Infección nosocomial en Cuidados Intensivos del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas / Nosocomial infection in the Intensive Care Unit of the Teaching Clinic-Surgical Hospital Faustino Pérez Hernández, of Matanzas

RESUMEN Introducción: la diseminación de microorganismos multirresistentes en el hospital, constituye un importante problema epidemiológico y terapéutico que afecta especialmente a pacientes de la Unidad de Cuidados Intensivos. Objetivo: escribir el comportamiento de las infecciones nosocomiales y la resistencia antimicrobiana en la Unidad de Cuidados Intensivos. Materiales y métodos: se realizó un estudio de tipo descriptivo, observacional y prospectivo en la Unidad de Cuidados Intensivos del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, durante el primer semestre de 2020. El universo estuvo constituido por 102 pacientes que ingresaron en la Unidad de Cuidados Intensivos en el período estudiado, a los que se les realizó estudios microbiológicos. Las variables analizas fueron: causas de ingreso, edad, infecciones nosocomiales, neumonía en ventilados, gérmenes, resistencia antimicrobiana y mortalidad. Se expresaron en tablas y gráficos porcentuales. Resultados: el sexo masculino presentó mayor número de infección nosocomial respecto al femenino, en edades diferentes de la vida. La causa más frecuente de ingreso fue el politrauma. El sitio más común de infección nosocomial fue la vía respiratoria. Predominaron gérmenes como los bacilos gramnegativos fermentadores y las enterobacterias. Antibióticos como los inhibidores de las betalactamasas, otras penicilinas, quinolonas, cefalosporinas, aminoglucósidos y meropenen han adquirido un mayor porciento de resistencia. Conclusiones: la infección nosocomial por bacterias multirresistentes a los antibióticos estratégicos, es un problema dentro de la Unidad de Cuidados Intensivos asociado a la ventilación mecánica, que provoca una elevada mortalidad (AU).

ABSTRACT Introduction: the spread of multi-resistant microorganisms in the hospital is a major epidemiological and therapeutic problem that particularly affects critical patients admitted to the Intensive Care Unit. Objective: to describe the behavior of nosocomial infections and antimicrobial resistance in the Intensive Care Unit. Materials and Methods: a descriptive, observational and prospective study was carried out in the Intensive Care Unit of the Teaching Clinic-Surgical Hospital Faustino Pérez Hernández, during the first half of 2020. The universe was formed by 102 patients who entered the Intensive Care Unit during the studied period, to whom microbiological studies were carried out. The analyzed variables were the following: causes of admission, age, nosocomial infections, ventilator-associated pneumonia, germs, antimicrobial resistance and mortality. The results were expressed in tables and percentage charts. Results: Male sex showed the highest number of nosocomial infection compared to the female, at different ages of life. The most common cause of admission was polytrauma. The most common site of nosocomial infection was the airway. Germs like fermentative Gram-negative bacilli and enterobacteria predominated. Antibiotics such as beta-lactamase inhibitors, other kinds of penicillin, quinolones, cephalosporin, aminoglycosides and meropenen have acquired a higher percent of resistance. Conclusions: nosocomial infection caused by bacteria that have developed multi-resistance to strategic antibiotics is a problem within the Intensive Care Unit, associated to mechanical ventilation, and leads to high mortality (AU).

Facilitating the gut brain axis by probiotic bacteria to modulate neuroimmune response on lead exposed zebra fish models

Unravelling the efficacy of gut biome has a major impact on health. An unbalanced microbiome composition is linked to many common illnesses such as gut dysbiosis, mental deformities and immunological imbalance. An optimistic influence on the gut biome can be made by consumingprobiotics. This would stimulate neuroprotection and immunomodulation intended by heavy metals pollution. Lead is a major source of neurotoxin that can induce neural deformities. Lactobacillusspecies isolated from curd were characterized to confirm its specificity. Zebra fish was reared at standard conditions and preclinical assessment on the intensity of induced neurotoxin lead was performed. The embryo toxic assay, immunomodulation effects and animal behavioural models endorsed the consequence of neurotoxicity. Different concentrations of bacterial isolate with standard antidepressant was considered for analysing the vigour of toxicity and its influence on cognitive behaviour by novel tank diving method. The restrain in the animal behaviour was also conferred by all the test samples with a decreased bottom dwelling time which was authenticated with haematology and histopathological studies. The alterations in morphology of the lymphocytes were balanced by the treated test samples. This study paves a twofold potential of probiotic as neuroprotectant and immune modulator against heavy metal toxicity.

