Impacto de infecciones y enterobacterias productoras de betalactamasa de espectro extendido en la supervivencia del injerto y del paciente en un programa de trasplante renal en México / Impact of infections and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae on graft and patient survival in a kidney transplantation program in Mexico

Resumen Introducción: Los tratamientos inmunosupresores han mejorado las tasas de supervivencia del injerto y del paciente, pero pueden incrementar las infecciones postrasplante. Objetivos: Analizar los datos de pacientes con trasplante renal y describir las bacterias responsables de las infecciones que presentan. Métodos: Estudio observacional, longitudinal y analítico de 103 pacientes sometidos a trasplante renal. El periodo de seguimiento fue de 5.07 ± 1.28 años. Resultados: La tasa de mortalidad fue de 10.68 % y la de pérdida del injerto de 14.56 %. Respecto al riesgo de muerte del receptor, el modelo de regresión de Cox mostró un cociente de riesgo (HR, hazard ratio) de 5.66 en los pacientes con cultivo bacteriano positivo y de 2.22 en aquellos con cepas productoras de betalactamasas de espectro extendido (BLEE); en cuanto a la pérdida del injerto, el HR fue de 4.59 en quienes tuvieron cultivo bacteriano positivo y de 4.25 en aquellos con cepas productoras de BLEE. Conclusiones: Se encontró riesgo significativo de muerte en receptores de trasplante renal con cultivo bacteriano positivo y mayor riesgo de pérdida del injerto en aquellos con cultivo bacteriano positivo y aislamiento de cepas productoras de BLEE. La tasa de enterobacterias productoras de BLEE es alta, por ello son necesarias estrategias más estrictas para controlar del uso de antibióticos.

Abstract Introduction: Immunosuppressive treatments have improved graft and patient survival rates, but can increase the incidence of post-transplant infections. Objectives: To analyze data from kidney transplant patients and describe the pathogens responsible for the infections they experience. Methods: Longitudinal, analytical, observational study of 103 patients who underwent kidney transplantation. The follow-up period was 5.07 ± 1.28 years. Results: Overall mortality rate was 10.68% and graft loss rate was 14.56%. Regarding recipient risk of death, the Cox regression model showed a hazard ratio (HR) of 5.66 for positive bacterial cultures and 2.22 for positive extended-spectrum beta-lactamase (ESBL)-producing strains; as for graft loss, HR was 4.59 in those with positive bacterial cultures and 4.25 in those who were positive for ESBL-producing strains Conclusions: Significant death risk was found in kidney transplant recipients with positive bacterial cultures and an increased risk of graft loss in those with positive bacterial cultures and in those who were positive for ESBL-producing Enterobacteriaceae isolates. The rate of ESBL-producing Enterobacteriaceae is high, and stricter strategies are therefore necessary to control the use of antibiotics.

Antibacterial potential of essential oils against planktonic and sessile cells of Escherichia coli isolated from diarrhea cases in swine / Potencial antibacteriano de aceites esenciales contra células de Escherichia coli planctónicas y sésiles aisladas de diarrea porcina

Escherichia coli is a pathogen associated with infections in piglets in the post-weaning phase, its pathogenicity is related to the animal's susceptibility to bacterial enterotoxins. The objective of the present study was to determine the EOs activity against E. colistrain, in the form planktonic and sessile. Although the Disc-Diffusion tests to determine the Minimum Inhibitory Concentration, do not fully corroborate with the other analyzes of this study, it was noticed bacteria inhibition. The EOs were prepared at 0.4%, 0.8% and 1.0% for tests. The tested EOs were effective against E. coliplanktonic cells (p<0.05). As for the sessile cells, the most significant result was inhibition and 100% sessile cells at the concentration of 1.0% of Cymbopogon citratusEO. Although there was resistance in some treatments, the tested EOs demonstrated inhibition capacity, constituting promising alternatives for the control of E. coli, especially of planktonic cells.

Escherichia coli es un patógeno asociado con infecciones en lechones en la fase posterior al destete, su patogenicidad está relacionada con la susceptibilidad del animal a las enterotoxinas bacterianas. El objetivo del presente estudio fue determinar la actividad de contra E. coli, en la forma planctónico y sésil. Aunque las pruebas de difusión de disco para determinar la concentración inhibitoria mínima, no corroboran completamente con los otros análisis de este estudio, se observó inhibición de la bacteria. Las soluciones basadas en AE se prepararon al 0.4%, 0.8% y 1.0% para pruebas. Los AEs probados fueron efectivos contra las células planctónicas (p<0.05). En cuanto a las células sésiles, el resultado más significativo fue la inhibición y el 100% de las células sésiles a la concentración de 1,0% de Cymbopogon citratus. Aunque hubo resistencia en algunos tratamientos, los AEs probados demostraron capacidad de inhibición, constituyendo alternativas prometedoras para el control de E. coli, especialmente de células planctónicas.

Use of MALDI-TOF for identification and surveillance of gram-negative bacteria in captive wild psittacines / Uso do MALDI-TOF para identificação e monitoramento de bactérias Gram-negativas em psitacídeos cativos

Microbiological studies of the sanitary and health status of psittacine birds that will be reintroduced is important in evaluating whether these animals act as carriers of pathogenic agents to other animals and humans. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a faster and more accurate method to identify bacteria than conventional microbiology methods. The aim of this study was to evaluate the health status of psittacines housed in captivity, by assessment of Gram-negative bacteria from fecal microbiota through MALDI- TOF MS identification. The results indicate high frequency of Gram-negative bacteria in feces (96.5%), especially from the Enterobacteriaceae family (88.7%). The most prevalent bacteria were Escherichia coli (39.0%), Proteus vulgaris (12.2%), Klebsiella spp. (12.1%) and Raoultella ornithinolytica (8.7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. and Escherichia hermannii were isolated with lower frequency. . All these agents are potentially pathogenic for parrots and can cause systemic infections in other animals and humans. These findings reinforce that MALDI- TOF MS proved to be a rapid and accurate method of identification of the microorganism and evaluation of the health status of psittacines, providing relevant data to assist decision-making regarding the sanitary protocols in wildlife centers, and possible future reintroduction of wild birds.

Estudos microbiológicos da sanidade de psitacídeos que serão reintroduzidos são importantes para avaliar se esses animais atuam como portadores de agentes patogênicos para outros animais e humanos. A espectrometria de massa por ionização/dessorção de matriz assistida por laser/tempo de vôo (MALDI-TOF MS) é um método mais rápido e preciso para identificar bactérias na comparação com métodos convencionais de microbiologia. O objetivo deste estudo foi avaliar o estado de saúde de psitacídeos cativos, identificando bactérias Gram-negativas da microbiota fecal por MALDI -TOF MS. Os resultados indicaram alta frequência de bactérias Gram-negativas nas fezes (96,5%), principalmente da família Enterobacteriaceae (88,7%). As mais prevalentes foram Escherichia coli (39,0%), Proteus vulgaris (12,2%), Klebsiella spp. (12,1%) e Raoultella ornithinolytica (8,7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. e Escherichia hermannii foram isolados com menor frequência. Todos esses agentes são potencialmente patogênicos para os papagaios e podem causar infecções sistêmicas em outros animais e seres humanos. Esses achados reforçam que o MALDI- TOF MS é um método rápido e preciso de identificação do microrganismo e avaliação do estado de saúde dos psitacídeos, fornecendo dados relevantes para auxiliar na tomada de decisões sobre os protocolos sanitários em centros de triagem de animais selvagens e sobre a possibilidade de reintrodução futura.

Caracterización clínica-microbiológica y factores de riesgo de las bacteriemias por enterobacterias productoras de betalactamasas de espectro extendido en el hospital universitario / Clinical-microbiological characterization and risk factors of bacteremia caused by extended-spectrum beta-lactamase-producing enterobacteria at the university hospital

