Resistência antimicrobiana na infecção urinária em unidade de terapia intensiva / Antimicrobial resistance in urinary tract infection in the intensive care unit / Resistencia a los antimicrobianos en la infección del tracto urinario en la unidad de cuidados intensivos

A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.

Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.

La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.

Filogenia y resistencia de cepas de Escherichia coli productoras de betalactamasas de espectro extendido a los antibióticos en pacientes con cáncer hospitalizados en Perú / Phylogeny and antimicrobial resistance of extended-spectrum beta-lactamase- producing Escherichia coli from hospitalized oncology patients in Perú

Introducción. Las infecciones asociadas con la atención en salud constituyen un problema de salud pública porque aumentan la morbimortalidad de los pacientes, sobre todo de aquellos con factores de riesgo, como la inmunosupresión debida a enfermedades oncológicas. Es importante conocer la diversidad genética de los principales microorganimos causantes de infecciones hospitalarias mediante la vigilancia epidemiológica tradicional y la epidemiología molecular, para hacer un mejor seguimiento y detectar brotes tempranamente. Objetivo. Determinar el grupo filogenético y la resistencia a antibióticos de las cepas de Escherichia coli aisladas de pacientes con cáncer hospitalizados. Materiales y métodos. Se hizo un estudio de tipo transversal que incluyó 67 cepas de Escherichia coli productoras de betalactamasas de espectro extendido (BLEE). Se determinó el grupo filogenético, el perfil de resistencia a los antibióticos, los genes de resistencia a betalactámicos, el tipo de las muestras y los servicios de hospitalización de donde fueron recuperadas. Resultados. El grupo filogenético más frecuente fue el B2 (36 %). El 57 % de las cepas B2 fueron aisladas de muestras de orina y el 33 % provenía del servicio de urología. La resistencia a ciprofloxacino y gentamicina fue de 91 y 53 %, respectivamente, y el 79 % de las cepas tenía el gen blaCTX-M. Se encontró una relación significativa (p<0,05) entre los grupos filogenéticos y la resistencia a ciprofloxacina, así como a la edad del paciente. Conclusión. El filogrupo de E. coli predominante fue el B2. Se evidenció una gran resistencia a ciprofloxacina y gentamicina, una proporción elevada de cepas BLEE con el blaCTX-M, y una relación entre el grupo filogenético y la resistencia a ciprofloxacino.

Introduction: Healthcare-associated infections are a public health problem due to the increased morbimortality of patients, especially those with risk factors such as immunosuppression due to oncological diseases. It is essential to determine the genetic diversity of the main microorganisms causing healthcare infections by combining traditional epidemiological surveillance and molecular epidemiology for better outbreak follow-up and early detection. Objective: To determine the phylogenetic group and antibiotic resistance of Escherichia coliisolated from hospitalized oncologic patients. Materials and methods: We conducted a cross-sectional study of 67 strains of ESBL-producing Escherichia coli to determine their phylogenetic group and described their antibiotic resistance profile, beta-lactam resistance genes, as well as the type of sample and the hospitalization areas from which they were recovered. Results: The most frequent phylogenetic group was B2 (36%); 57% of B2 strains were isolated from urine and 33% came from the urology department. Resistance to ciprofloxacin and gentamicin was 92% and 53%, respectively, and 79% of the strains had the blaCTX-Mgene. A significant association (p<0.05) was found between the phylogenetic groups, ciprofloxacin resistance, and the age of the patients. Conclusion: The predominant E. coli phylogroup was B2. We evidenced high resistance to ciprofloxacin and gentamicin, a high proportion of ESBL strains with the blaCTX-M gene, and a significant association between the phylogenetic group and the resistance to ciprofloxacin.

