Diagnosis, evolution, and treatment of a patient with pyomyositis / Diagnóstico, evolução e tratamento de paciente com piomiosite

Pyomyositis is a deep muscle infection of bacterial origin and subacute, which can evolve with multiple intramuscular abscesses. Despite being characterized as an affection of tropical zones, its incidence in temperate zones has been increasing due to immunosuppression factors, such as infection by the human immunodeficiency virus (HIV) and some types of immunosuppressive treatments. Even though it has been known for over a century, it is a rare and potentially serious condition that can lead to septic shock and death. This is a case report of a descriptive nature, which found the relevance of knowledge about this condition for an early diagnosis, enabling positive prognostic repercussions.

A piomiosite é uma infecção muscular profunda, de origem bacteriana e caráter subagudo, que pode evoluir com abcessos intramusculares múltiplos. Apesar de ser caracterizada como uma afecção de zonas tropicais, sua incidência em zonas temperadas vem aumentando por fatores de imunossupressão, como a infecção pelo vírus da imunodeficiência humana (HIV) e alguns tipos de tratamentos imunossupressivos. Mesmo sendo conhecida há mais de um século, é uma condição rara e potencialmente grave, podendo levar ao choque séptico e óbito. Trata-se de um relato de caso de caráter descritivo, que constatou a relevância do conhecimento desta afecção para um diagnóstico precoce, possibilitando repercussões prognósticas positivas.

Piomiositis en pediatría: experiencia de 10 años en un hospital pediátrico de alta complejidad en Argentina

Introducción: La piomiositis es una infección bacteriana agudasubaguda del músculo esquelético. Objetivo: Estimar la incidencia de piomiositis en pacientes internados, describir e identificar factores de riesgo para bacteriemia y hospitalización, y evaluar diferencias entre Staphylococccus aureus sensible y resistente a meticilina (SASM y SARM). Pacientes y Métodos: Estudio descriptivo, retrospectivo, observacional, con pacientes de 1 mes a 18 años de edad, internados entre el 1 de enero de 2008 y 31 de diciembre de 2018. Variables: sexo, edad, hacinamiento en el hogar, existencia de lesión previa, estacionalidad, localización anatómica e imágenes, antibioterapia previa, estadio clínico, parámetros de laboratorio, cultivos y antibiograma, días de tratamiento intravenoso (IV), de internación, de fiebre y bacteriemia. Resultados: Se incluyeron 188 pacientes. Incidencia: 38,9 casos / 10.000 admisiones (IC95 % 33,7 - 44,9). Días de internación y tratamiento IV: 11 (RQ 8-15 y RQ 8-14, respectivamente). El desarrollo de bacteriemia se asoció a PCR elevada (p = 0,03) y fiebre prolongada (p < 0,001). No hubo diferencias en la evolución y parámetros de laboratorio entre SASM y SARM. La leucocitosis (p = 0,004), neutrofilia (p = 0,005) y bacteriemia (p = 0,001) se asociaron a mayor estadía hospitalaria. Conclusiones: Este estudio recaba la experiencia de más de 10 años de niños internados con diagnóstico de piomiositis y proporciona información sobre sus características. Se describen parámetros asociados a bacteriemia y estadía hospitalaria.

Background: Pyomyositis is an acute-subacute bacterial infection of skeletal muscle. Aim: To estimate the incidence of pyomyositis in hospitalized patients, describe and identify risk factors for bacteremia and hospitalization, and evaluate differences between MSSA and MRSA. Methods: Descriptive, retrospective, observational study with patients aged 1 month to 18 years hospitalized between January, 1, 2008 and December 1, 2018. Variables: sex, age, home overcrowding, previous injury, seasonality, anatomical location and images, previous antibiotherapy, clinical stage, laboratory, cultures and antibiogram, days of intravenous (IV) treatment, hospitalization, fever and bacteremia. Results: 188 patients were included. Incidence: 38.9 cases/10,000 admissions (95% CI 33.7 - 44.9). Days of hospitalization and IV treatment: 11 (RQ 8-15 and RQ 8-14, respectively). The development of bacteremia was associated with elevated CRP (p = 0.03) and prolonged fever (p < 0.001). There were no differences in the evolution and laboratory parameters between MSSA and MRSA. Leukocytosis (p = 0.004), neutrophilia (p = 0.005), and bacteremia (p = 0.001) were associated with a longer hospital stay. Conclusions: This study collects the experience of more than 10 years of hospitalized children diagnosed with pyomyositis and provides information on its characteristics. Parameters associated with bacteremia and hospital stay are described.

Antimicrobial peptide for bacterial infection imaging: first case reported in Brazil

ABSTRACT Molecular imaging markers can be used to differentiate between infection and aseptic inflammation, determine the severity of infection, and monitor treatment responses. One of these markers is ubiquicidin(29-41) (UBI), a cationic peptide fragment that binds to the bacterial membrane wall and is labeled with gallium-68 (68Ga), a positron emitter radioisotope. The use of UBI in positron emission tomography (PET)/computed tomography (CT) for improved detection of lesions has been receiving considerable attention recently. Herein, we report the first case of 68Ga-UBI PET/CT performed in Brazil. The patient was a 39-year-old woman referred for a scan to confirm a clinical suspicion of chronic osteomyelitis of her fractured left tibia. PET images revealed radiotracer uptake near the posterior contour of the tibial fracture focus and the fixation plate, in the soft tissue around the distal half of the tibia, and in the non-consolidated fracture of the left distal fibula. Surgery for local cleaning was performed, and culture of a specimen collected from the surgical site confirmed the presence of Staphylococcus aureus. In the present case, 68Ga-UBI PET/CT, a non-invasive imaging modality, identified the infection foci in vivo, indicating its potential for clinical use.