INTRODUCCIÓN: Las infecciones del torrente sanguíneo se asocian con alta morbi- mortalidad, siendo frecuentemente causadas por enterobacterias, y cuando éstas producen ß-lactamasas de espectro extendido (BLEEs), la morbi-mortalidad, duración internación y costos sanitarios son aún mayores. OBJETIVO: Caracterizar los episodios de bacteriemia por enterobacterias en el Hospital Universitario en un período de 2 años. METODOLOGÍA: Estudio observacional, analítico, casos controles (1:1), con recolección de datos retrospectiva. Población: pacientes ≥18 años atendidos en el Hospital Universitario en período 01/01/2014 - 30/11/2015, con hemocultivo positivo por enterobacteria. Recolección datos clínicos-epidemiológicos: revisión registros médicos. Estudio microbiológico: Identificación y susceptibilidad - equipo automatizado Vitek® 2 system (bioMérieux, Marcy l'Etoile, France). Sensibilidad a fosfomicina: disco-difusión (E. coli) y dilución en agar (resto de las enterobacterias). Ceftazidime-avibactam: disco-difusión. Aislamientos BLEE+ según Vitek: confirmación y caracterización de BLEE: reacción en cadena de la polimerasa (PCR) y secuenciación. Investigación mecanismos transferibles de resistencia a quinolonas (TMQR) qnrB y aac(6')-Ib-cr: PCR. Caracterización molecular enterobacterias BLEE más prevalentes: MultiLocus Sequence Typing (MLST) y Pulsed Field Gel Electrophoresis (PFGE). Análisis casos y controles: I)Factores de riesgo bacteriemia BLEE: Casos - pacientes con bacteriemia por enterobacteria BLEE(+). Controles - pacientes con bacteriemia por enterobacteria BLEE (-) sensible a cefalosporinas tercera generación. II) Factores de riesgo mortalidad intrahospitalaria: Casos - pacientes con mortalidad hospitalaria por cualquier causa. Controles ­ pacientes egresados vivos. Análisis estadístico: paquete estadístico IBM SPSS Statistics 23. Análisis casos y controles: cálculo de odd ratios (OR) e intervalo de confianza al 95% (IC95%). Variables con p ≤0.05 en análisis univariado incluídas en análisis multivariado (regresión logística). Proyecto aprobado por Comité Ética del Hospital de Clínicas y financiado por ANII (FMV_3_2016_1_126580, Fondo María Viña ­ 2016). RESULTADOS: Principales resultados microbiológicos: 174 episodios de bacteriemia y 178 enterobacterias recuperadas, con confirmación molecular de producción BLEE en 41 enterobacterias (23%): 29 Klebsiella pneumoniae, 7 Escherichia coli, 2 Serratia marcescens, 1 Enterobacter cloacae, 1 Citrobacter freundii y 1 Morganella morganii. E. coli enterobacteria más recuperada (n=69), pero K. pneumoniae la enterobacteria BLEE más prevalente (56 aislamientos y 29/56 BLEE+), seguida de E. coli (7/69). Distribución de las enterobacterias BLEE+ según enzima detectada: CTX- M-15: 32 aislamientos, CTX-M-15 + CTX- M-14: 3 aislamientos, CTX-M-2: 3, CTX-M-8: 2, SHV-5: 1. Susceptibilidad enterobacterias BLEE: meropenem 100%, ceftazidime-avibactam 100%, fosfomicina 100%, imipenem 98%, ertapenem 97,6%, colistin 92,7%, amikacina 85,4%, gentamicina 36,6%, tigeciclina 29,3%, piperacilina-tazobactam 26,8%, trimetoprim-sulfametoxazol 19,5%, ciprofloxacina 12,2%. Detección de mecansimos transferibles de resistencia a quinolonas (TMQR) en 33/41 aislamientos (80,5%): aac(6')-Ib-cr: 22 aislamientos, qnrB: 2 aislamientos, y aac(6')-Ib-cr + qnrB: 9 aislamientos. Detección de secuenciotipos "exitosos" en principales enterobacterias BLEE: E. coli ST 73 (1), ST 95(1) y ST 38 (2) y ST 258 en K. pneumoniae (12/29=41,4%). También detección ST 258 en un aislamiento de K. pneumoniae BLEE (-). Principales resultados clínicos ­ epidemiológicos: Se revisaron 98 registros médicos; 60 bacteriemias nosocomiales, 29 comunitarias, 8 asociadas a los cuidados de la salud, 1 sin dato. 41 BLEE(+) y 57 BLEE(-). 80 pacientes vivos al egreso, 17 fallecidos y 1 sin dato. Factores de riesgo bacteriemia BLEE(+) (análisis multivariado) : presencia de dispositivo médico a permanencia previo (p 0,001, OR 55,2, IC 95%5,5-553) ) y bacteriemia no comunitaria (p 0,008 OR 17,4 IC95% 2,1-143). Factores de riesgo mortalidad intrahospitalaria (análisis multivariado): enfermedad hematooncológica o neoplásica (OR 4,687 IC95% 1,207-18,200) y score qPitt ≥2 (OR 10,332 IC95% 2,639-40,442). Antibioticoterapia empírica activa in vitro para la bacteriemia: 10/29(34,5%) en pacientes BLEE(+) y 36/40 BLEE(-) (90%). Se encontró asociación entre bacteriemia BLEE + y recibir antibioticoterapia empírica inactiva (p<0,0001) ; siendo el riesgo de recibir antibioticoterapia empírica inactiva 17 veces mayor en bacteriemias BLEE(+) respecto a BLEE(-). Se encontró que la mediana de la duración de la hospitalización a partir del episodio de bacteriemia es más prolongada en casos BLEE+ que en los controles BLEE- (22,5 versus 14 días, p=0,006). CONCLUSIONES: Enterobacteria BLEE más prevalente K. pneumoniae, y dentro de ella alta prevalencia del clon exitoso de alto riesgo ST 258. Predominio de CTX-M-15, y alta prevalencia (> 80%) de TMQR en aislamientos BLEE. Presencia de BLEE aumenta significativamente el riesgo de recibir antibioticoterapia empírica inactiva. Necesidad de mantener vigilancia de perfiles de susceptibilidad y clones circulantes y considerar posibles factores de riesgo al momento se seleccionar antibioticoterapia empírica.

BACKGROUND: Bloodstream infections are associated with high morbidity and mortality, being frequently caused by Enterobacteriaceae, and when they produce extended spectrum ß-lactamases (ESBL), morbidity, mortality and healthcare costs are even higher. OBJECTIVE: We aimed to characterize Enterobacteriaceae bacteremia episodes at the "Hospital de Clínicas", in a 2 years period. METHODS: Observational, analytical study, case-controls (1: 1), with retrospective data collection. Population: ≥18 years old patients attended at the "Hospital de Clínicas" between 01/01/2014 and 11/30/2015, with Enterobacteriaceae recovered from blood culture. Collection of clinical-epidemiological data: review of medical records. Microbiological study: identification and susceptibility: automated system Vitek® 2 (bioMérieux, Marcy l'Etoile, France). Susceptibility to fosfomycin: disc-diffusion (E. coli) and agar dilution (others Enterobacterales). Ceftazidime-avibactam: disc-diffusion. ESBL (+) isolates according to Vitek: ESBL confirmation and characterization by Polymerase Chain Reaction (PCR) and sequencing. Investigation of transferable mechanisms of quinolone resistance (TMQR) qnrB and aac (6 ')- Ib-cr: PCR. Molecular characterization of the most prevalent ESBL enterobacterales: MultiLocus Sequence Typing (MLST) and Pulsed Field Gel Electrophoresis (PFGE). Case-control analysis: I) ESBL bacteremia risk factors: Cases - patients with bacteremia by an ESBL-producing enterobacteria. Controls - patients with third generation cephalosporin susceptible enterobacteria, not ESBL-producing. II) In-hospital mortality risk factors: Cases - patients with in-hospital mortality from any cause. Controls - patients discharged alive. Statistical analysis: IBM SPSS Statistics 23 statistical package. Case-control analysis: calculation of odd ratios (OR) and 95% confidence interval (95% CI). Variables with p ≤0.05 in univariate analysis were included in multivariate analysis (logistic regression). Project approved by the Hospital de Clinicas Ethics Committee and financed by ANII (FMV_3_2016_1_126580, María Viña Fund - 2016). RESULTS: Main microbiological results: 174 bacteremia episodes and 178 enterobacterales recovered. ESBL production confirmated in 41 isolates (23%): 29 Klebsiella pneumoniae, 7 Escherichia coli, 2 Serratia marcescens, 1 Enterobacter cloacae, 1 Citrobacter freundii y 1 Morganella morganii.E. coli was the most recovered enterobacteria (n = 69), but K. pneumoniae was the most prevalent ESBL producing specie (56 isolates and 29/56 ESBL +), followed by E. coli (7/69). Distribution of ESBL producing enterobacterales according to enzyme detected: CTX- M-15: 32 isolates, CTX-M-15 + CTX-M-14: 3 isoaltes, CTX-M-2: 3, CTX-M-8: 2, SHV-5: 1. Antibiotic susceptibility in ESBL producers: meropenem 100%, ceftazidime-avibactam 100%, fosfomycin 100%, imipenem 98%, ertapenem 97,6%, colistin 92,7%, amikacin 85,4%, gentamicin 36,6%, tigecycline 29,3%, piperacillin-tazobactam 26,8%, trimethroprim sulfamethoxazole 19,5%, ciprofloxacin 12,2%. Detection of TMQR in 33/41 isolates (80.5%): aac(6')-Ib-cr: 22 isolates, qnrB: 2 isolates, and aac(6')Ib-cr + qnrb: 9 isolates. We detected "successful" sequence types within E. coli ESBL producing: ST 73 (1 isolate), ST 95 (1) and ST 38 (2) and a high prevalence of ST 258 among K. pneumoniae isolates (12/29 = 41.4%). ST 258 was also detected in one ESBL(-) K. pneumoniae isolate. Main clinical-epidemiological results: 98 medical records were reviewed; 60 bacteremia episodes were classified as nosomial, 29 as community acquired, 8 health care associated, and for one episode, data was insufficient for its classification. 41 were ESBL(+) and 57 ESBL(-). 80 patients alive at discharge, 17 deceased and 1 without data. Risk factors for ESBL bacteremia according to multivariate analysis were: use of medical device prior to hospitalization (OR = 50.226, 95% CI 4.367 - 577.721) and non-community bacteremia (OR 12.052, 95% CI 1.350-107.605). In-hospital mortality risk factors (multivariate analysis): hemato-oncological or neoplasic disease (OR 4,687 95% CI 1,207-18,200) and qPitt score ≥2 (OR 10,332 95% CI 2,639-40,442). The empirical antibiotic therapy was active according to the susceptibility test in 10/29 (34,5%) patients with ESBL (+) bacteremia and in 36/40 patients with ESBL (-) (90%). Presence of ESBL was found to be associated with inactive empirical antibiotic therapy (p<0.0001), and risk for receiving inactive empirical antibiotic therapy was 17 times higher in ESBL (+) compared to ESBL (-). The mean length of hospital stay after the onset of bacteraemia was longer in the cases of ESBL producers than in the cases of non-ESBL producers ( 22,5 vs. 14 days; P=0.006). CONCLUSIONS: K. pneumoniae was the most prevalent ESBL producing specie, and within it we found a high prevalence of the successful high-risk clone ST258. CTX-M-15 was the main ESBL detected and we found high prevalence (80%) of TMQR among ESBL(+). Presence of ESBL significantly increases the risk of receiving inactive empirical antibiotic therapy. Need to maintain surveillance of susceptibility profiles and circulating clones and to take into account possible risk factors when selecting empirical antibiotic therapy.

