term. Also found history of Prolonged Rupture of Membrane (PROM) in 22% cases, maternal fever in 18%, home deliveries in 14% and foul smelling liquor in 18%. Out of 100 cases, 51 (51%) cases had positive finding in Chest X-Ray for neonatal pneumonia and 57(57%) had pneumonia with septicemia. Out of 100 cases, 9% of cases are positive for Coagulase negative staphylococcus (CONS), 5% for Klebsiella pneumonia, 2% for Pseudomonas aeroginosa and the remaining 84% of the cases had no growth for any organism.Conclusions: Major predisposing factors included PROM, foul smelling liquor, maternal fever, and home deliveries. CONS was the commonest organism isolated in blood culture.

Inhibition of the growth of major mastitis-causing pathogens by non-aureus Staphylococcus isolates using the cross-streaking method / Comunicação: Inibição do crescimento dos principais patógenos causadores de mastite por isolados de estafilococos não aureus pelo método cross-streaking

O objetivo do presente estudo foi avaliar a capacidade de estafilococos não aureus (NAS) isolados de diferentes nichos ecológicos (leite, ambiente e ápice do teto), associados a vacas leiteiras, de inibir os principais agentes etiológicos da mastite bovina (Staphylococcus aureus, Streptococcus agalactiae, Streptococcus uberis e Escherichia coli). Neste estudo, 38 isolados NAS de diferentes nichos ecológicos foram avaliados quanto à capacidade de inibir o crescimento in vitro de importantes patógenos causadores de mastite pelo método cross-streaking. No total, 19 (50%) isolados de NAS (oito isolados de S. chromogenes, 10 de S. fleurettii e um de S. haemolyticus) apresentaram inibição contra os principais patógenos causadores de mastite. No entanto, a inibição dos patógenos causadores da mastite bovina por isolados de NAS foi maior contra bactérias Gram-positivas. Além disso, o presente estudo não sugeriu que os nichos ecológicos influenciam a capacidade do NAS de inibir os principais patógenos causadores da mastite bovina. Com base nesses resultados, concluiu-se que certos isolados de NAS apresentam potencial efeito protetor contra os principais patógenos da mastite, pelo menos in vitro.(AU)

Medically Important Coagulase Negative Staphylococci

In recent years, coagulase negative Staphylococci(CONS) are increasingly recognized as one of the major causes of health care associated infections (HCAI). CONS infections are one of the major causes of morbidity and mortality in hospitalized patients. As CONS colonize various parts of the skin and mucous membranes, most of infections are en-dogenous in origin. However, they are also transmitted exogenously via various medical/ surgical procedures. The aim of present review article is to update and summarize the information available on medically important CONS with special reference to epidemiology, laboratory diagnosis and antibiotic resistance.

Neonatal sepsis due to coagulase negative Staphylococci: a study from Kashmir valley, India

Background: Neonatal sepsis is a leading cause of neonatal mortality and morbidity. Early diagnosis and treatment with appropriate antibiotics are important to improve the prognosis of neonatal sepsis. Coagulase-negative Staphylococci (CoNS) have emerged as prominent pathogens in the neonatal intensive care unit. These infections are rarely fatal, but they cause significant morbidity, especially among very low birth weight infants. This study was done to know the prevalence of Coagulase-negative Staphylococci in neonatal sepsis and to determine their antibiotic susceptibility pattern.Methods: A prospective study was conducted on blood samples of suspected neonatal septicaemia between August 2017 and May 2018 received at Department of Microbiology, Government Medical College, Srinagar. Blood culture was done by automated blood culture system, (BacT/Alert) and identification and antibiotic susceptibility was done by VITEK2 method.Results: Out of 356 neonates screened, there were 185 (53.4%) positive blood cultures. Among the culture positive cases, 107 (57.83%) were male and 78 (42.16%) were female. Early Onset Septicaemia cases (130 [70.27%]) were found to be three times higher than late onset Septicaemia (55 [29.72%]). Coagulase-negative Staphylococci (CoNs) (30.27%) were the most common organisms isolated followed by Acinetobacter sp (15.1%), Klebsiella sp (5.4%) S. aureus (4.8%) and E. coli (4.8%). All the isolates of CoNS were sensitive to linezolid and vancomycin and tigecycline. Methicillin resistance was seen in 84% isolates.Conclusions: Present study highlights the emergence of Coagulase-negative Staphylococci (CoNS) as predominant cause of neonatal septicaemia. Most of the isolates were resistant to methicillin which is alarming and a cause for concern.

Bacteriological Profile and Antibiotic Susceptibility Patterns in Neonatal Septicaemia in Tertiary Care Hospital

Introduction: Neonatal septicaemia has great role in morbidityand mortality among neonates. Neonatal mortality rate hasbeen reported in India as 17 per 1000 live births as per 2016-17 data. Neonatal septicaemia may be of early onset or lateonset depending of the age of the neonates. The mostcommon bacterial agents involved are Group B Streptococcus,Klebsiella pneumoniae, CoNS, Streptococcus pneumoniae,Haemophilus influenzae etc. Diagnosis is done by manymethods but the most important and absolute mode ofdiagnosis is blood culture.Aims and Objectives: The present study is done for thedetection of bacteriological profile and their antibioticsusceptibility pattern in case of neonatal septicaemia. Earlydiagnosis and specific treatment can save the lives of manyneonates who are suffering from neonatal septicaemia.Materials and Methods: The material used for the diagnosis isvenous blood of the suspected neonates. Blood culture methodis used for the diagnosis of Neonatal septicaemia. Repeatedsubculture is done on Blood agar, Nutrient agar, andMacConkey agar plates. Confirmation of organism is donethrough different biochemical tests. The antibiotic susceptibilitytesting was performed on Muller Hinton agar (MHA) by KirbyBauer disc diffusion method for bacterial isolates, as perclinical and laboratory standards institute (CLSI) guideline.Results: Total 206 cases of suspected neonatal septicaemiawere investigated in which 142 cases are found positive. Mostcommon organism isolated was Klebsiella pneumoniae(39.44%) than Staphylococcus aureus (33.8%), otherorganisms are Escherichia coli (9.86%), CoNS (8.48%),Pseudomonas (5.63%), Enterococcus (2.82%) etc. overallincidence of Gram negative organism (54.93%) was more thanGram positive organism (45.07%). As far as antibioticsensitivity pattern was concerned most of the organism were100% sensitive to imipenem, meropenem and colistin B andresistant to Ampicillin.Conclusion: Gram negative isolates were more common thanGram positive as the causative agents of neonatal sepsis. Themost common causative organism was Klebsiella pneumoniae.The other organisms isolated were Pseudomonas aeruginosa,Staphylococcus aureus, CoNS, etc. Most of the Gram negativeisolates were sensitive to Amikacin, Gentamycin, Ofloxacin andCiprofloxacin but were highly susceptible to Meropenem,Imipenem and Collistin-B. The Gram positive isolates werebetter sensitive to Amikacin, Cephalosporin, Ciprofloxacin andClindamycin but were less sensitive or resistant to Ampicillinand Erythromycin. They showed high susceptibility toTicoplanim, Linezolid, Vancomycin and Methicillin.