A Report of Staphylococcus Scalded Skin Syndrome in Adult

Summary@#Staphylococcal scalded skin syndrome (SSSS) is typically a clinical diagnosis,1 affecting primarily neonates and children. It is characterised by a diffuse skin disorder with tenderness, erythema, large wrinkled superficial blistering, and desquamation caused by the hematogenous dissemination of exotoxin-producing strains of staphylococcus aureus to the skin.4,10 Hospital admission is required for intravenous anti-staphylococcal antibiotic therapy and supportive care. The rarity of SSSS in adults is best explained by the presence of exotoxins neutralizing antibodies and renal elimination of the toxins.2 Two major risk factors are kidney failure and immunosuppression. Therefore, SSSS in adults warrants thorough evaluation.3 Mortality is also greater than 60% in adults, attributed to predisposing comorbid conditions.1,4 One of the mimickers of SSSS is toxic epidermal necrolysis (TEN). Here, we report a successful treatment of SSSS in an adult with recreational drug abuse and incidental liver cirrhosis possibly secondary to hepatitis C viral infection, after careful exclusion of TEN.

No Epidermis: Is it the drug, COVID-19 or Something Else?

Summary@#Staphylococcal toxic shock syndrome (TSS) is a clinical disease with acute onset of fever, rash, hypotension and multi-organ system involvement. Staphylococcal scalded skin syndrome (SSSS), mostly described in neonate and children, is a superficial blistering disease caused by the exfoliative toxin of specific strains of Staphylococcus aureus. TSS and SSSS rarely occur concurrently in adults. We here describe a 35-year-old woman who was initially referred to dermatology team as toxic epidermal necrolysis. She presented with a rapid epidermal detachment without mucosal involvement, fever and shock, associated with acute kidney injury and transaminitis, severe metabolic acidosis, complicated by COVID-19 infection, and finally succumbed within 36 hours of hospitalization. Early recognition and prompt treatment are the key factors in the management as TSS itself can lead to mortality. Staphylococcal TSS and SSSS are important differential diagnosis to consider in acute epidermal detachment, as not all cases are drug-induced.

Characteristic analysis of Panton-Valentine leukocidin in children with invasive staphylococcus infection / 中华急诊医学杂志

Objective:To evaluate the relationship between the Panton-Valentine leukocidin (pvl) strain and clinical characteristics, and to describe the molecular biological characteristics of invasive Staphylococcus aureus ( S. aureus) infected clinical isolates. Methods:The isolates of S. aureus caused by invasive infection were collected in Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2019, and the clinical data of the corresponding children were collected retrospectively using electronic medical records. Multilocus sequence typing, spa typing and pvl gene were analyzed using the PCR. In addition, the minimum inhibitory concentrations (MIC) of antibiotics of all isolates were detected by the micro-broth dilution method, and the isolates were divided into the pvl+ and pvl- groups according to whether or not the S. aureus isolates carried pvl. The t test and the Mann-Whitney U test were used to compare the clinical symptoms between the pvl+ and pvl- groups. Chi-square test was used to compare the drug susceptibility between the two isolates. Results:A total of 127 cases of invasive S. aureus infection were collected during the study period. The white blood cell count, neutrophil count, and C-reaction protein level in the pvl+ group were significantly higher than those in the pvl- group ( P=0.001, P=0.001, P=0.005). The rate of pvl carrier was 44.9%. Among 57 pvl+ pathogenic strains, 64.9% (37/57) were MRSA. The multidrug resistance rate of pvl- isolates was higher than that of pvl+ isolates (70% vs. 49.12%, P=0.02). Conclusions:In invasive S. aureus infection, pvl+ strain is associated with elevated inflammatory markers in children. the positive rate of pvl is higher in clinical isolates, and the multidrug resistance rate of pvl- S. aureus is higher.

Descripcion Fisiopatológica de la Descamacion Cutanea por Toxinas Exfoliativas Estafilococicas, Nuevo Enfoque de Diagnostico Diferencial

Resumen El síndrome de piel escaldada estafilocócica, la escarlatina estafilocócica y el impétigo ampollar son patologías que tienen en común el mecanismo de lesión de la piel por toxinas exfoliativas producidas por estafilococos, su presentación y manifestaciones clínicas son difíciles de diferenciar de otras patologías sistémicas como la enfermedad de Kawasaki, el síndrome de Steven Johnson y diferentes farmacodermias. En los últimos años se ha podido explicar el mecanismo molecular de lesión cutánea, lo que ayudo de manera importante a interpretar y poder realizar un adecuado diagnóstico diferencial entre estas patologías. Los pediatras necesitan múltiples herramientas para llegar a un diagnóstico certero de las noxas que producen lesiones en piel y manifestaciones sistémicas. Una buena anamnesis y el conocimiento de un abanico de diagnósticos diferenciales son importantes para el tratamiento médico.