Evaluation of the efficiency of ciprofloxacin against S. Typhi by altering the production of cytokines in acute typhoid fever in patients at Al-Diwaniyah Hospitals, Iraq

Aims@#Typhoid fever is a life-threatening disease in the developing world that claims >600,000 deaths per year. Its causative agent Salmonella Typhimurium (S. Typhi) can be treated with ciprofloxacin, an effective broad-spectrum antibiotic that enhances the natural host defenses. However, the emergence of resistant bacterial strains may be a warning alarm against the clinical use of this antibiotic. This study was aimed to investigate the efficiency of ciprofloxacin treatment (250 mg/mL) against S. Typhi by altering the production of serum cytokines IL-10, 1L-6 and TNF-α in acute typhoid fever patients in Diwanyah Hospitals.@*Methodology and results@#ELISA and Western Blot methods were used to investigate cytokine levels in patients and healthy controls sera. Our results showed that all cytokines’ levels before treatment with ciprofloxacin were significantly higher than the control (healthy group). However, treated patients with ciprofloxacin revealed a significantly reduced concentration of IL-10 and TNF-α compared to untreated control samples. However, the level of IL-6 was higher even with ciprofloxacin treatment.@*Conclusion, significance and impact of study@#The study concluded that ciprofloxacin (250 mg/mL) might significantly alter serum cytokines IL-6, IL-10 and TNF-α levels in acute typhoid fever patients. Therefore, further molecular studies are essential to understand the effect of ciprofloxacin on the production of cytokines.

Antibiotic susceptibility patterns of bacterial isolates of patients with upper respiratory tract infections

Abstract To evaluate the antibiotic susceptibility patterns in URTIs reporting to tertiary hospitals of Lahore. A cross-sectional study employing 259 culture sensitivity reports obtained from tertiary care hospitals of Lahore. Using SPSS, descriptive statistics were used to estimate frequencies and percentages. In URTIs, S. aureus (5%) was the frequent gram-positive isolate followed by MRSA (1.5%) and MSSA (1.5%), while P. aeruginosa (15.8%) was the prevalent gram-negative isolate followed by Klebsiella (13.1%) and E. coli (6.9%). Against P. aeruginosa, ceftazidime (7.7%), cefuroxime/ceftriaxone (4.6%), amoxicillin (4.3%) and ciprofloxacin (4.2%), were tested resistant, while imipenem (11.2%), ciprofloxacin (9.2%), amikacin (9.2%), meropenem/ levofloxacin/gentamicin (8.1%) and piptaz (6.9%) were found sensitive. Against Klebsiella, carbepenems (7.3%), amikacin (6.5%), ciprofloxacin (5.4%) and gentamicin (5%) were tested sensitive, whereas, ceftazidime (8.5%), ceftriaxone (5.8%), cefaclor (5.5%), ampicillin (4.6%), co-amoxiclave (4.2%) and ciftazidime/ciprofloxacin (3.8%) were found resistant. Overall, imipenem (35%), meropenem (30.8%) and amikacin (31.9%) were the three most sensitive antibiotics, while ceftazidime (25.4%), ceftriaxone (19.2%) and ampicillin (18.5%) were the three most resistant antibiotics. Data suggested that P.aeruginosa and Klebsiella, were the most frequent bacterial isolates in URTIs of Lahore. These isolates were resistant to ampicillin, cefuroxime and ceftazidime, but were sensitive to carbapenem and aminoglycosides

Evolution of the prevalence and antimicrobial resistance among Escherichia coli isolated as a cause of infection in patients admitted to a iv-level hospital in Lima, Peru

The levels and evolution of antimicrobial resistance of Escherichia coli during 01/2009-06/2010 (Period 1), 01/2012-06-2013 (Period 2) and 07/2013-12/2014 (Period 3) were analyzed. Identification, susceptibility levels to 13 antibiotics and the presence of extendedspectrum ß-lactamases (ESBLs) were determined. Overall, 9,918 microorganisms were isolated as a cause of infection. Of these 3,016 (30.4%) were E. coli, with 1,770 (59%), 992 (33%) and 254 (8%), from the Medicine and the Surgery Departments and the Intensive Care Unit (ICU), respectively. There was a significant increase (p=0.0002) of E. coli throughout considered periods. The isolates presented high levels of resistance (>60%) to cephalosporins, ciprofloxacin and cotrimoxazole, being only susceptible to imipenem (0.3% of resistance) and tigecycline. Overall the analysis of evolution of antimicrobial resistance showed that resistance to cephalosporins and amikacin significantly increased, while, the ones of piperacillintazobactam, cotrimoxazole and gentamicin had significantly decreased. Nevertheless, the ICU isolates showed an inverse scenario for cephalosporins. These findings agree with an increase of ESBLs on the Medicine (56% to 66%; p<0.0001) and on the Surgery (54% to 62%; p=0.0197) departments, with a parallel decrease in the ICU (76% to 68%). In summary, high levels of antimicrobial resistance have been reported among E. coli, with worrisome levels of ESBL. A continuous surveillance of antimicrobial resistance levels in the area is needed.