Use of MALDI-TOF for identification and surveillance of gramnegative bacteria in captive wild psittacines / Uso do MALDI-TOF para identificação e monitoramento de bactérias Gram negativas em psitacídeos cativos

Microbiological studies of the sanitary and health status of psittacine birds that will be reintroduced is important in evaluating whether these animals act as carriers of pathogenic agents to other animals and humans. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a faster and more accurate method to identify bacteria than conventional microbiology methods. The aim of this study was to evaluate the health status of psittacines housed in captivity, by assessment of Gram-negative bacteria from fecal microbiota through MALDI- TOF MS identification. The results indicate high frequency of Gram-negative bacteria in feces (96.5%), especially from the Enterobacteriaceae family (88.7%). The most prevalent bacteria were Escherichia coli (39.0%), Proteus vulgaris (12.2%), Klebsiella spp. (12.1%) and Raoultella ornithinolytica (8.7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. and Escherichia hermannii were isolated with lower frequency. . All these agents are potentially pathogenic for parrots and can cause systemic infections in other animals and humans. These findings reinforce that MALDI- TOF MS proved to be a rapid and accurate method of identification of the microorganism and evaluation of the health status of psittacines, providing relevant data to assist decision-making regarding the sanitary protocols in wildlife centers, and possible future reintroduction of wild birds.

Estudos microbiológicos da sanidade de psitacídeos que serão reintroduzidos são importantes para avaliar se esses animais atuam como portadores de agentes patogênicos para outros animais e humanos. A espectrometria de massa por ionização/dessorção de matriz assistida por laser/tempo de vôo (MALDI-TOF MS) é um método mais rápido e preciso para identificar bactérias na comparação com métodos convencionais de microbiologia. O objetivo deste estudo foi avaliar o estado de saúde de psitacídeos cativos, identificando bactérias Gram-negativas da microbiota fecal por MALDI -TOF MS. Os resultados indicaram alta frequência de bactérias Gram-negativas nas fezes (96,5%), principalmente da família Enterobacteriaceae (88,7%). As mais prevalentes foram Escherichia coli (39,0%), Proteus vulgaris (12,2%), Klebsiella spp. (12,1%) e Raoultella ornithinolytica (8,7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. e Escherichia hermannii foram isolados com menor frequência. Todos esses agentes são potencialmente patogênicos para os papagaios e podem causar infecções sistêmicas em outros animais e seres humanos. Esses achados reforçam que o MALDI- TOF MS é um método rápido e preciso de identificação do microrganismo e avaliação do estado de saúde dos psitacídeos, fornecendo dados relevantes para auxiliar na tomada de decisões sobre os protocolos sanitários em centros de triagem de animais selvagens e sobre a possibilidade de reintrodução futura.

Use of MALDI-TOF for identification and surveillance of gram-negative bacteria in captive wild psittacines

Abstract Microbiological studies of the sanitary and health status of psittacine birds that will be reintroduced is important in evaluating whether these animals act as carriers of pathogenic agents to other animals and humans. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a faster and more accurate method to identify bacteria than conventional microbiology methods. The aim of this study was to evaluate the health status of psittacines housed in captivity, by assessment of Gram-negative bacteria from fecal microbiota through MALDI- TOF MS identification. The results indicate high frequency of Gram-negative bacteria in feces (96.5%), especially from the Enterobacteriaceae family (88.7%). The most prevalent bacteria were Escherichia coli (39.0%), Proteus vulgaris (12.2%), Klebsiella spp. (12.1%) and Raoultella ornithinolytica (8.7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. and Escherichia hermannii were isolated with lower frequency. . All these agents are potentially pathogenic for parrots and can cause systemic infections in other animals and humans. These findings reinforce that MALDI- TOF MS proved to be a rapid and accurate method of identification of the microorganism and evaluation of the health status of psittacines, providing relevant data to assist decision-making regarding the sanitary protocols in wildlife centers, and possible future reintroduction of wild birds.

Resumo Estudos microbiológicos da sanidade de psitacídeos que serão reintroduzidos são importantes para avaliar se esses animais atuam como portadores de agentes patogênicos para outros animais e humanos. A espectrometria de massa por ionização/dessorção de matriz assistida por laser/tempo de vôo (MALDI-TOF MS) é um método mais rápido e preciso para identificar bactérias na comparação com métodos convencionais de microbiologia. O objetivo deste estudo foi avaliar o estado de saúde de psitacídeos cativos, identificando bactérias Gram-negativas da microbiota fecal por MALDI -TOF MS. Os resultados indicaram alta frequência de bactérias Gram-negativas nas fezes (96,5%), principalmente da família Enterobacteriaceae (88,7%). As mais prevalentes foram Escherichia coli (39,0%), Proteus vulgaris (12,2%), Klebsiella spp. (12,1%) e Raoultella ornithinolytica (8,7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. e Escherichia hermannii foram isolados com menor frequência. Todos esses agentes são potencialmente patogênicos para os papagaios e podem causar infecções sistêmicas em outros animais e seres humanos. Esses achados reforçam que o MALDI- TOF MS é um método rápido e preciso de identificação do microrganismo e avaliação do estado de saúde dos psitacídeos, fornecendo dados relevantes para auxiliar na tomada de decisões sobre os protocolos sanitários em centros de triagem de animais selvagens e sobre a possibilidade de reintrodução futura.

Prevalencia de infección del tracto urinario y perfil de susceptibilidad antimicrobiana en Enterobacterias

Resumen Las Infecciones del Tracto Urinario (ITU), constituyen uno de los principales motivos de consulta en el ámbito de atención primaria, debido al aumento de la resistencia antibacteriana. Objetivo . Caracterizar la prevalencia de infección del tracto urinario y el perfil de susceptibilidad antimicrobiana in vitro en Enterobacterias en los pacientes de la provincia de Santa Elena - Ecuador. Método . Esta investigación fue descriptiva de diseño documental. La población fue de 827 registros de urocultivos, recopilados de la base de datos del laboratorio de microbiología del Centro de Especialidades IESS La Libertad, en el período comprendido desde agosto 2019 hasta marzo de 2020. Los datos fueron procesados mediante estadística descriptiva, análisis de frecuencia y chi cuadrado. Resultados . De este estudio indican que la prevalencia de ITU fue 22,1%; los principales agentes etiológicos fueron: E. coli (76,0%), Klebsiella oxytoca (6,5%), Klebsiella pneumoniae (5,8%) y Proteus mirabilis (3,9%). La ITU y la infección por E. coli fueron estadísticamente mayores en mujeres y adultos mayores. La mayor frecuencia de resistencia de E. coli fue para ácido nalidíxico (81,2%), ampicilina (79,9%), ciprofloxacina (72,6%) y sulfametoxazol trimetoprima (61,5%); en Klebsiella oxytoca fue ampicilina (80,0%), sulfametoxazol trimetoprima (70,0%), ácido nalidíxico (60,0%) y ciprofloxacina (40,0%). Mientras que en Klebsiella pneumoniae se halló una resistencia del (100%) para ampicilina y cefalotina, amoxicilina y ácido clavulánico (66,7%), ciprofloxacina (55,6%), ácido nalidíxico (44,4%), meropenem e imipenem (11,1%). Conclusiones. La E. coli continúa siendo el microorganismo más frecuente en ITU. El tratamiento empírico de ITU debería incluir amikacina, nitrofurantoina y piperacilina tazobactam.