Abstract Staphylococcal scalded skin syndrome, staphylococcal scarlet fever and bullous impetigo are pathologies that have in common the mechanism of skin injury by exfoliative toxins produced by staphylococci, their presentation and clinical manifestations are difficult to differentiate from other systemic pathologies such as Kawasaki disease, the syndrome of Steven Johnson and drug induced skin diseases. In recent years, it has been possible to explain the molecular mechanism of skin injury, which has helped in an important way to interpret and be able to make an adequate differential diagnosis between these pathologies. Pediatricians need multiple tools to reach an accurate diagnosis of the disease that produce skin lesions and systemic manifestations. A good history and knowledge of a range of differential diagnoses are important for medical management.

Proteinograma e inmunoglobulinas séricas en las infecciones cutáneas por Staphylococcus aureus / Proteinogram and serum immunoglobulins in skin infections caused by Staphylococcus aureus

RESUMEN Introducción: lesión típica ocasionada por el Staphylococcus aureus es el furúnculo o cualquier otro absceso localizado. Objetivo: describir el comportamiento del proteinograma y los niveles de inmunoglobulinas séricas. Métodos: se realizó un estudio longitudinal prospectivo con 70 pacientes portadores de forúnculos infectados por Staphylococcus aureus, que acudieron a las consultas de Inmunología en varias localidades de Villa Clara. Resultados: se determinaron las fracciones proteicas por método de elusión; se cuantificaron las inmunoglobulinas séricas por inmunodifusión radial simple, según edad, sexo y color de la piel de los pacientes. Se contrastaron las variables bajo la prueba de Ji cuadrado, con una significación de confianza del 95 %. Predominaron los pacientes con el color de la piel blanca sobre los no blancos. En la electroforesis de proteínas se obtuvieron resultados normales para las proteínas totales y la fracción gamma. Para la albúmina, fracción alfa 1, alfa 2 y beta globulina se obtuvieron valores bajos, por encima del 95 % válido. Conclusiones: todas las inmunoglobulinas resultaron normales o altas, según los intervalos de referencia para cada grupo de edad. Al correlacionar los valores de las inmunoglobulinas con las fracciones de la electroforesis, fue llamativo el resultado obtenido en la correlación entre la IgA y la fracción beta. De manera general, los anticuerpos no mostraron variaciones significativas en sus correlaciones, lo cual evidenció un pobre papel en la infección. Se concluyó que los valores de alfa 1, alfa 2 y beta globulina pueden tener importancia en la enfermedad.

ABSTRACT Introduction: the typical lesion caused by Staphylococcus aureus is the furuncle or any other localized abscess. Objective: to describe the manifestation of the proteinogram and serum immunoglobulin levels. Methods: a prospective longitudinal study was carried out in 70 patients with furuncles infected by Staphylococcus aureus, who came to the Immunology consultations from various locations of Villa Clara. Results: protein fractions were determined by elution method; serum immunoglobulins were quantified according to age, gender and skin color of the patients by simple radial immunodiffusion. Variables were contrasted under the Chi-square test, with 95% confidence significance. White patients predominated over non-white ones. Normal results were obtained for total proteins and gamma fraction in protein electrophoresis. Low values were obtained for albumin, alpha 1, alpha 2 and beta globulin fraction, above 95% valid. Conclusions: all immunoglobulins were normal or high, according to the reference intervals for each age group. The result obtained in the correlation between IgA and the beta fraction was striking when correlating the immunoglobulin values with the electrophoresis fractions. In general, the antibodies did not show significant variations in their correlations, which evidenced a poor role in infection. We concluded that alpha 1, alpha 2 and beta globulin values may be important in the disease.

Actividad antimicrobiana de la peroxiadenosina en cultivos in vitro de Staphylococcus aureus resistente a meticilina / Antimicrobial activity of peroxyadenosine in vitro culture of resistant methicillin Staphylococcus aureus

RESUMEN Fundamento : las infecciones asociadas a la asistencia sanitaria y de la comunidad causadas por Staphylococcus aureus resistente a la meticilina, constituyen un problema de salud en el mundo. Esta situación se asocia al uso indiscriminado de antimicrobianos y a la mutagénesis bacteriana, por tanto, el desarrollo de nuevos productos con actividad antimicrobiana constituye una prioridad para Cuba. Objetivo : evaluar la actividad antimicrobiana de la peroxiadenosina en cultivo in vitro de Staphylococcus aureus resistente a la meticilina. Métodos : se realizó un estudio experimental de laboratorio en un modelo biológico (cultivo microbiano) en el Hospital Universitario Amalia Simoni de la provincia Camagüey, desde enero de 2016 hasta julio de 2020. La muestra se conformó con 60 cultivos biológicos de Staphylococcus aureus resistentes a la meticilina, mediante un muestreo aleatorio simple, distribuidos en dos grupos, cada uno con 30 cultivos. Un grupo correspondió a una cepa salvaje de Staphylococcus aureus resistentes a la meticilina, obtenida de la colección de cultivos del hospital y el otro a la cepa de referencia (ATCC 25923) de la American Type Culture Collection. Se estudiaron las variables: formación y concentración de la peroxiadenosina, preservación de la estructura aromática de la adenosina y el patrón de susceptibilidad a la meticilina. Resultados : la peroxiadenosina se formó a partir de la interacción del peróxido de hidrógeno con la adenosina. Los cultivos de Staphylococcus aureus resistentes a la meticilina se mostraron sensibles a las concentraciones de peroxiadenosina sin diluir y 1:2, demostrado por la presencia de halos de inhibición en el cultivo. Conclusiones : la inhibición del crecimiento de Staphylococcus aureus resistentes a la meticilina por la peroxiadenosina sugiere su evaluación como un nuevo producto antibacteriano eficaz contra este microorganismo.