Comparative effect of ciprofloxacin and moxifloxacin on the modulation of bile acid profiles and gut microbiota in rats

Abstract Fluoroquinolones are an important class of antimicrobial agents to manage infectious diseases. However, knowledge about how host bile acids are modified by fluoroquinolones is limited. We investigated and compared the impact of fluoroquinolones on circulating bile acid profiles and gut microbiota from in vivo studies. We administered ciprofloxacin (100 mg/kg/day) or moxifloxacin (40 mg/kg/day) orally to male Wistar rats for seven days. Fifteen bile acids (BAs) from the serum and large intestine were quantified by HPLC-MS/MS. The diversity of gut microbiota after ciprofloxacin and moxifloxacin treatment was analyzed using high-throughput, next-generation sequencing technology. The two fluoroquinolone-treated groups had different BA profiles. Ciprofloxacin significantly reduced the hydrophobicity index of the BA pool, reduced secondary BAs, and increased taurine-conjugated primary BAs in both the serum and large intestine as compared with moxifloxacin. Besides, ciprofloxacin treatment altered intestinal microbiota with a remarkable increase in Firmicutes to Bacteroidetes ratio, while moxifloxacin exerted no effect. What we found suggests that different fluoroquinolones have a distinct effect on the host BAs metabolism and intestinal bacteria, and therefore provide guidance on the selection of fluoroquinolones to treat infectious diseases.

Resistencia antimicrobiana en Escherichia coli aislada de urocultivos / Antimicrobial resistance in Escherichia coli isolated from urine cultures / Resistência antimicrobiana em Escherichia coli isolada de culturas de urina

Las infecciones del tracto urinario (ITU) son un problema de salud común, la morbilidad por infecciones del tracto urinario adquiridas en la comunidad es alta y el uropatógeno más frecuente en este estudio es Escherichia coli. OBJETIVO. Determinar la resistencia de antimicrobianos en E. coli aislada de urocultivos, durante Enero - Julio 2019, en pacientes que asistieron al laboratorio clínico Neolab. MATERIALES Y METODOS. La investigación es de tipo cuantitativa, documental, de corte longitudinal descriptiva. Se desarrolló en la ciudad de Cuenca, con un universo de 936 pacientes atendidos en el laboratorio clínico Neolab de Enero a Julio de 2019 con un muestreo no probabilístico por conveniencia con lo cual se obtuvo una muestra de 330 registros de datos, cuyos urocultivos presentaron E. coli. RESULTADOS. Se observó resistencia del 55,15% en Amoxicilina, Ácido Nalidíxico 50,91 % y Trimetoprim Sulfametoxazol 46,67%, Ciprofloxacino 26,67%, se evidencia mayor resistencia en mujeres tanto en ß-lactámicos, Quinolonas, Sulfas y Macrólidos, se encontró que el mayor número de pacientes se encuentran dentro del grupo de adultos que representa el 54,4 % y adulto mayor con 25,3%. CONCLUSIONES. La resistencia elevada a los antibióticos estudiados, podrían sugerir un uso empírico de los mismos, la detección de estas cifras representa una señal de alarma. La automedicación facilitada por la venta libre de antimicrobianos empeora el problema, por lo que se requiere control estricto y legislación oportuna.