Abstract Urinary Tract Infections (UTI) are one of the main reasons for consultation in the primary care setting, due to the increase in antibacterial resistance. Objective . To characterize the prevalence of urinary tract infection and the in vitro antimicrobial susceptibility profile of Enterobacteriaceae in patients in the province of Santa Elena - Ecuador. Method. This was a descriptive research of documentary design. The population was 827 urine culture records, collected from the database of the microbiology laboratory of the Centro de Especialidades IESS La Libertad, in the period from August 2019 to March 2020. The data were processed using descriptive statistics, frequency analysis and chi-square. Results . From this study indicate that the prevalence of UTI was 22.1%; the main etiological agents were: E. coli (76.0%), Klebsiella oxytoca (6.5%), Klebsiella pneumoniae (5.8%) and Proteus mirabilis (3.9%). UTI and E. coli infection were statistically higher in women and older adults. The highest frequency of E. coli resistance was for nalidixic acid (81.2%), ampicillin (79.9%), ciprofloxacin (72.6%) and trimethoprim sulfamethoxazole (61.5%); in Klebsiella oxytoca it was ampicillin (80.0%), trimethoprim sulfamethoxazole (70.0%), nalidixic acid (60.0%) and ciprofloxacin (40.0%). While in Klebsiella pneumoniae, 100% resistance was found for ampicillin and cephalothin, amoxicillin and clavulanic acid (66.7%), ciprofloxacin (55.6%), nalidixic acid (44.4%), meropenem and imipenem (11.1%). Conclusions . E. coli continues to be the most frequent microorganism in UTI. Empirical treatment of UTI should include amikacin, nitrofurantoin and piperacillin tazobactam.

Resumo As infecções do trato urinário (IU) são um dos principais motivos de consulta no âmbito dos cuidados primários, devido ao aumento da resistência antibacteriana. Objetivo . Caracterizar a prevalência da infecção do trato urinário e o perfil de suscetibilidade antimicrobiana in vitro de Enterobacteriaceae em pacientes da província de Santa Elena - Equador. Método . Esta foi uma pesquisa descritiva do projeto documental. A população era de 827 registros de cultura de urina, coletados do banco de dados do laboratório de microbiologia do Centro de Especialidades IESS La Libertad, no período de agosto de 2019 a março de 2020. Os dados foram processados utilizando estatísticas descritivas, análise de freqüência e qui-quadrado. Resultados. Deste estudo indicam que a prevalência de UTI foi de 22,1%; os principais agentes etiológicos foram: E. coli (76,0%), Klebsiella oxytoca (6,5%), Klebsiella pneumoniae (5,8%) e Proteus mirabilis (3,9%). A infecção por UTI e E. coli foi estatisticamente maior nas mulheres e nos adultos mais velhos. A maior freqüência de resistência do E. coli foi para o ácido nalidíxico (81,2%), ampicilina (79,9%), ciprofloxacina (72,6%) e trimetoprim sulfametoxazol (61,5%); em Klebsiella oxytoca era ampicilina (80,0%), trimetoprim sulfametoxazol (70,0%), ácido nalidíxico (60,0%) e ciprofloxacina (40,0%). Enquanto em Klebsiella pneumoniae, foi encontrada 100% de resistência para ampicilina e cefalotina, amoxicilina e ácido clavulânico (66,7%), ciprofloxacina (55,6%), ácido nalidíxico (44,4%), meropenem e imipenem (11,1%). Conclusões . A E. coli continua sendo o microorganismo mais freqüente na UTI. O tratamento empírico da UTI deve incluir amikacina, nitrofurantoína e piperacilina tazobactam.

Detección rápida de Enterobacterias productoras de carbapenemasas en hisopados rectales de pacientes neonatos colonizados / Rapid detection of carbapenemase-producing Enterobacteriaceae in rectal swabs of colonized neonatal patients

Resumen Objetivo: Detectar la presencia de Enterobacterias productoras de carbapenemasas en hisopados rectales de neonatos mediante técnica de nefelometría láser y caracterización del tipo de carbapenemasa mediante test inmunocromatográfico. Materiales y Métodos: Estudio descriptivo de corte transversal. Fueron incluidos 57 neonatos, tamizados al ingreso a UCI, mediante hisopado rectal, procesado por nefelometría laser HB&L Carbapenemase (Alifax®) y caracterización del tipo de carbapenemasa por inmunocromatografía rápida RESIST-3 (Coris BioConcept®). Resultados: Encontramos un alto porcentaje de colonización rectal (22.9%) correspondiente a 13 hisopados positivos y 44 (77.1%) fueron negativos por nefelometría láser. Por VITEK 2® se obtuvo identificación de Klebsiella pneumoniae resistente a carbapenémicos en los 13 aislamientos y el test inmunocromatográfico reveló la presencia de carbapenemasas blaKPC en estos aislamientos. Discusión: Estudios evidencian el aumento de la colonización por microorganismos productores de carbapenemasas en neonatos. Los resultados de este estudio demuestran que un porcentaje significativo de neonatos que ingresan a las Unidades de Cuidado Neonatal se encuentran colonizados con Enterobacterias productoras de carbapenemasas en tracto intestinal. Lo anterior constituye un riesgo potencial para su diseminación y posterior desarrollo de brotes, en donde surge la importancia de implementar estrategias de vigilancia activa como la tamización rectal para la detección oportuna de neonatos colonizados.

Abstract Objective: To detect the presence of carbapenemase-producing Enterobacteriaceae in rectal swabs of neonates by means of laser nephelometry technique and characterization of the type of carbapenemase by immunochromatographic test. Materials and Methods: Descriptive cross-sectional study. 57 neonatal patients were included; They underwent rectal screening upon admission to the ICU, using swabs which were processed by HB&L Carbapenemase laser nephelometry (Alifax®) and characterization of the type of carbapenemase by RESIST-3 rapid immu nochromatography (Coris BioConcept®). Results: We found a high percentage of rectal colonization (22.9%) corresponding to 13 positive swabs and 44 samples (77.1%) were negative by laser nephelome try. Identification of carbapenem-resistant Klebsiella pneumoniae was obtained by VITEK 2® in the 13 isolates and the immunochromatographic test revealed the presence of blaKPC carbapenemases in these isolates. Discussion: Studies show increased colonization by carbapenemase-producing microorganisms in neonates. The results of this study demonstrate that a significant percentage of neonates who enter Neonatal Care Units are colonized with Enterobacteriaceae that produce carbapenemases in the intestinal tract. This constitu tes a potential risk for its spread and subsequent development of outbreaks, where the importance of implementing active surveillance strategies such as rectal screening for the timely detection of colonized neonates arises.

Detección fenotípica y genotípica de la producción de carbapenemasas tipo NDM-1 y KPC en enterobacterias aisladas en un laboratorio clínico en Maracay, Venezuela / Phenotypic and genotypic detection of the production of carbapenemases type NDM-1 and KPC in isolated Enterobacteriaceae in a clinical laboratory in Maracay, Venezuela

INTRODUCCIÓN: La producción de beta-lactamasas capaces de hidrolizar a los carbapenémicos es uno de los mecanismos de resistencia más preocupantes porque eliminan la última opción terapéutica frente a los microorganismos multi-resistentes. OBJETIVO: Determinar la producción de carbapenemasas tipo KPC y NDM-1, empleando métodos fenotípicos y genotípicos, en enterobacterias aisladas en un laboratorio clínico de la ciudad de Maracay, Venezuela. MÉTODOS: Se determinó la producción de carbapenemasas mediante métodos fenotípicos (según algoritmo de Malbrán) y genotípicos (amplificación de los genes blaNDM-1 y blaKPC por RPC) en enterobacterias aisladas en un laboratorio clínico durante el período marzo-agosto 2018. RESULTADOS: Se identificaron 605 enterobacterias de diferentes especies, siendo Escherichia coli la cepa con mayor porcentaje de aislamiento (61,3%), seguida por Klebsiella pneumoniae (14,9%). Diez y seis enterobacterias (2,64%) fueron positivas para la producción de carbapenemasas: 13 cepas de K. pneumoniae y tres del complejo Enterobacter cloacae. La RPC demostró que 14 cepas (87,5%) contienen el gen blaNDM-1 y dos (12,5%) el gen blaKPC; se observó 100% de concordancia entre la determinación fenotípica y la RPC para ambos grupos de enzimas. CONCLUSIONES: Los resultados mostraron mayor incidencia de la metalo-beta-lactamasa tipo NDM-1, reconocida como una alarma epidemiológica debido a que su rápida diseminación dificulta su control, por lo que la identificación del tipo de enzima permitiría establecer estrategias de manejo y control más certeras con la finalidad de erradicar a dichos patógenos.