ABSTRACT Background: infections associated with healthcare and the community caused by methicillin-resistant Staphylococcus aureus (MRSA) constitutes a health problem in the world. This situation is associated with the indiscriminate use of antimicrobials and bacterial mutagenesis, therefore, the development of new products with antimicrobial activity is a priority for Cuba. Objective: to evaluate the antimicrobial activity of peroxyadenosine in vitro culture of MRSA. Methods: an experimental laboratory study was carried out in a biological model (microbial culture) at the Amalia Simoni Hospital in Camagüey province, from January 2016 to July 2020. The sample consisted of 60 biological cultures through simple random sampling, distributed in two groups with 30 crops of each investigated layer. One group corresponded to a wild MRSA strain, obtained from the hospital culture collection and the other to the reference strain (ATCC 25923) from the American Type Culture Collection. The studied variables were: formation and concentration of peroxyadenosine, preservation of the aromatic structure of adenosine and the pattern of susceptibility to methicillin. Results: peroxyadenosine was formed from the interaction of hydrogen peroxide with adenosine. The MRSA cultures were sensitive to 1: 2 undiluted peroxyadenosine concentrations, demonstrated by the presence of inhibition halos in the culture. Conclusions: the inhibition of MRSA growth by peroxyadenosine suggests its evaluation as a new antibacterial product effective against this microorganism.

Protocolo clínico de diagnóstico y tratamiento de pacientes con neumonía adquirida en la comunidad que ingresan a la Unidad de Cuidados Intensivos / Clinical protocol for diagnosis and treatment of patients with community-acquired pneumonia admitted to the Intensive Care Unit

La neumonía es una infección frecuente que se presenta en todas las edades, en cualquier tipo de pacientes y a nivel co-munitario u hospitalario. La neumonía que se origina en la comunidad afecta a los pacientes con comorbilidades y en los extremos de la vida. La mortalidad de la neumonía comunitaria (NC) per-manece elevada, los sistemas de salud deben implementar estrategias para diagnosticar y tratar de forma rápida a estos pacientes. Cuando un paciente con neumonía comunitaria es ingresado en la emergencia de cualquier hospital se debe categorizar su estado para que reciba el mejor tratamiento posible. La Unidad de Cuidados Intensivos (UCI) participa en la detección de los pacientes con neu-monía adquirida en la comunidad grave, con el objetivo de priorizar su atención para lograr las metas de manejo lo más rápido posible y disminuir la mortalidad de estos pacientes.

Pneumonia is a common infection that occurs in all ages, in any type of patient and at the community or hospital level. Community-originating pneumonia affects patients with comorbidities and at the ex-tremes of life. Mortality from commu-nity pneumonia remains high, health sys-tems must implement strategies to quickly diagnose and treat these patients. When a patient with community pneumonia is admitted to any hospital emergency, their condition must be categorized so that they receive the best possible treat-ment. The Intensive Care Unit (ICU) participates in the detection of patients with severe community-acquired pneu-monia, with the objective of prioritizing their care to achieve management goals as quickly as possible and reduce the mortality of these patients.

Perfil del riesgo de brotes alimentarios por intoxicación estafilocócica en Cuba / Risk profile of staphylococcal food poisoning outbreaks in Cuba

Introducción: Staphylococcus ocasiona con frecuencia intoxicaciones alimentarias; en Cuba es una de las principales causas de brotes. Objetivo: analizar el perfil del riesgo de brotes alimentarios por Staphylococcus en Cuba. Métodos: Se realizó un estudio observacional analítico sobre los factores higiénicos y epidemiológicos asociados al riesgo de la intoxicación alimentaria por Staphylococcus en Cuba, en el Instituto Nacional de Higiene Epidemiología y Microbiología, durante el periodo de enero a noviembre de 2018. La información se obtuvo mediante revisión bibliográfica sistémica, análisis de datos del Laboratorio de Referencia Nacional en Microbiología Sanitaria y informes de brotes de la Dirección Nacional de Salud Ambiental. Se estimó el riesgo microbiológico mediante el programa semicuantitativo Ross-Sumner. Resultados: Se identificó como principal peligro Stahylococcus aureus, productores de enterotoxina A y la determinación de aislamientos resistentes a los antimicrobianos, como Stahylococcus aureus meticilina resistentes. Los alimentos más implicados fueron los productos de repostería y la inocuidad se afectó en mayor frecuencia por la contaminación cruzada en el 31,4 por ciento brotes y la inadecuada conservación en 46,1 por ciento. La predicción de personas que enferman por año en la población de interés fue de 6 260. Conclusiones: El riesgo de la ocurrencia de brotes por Staphylococcus se estimó como alto; la vigilancia se recomienda en alimentos que requieren manipulación directa y no se aplica tratamiento térmico antes del consumo, con gestiones de riesgo dirigidas a productores y consumidores(AU)