JMT-1: a novel, spherical lytic halotolerant phage isolated from Yuncheng saline lake

ABSTRACT This work described a novel halotolerant phage, JMT-1, with a spherical morphology. JMT-1, which was isolated from a hypersaline lake, could produce clear plaques on Chromohalobacter sp. LY7-3. The purified virions are spherical, have no visible tail, and are about 30-50 nm in diameter. JMT-1 has a wide host range, and this study showed that the phage can infect at least five halophilic bacteria. The proteins of JMT-1 were analyzed using sodium dodecyl sulfate polyacrylamide gel electrophoresis, and six proteins were detected. Results show that JMT-1 is a bacteriophage with a linear double-stranded DNA. Meanwhile, the genome is approximately 23 kb in length and is sensitive to the restriction endonucleases Bam I, EcoR I, Hind III and Kpa I. JMT-1 has a high titer, approaching 1.5 × 109 pfu/mL after dilution to 10−6 pfu/mL. The phage is also sensitive to chloroform but not to temperature, pH, and lowered salt concentration. JMT-1 is a spherical lytic halotolerant phage with a wide host range and has the tolerance to specific extreme environments. These data could provide references for studying phage resources in extreme environments and would also provide the useful methods for isolation and identification of other valuable phage in the salt lake environment.

Aerococcus viridans como agente etiológico de endocardite em valva nativa / Aerococcus viridans as etiological agent in native valve endocarditis

Aerococcus viridans é um patógeno humano incomum e endocardite por este agente na literatura é rara. Relata-se o caso de paciente feminina, 56 anos,hospitalizada devido a quadro de picos febris que, após investigação, foi diagnosticada através dos critérios clínicos de Duke, com endocardite em valva nativa. Foi evidenciado através das hemoculturas o crescimento de A. viridans, sendo o primeiro casoreportado no Brasil. Há relatos desse agente também em infecções urinárias, bacteremia, meningite e artrite séptica. No presente caso, a paciente teve melhorresposta clínica após o início da ampicilina, confirmando alguns artigos que orientam o tratamento com penicilinas.

Aerococcus viridans is an uncommon human pathogen and reports of endocarditis caused by this agent arerare in the literature. This clinical case study describes a 56 year-old female patient admitted to hospital forspiking fevers. After investigation, this was diagnosed as native valve endocarditis, based on the Duke clinicalcriteria and confirmed through the growth of A. viridans in blood cultures, making this the first reported case in Brazil. There are also reports of thisagent in urinary tract infections, bacteremia, meningitis and septic arthritis. In this case, the patient had a better clinical response after starting on ampicillin, confirmed by some articles that recommend treatment withpenicillins.

Formación de biopelículas y susceptibilidad antimicrobiana entre coliformes aislados en agua potable embotellada en Carabobo, Venezuela / Biofilms formation and antimicrobial susceptibility among coliforms isolated in bottled drinking water in Carabobo, Venezuela

Bacterias indicadoras de contaminación tales como bacterias heterótrofas, coliformes totales y termotolerantes fueron enumeradas en agua potable embotellada usando métodos estándar y filtración a través de membrana. El desarrollo de biopelículas y la susceptibilidad antimicrobiana (método de Kirby-Bauer) fueron evaluados sobre sesenta aislados de coliformes seleccionados de forma aleatoria. De 50 muestras, en un elevado porcentaje (94), se observó niveles de bacterias heterotróficas por encima de 100 UFC/mL de agua, 38 % presentó al menos una UFC/100 mL de coliformes totales o termotolerantes, mientras que, 30 % y 28 %, presentaron más de diez UFC/100 mL para ambos indicadores, respectivamente. Las especies de coliformes identificadas en mayor proporción fueron, Klebsiella pneumoniae, Enterobacter cloacae, Enterobacter aerogenes, Escherichia coli y Klebsiella oxytoca. Usando un ensayo in vitro para detectar la formación de biopelículas se determinó que entre un 75,8 y 79,2 % de los coliformes totales y termotolerantes, respectivamente, fueron descritos como moderados o fuertes formadores de biopelículas. No se observaron diferencias significativas (P>0,05) con respecto a la capacidad de formación de biopelículas entre los dos grupos. La mayoría de los aislados resultaron susceptibles frente a los antimicrobianos evaluados, únicamente dos especies presentaron fenotipos de resistencia no naturales. Perfiles de multiresistencia, típicos de especies asociadas con actividades clínicas o veterinarias, fueron identificados en un aislado de Enterobacter cloacae (betalactamasas tipo AmpC derreprimida) y un aislado de Escherichia coli fue resistente a ampicilina. Este estudio sugiere que el agua potable en botellones plásticos que se expende en algunas áreas urbanas de Carabobo, Venezuela, puede representar un riesgo para la salud.