BACKGROUND: The production of carbapenem-hydrolyzing beta-lactamases is one of the most concerning resistance mechanisms since it eliminates the last therapeutic option against multidrug resistant microorganisms. AIM: To determine the production of KPC and NDM-1 type carbapenemases, using phenotypic and genotypic methods, in isolated enterobacteria in a clinical laboratory in the city of Maracay, Venezuela. METHODS: The production of carbapenemases was determined by phenotypic (according to the Malbrán algorithm) and genotypic methods (amplification of the blaNDM-1 and blaKPC genes by PCR) in clinical isolates of Enterobacteriaceae during the period March-August 2018. RESULTS: 605 Enterobacteriaceae of different species were identified, being Escherichia coli the strain with the highest percentage of isolation (61.3%), followed by Klebsiella pneumoniae (14.9%). Sixteen strains (2.64%) were positive for carbapenemases production: 13 strains of K. pneumoniae and three of the Enterobacter cloacae complex. PCR showed that 14 strains (87.5%) carry the blaNDM-1 gene and two strains (12.5%) the blaKPC gene; 100% agreement was observed between phenotypic determination and PCR for both groups of enzymes. CONCLUSIONS: The results of this study showed a higher incidence of metallo-beta-lactamase type NDM-1, which rapid dissemination and consequently difficult control has been cause of epidemiological alert. The identification of the type of enzyme would allow establishing more accurate management and control strategies in order to eradicate these pathogens.

Antimicrobial resistance of Escherichia coli isolates from spray‑chilled sheep carcasses during cooling / Resistencia antimicrobiana en aislados de Escherichia coli de canales de ovejas asperjadas durante la refrigeración / Resistência antimicrobiana de isolados de Escherichia coli de carcaças ovinas aspergidas durante o resfriamento

Abstract Background: Multidrug-resistant bacteria present in food of animal origin raise human and animal health concerns. Objective: To assess antimicrobial resistance of Escherichia coli isolates from sheep carcasses subjected to spray-chilling with water (4 and 10 hours) during cooling. Methods: Thirty surface swabs were collected from carcasses before and after the last water spray in two slaughter periods. In a first assessment (1st sampling), three spray-chilled carcasses (4 hours), three non-sprayed and one control carcass were sampled. In a second assessment (2nd sampling), the same number of carcasses and treatments were maintained, but spray-chilling was extended to 10 hours. All samples collected were isolated and submitted to susceptibility test using 16 (1st sampling) and 17 (2nd sampling) antimicrobials, respectively. Results: Overall, E. coli isolates were resistant most antimicrobials. Spray-chilled and control carcasses (10 hours) showed resistance to meropenem. Conclusion: E. coli isolates from carcasses subjected to spray-chilling with water for 10 hours had higher antimicrobial resistance to one, two, and four antimicrobial classes, characterizing a multidrug resistance profile. These results highlight the need to monitor health status throughout the meat production processes.

Resumen Antecedentes: las bacterias multirresistentes presentes en alimentos de origen animal son motivo de alerta para la salud humana y animal. Objetivo: verificar la resistencia a antimicrobianos de aislados de Escherichia coli en canales ovinas sometidas a aspersión (4 y 10 h) durante la refrigeración. Métodos: Luego de dos faenas de sacrificio, treinta hisopos fueron colectados en la superficie de las canales antes y después de la última aspersión. En un primer sacrificio (1era colecta) se recolectaron muestras de tres canales sometidas a aspersión (4 horas), tres sin aspersión y una canal como control. En un segundo sacrificio (2da colecta), el mismo número de canales y tratamientos se mantuvo, y el período de aspersión se extendió a 10 horas. Las muestras recogidas fueron aisladas y sometidas a la prueba de susceptibilidad utilizándo 16 (1.ª colecta) y 17 (2.ª colecta) antimicrobianos, respectivamente. Resultados: los aislamientos de E. coli fueron, en general, resistentes a las principales clases de antimicrobianos. Las canales con aspersión y el control (10 h) presentaron resistencia al meropenem. Conclusión: cuando la asperción duró 10 h, los aislados de E. coli presentaron mayor resistencia para una, dos y cuatro clases de antimicrobianos, es decir, fueron multirresistentes a los fármacos utilizados. Esto resalta la necesidad de monitorear el estado de salud durante todos los procesos de producción de carne.

Resumo Antecedentes: bactérias multirresistentes presentes em alimentos de origem animal são motivo de preocupação e alerta na saúde humana e animal. Objetivo: verificar a resistência antimicrobiana em isolados de Escherichia coli de carcaças de ovinos pulverizadas ou não (4 e 10 horas) durante a refrigeração. Métodos: foram coletados trinta swabs de superfície em carcaças antes e após a última aspersão em dois abates. Em outubro do 2015, três carcaças aspergidas foram amostradas, três sem aspersão e uma carcaça para controle, por um período de 4 horas. Em julho de 2016 (2ª coleta), o mesmo número de carcaças e tratamentos foram mantidos e o período de aspersão foi prolongado em 10 horas. As amostras coletadas foram isoladas e submetidas ao teste de susceptibilidade em 16 (1ª coleta) e 17 (2ª coleta) antimicrobianos, respectivamente. Resultados: isolados de E. coli foram, em geral, resistentes às principais classes de antimicrobianos. As carcaças e o controle aspergidos (10 h) apresentaram resistência ao meropenem. Conclusão: quando a aspersão de água durou 10 horas, os isolados de E. coli apresentaram maior resistência antimicrobiana a uma, duas e quatro classes de antimicrobianos, o que é uma multirresistência aos fármacos testados. Isso alerta para a necessidade de monitorar os aspectos de saúde durante todos os processos de produção de carne.

Fluoroquinolonas en aves, huevos, alimentos avícolas y su impacto en la microbiota intestinal de aves / Fluoroquinolone in birds, eggs, poultry feeds and their impact on the intestinal microbiota

Se detectó la presencia de fluoroquinolonas en varios alimentos (huevos, alimentos para aves y pechuga de pollo), así como determinar el perfil de susceptibilidad de ácido nalidíxico y ciprofloxacina de las enterobacterias aisladas del contenido intestinal de pollos de Cumaná. Se estudiaron alimentos iniciadores y de engorde (de cinco marcas comerciales) y uno para gallinas ponedoras, así como pechugas de pollos nacionales y de Brasil. I-2 y E-1 fueron los que tuvieron las concentraciones más altas de enrofloxacina. El alimento para las gallinas ponedoras (AP 2,35 µg/mg) tuvo más enrofloxacina que los de los pollos. En los huevos, la mayor acumulación se vio en las yemas. Los pollos nacionales (0,43-0,56 µg/mg) acumularon más ciprofloxacina que los pollos de Brasil (0,14 µg/mg). De los hisopados rectales de los pollos, E. coli fue la principal especie aislada. Por antibiograma, 48% de las cepas fueron resistentes a las quinolonas probadas (ácido nalidíxico y ciprofloxacina). Cuando se determinó la concentración mínima inhibitoria a ciprofloxacina, todas las cepas fueron resistentes (8-128 µg/ml). Todos los alimentos muestreados exceden los límites máximos de fluoroquinolonas permitidos en humanos, lo cual ejerce una presión selectiva importante en las bacterias de la microbiota intestinal de los pollos

To detect the presence of fluoroquinolones in several foods (eggs, poultry food and chicken breast), as well as to determine the susceptibility profile of nalidixic acid and ciprofloxacin of strains of enterobacterias from chicken's intestinal content from Cumaná. Starter and fattening foods (of five commercial marks), and one for laying hens, were studied, as well as domestic chicken's breast (and Brazil. I-2 and E-1 were the ones with the highest concentrations of enrofloxacin. The food for laying hens (AP 2,35 µg/mg) had more enrofloxacin than those for chickens. In eggs, greatest accumulation was seen in the yolks. Domestic chickens (0,43-0,56 µg/mg) accumulated more ciprofloxacin than Brazilian ones (0,14 µg/mg). E. coli was the main specie from chicken rectal swabs. By antimicrobial susceptibility testing, 48% were resistant to both quinolones (nalidixic acid and ciprofloxacin). When the minimum inhibitory concentration of ciprofloxacin was determined, all strains were resistant (8-128 µg/ml). All sampled foods exceeded the maximum limits of fluoroquinolones allowed in humans, which puts significant selective pressure on the bacteria in the chicken gut microbiota

Antimicrobial susceptibility profile of enterobacteria isolated from wild grey-breasted parakeets (Pyrrhura griseipectus) / Perfil de susceptibilidade antimicrobiana de enterobactérias isoladas de periquitos-de-cara-suja (Pyrrhura griseipectus)