Introduction: Staphylococcus is a frequent cause of food poisoning. In Cuba it is one of the main causes of outbreaks. Objective: Analyze the risk profile of staphylococcal food poisoning outbreaks in Cuba. Methods: An observational analytical study was conducted about hygienic and epidemiological factors associated to the risk for staphylococcal food poisoning in Cuba. The study was carried out at the National Institute of Hygiene, Epidemiology and Microbiology from January to November 2018. The information was obtained from a systematic bibliographic review, analysis of data from the Medical Microbiology National Reference Laboratory, and outbreak reports from the National Environmental Health Division. Microbiological risk was estimated with Ross-Sumner semi-quantitative software. Results: The main hazard identified was Staphylococcus aureus, enterotoxin A producers and determination of antimicrobial resistant isolates like methicillin-resistant Staphylococcus aureus. The food items most commonly involved were sweets, and safety was most frequently affected by cross-contamination in 31.4 percent of the outbreaks and inadequate preservation in 46.1 percent. Prediction of members of the population of interest becoming ill every year was 6 260. Conclusions: Risk for the occurrence of staphylococcal food poisoning outbreaks was considered to be high; surveillance is recommended of food items requiring direct manipulation and appropriate thermal treatment is not applied before consumption, with risk management actions aimed at manufacturers and consumers(AU)

Genotypic evaluation of antimicrobial resistance in Staphylococcus spp. isolated from bovine clinical mastitis / [Avaliação genotípica da resistência antimicrobiana em Staphylococcus spp. isolados de mastite clínica bovina]

Bovine clinical mastitis caused by Staphylococcus spp. is a serious and widespread disease in the world of dairy farming. Antimicrobial therapy is of fundamental importance in the prevention and treatment of infectious mastitis, but the indiscriminate use of antimicrobials acts as a determining factor for the spread of the disease. The present study evaluated the resistance profiles of 57 Staphylococcus spp. isolated from bovine clinical mastitis to beta-lactams and gentamicin, relating characteristics of phenotype (in vitro susceptibility tests) and genotype (detection and expression of genes encoding resistance - mecA, mecALGA251, blaZ, femA, femB, and aacA-aphD - using PCR and RT-PCR, respectively). One or more genes coding for resistance to different antimicrobials were detected in 50 Staphylococcus spp. isolates. The femA and femB genes were the most frequent (75.4% for both). The observed expression of the genes was as follows: blaZ (60%), femA (39.5%), aacA-aphD (50%), femB (32.6%), mecA (8.3%), and mecALGA251 (0%). Considering the relevance of the genus Staphylococcus to bovine mastitis, this study aimed to elucidate aspects regarding the genotypic and phenotypic profiles of these microorganisms so as to contribute to the development of effective strategies for mastitis control.(AU)

A mastite clínica bovina causada por Staphylococcus spp. é uma doença grave e generalizada no mundo da pecuária leiteira. A terapia antimicrobiana é de fundamental importância na prevenção e no tratamento da mastite infecciosa, mas o uso indiscriminado de antimicrobianos atua como fator determinante para a disseminação da doença. O presente estudo avaliou os perfis de resistência de 57 Staphylococcus spp. isolados de mastite clínica bovina em relação ao uso de betalactâmicos e gentamicina, relacionando características do fenótipo (testes de suscetibilidade in vitro) e genótipo (detecção e expressão de genes que codificam resistência - mecA, mecALGA251, blaZ, femA, femB, e aacA-aphD - usando PCR e RT-PCR, respectivamente). Um ou mais genes que codificam resistência a diferentes antimicrobianos foram detectados em 50 Staphylococcus spp. isolados. Os genes femA e femB foram os mais frequentes (75,4% para ambos). A expressão observada dos genes foi a seguinte: blaZ (60%), femA (39,5%), aacA-aphD (50%), femB (32,6%), mecA (8,3%) e mecALGA251 (0%). Considerando-se a relevância do gênero Staphylococcus para a mastite bovina, este estudo teve como objetivo elucidar aspectos referentes aos perfis genotípico e fenotípico desses microrganismos, a fim de contribuir para o desenvolvimento de estratégias eficazes para o controle da mastite.(AU)

Neumonía por Staphylococcus aureus resistente a meticilina adquirido de la comunidad en un hospital pediátrico. Nuestra experiencia de 10 años / Community-acquired methicillin-resistant Staphylococcusaureus pneumonia in a children's hospital. Our ten-year experience

Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.

Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement

A case report of staphylococcal protein A immunoadsorption therapy for refractory myasthenia gravis / 中华神经科杂志

Staphylococcal protein A (SPA) has a high affinity for human immunoglobulin, and SPA immunoadsorption can specifically reduce the titer of autoantibodies and quickly relieve the clinical symptoms of myasthenia gravis (MG). Recent studies have suggested that immunoadsorption has better clinical efficacy and a lower incidence of adverse reactions than plasma exchange. A case of refractory MG with poor response to corticosteroids, intravenous immunoglobulins and immunosuppressive therapy was reported. The patient had low immune function and progressive pulmonary infection in the later stage of the disease. Respiratory muscle weakness was relieved quickly after four times of immunoadsorption therapy. The value of immunoadsorption in the treatment of refractory MG was explored with literature review.