Urinary tract infections (UTI) are a common health problem, morbidity from community-acquired urinary tract infections is high, and the most common uropathogen in this study is Escherichia coli. OBJECTIVE. To determine the antimicrobial resistance in E. coli isolated from urine cultures, during January - July 2019, in patients who attended the Neolab clinical laboratory. MATERIALS AND METHODS. The research is quantitative, documentary, descriptive longitudinal cut. It was developed in the city of Cuenca, with a universe of 936 patients treated in the Neolab clinical laboratory from January to July 2019 with a non-probabilistic convenience sampling with which a sample of 330 data records was obtained, whose urine cultures presented E coli. RESULTS. Resistance of 55.15% was observed in Amoxicillin, Nalidixic Acid 50.91% and Trimethoprim Sulfamethoxazole 46.67%, Ciprofloxacin 26.67%, greater resistance is evidenced in women both in ß-lactams, Quinolones, Sulfas and Macrolides It was found that the largest number of patients are within the group of adults that represents 54.4% and the elderly with 25.3%. COCLUSIONS. The high resistance to the studied antibiotics could suggest an empirical use of them, the detection of these figures represents an alarm signal. Self-medication facilitated by the over-the-counter sale of antimicrobials worsens the problem, requiring strict control and timely legislation.

As infecções do trato urinário (IU) são um problema de saúde comum, a morbidade das infecções do trato urinário adquiridas na comunidade é alta e o uropógeno mais frequente neste estudo é a Escherichia coli. OBJETIVO. Para determinar a resistência antimicrobiana em E. coli isolada de culturas de urina, durante janeiro - julho de 2019, em pacientes que freqüentam o laboratório clínico Neolab. MATERIALS E MÈTODOS. Esta é uma pesquisa longitudinal quantitativa, documental e descritiva. Foi desenvolvido na cidade de Cuenca, com um universo de 936 pacientes atendidos no laboratório clínico do Neolab de janeiro a julho de 2019 com uma amostragem não-probabilística por conveniência, com a qual foi obtida uma amostra de 330 registros de dados, cujas culturas de urina apresentaram E. coli. RESULTADOS. Foi observada uma resistência de 55,15% em Amoxicilina, Ácido Nalidíxico 50,91% e Trimethoprim Sulfametoxazol 46,67%, Ciprofloxacina 26,67%, maior resistência é evidenciada nas mulheres tanto em ß-lactams, Quinolones, Sulfas e Macrolides, verificou-se que o maior número de pacientes está dentro do grupo adulto representando 54,4% e adulto mais velho com 25,3%. CONCLUSÕES. A alta resistência aos antibióticos estudados poderia sugerir um uso empírico de antibióticos, e a detecção destes números representa um sinal de alarme. A automedicação facilitada pela venda sem prescrição de antimicrobianos agrava o problema, de modo que é necessário um controle rigoroso e legislação oportuna.

Structural elucidation, mechanism of action, antibacterial proficiency and synergistic forte of purified Euphorbia hirta whole plant extract against multi-drug resistant otitis media infection / Elucidación estructural, mecanismo de acción, competencia antibacteriana y fuerza sinérgica del extracto de planta entera de Euphorbia hirta purificado contra la infección por otitis media resistente a múltiples fármacos

This study investigated the antibacterial potential of Euphorbia hirtawhole plant extracts, honey and conventional antibiotics and their synergistic effects against selected multidrug resistant and typed bacterial strains associated with otitis media. E. hirtawhole plant extract was purified using column chromatography technique. The antibacterial assays of extracts were done using standard microbiological procedures. Protein, sodium and potassium ion leakage of the synergistic mixtures was determined using flame-photometry. At 100 mg/ml, acetone extracts presented highest inhibition against S. aureus (NCTC 6571) with 32 ± 0.83 mm zone of inhibition. The fractional inhibitory concentration indices displayed higher synergism in combination of plant extract, honey and ciprofloxacin against P. mirabilisat 0.02 compared to drug combination synergy standard (≤ 0.5). This work revealed augmentation of ciprofloxacin potency when combined with purified E. hirta acetone extract and honey and implies their high potential in the treatment of multidrug resistant infectionof otitis media.