The grey-breasted parakeet (Pyrrhura griseipectus) is an endangered psittacine species that have been affected by illegal trade and deforestation. Currently, this endemic species is only found in three areas in Ceará state, in Brazil. This study aimed to investigate the frequency and diversity of Enterobacteriaceae in wild adult grey-breasted parakeets and determine their susceptibility to antimicrobial agents. Cloacal swab samples were collected from 27 individuals and environmental swabs (drag swabs) from five nests used by these birds. Twenty-seven strains from nine species of Enterobacteriaceae were recovered from cloacal swabs, and the most prevalent bacteria strains were Hafnia alvei (22%) and Pantoea agglomerans (22%). From environmental nest samples, seven strains from three bacterial species were isolated, being the P. agglomerans the most frequent species (100%). Twenty-two of the 27 isolates (81.4%) exhibited antibiotic resistance, varying from one to eight of the 12 antimicrobials commonly used. Resistance to amoxicillin was the most prevalent (70.4%), followed by azithromycin (22.2%) and ceftriaxone (18.5%). None of the strains were resistant to gentamicin, tobramycin, ciprofloxacin or tetracycline. The H. alvei was the main species presenting multidrug resistance, including resistance against meropenem, which is an important finding. These results could provide interesting information on the health of these endangered wild grey-breasted parakeets. They could also indicate that the obtained isolates are part of a group of bacteria that are typical components of the enteric microbiota of birds, which present elevated rates of resistance to amoxicillin.(AU)

O periquito-de-cara-suja (Pyrrhura griseipectus) é uma espécie de psitacídeo considerado pela IUCN como ameaçado de extinção, resultado do comércio ilegal e do desmatamento. Atualmente, essa espécie endêmica é encontrada apenas em três áreas no estado do Ceará, Brasil. O objetivo deste estudo foi investigar a frequência e a diversidade de Enterobacteriaceae em periquitos de peito cinza adultos selvagens e determinar sua suscetibilidade a agentes antimicrobianos. Amostras de suabes cloacais foram coletadas de 27 indivíduos e de suabes ambientais (suabes de arrasto) de cinco ninhos utilizados por essas aves. Vinte e sete cepas de nove espécies de Enterobacteriaceae foram isoladas a partir de suabes cloacais, sendo as cepas bacterianas mais prevalentes Hafnia alvei (22%) e Pantoea agglomerans (22%). Das amostras ambientais de ninhos foram isoladas sete linhagens de três espécies bacterianas, sendo P. agglomerans a espécie mais frequente (100%). Vinte e dois dos 27 isolados (81,4%) exibiram resistência a antibióticos, variando de um a oito dos 12 antimicrobianos comumente usados. A resistência a amoxicilina foi a mais prevalente (70,4%), seguida por azitromicina (22,2%) e ceftriaxona (18,5%). Nenhuma das cepas era resistente à gentamicina, tobramicina, ciprofloxacina ou tetraciclina. H. alvei foi a principal espécie que apresentou resistência a múltiplas drogas e que também esteve associada a um outro achado relevante desta pesquisa, que foi a detecção de um caso de resistência ao meropenem. Esses dados fornecem informações relevantes sobre a saúde desses periquitos selvagens ameaçados e permite concluir que os isolados obtidos fazem parte de um grupo de bactérias que normalmente compõe a microbiota entérica das aves, sendo a amoxicilina envolvida em elevadas taxas de resistência.(AU)

Antimicrobial susceptibility profile of enterobacteria isolated from wild grey-breasted parakeets (Pyrrhura griseipectus)

ABSTRACT: The grey-breasted parakeet (Pyrrhura griseipectus) is an endangered psittacine species that have been affected by illegal trade and deforestation. Currently, this endemic species is only found in three areas in Ceará state, in Brazil. This study aimed to investigate the frequency and diversity of Enterobacteriaceae in wild adult grey-breasted parakeets and determine their susceptibility to antimicrobial agents. Cloacal swab samples were collected from 27 individuals and environmental swabs (drag swabs) from five nests used by these birds. Twenty-seven strains from nine species of Enterobacteriaceae were recovered from cloacal swabs, and the most prevalent bacteria strains were Hafnia alvei (22%) and Pantoea agglomerans (22%). From environmental nest samples, seven strains from three bacterial species were isolated, being the P. agglomerans the most frequent species (100%). Twenty-two of the 27 isolates (81.4%) exhibited antibiotic resistance, varying from one to eight of the 12 antimicrobials commonly used. Resistance to amoxicillin was the most prevalent (70.4%), followed by azithromycin (22.2%) and ceftriaxone (18.5%). None of the strains were resistant to gentamicin, tobramycin, ciprofloxacin or tetracycline. The H. alvei was the main species presenting multidrug resistance, including resistance against meropenem, which is an important finding. These results could provide interesting information on the health of these endangered wild grey-breasted parakeets. They could also indicate that the obtained isolates are part of a group of bacteria that are typical components of the enteric microbiota of birds, which present elevated rates of resistance to amoxicillin.

RESUMO: O periquito-de-cara-suja (Pyrrhura griseipectus) é uma espécie de psitacídeo considerado pela IUCN como ameaçado de extinção, resultado do comércio ilegal e do desmatamento. Atualmente, essa espécie endêmica é encontrada apenas em três áreas no estado do Ceará, Brasil. O objetivo deste estudo foi investigar a frequência e a diversidade de Enterobacteriaceae em periquitos de peito cinza adultos selvagens e determinar sua suscetibilidade a agentes antimicrobianos. Amostras de suabes cloacais foram coletadas de 27 indivíduos e de suabes ambientais (suabes de arrasto) de cinco ninhos utilizados por essas aves. Vinte e sete cepas de nove espécies de Enterobacteriaceae foram isoladas a partir de suabes cloacais, sendo as cepas bacterianas mais prevalentes Hafnia alvei (22%) e Pantoea agglomerans (22%). Das amostras ambientais de ninhos foram isoladas sete linhagens de três espécies bacterianas, sendo P. agglomerans a espécie mais frequente (100%). Vinte e dois dos 27 isolados (81,4%) exibiram resistência a antibióticos, variando de um a oito dos 12 antimicrobianos comumente usados. A resistência a amoxicilina foi a mais prevalente (70,4%), seguida por azitromicina (22,2%) e ceftriaxona (18,5%). Nenhuma das cepas era resistente à gentamicina, tobramicina, ciprofloxacina ou tetraciclina. H. alvei foi a principal espécie que apresentou resistência a múltiplas drogas e que também esteve associada a um outro achado relevante desta pesquisa, que foi a detecção de um caso de resistência ao meropenem. Esses dados fornecem informações relevantes sobre a saúde desses periquitos selvagens ameaçados e permite concluir que os isolados obtidos fazem parte de um grupo de bactérias que normalmente compõe a microbiota entérica das aves, sendo a amoxicilina envolvida em elevadas taxas de resistência.

Caracterización de carbapenemasas en enterobacterias de muestras de pacientes que acudieron al Hospital General San Juan de Dios de la ciudad de Guatemala durante 2014 y 2015 / Characterization of carbapenemases in Enterobacteriaceae of samples of patients who attended the San Juan de Dios General Hospital in Guatemala City during 2014 and 2015

En salud pública a nivel mundial, la producción de carbapenemasas es actualmente el mayor problema de resistencia antimicrobiana. El objetivo de este estudio fue caracterizar las carbapenemasas en enterobacterias en pacientes que acudieron al Hospital General San Juan de Dios de la ciudad de Guatemala y determinar servicios hospitalarios y tipos de muestras más frecuentes. Se usaron datos de 2014 y 2015 del área de bacteriología del hospital; se realizó una revisión sistemática, selección, ordenamiento y cálculo de frecuencias y porcentajes. En 2014, 165/165 (100 %) de las carbapenemasas fueron de tipo metalo-ß-lactamasas (MBL); en 2015, 90/118 (76 %) MBL y 28/118 (24 %) Klebsiella pneumoniae carbapenemasa (KPC). Klebsiella pneumoniae fue la enterobacteria productora de carbapenemasas (CPE) aislada con más frecuencia, 134/165 (81 %) en 2014 y 82/118 (69 %) en 2015. En 2014 la unidad de cuidados intensivos de neonatos obtuvo el mayor porcentaje de aislamientos de CPE, 30/165 (18 %); en 2015, medicina de hombres fue el servicio con el mayor porcentaje de CPE, 13/118 (11 %). El tipo de muestra más frecuente en 2014 fue sangre, 67/165 (41 %); en el 2015 fue orina, 31/118 (26 %). Los resultados evidencian la persistencia de carbapenemasas tipo MBL y la aparición de nuevos tipos, específicamente carbapenemasas tipo KPC, que destacan la necesidad de actuar urgentemente ante el riesgo que suponen para la salud de la población.

