Programa de Segurança do Paciente Focado nas Estratégias do Stewardship de Antimicrobianos para Staphylococcus Spp / Patient safety program focused on antimicrobial stewardship strategies for Staphylococcus spp

Introdução: A sedimentação do Programa de Stewardship de Antimicrobianos (ATMs), além de reduzir a indução da resistência bacteriana, assegura maior segurança aos pacientes. Este estudo teve por objetivo descrever o perfil de sensibilidade do Staphylococcus aureus e Staphylococcus coagulase negativo (S. CON) nas unidades de internação adulta do hospital para instrumentalizar as equipes e realizar o gerenciamento de ATMs. Métodos: Este estudo retrospectivo foi realizado através de busca em prontuário eletrônico de culturas laboratoriais com S. aureus e S. CON, independentemente do foco, dos anos de 2017, 2018 e 2019, das unidades de internação adultas não críticas e UTI adulto. Para análise, foi realizado o cálculo de coeficiente de sensibilidade absoluto e de médias. As variáveis qualitativas foram apresentadas em relação ao agente etiológico, antibiótico e local de isolamento, com posterior identificação de variabilidade e possibilidades terapêuticas disponíveis. Resultados: Apesar de ocorrer similaridade na distribuição das cepas de Staphylococcus spp. nos locais analisados do hospital, observou-se divergência entre os perfis de sensibilidade do S. aureus e S. CON. Existe superioridade no perfil de sensibilidade do S. aureus em comparação com o S. CON em relação a todos ATMs. A sensibilidade do S. aureus à oxacilina, ainda, possibilita tratamento com ß-lactâmicos; entretanto, a escolha de outras classes de ATMs torna-se necessária em casos de infecções complexas e graves. Conclusão: A análise periódica do perfil de sensibilidade aos ATMs é uma estratégia a ser alcançada para um eficaz programa de gerenciamento de ATMs, com fundamentação de protocolos e melhor assistência dos pacientes.

Introduction: The sedimentation of the antimicrobial stewardship program (ASP) reduces the induction of bacterial resistance and ensures greater patient safety. This study aimed to describe the sensitivity profile of Staphylococcus aureus and negative-coagulase Staphylococcus (CoNS) in adult inpatient units of the hospital to instrumentalize the teams and perform ASP management. Methods: This retrospective study was conducted by searching electronic medical records for laboratory cultures with S. aureus and CoNS, regardless of the focus, from 2017, 2018, and 2019, from the adult non-critical inpatient units and adult ICU. For the analysis, the study calculated the absolute sensitivity coefficient and means. Qualitative variables were related to the etiologic agent, antibiotic, and isolation site, with subsequent identification of variability and available therapeutic possibilities. Results: Although similarity occurred in the distribution of Staphylococcus spp. strains in the analyzed hospital sites, divergence was observed between the sensitivity profiles of S. aureus and CoNS. There is superiority in the sensitivity profile of S. aureus over CoNS concerning all ASP. The sensitivity of S. aureus to oxacillin still allows treatment with ß-lactams. However, the choice of other classes of ASP becomes necessary in cases of complex and severe infections. Conclusion: Periodic analysis of the ASP sensitivity profile is a strategy to achieve an effective ASP management program to support protocols and better patient care.

Detection of inducible clindamycin resistance in Staphylococcus aureus from various samples in a tertiary care hospital

Background: The increasing frequency of MRSA infections and rapidly changing patterns in antimicrobial resistance, led to renewed interest in the usage of Macrolides-Lincosamide-Streptogramin B (MLSB) antibiotics to treat Staphylococcus aureus infection. Clindamycin is an important drug used in the treatment of MRSA and MSSA infection. The aim of this study was to determine inducible and constitutive clindamycin resistance among clinical isolates of Staphylococcus aureus by D-test.Methods: During a period of 6 months from July 2018 to December 2018, a total of 100 Staphylococcus aureus isolated from different clinical samples were subjected to routine antibiotic sensitivity testing by Kirby Bauer’s disc diffusion method. Methicillin-resistance was determined by using the cefoxitin (30 µg) disc. Incidence of MLSBc and MLSBi in Staphylococcus aureus isolates by D-test as per CLSI guidelines.Results: Out of 100 isolates of Staphylococcus aureus obtained from 350 clinical samples, 70(70%) were found to be MRSA and 30(30%) were MSSA. Among 100 Staphylococcus aureus isolates, 40% isolates showed MLSBi resistance, 28% isolates showed MLSBc resistance, 6% isolates showed MS phenotype and 26% isolates showed Sensitive phenotype. MLSBc and MLSBi were found to be higher in MRSA as compared to MSSA (21%, 27% and 7%, 10% respectively). All clinical isolates showed 100% sensitivity to Vancomycin and Linezolid in routine antibiotic susceptibility testing.Conclusions: Continuous surveillance of the MLSB resistance is important and required before the prescription of clindamycin to treat MRSA infections.