Este estudio investigó el potencial antibacteriano de extractos de plantas enteras de Euphorbia hirta, miel y antibióticos convencionales y sus efectos sinérgicos contra cepas bacterianas seleccionadas multirresistentes y tipificadas asociadas con la otitis media. El extracto de la planta entera de E. hirtase purificó usando la técnica de cromatografía en columna. Los ensayos antibacterianos de extractos se realizaron utilizando procedimientos microbiológicos estándar. La fuga de iones de proteínas, sodio y potasio de las mezclas sinérgicas se determinó mediante fotometría de llama. A 100 mg/ml, los extractos de acetona presentaron la mayor inhibición contra S. aureus (NCTC 6571) con una zona de inhibición de 32 ± 0,83 mm. Los índices de concentración inhibitoria fraccional mostraron un mayor sinergismo en combinación de extracto de planta, miel y ciprofloxacina contra P. mirabilisa 0,02 en comparación con el estándar de sinergia de combinación de fármacos (≤ 0,5). Este trabajo reveló un aumento de la potencia de la ciprofloxacina cuando se combina con extracto de acetona purificado de E. hirtay miel e implica sualto potencial en el tratamiento de infecciones de otitis media resistentes a múltiples fármacos.

Elevada proporción de Staphylococcus aureus meticilino resistentes aislados en pacientes atendidos en un servicio ambulatorio dermatológico de referencia nacional: cohorte 2010 a 2019 / High proportion of isolated resistant methicillin-resistant Staphylococcus aureus in patients treated in a national refe rence dermatological outpatient service: cohort 2010 to 2019

Resumen Objetivo: Estimar la resistencia del Staphylococcus aureus frente a diferentes antibióticos usados para el manejo ambulatorio de piodermias. Métodos: Se realizaron análisis descriptivos y de tendencias mediante modelos de regresión segmentada. Resultados: La mayor resistencia se presentó a la oxacilina, con mediana de 54,3% (RIQ: 43 - 58,8), seguido de eritromicina con el 20%, (RIQ: 15,4 - 26,5), clindami cina con el 14% (RIQ: 7,9 - 20), gentamicina con el 7,5% (RIQ: 0 -10), trimetoprima/sulfametoxazol (SXT) con el 5,5% (RIQ: 4 - 11), y ciprofloxacina con 2,1% (RIQ: 2 - 8.4). La tendencia de la resistencia del S. aureus a la oxacilina fue creciente con un cambio anual porcentual no significativo de (0,07) (IC 95%: -3,7; 3,9). Para eritromicina, clindamicina, ciprofloxacina, trimetoprima/sulfametoxazol, y gentamicina hubo decrecimiento. Conclusiones: La resistencia del S. aureus a oxacilina fue ligeramente creciente para el periodo 2010 al 2019 y francamente creciente en los últimos 3 años, superando en promedio a lo reportado a nivel país y Latinoamérica. Los antibióticos con menor resistencia fueron ciprofloxacina, SXT, clindamicina para uso sistémico, y ácido fusídico, mupirocina para manejo tópico y descolonización. Es pertinente articular la vigilancia del S. aureus en la atención ambulatoria a la red de vigilancia nacional.

Abstract Objective: To estimate the resistance trend of Staphylococcus aureus (S. aureus) against different antibiotics in a reference dermatology outpatient center in Colombia. Methods: Descriptive and trend analyzes were performed using segmented regression models for the period 2010 to 2019. Results: The greatest resistance was presented to oxacillin, with a median of 54.3% (RIQ: 43 - 58.8), followed by erythromycin with 20%, (RIQ: 15.4 - 26.5), then clindamycin with 14% (RIQ: 7.9 - 20), gentamicin with 7.5% (RIQ: 0 -10), trimethoprim / sulfamethoxazole (SXT) with 5.5% (RIQ: 4 - 11), and ciprofloxacin with 2.1% (RIQ: 2 - 8.4). The trend of S. aureus resistance to oxacillin from 2010 to 2019 was increasing with a non-significant Annual Percent Change (APC) of (0.07) (95% CI -3.7, 3.9). APC for erythromycin (-1.2) (95% CI: -11.3; 10), clindamycin (-1.7) (95% CI: 11; -12.9), ciprofloxacin (-25.4) (95% CI: -44.6; 0.5) and trimethoprim / sul famethoxazole (-20.7) (95% CI: -43.5; 11.2), were decreasing not significant. For gentamicin the trend was decreasing and significant (-44.2) (95% CI: -19.9; -61.1). Conclusions: The resistance of S. aureus to oxacillin exhibited a slightly increasing trend for the period 2010 to 2019 and increasing in the last 3 years, exceeding on average that reported at the country level and the world average. Antibiotics for outpatient management of skin and soft tissue pyoderma with less resistance were ciprofloxacin, SXT, clindamycin for systemic use, and fusidic acid, mupirocin for topical management and decolonization. It is important to articulate surveillance of S. aureus in outpatient care to the national surveillance network.