In public health worldwide, carbapenemase production is currently the biggest problem of antimicrobial resistance. The objective of this study was to characterize carbapenemases in Enterobacteriaceae of patients who attended the San Juan de Dios General Hospital in Guatemala City and to determine hospital services and types of samples more frequent. Data from 2014 and 2015 of the bacteriology department of the hospital were used; a systematic review, selection, ordering and calculation of frequencies and percentages was conducted. In 2014, 165/165 (100 %) of the carbapenemases were metallo-ß-lactamases (MBL); in 2015, 90/118 (76 %) MBL and 28/118 (24 %) Klebsiella pneumoniae carbapenemase (KPC). Klebsiella pneumoniae was the carbapenemases-producing Enterobacteriaceae (CPE) most frequently isolated, 134/165 (81 %) in 2014 and 82/118 (69 %) in 2015. In 2014 the neonatal intensive care unit obtained the highest percentage in CPE, 30/165 (18 %); in 2015, men's medicine was the service with the highest percentage of carbapenemases, 11/138 (11 %). The most frequent type of sample in 2014 was blood, 67/165 (41 %). In 2015 it was urine, 31/118 (26 %). The results obtained highlight the persistence of MBL-type carbapenemases and the appearance of new types of carbapenemases, specifically KPC. These results underline the need to act urgently in Guatemala in the face of the problems that carbapenemases-producing Enterobacteriaceae pose for the health of the population.

Classificação dos graus de lesões de aerossaculite em perus associadas com enterobactérias / [Classification of the levels of the airsacculitis injuries in turkeys associated with Enterobacteriaceae]

Foram padronizados os graus de lesões dos sacos aéreos em perus com aerossaculite, associadas com a presença de isolados de enterobactérias nesses órgãos. Um total de 110 amostras de sacos aéreos de perus machos com aerossaculite foi coletado para o estudo. Durante o processo de abate, as amostras foram coletadas por meio de swabs e submetidas a três métodos de armazenamento (imediato, congelado ou pré-incubado após congelamento) para posterior comparação das suas eficiências de isolamento. Os gêneros da família Enterobacteriaceae foram identificados pelas séries bioquímicas EPM, MILi e citrato de Simmons. O crescimento bacteriano ocorreu em 43,64% das amostras. Neste estudo, quatro padrões de lesões de aerossaculite foram identificados de acordo com as características patológicas dos sacos aéreos. Os principais gêneros de enterobactérias identificadas foram: Escherichia coli, Citrobacter, Proteus, Edwardsiella, Morganella, Kluyvera, Salmonella e Klebsiella. Foi observado que os graus padronizados como 3 e 4 apresentaram maior variedade de gêneros bacterianos. O armazenamento imediato apresentou maior porcentagem de positividade, 41,82%, no entanto o pré-incubado após congelamento se apresentou mais eficaz em relação à quantidade de colônias.(AU)

The degrees of air sac lesions in turkeys with airsacculitis were standardized, associated with the presence of Enterobacteriaceae isolated from these organs. A total of 110 samples of air sacs from male turkeys with airsacculitis were collected and analyzed. During the slaughtering process, the sample collection was done using swabs and submitted to three storage methods (immediate, frozen, or pre incubated after freezing) for further comparison of their isolated efficiency. The bacterial genera of the family Enterobacteriaceae were identified biochemical series EPM, MILi and Simmons citrate. Bacterial growth occurred in 43.64% of samples. In this study, four patterns of aerossaculitis lesions were identified according to the pathological characteristics of air sacs. The frequencies of the Enterobacteriaceae isolated identified in the samples were: Escherichia coli, Citrobacter, Proteus, Edwardsiella, Morganell, Kluyvera, Salmonella and Klebsiella. Otherwise, it was observed that the levels already standardized as level three and four showed higher variety of genus. The immediate storage showed higher percentage of positivity at 41.82%, however, the pre incubated after freezing showed more efficiency in relation to the quantity of colonies.(AU)

Caracterización clínica, epidemiológica y microbiológica de bacteriemias producidas por enterobacterias resistentes a carbapenems en un hospital universitario de Córdoba, Argentina / Clinical, epidemiological and microbiological characterization of bacteremia produced by carbapenem-resistant enterobacteria in a university hospital in Córdoba, Argentina

Resumen Introducción: Las enterobacterias son una causa principal de infecciones del torrente sanguíneo y su resistencia antimicrobiana se encuentra en aumento. Esto lleva a un incremento de la morbilidad-mortalidad y de los costos en la salud pública. Las enterobacterias resistentes a carbapenems representan un grave desafío a nivel global ya que existen escasas opciones terapéuticas disponibles. Objetivo: Caracterización clínico/microbiológica de las bacteriemias resistentes a carbapenémicos observadas en un período de 4 años. Material y Método: Estudio retrospectivo, observacional y descriptivo, sobre las bacteriemias por enterobacterias resistentes y sensibles a carbapenems. Resultados: Se analizó un total de 84 pacientes con bacteriemia por enterobacterias resistentes y sensibles a carbapenems. Entre las resistentes, observamos una mayor proporción de: tratamiento antimicrobiano previo, hospitalización en unidad de terapia intensiva (UTI), inicio de la bacteriemia en UTI y antecedentes de β-lactamasas de espectro extendido. Además, se detectó un amplio predominio de Klebsiella pneumoniae productor de KPC y una mortalidad atribuible de 52,4%. Discusión: El estudio posibilitó profundizar el conocimiento de una enfermedad emergente de elevada mortalidad, en vistas al diseño y aplicación de estrategias de control de infecciones y de esquemas de tratamiento efectivos adaptados a la epidemiologia local.

Abstract Background: Enterobacteriaceae are a major cause of bloodstream infections and their antimicrobial resistance continues to increase. This leads to higher morbidity-mortality rates and public health costs. Carbapenem-resistant Enterobacteriaceae represent a serious challenge globally, since there are few therapeutic options available. Aim: Clinical/microbiological characterization of the carbapenem-resistant bacteremia observed over a period of 4 years. Methods: Retrospective, observational and descriptive study about bacteremia caused by carbapenem-resistant and susceptible Enterobacteriaceae. Results: A total of 84 patients with bacteremia including carbapenem-resistant and susceptible Enterobacteriaceae were analyzed. We found that patients infected with carbapenem-resistant strains presented a higher proportion of: previous antibiotic treatment, hospitalization in intensive care unit (ICU), onset of the bacteremia during hospitalization in ICU and previous infection with extended-spectrum-beta-lactamase producing Enterobacteriaceae. Additionally, we observed a predominance of KPC-producing Klebsiella pneumoniae and an attributable mortality rate of 52.4%. Discussion: This study allowed for a better understanding of an emerging problem with high mortality, which in turn is useful for the design and adoption of infection control strategies and effective treatment regimens adapted to our local epidemiology.

Epidemiología, tratamiento y mortalidad en pacientes infectados por enterobacterias productoras de carbapenemasas: estudio retrospectivo / Epidemiology, treatment and mortality in infection by carbapenemase-producing Enterobacteriaceae: retrospective study

Resumen Introducción: Las enterobacterias productoras de carbapenemasas (EPC) suponen un reto para la salud pública y la práctica clínica. Objetivo: Analizar la epidemiología, el tratamiento y la mortalidad en pacientes infectados por EPC. Material y Métodos: Análisis retrospectivo de 163 pacientes infectados por EPC en un hospital universitario desde julio de 2013 a octubre de 2015. Resultados: Klebsiella pneumoniae fue aislada en 95,1% de los casos, y la mayoría de las carbapenemasas pertenecían al grupo OXA-48 (93%). La adquisición fue nosocomial en 124 casos (77%), asociada a cuidados sanitarios en 30 (18,6%), y 7 (4,3%) fueron de adquisición comunitaria. Las infecciones más frecuentes fueron las del tracto urinario (48,4%) y las respiratorias (19,5%). Aproximadamente, la mitad de los pacientes recibieron monoterapia antimicrobiana. La tasa de mortalidad a los 30 días fue de 23,3%. El análisis multivariante identificó que la presencia de shock séptico al diagnóstico (OR 4,2; IC 95% 1,5-11) estaba asociada de manera independiente con mayor mortalidad en el primer mes, sin lograr identificar asociación con el tratamiento antimicrobiano inapropiado. Discusión: Son necesarios más estudios para aclarar si el tratamiento antimicrobiano de las infecciones por EPC debe ser combinado o si podría ser suficiente la monoterapia en infecciones leves.