Nasal colonization with Staphylococcus aureus in individuals with HIV/ AIDS attended in a Brazilian Teaching Hospital / Colonização nasal por Staphylococcus aureus em indivíduos com HIV/Aids atendidos em um hospital-escola brasileiro / Colonización nasal por Staphylococcus aureus en individuos con VIH/SIDA atendidos en un Hospital Escuela brasileño

OBJECTIVE: to evaluate the prevalence of nasal colonization with Staphylococcus aureus in individuals with HIV/AIDS under inpatient treatment in a teaching hospital in the state of São Paulo (Brazil). METHOD: a cross-sectional study undertaken in two units specialized in attending people living with HIV/AIDS, in the period August 2011 - July 2012. Socio-demographic and clinical data was collected through individual interviews and from the medical records; samples of nasal secretion were collected with Stuart swabs on the first day of inpatient treatment. Ethical aspects were respected. RESULT: of the 229 individuals with HIV/AIDS hospitalized in this period, 169 participated in the study, with Staphylococcus aureus being identified in the culture tests of 46 (27.2%) of the individuals, resistance to oxacillin being evidenced in 10 (21.8%) participants. CONCLUSION: the results of the research indicate that the prevalence of colonization with Staphylococcus aureus in individuals with HIV/AIDS in the specialized units was considered relevant, possibly contributing to future investigations and, moreover, to the implementation of measures to prevent and control this pathogen in this population. .

OBJETIVO: avaliar a prevalência da colonização nasal por Staphylococcus aureus em indivíduos com HIV/Aids internados em um hospital-escola do Estado de São Paulo (Brasil). MÉTODO: estudo de corte transversal, realizado em duas unidades especializadas no atendimento a pessoas que vivem com HIV/ Aids, no período de agosto 2011 a julho 2012. Foram coletados dados sociodemográficos e clínicos, por entrevista individual e prontuário; as amostras de secreção nasal foram coletadas por meio de swab Stuart no primeiro dia de internação. Os aspectos éticos foram contemplados. RESULTADOS: dos 229 indivíduos com HIV/Aids internados no período, 169 participaram do estudo, sendo identificado Staphylococcus aureus nos exames de cultura de 46 (27,2%) dos indivíduos, evidenciando-se resistência à oxacilina em 10 (21,8%) participantes. CONCLUSÃO: os resultados da pesquisa apontam que a prevalência da colonização por Staphylococcus aureus em indivíduos com HIV/Aids internados nas unidades especializadas foi considerada relevante, podendo contribuir para novas investigações e, ainda, para implementar medidas de prevenção e de controle desse patógeno nessa população. .

OBJETIVO: evaluar la prevalencia de la colonización nasal por Staphylococcus aureus en individuos con VIH/sida internados en un hospital escuela del Estado de São Paulo (Brasil). MÉTODO: estudio trasversal, desarrollado en dos unidades especializadas en la atención a personas que viven con VIH/ sida, en el período de agosto del 2011 a julio del 2012. Fueron recolectados datos sociodemográficos y clínicos, mediante entrevista individual y archivo; las muestras de secreción nasal fueron recolectadas mediante Swab Stuart en el primer día de internación. Los aspectos éticos fueron contemplados. RESULTADOS: de los 229 individuos con VIH/sida internados en el período, 169 participaron del estudio, siendo identificado Staphylococcus aureus en las pruebas de cultura de 46 (27,2%) de los individuos, evidenciándose resistencia a la oxacilina en 10 (21,8%) participantes. CONCLUSIÓN: los resultados de la investigación indican que la prevalencia de la colonización por Staphylococcus aureus en individuos con VIH/sida internados en las unidades especializadas fue considerada relevante y puede contribuir a otras investigaciones y, además, para implementar medidas de prevención y de control de ese patógeno en esa población. .

Incidencia y fármaco-resistencia de cepas de Staphylococcus spp aisladas de exudados conjuntivales / Incidence and drug-resistance of Staphylococcus spp strains isolated from conjunctival swabs

OBJETIVO: Determinar la incidencia de cepas del género Staphylococcus aisladas de exudados conjuntivales y analizar su resistencia frente a diferentes antimicrobianos. MÉTODOS: Se realizó un estudio observacional descriptivo retrospectivo en el que se revisaron 3554 exudados conjuntivales a pacientes que acudieron en el período comprendido entre enero de 2002 a diciembre de 2003 y desde enero de 2005 hasta diciembre de 2007 al Instituto Cubano de Oftalmología Ramón Pando Ferrer por presentar un diagnóstico de infección ocular externa. RESULTADOS: Se aislaron 874 cepas de Staphylococcus aureus para un 47,5 por ciento y 965 cepas de Staphylococcus spp. coagulasa negativa con prueba de patogenicidad positiva para un 52,4 por ciento. En 69 de esos exudados los cultivos presentaron etiología mixta con dos bacterias diferentes, para el 3,7 por ciento. Se determinaron los porcentajes de resistencia a las cepas aisladas pertenecientes al género Staphylococcus. CONCLUSIONES: Se encontró una alta incidencia de las especies del género Staphylococcus en las infecciones oculares, así como se pudo apreciar que la menor fármaco-resistencia para Staphylococcus aureus y Staphylococcus spp. coagulasa negativa correspondieron a los antimicrobianos ciprofloxacina y amikacina. La mayor fármaco-resistencia de las cepas de Staphylococcus aureus correspondió a eritromicina y tetraciclina y en Staphylococcus spp coagulasa negativa fue frente a la tetraciclina