Role of autophagy-related molecules Beclin1 and LC3 in multidrug-resistant Staphylococcus aureus infection in diabetic foot / 中国医师杂志

Objective:To investigate the role of autophagy-related molecules Beclin1 and LC3 in diabetic foot infection with multidrug resistant (MDR) Staphylococcus aureus.Methods:From June 2016 to October 2017, 62 patients with diabetic foot infected by Staphylococcus aureus were selected as the diabetic foot infection group, and 38 patients with foot burns were selected as the control group. Staphylococcus aureus isolation, identification and drug sensitivity test were carried out. According to drug resistance, the patients with diabetic foot infection were further divided into multidrug resistance group and non-multidrug resistance group. The granulation tissue of foot wound was collected and the expression of Beclin1 and LC3 was detected by immunohistochemistry. The expression of LC3 in macrophages was detected by immunofluorescence double staining.Results:The levels of glycosylated hemoglobin, white blood cell count and erythrocyte sedimentation rate in diabetic foot infection group were significantly higher than those in control group ( P<0.05). Multidrug-resistant Staphylococcus aureus was detected in 30 cases (48.39%) of 62 patients with diabetic foot infection, 2 cases (5.26%) of 38 patients in the control group, and the detection rate of multidrug-resistant Staphylococcus aureus in the diabetic foot infection group was significantly higher than that in the control group ( P<0.05). The white blood cell count, neutrophil ratio and C-reactive protein levels in MDR group were significantly higher than those in non-MDR group ( P<0.05). Immunohistochemical examination showed that the expression levels of Beclin1 and LC3 in wound granulatin tissue of diabetic foot infection group were significantly lower than those in control group ( P<0.01); the expression levels of Beclin1 and LC3 in wound granulation tissue of multidrug resistance group were significantly lower than those in non-multidrug resistance group ( P<0.05). Immunofluorescence double staining showed that the co-expression intensity of LC3 and CD14 in wound granulation tissue of diabetic foot infection group was significantly lower than that of control group, suggesting that LC3 expression in macrophages was significantly reduced. Conclusions:The expression of Beclin1 and LC3 in the wound granulation tissue of diabetic foot patients infected with Staphylococcus aureus decreased significantly, especially in those infected with multidrug resistant Staphylococcus aureus. The occurrence and development of multidrug resistance of Staphylococcus aureus in diabetic foot patients may be related to the decrease of autophagy level.

Prevalence of central venous catheter salvage in newborn with staphylococcal bloodstream infection / Prevalencia del rescate del catéter venoso central en recién nacidos con infección del torrente sanguíneo estafilocócica / Prevalência de salvamento de cateter venoso central em recém-nascidos com infecção de corrente sanguínea estafilocócica

ABSTRACT Objectives: to establish the prevalence of salvage of central venous catheters in newborns with bloodstream infection caused by coagulase-negative staphylococci. Methods: retrospective cross-sectional study with 136 newborns admitted to the Neonatal Intensive Care Unit between 2011 and 2017. The total of 143 infection events undergoing antibiotic therapy were evaluated. Results: among the 143 infection events, 39 catheters in which antibiotic therapy was used were saved and in 69 cases, the device was removed. Positive central blood culture and single lumen catheter were factors associated with salvage failure. The probability of salvage decreased with infections diagnosed from 15 days of using the catheter. Negative blood culture raised the chance of salvage by fourfold. Conclusions: the use of antibiotic therapy in the treatment of infections resulted in a low prevalence of salvage of the central venous catheter. The probability of salvage was associated with variables of the device.

RESUMEN Objetivos: establecer la prevalencia de rescate de catéteres venosos centrales en recién nacidos con infección del torrente sanguíneo causada por estafilococos coagulasa negativos. Métodos: estudio transversal retrospectivo con 136 recién nacidos ingresados en la Unidad de Cuidados Intensivos Neonatales, entre 2011 y 2017. Se evaluaron 143 eventos de infección sometidos a terapia antibiótica. Resultados: de los 143 eventos de infección, se rescataron 39 catéteres en los que se utilizó antibioticoterapia y en 69 casos se retiró el dispositivo. El hemocultivo central positivo y el catéter de un lumen fueron factores asociados con el fracaso del rescate. La probabilidad de rescate disminuyó con las infecciones diagnosticadas a partir de los 15 días de uso del catéter. Los hemocultivos negativos multiplicaron por cuatro la posibilidad de recuperación. Conclusiones: el uso de terapia antibiótica en el tratamiento de infecciones resultó en una baja prevalencia de rescate del catéter venoso central. La probabilidad de rescate se asoció con las variables del dispositivo.

RESUMO Objetivos: estabelecer a prevalência de salvamento de cateteres venosos centrais em recém-nascidos com infecção de corrente sanguínea ocasionada por estafilococos coagulase-negativa. Métodos: estudo transversal, retrospectivo com 136 recém-nascidos internados em Unidade de Terapia Intensiva Neonatal, entre 2011 a 2017. Foram avaliados 143 eventos de infecção submetidos à antibioticoterapia. Resultados: entre os 143 eventos de infecção, 39 cateteres nos quais se usou antibioticoterapia foram salvos e em 69 casos, o dispositivo foi removido. Hemocultura central positiva e cateter mono lúmen foram fatores associados à falha de salvamento. A probabilidade de salvamento diminuiu com infecções diagnosticadas a partir de 15 dias de uso do cateter. Hemocultura negativa elevou a chance de salvamento em quatro vezes. Conclusões: o uso da antibioticoterapia no tratamento das infecções resultou em baixa prevalência de salvamento do cateter venoso central. A probabilidade de salvamento mostrou-se associada às variáveis do dispositivo.