Pollution indicator bacteria such as heterotrophic bacteria, total and thermotolerant coliforms were quantified in bottled drinking water using standard method and membrane filter procedure. Biofilm formation and antimicrobial susceptibility (Kirby-Bauer method) were tested on sixty randomly selected coliform strains. Among 50 water samples, a large percentage (94) were found with heterotrophic bacteria levels above 100 CFU/mL, 46 % showed at least one CFU/100 mL of thermotolerant or total coliformes whereas 28 % and 30 % showed more than ten CFU/100 mL for both indicators. Coliform species found in higher proportion were, Klebsiella pneumoniae, Enterobacter cloacae, Enterobacter aerogenes, Escherichia coli and Klebsiella oxytoca. Using an "in vitro" assay for biofilms formation it was determined that between 75.8 y 79.2 % of total and thermotolerant coliforms, respectively, were found to be moderate or strong biofilm formers. There were no significant differences (P>0.05) between both groups regarding the capacity for biofilm formation. Most of the isolates were susceptible against the antibiotics tested and only two species showed unnatural resistance phenotypes. Multiresistance profiles, typical of strains associated with human clinical or veterinary activities were identified in one Enterobacter cloacae isolated (derepressed AmpC beta-lactamases) and one Escherichia coli strain was ampicilin resistant. This study suggests that the water sold in some plastic bottles in some urban areas near by Carabobo, Venezuela, may be a risk to health.

Klebsiella pneumoniae como patógeno intrahospitalario: epidemiología y resistencia / Klebsiella pneumoniae as a nosocomial pathogen: epidemiology and drug resistance

La resistencia bacteriana es un problema serio, de magnitud creciente y presentación universal, que reviste gran importancia, especialmente en los ambientes hospitalarios; los microorganismos más frecuentemente aislados de pacientes con infecciones intrahospitalarias son Staphylococcus aureus y Escherichia coli. En Medellín, sin embargo, Klebsiella pneumoniae ha cobrado gran importancia en años recientes debido a su gran incremento como agente causal de ese tipo de infecciones, lo que motiva esta revisión. Se incluyen los siguientes aspectos: microbiología, epidemiología, diseminación, resistencia a los beta-lactámicos y sus mecanismos, impacto clínico e importancia del problema en la ciudad.

Worldwide, bacterial resistance is an increasingly serious problem, especially in hospital environments. Staphylococcus aureus and Escherichia coli are the most frequently isolated microorganisms in patients with nosocomial infections. In Medellín, Colombia, however, Klebsiella pneumoniae has become increasingly important in this kind of infection, for which reason this review was carried out. It includes the following aspects: microbiology, epidemiology, dissemination, resistance to betalactamic antibiotics and its mechanisms, clinical impact and importance of the problem in this city.

Prevención en infecciones de la cirugía cardiovascular neonatal y pediátrica / Infections prevention in neonatal and pediatric cardiovascular surgery

Con la introducción de los principios de antisepsia, logró disminuir sustancialmente las infeccionespostoperatorias y la mortalidad. El riesgo de infección del sitio quirúrgico depende de una relación entre el número de bacterias, la virulencia y la susceptibilidad del huésped. La principal fuente de patógenos es la flora endógena del paciente y la flora exógena. Los factores de riesgo para las infecciones del sitio quirúrgico (ISQ) en cirugía cardiovascular pediátrico no están claramente definidos. Las ISQ se consideran asociadas al cuidado de la salud o antes llamadas intrahospitalarias si ocurren dentro de los siguientes 30 días luego del procedimiento quirúrgico independiente que el paciente se encuentre o no hospitalizado. En conclusión, las ISQ en cirugía cardiovascular pediátrica aumentan la morbilidad, la mortalidad y los costos.

With the introduction of the principles of antisepsis, possible to substantially reduce postoperativeinfections and mortality. The risk of surgical site infection depends on a relationship between thenumber of bacteria, virulence and host susceptibility. The main source of pathogens is the patient'sendogenous flora and exogenous flora. Risk factors for surgical site infections (SSIs) in pediatriccardiovascular surgery are not clearly defined. SSIs are associated with the health care or formerly known as nosocomial if they occur within 30 days after the independent surgical procedure the patient is hospitalized or not. In conclusion, the SSI in pediatric cardiovascular surgery, increased morbidity, mortality and costs.

Un caso de infección multinodular por staphylococcus aureus en una escolar de 11 años / In case of infection for staphylococcus aureos in scholastic of 11 years

Se trata de una escolar de 11 años de edad, la cual presentó una infección severa, por staphylococcus Aureus, dado por una diseminación en todo el cuerpo tipo sepsis, lo cual es poco usual a esta edad, en una niña bien nutrida y sobretodo el tipo multinodular, abcesos multifocales y de diversos tamaños, con mialgias severas, cuyo inicio fué por una herida a nivel del pie derecho parcialmente tratada y a los 10 días consulta a éste Hospital en graves condiciones generales-sépticas, con múltiples tumoraciones en el cuerpo, con una herida casi curada del pie derecho. en los cultivos realizados creció: Staphylococcus Aureos, sensible a Oxacilina y gentamicina, con una evolución satisfactoria, egresando a los 10 días