Abstract Background: Carbapenemase-producing Enterobacteriaceae (CPE) has become a significant problem in terms of public health and clinical outcome. Objective: To assess the epidemiology, treatment and mortality in patients with infection due to CPE. Material and Methods: A retrospective analysis of 163 patients with CPE infection was carried out in a university hospital from July 2013 to October 2015. Results: A total of 163 patients were included over the study period. Klebsiella pneumoniae was isolated in 95.1% of cases, and most of carbapenemases belonged to the OXA-48 group (93.0%). Acquisition was nosocomial in 124 cases (77.0%), healthcare-associated in 30 (18.6%), and 7 cases (4.3%) were community-acquired. The most frequent infections identified in this study were urinary tract (48.4%) and respiratory (19.5%) infections. Approximately half of the patients received antibiotic monotherapy. The 30-day mortality rate was 23.3%. Multivariate analysis revealed that the presence of septic shock at diagnosis (OR 4.2; IC 95% 1.5-11) was independently associated with an increase in death during the first month, unable to identify association with inappropriate antibiotic treatment. Discussion: Further studies are needed to clarify whether antibiotic treatment of EPC infections should be combined or if monotherapy might be sufficient in mild infections.

Análises de matérias estranhas e microbiológicas de chás industrializados comercializados em Pouso Alegre MG / Analysis of extraneous materials and microbiological from industrialized teas marketed in Pouso Alegre MG

O objetivo deste estudo foi de avaliar as condições higiênico-sanitárias de quatro marcas de chás industrializados comercializados na cidade de Pouso Alegre - MG utilizando parâmetros de presença de matérias estranhas e análises microbiológicas. Foram coletadas no período de setembro a outubro de 2017, amostras de chás de camomila, erva-doce, hortelã e chá misto que contém em sua formulação essas mesmas ervas. Foram utilizados os métodos da Association of Official Analytical Chemists International (AOAC) de acordo com a RDC n°14 para capturar as sujidades leves e nas análises microbiológicas, foram utilizados métodos da International Organization for Standardization (ISO) de acordo com a RDC n° 12 para avaliar coliformes totais e termotolerantes, fungos e Salmonella spp. Nas pesquisas de matérias estranhas somente três marcas de camomila foram aprovadas, estando o restante dos chás em desacordo com a legislação vigente por estarem acima do limite de tolerância aceitável. Na avaliação de coliformes e Salmonella sp. todas as amostras foram aprovadas porém, houve um crescimento considerável de fungos filamentosos nestas amostras...

The aim of this study was to evaluate the hygienic-sanitary conditions of four brands of industrialized teas marketed in the city of Pouso Alegre - MG using parameters of presence of foreign matter and microbiological analyzes. Were collected in the period from September to October 2017, samples of chamomile teas, fennel, mint and mixed tea that contains in its formulation these same herbs. Were used the methods of the International Association of Analytical Chemists (AOAC) according to RDC n° 14 to capture light dirt and in the microbiological analyzes, were used the methods of the International Organization for Standardization (ISO) according to RDC nº 12 to evaluate total and thermotolerant coliforms, fungi and Salmonella spp. In the research of extraneous materials, only three brands of chamomile were approved, the rest of the teas being in disagreement with the current legislation because they are above the acceptable tolerance limit. In the evaluation of coliforms and Salmonella sp. all samples were approved, however, there was a considerable growth of filamentous fungi in these samples

ANÁLISES DE MATÉRIAS ESTRANHAS E MICROBIOLÓGICAS DE CHÁS INDUSTRIALIZADOS COMERCIALIZADOS EM POUSO ALEGRE MG / ANALYSIS OF EXTRANEOUS MATERIALS AND MICROBIOLOGICAL FROM INDUSTRIALIZED TEAS MARKETED IN POUSO ALEGRE MG

O objetivo deste estudo foi de avaliar as condições higiênico-sanitárias de quatro marcas de chás industrializados comercializados na cidade de Pouso Alegre ­ MG utilizando parâmetros de presença de matérias estranhas e análises microbiológicas. Foram coletadas no período de setembro a outubro de 2017, amostras de chás de camomila, erva-doce, hortelã e chá misto que contém em sua formulação essas mesmas ervas. Foram utilizados os métodos da Association of Official Analytical Chemists International (AOAC) de acordo com a RDC n°14 para capturar as sujidades leves e nas análises microbiológicas, foram utilizados métodos da International Organization for Standardization (ISO) de acordo com a RDC n° 12 para avaliar coliformes totais e termotolerantes, fungos e Salmonella spp. Nas pesquisas de matérias estranhas somente três marcas de camomila foram aprovadas, estando o restante dos chás em desacordo com a legislação vigente por estarem acima do limite de tolerância aceitável. Na avaliação de coliformes e Salmonella sp. todas as amostras foram aprovadas porém, houve um crescimento considerável de fungos filamentosos nestas amostras. Os estudos apontam grandes falhas nas boas praticas de fabricação, por se tratarem de produtos industrializados que contam com processos de limpeza e controle de qualidade para certificarem alimentos livres de risco a saúde dos consumidores. A pesquisa sugere uma revisão da resolução vigente para implantar a análise de presença de fungos

The aim of this study was to evaluate the hygienic-sanitary conditions of four brands of industrialized teas marketed in the city of Pouso Alegre ­ MG using parameters of presence of foreign matter and microbiological analyzes. Were collected in the period from September to October 2017, samples of chamomile teas, fennel, mint and mixed tea that contains in its formulation these same herbs. Were used the methods of the International Association of Analytical Chemists (AOAC) according to RDC n° 14 to capture light dirt and in the microbiological analyzes, were used the methods of the International Organization for Standardization (ISO) according to RDC nº 12 to evaluate total and thermotolerant coliforms, fungi and Salmonella spp. In the research of extraneous materials, only three brands of chamomile were approved, the rest of the teas being in disagreement with the current legislation because they are above the acceptable tolerance limit. In the evaluation of coliforms and Salmonella sp. all samples were approved, however, there was a considerable growth of filamentous fungi in these samples. The studies point out major flaws in good manufacturing practices, as they are industrialized products that rely on cleaning and quality control processes to certify foods that are free from risks to the health of consumers. The research suggests a revision of the current resolution to implement the analysis of the presence of fungi

Prevalencia de infecciones osteoarticulares por enterobacterias productoras de ß-lactamasas de espectro extendido / Prevalence of osteoarticular infections by Enterobacteria producing extended-spectrum ß-lactamases

Resumen: Introducción: Las infecciones por enterobacterias productoras de β-lactamasas de espectro extendido (BLEEs) ocasionan una gran carga a los sistemas de salud. Poco se conoce de las infecciones osteoarticulares, por lo que este trabajo estudió la prevalencia de estas infecciones en un hospital de tercer nivel. Material y métodos: Estudio de prevalencia en pacientes de un servicio de traumatología durante 2016, con criterios de infección proporcionados por el CDC de Atlanta, Georgia. Se utilizó el sistema VITEK® 2 AST-N272 (bioMérieux) para la identificación bacteriana a nivel de especie y para las pruebas de susceptibilidad antimicrobiana. Resultados: Se reportaron 7.85% (n = 86) con infecciones osteoarticulares; 22.09% (n = 19) fueron por enterobacterias BLEEs. Con un promedio de 77.1 días de hospitalización (DE 37.7) (46-200 días); el aislamiento del microorganismo se produjo 15 días posteriores al ingreso; 16 (84.2%) pacientes presentaron osteomielitis, tres (15.8%) tuvieron infección protésica de rodilla o cadera. El promedio de días de tratamiento fue de 60 días (21-129 días); 18 pacientes (94.7%) fueron dados de alta con resolución de su cuadro infeccioso; un paciente falleció con infección sobreagregada por neumonía debida a K. pneumoniae resistente a carbapenémicos. Discusión: La prevalencia de infecciones osteoarticulares por enterobacterias BLEEs no se pudo calcular con precisión, pero consideramos que se encuentra dentro de lo esperado, las medidas de control de infecciones requieren tener estándares más elevados y falta desarrollar programas de uso racional de antimicrobianos para controlar la aparición de estas patologías.

Abstract: Introduction: Infections of enterobacteria producing extended-spectrum ß-lactamases place a heavy burden on health systems. Little is known in osteoarticular infections, so this work studied the prevalence of these infections in a third-level hospital. Material and methods: Prevalence study in patients of a Traumatology Service during 2016, with infection criteria provided by the CDC in Atlanta, Georgia. The VITEK® 2 AST-N272 (bioMérieux) system was used for bacterial identification at the species level and for antimicrobial susceptibility tests. Results: 7.85% (n = 86) were reported with osteoarticular infections; 22.09% (n = 19) were by enterobacteria BLEEs. An average of 77.1 days of hospitalization (SD 37.7) (46-200 days); isolation of the microorganism occurred 15 days after entry. Sixteen (84.2%) patients had osteomyelitis, three (15.8%) had a prosthetic knee or hip infection. The average number of treatment days was 60 days (21-129 days). Eighteen patients (94.7%) were discharged with resolution of their infectious picture; one patient died with infection over aggregated pneumonia due to carbapenem-resistant K. pneumoniae. Discussion: The prevalence of osteoarticular infections by enterobacteria BLEEs could not be accurately calculated, but we consider it to be within what is expected, infection control measures require higher standards and there is a lack of development programs to use antimicrobials rationally to control the emergence of these pathologies.