Perfil epidemiológico de Staphylococcus spp. isolados de hemoculturas de pacientes internados em um hospital de atenção terciária da rede pública do Ceará / Epidemiological profile of Staphylococcus spp. isolated from hemocultures of interned patients in a tertiary attention hospital of the Ceará public network

Staphylococcus spp. vem ganhando destaque em infecções na corrente sanguínea (ICS), apresentando alta prevalência, multirresistência e considerável poder de letalidade. O presente estudo teve como objetivo analisar a prevalência e traçar o perfil de sensibilidade das espécies de Staphylococcus spp. isoladas de amostras de hemoculturas positivas obtidas de um hospital de atenção terciária da rede pública do Ceará, no período de janeiro de 2015 a dezembro de 2018. Dos 3292 exames de hemocultura realizados, apenas 15,88% tiveram resultado positivo, dos quais 24,85% eram cocos Gram positivos. S. aureus representou 1,53% das hemoculturas positivas com 50% das cepas resistentes à oxacilina. Os isolados de Staphylococcus sp. coagulase negativo obtiveram prevalência de 10,89%, representados por: S. epidermidis (n=23), S. haemolyticus (n=17), S. hominis (n=13), S. saprophyticus (n=2) e S. warneri (n=2). Verificou-se multirresistência em diversos isolados analisados, apresentando variações intra e interespécies. Portanto, nossos achados melhoram o entendimento da epidemiologia das ICS causadas por Staphylococcus spp., na instituição de estudo, bem como seu perfil de sensibilidade. A identificação precoce do agente infeccioso auxilia na escolha adequada do tratamento, aumentando as chances de cura e reduzindo o tempo de internação do paciente. (AU)

Staphylococcus spp. has been highlighted among bloodstream infections (BI), presenting high prevalence, multidrug resistance and considerable lethality. The present study aimed to analyze the prevalence and the susceptibility profile of Staphylococcus spp. isolated from positive blood cultures from a tertiary care public hospital of Ceará, from January 2015 to December 2018. Of the 3292 blood cultures performed during this period, only 15.88% were positive, of which 24.85% were Gram positive cocci. S. aureus represented 1.53% of positive blood cultures, of which 50% were oxacilin resistant. Isolates of coagulase-negative Staphylococcus spp. showed a prevalence of 10.89%, represented by: S. epidermidis (n = 23), S. haemolyticus (n = 17), S. hominis (n = 13), S. saprophyticus (n = 2) and S. warneri (n = 2). Multiresistance occurrence was verified in several of the analyzed isolates, presenting intra and inters species variations. Therefore, our findings improve the understanding of the epidemiology of BI caused by Staphylococcus spp. in the studied institution, as well as its susceptibility profile. Early identification of the infectious agent might aid in the appropriate choice of treatment, increasing the chance of cure and reducing the patient length stay in hospital. (AU)

Short-term clinical effect of hypochlorous acid eye cleansing wipes on blepharitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the therapeutic effect on blepharitis by using hypochlorous acid eye cleansing wipes for 1wk. <p>METHODS: Prospective case-control study. Unlateral eyes of 48 patients with blepharitis who attended the ophthalmology clinic of our hospital on March 08, 2020 were selected and grouped according to the clinical diagnosis, including 16 patients in the staphylococcal blepharitis group and 22 patients in the seborrheic blepharitis group, 10 patients in the meibomian gland dysfunction blepharitis group. Hypochlorous acid eye cleansing wipes were given to clean the eyelid margin for 1wk, and related parameters of the eye surface and meibomian glands were collected before and after treatment.<p>RESULTS: Compared with pre-treatment, after 1wk of treatment, the overall ocular surface disease index(OSDI), conjunctival hyperemia, and eyelid margin hyperemia scores of the patients included in this study were significantly reduced(<i>P</i><0.001), and the OSDI scores of the three groups of patients were all significantly decreased, the tear film rupture time(TBUT)of patients in the seborrheic blepharitis group was significantly increased, and the degree of conjunctival congestion was significantly alleviated, and the scores of blepharocongestion in the staphylococcal blepharitis group and the seborrheic blepharitis group were both significantly decreased(<i>P</i><0.05).<p>CONCLUSION: The use of hypochlorous acid eye cleansing wipes to clean the eyelid margins for 1wk has a positive effect on different types of blepharitis. It could relieve the ocular symptoms of blepharitis and reduce the incidence of staphylococcal blepharitis and seborrheic blepharitis. Eyelid congestion, improve conjunctival hyperemia of seborrheic blepharitis, and improve tear film stability.

Genetic traceability of Staphylococcus aureus strains isolated from primiparous dairy cows mastitis, humans and environment in the Northeast region of Brazil / Rastreabilidade genética de cepas de Staphylococcus aureus isoladas de mastite de vacas primíparas, ordenhadores e ambiente de ordenha na região Nordeste do Brasil

ABSTRACT: This research aimed to investigate the genotypic relatedness of 18 Staphylococcus aureus strains isolated from intramammary infections in primiparous cows and extramammary sites on five dairy herds by rep-PCR using RW3A primers, and by PFGE using the endonuclease SmaI. The isolates were also evaluated in vitro for the susceptibility against beta-lactam antimicrobials drugs (penicillin and oxacillin), considering that beta-lactams are frequently used for treating staphylococcal intrammamary infections. The rep-PCR typing was highly discriminatory (D value= 0.9804) and a total of 15 patterns were detected. The PFGE method was also highly discriminatory (D value= 0.9667) and a total of 13 patterns were observed. A total of 15 out of 18 (83%) isolates were resistant to penicillin and one out of 18 (6%) to oxacillin. In conclusion, these findings confirmed the occurrence of a high genetic diversity of S. aureus strains at the herds and the presence of clonally-related strains only at the same herd, emphasizing a variety of genotypic profiles among the isolates.