OBJECTIVE: To determine the incidence of Staphylococcus strains isolated from conjunctival swaps and their resistance to several antimicrobial agents. METHODS: A retrospective, descriptive and observational study was performed to review 3554 conjunctival swabs from patients who went to Ramón Pando Ferrer Institute of Ophthalmology in the period from January 2002 to December 2009 due to a diagnosis of external ocular infection. RESULTS: From the total of conjunctival swabs, 874 Staphylococcus aureus strains (47.5 percent) and 965 (52.4 percent) negative Staphylococcus spp. coagulasa strains were isolated, being pathogenecity test positive in 52.4 percent. In 69 swabs, the cultures presented mixed etiology with two different bacteria accounting for 3.7 percent. Resistance percentages of Staphylococcus strains were estimated. CONCLUSION: The incidence of Staphylococcus species in eye infections was high and the drug resistance for Staphylococcus aureus and Staphylococcus spp. coagulasa negative to Ciprofloxacin and Amikacyn was lower. The greatest drug resistance of S. aureus strains corresponded to erythromycin and tetracycline whereas Staphylococcus spp coagulasa negative were more resistant to tetracycline

Expression, purification of Staphylococcus aureus Efb protein and preparation of its functional antibody / 军事医学科学院院刊

Objective:To clone and express the Staphylococcus aureus Efb(extracellular fibrinogen-binding protein) protein in Escherichia coli, to purify the expression product and prepare its functional antibody and to detect the functions of Efb protein for further studies on S.aureus infection.Methods: Efb gene was amplified by PCR using S.aureus NCTC-8325 genome DNA as template and cloned into the recombinant expression vectors pET28a. E.coli BL21(DE3) with the plasmid was induced with IPTG for protein production. The protein was purified by Ni~(2+) affinity chromatography. The function of Efb protein was determined by complement activity assay and inhibition ELISA.The polyclonal antibodies were prepared by immunizing the animals. Results: The purified recombinant Efb was obtained, which could inhibit the CH50 and AH50 effectively. The functional poly-antibodies of Efb were prepared.Conclusion:Efb could inhibit the classical pathway and alternative pathway of complement activation, and the antibodies against to Efb could block the inhibition of the classical pathway of complement activation induced by Efb.

Changes and significance of cytokine signaling suppressor mRNA in burn rats with Staphylococcus aureus sepsis / 中华创伤杂志

Objective To observe the expression law of cytokine signaling suppressors (SOCSs) mRNA in burn rats with Staphylococcus aureus sepsis and investigate their potential role in the pathogenesis of postburn sepsis. Methods Wistar rats were inflicted with 20% TBSA Ⅲ? scald, followed by Staphylococcus aureus challenge. Then, the expressions of SOCS1, SOCS2 and SOCS3 mRNA and interferon-? (IFN-?) levels in the liver and lungs were determined. Results With Staphylococcus aureus challenge after burn, IFN-? levels in the liver and lungs were significantly elevated and reached peak at the 0.5th and 6th hours, respectively (P

The Study of Microbiology and Antibiotic Susceptibility of Bacterial Strains Isolated From Patients with Impetigo / 中华皮肤科杂志

Objective To investigate the bacteriological features and the epidemiology of methicillin－ resistant Staphylococcus aureus (MRSA) in patients with impetigo, and provide evidence for selection of appropriate agents for treating impetigo and its complications. Methods Two hundred and forty－ six out- patients with impetigo were surveyed. Cultures were obtained from impetiginous lesions. Antibiotic susceptibility tests on 212 S.aureus isolates were performed by standard agar dilution testing (MIC). Results In a total of 246 isolates, 87.0％ yielded S.aureus alone, 2.0％ S.aureus and Group A beta－ hemolytic streptococcus (GABHS), 1.6％ GABHS alone, 4.1％ Staphylococcus epidermidis. Fifteen antimicrobial agents were used in the susceptibility tests. One hundred percent of S. aureus isolates were resistant to penicillin, 87.7％ were resistant to erythromycin, followed by clindamycin (75.5％ ), tetracycline (63.2％ ), chloramphenicol (54.2％ ), ampicillin－ sulbactam (44.8％ ), oxacillin (30.2％ ), ciprofloxacin (12.8％ ), cefotaxime (0.9％ ), fusidic acid (0.9％ ) and gentamicin (0.9％ ). None of the S.aureus isolates was resistant to vancomycin, cefazolin, cefuroxime and mupirocin. Sixty- four MRSA strains were isolated. No vancomycin resistant S.aureus strain was found. Conclusions Penicillin, erythromycin, clindamycin, tetracycline, chloramphenicol and ampicillin－ sulbactam prove to be no longer the appropriate therapeutic agents. Cephalosporin, mupirocin and fusidic acid might be the good choice for treatment of impetigo in our region.