RESUMO: Objetivou-se com este estudo investigar a correlação genética de 18 cepas de Staphylococcus aureus isoladas de infecções intramamárias em vacas primíparas e de locais extramamários em cinco propriedades leiteiras através das técnicas de PCR por sequências palindrômicas extragênicas repetitivas (rep-PCR), usando iniciadores RW3A, e de eletroforese em gel de campo pulsado (PFGE), usando a endonuclease SmaI. Os isolados também foram avaliados in vitro quanto à suscetibilidade aos antimicrobianos beta-lactâmicos (penicilina e oxacilina). A tipagem por rep-PCR foi altamente discriminatória (valor D = 0,9804) e um total de 15 padrões foram detectados. Os isolados de S. aureus foram agrupados em três grupos diferentes (A a C), com 80% de similaridade. A técnica de PFGE também foi altamente discriminatória (valor D = 0,9667) e um total de 13 padrões foi observado. A análise do dendrograma com um coeficiente de similaridade de 80% gerou dois grupos diferentes (A e B). Além disso, cepas clonais isoladas do leite foram identificadas na mesma propriedade pelos dois métodos de tipificação e, apesar da presença de cepas dominantes, nossos resultados sugerem uma alta diversidade genética dentre as cepas de S. aureus analisadas. Um total de 15, dos 18 (83%) isolados, eram resistentes à penicilina e um dos 18 (6%) à oxacilina. Assim, esses achados confirmam a ocorrência de uma alta diversidade genética de cepas de S. aureus nas propriedades e a presença de cepas clonalmente relacionadas apenas na mesma propriedade, enfatizando uma variedade de perfis genotípicos entre os isolados.

Prevalencia de Neumonía Complicada en Pacientes Pediátricos Hospitalizados en el Hospital José Carrasco Arteaga. Enero del 2014 a Diciembre del 2017 / Prevalence of Complicated Pneumonia in Hospitalized Pediatric Patients at Hospital José Carrasco Arteaga. January 2014 to December 2017

Introducción: La neumonía complicada representa un problema de salud en la población pediátrica, forma parte de las enfermedades respiratorias agudas, siendo la principal causa de morbimortalidad hospitalaria, siendo necesario el diagnóstico y tratamiento oportuno. El objetivo del estudio fue determinar la prevalencia de neumonía complicada en los pacientes hospitalizados del servicio de pediatría del Hospital "José Carrasco Arteaga" de la ciudad de Cuenca de enero del 2014 a diciembre del 2017. Metodología: Estudio descriptivo transversal en pacientes del área de Pediatría y Cuidados Intensivos Pediátricos desde enero del 2014 a diciembre del 2017. Para el análisis se utilizó la estadística descriptiva, los datos fueron tabulados en el programa SPSS v.15 Resultados: La prevalencia de neumonía complicada es de 28,8%. Hubo predominio del sexo masculino con 56.4%, así como del grupo etario de 0 a 3 años con 43.6% y la población proviene en su mayoría de la zona urbana en 58,9%. Se encontró desnutrición en el 51.1%, las comorbilidades más comunes fueron las respiratorias con 12.4%. La mayoría requirió hospitalización por 5-9 días representando 54.6%, los antibióticos más utilizados fueron los betaláctamicos en el 85.8% de los casos. La complicación más frecuente fue la bacteremia en 43.2% y la mortalidad alcanzó el 8.1%. Conclusiones: La prevalencia de la neumonía complicada es elevada, con predominio de la bacteremia, en el sexo masculino, en menores de 3 años, con desnutrición, el antibiótico que más se utilizó fueron los betalactámicos

Introduction: Complicated pneumonia represents a health problem in the pediatric population, it is part of acute respiratory diseases, being the main cause of hospital morbidity and mortality, requiring timely diagnosis and treatment. The objective of the study was to determine the prevalence of complicated pneumonia in hospitalized patients of the Pediatric service of the Hospital "José Carrasco Arteaga" in the city of Cuenca from January 2014 to December 2017. Methodology: Cross-sectional descriptive study in patients in the area of Pediatrics and Pediatric Intensive Care from January 2014 to December 2017. Descriptive statistics were used for the analysis, the data were tabulated in the SPSS v.15 program. Results: The prevalence of complicated pneumonia is 28.8%. There was a predominance of males with 56.4%, as well as the age group from 0 to 3 years with 43.6% and the population comes mostly from the urban area in 58.9%. Malnutrition was found in 51.1%, the most common comorbidities were respiratory with 12.4%. Most required hospitalization for 5-9 days, representing 54.6%, the most widely used antibiotics were betalactamic in 85.8% of the cases. The most frequent complication was bacteremia in 43.2% and mortality reached 8.1%. Conclusions: The prevalence of complicated pneumonia is high, with a predominance of bacteremia, in males, in children under 3 years of age, with malnutrition, the antibiotic that was used the most were beta-lactams