Potencial antimicrobiano de extractos de plantas medicinales y sus mezclas frente a bacterias asociadas con conjuntivitis / Antimicrobial potential of plant extracts and their mixtures against bacteria associated with conjunctivitis

Resumen Introducción. La conjuntivitis bacteriana es una de las infecciones oculares con mayor tasa de consulta oftálmica, siendo el género Staphylococcus el agente etiológico que presenta mayor resistencia a los antibióticos. Objetivo. Determinar el potencial antimicrobiano de extractos de plantas medicinales y sus mezclas frente a bacterias asociadas con conjuntivitis. Métodos. A partir de plantas como Belladona, Caléndula, Albahaca, Achiote y Romerillo se prepararon los extractos etanólicos y se evaluó su potencial antibacteriano frente a S. aureus y S. epidermidis, mediante las técnicas de difusión en disco y dilución en tubo. El efecto de las mezclas se determinó para el extracto con mejor actividad y el antibiótico con mayor halo de inhibición a través de la técnica de tablero. Resultados. Se encontró que el extracto con mayor potencial para S. aureus fue el de achiote (hojas) con un halo de inhibición de 13 mm y CMIs de 15 mg/mL, mientras que para S. epidermidis fueron los de hojas y frutos de achiote con halos de 16,6 y 9,6 mm y CMIs de 15 y 30 mg/mL respectivamente. En relación con las combinaciones, el extracto de achiote y ciprofloxacina mostró un efecto de sinergia parcial para S. aureus con una CFI de 0,83 y un efecto aditivo para S. epidermidis con una CFI de 1,84. Conclusiones. Este trabajo se constituye en la base de futuras investigaciones orientadas hacia el desarrollo de bioproductos de uso ocular que puedan ser considerados como alternativa en el tratamiento de infecciones causadas por Staphylococcus.

Abstract Introduction. Bacterial conjunctivitis is one of the ocular infections with the highest rate of ophthalmic consultation, being the Staphylococcus genus the etiological agent that presents the greatest resistance to antibiotics. Objective. To determine the antimicrobial potential of medicinal plant extracts and their mixtures against bacteria associated with conjunctivitis. Methods. From plants such as Belladonna, Calendula, Basil, Achiote and Romerillo, ethanolic extracts were prepared and their antibacterial potential against S. aureus and S. epidermidis was evaluated by means of disk diffusion and tube dilution techniques. The effect of the mixtures was determined for the extract with the best activity and the antibiotic with the highest inhibition halo through the board technique. Results. It was found that the extract with the highest potential for S. aureus was that of annatto (leaves) with an inhibition halo of 13 mm and MICs of 15 mg / mL, while for S. epidermidis it was those of annatto leaves and fruits with halos of 16.6 and 9.6 mm and MICs of 15 and 30 mg / mL respectively. In relation to the combinations, the annatto extract and ciprofloxacin showed a partial synergistic effect for S. aureus with a CFI of 0.83 and an additive effect for S. epidermidis with a CFI of 1.84. Conclusions. This work constitutes the basis for future research aimed at the development of bioproducts for ocular use that can be considered as an alternative in the treatment of infections caused by Staphylococcus.

Sensibilidad in vitro de Escherichia coli a la fosfomicina en urocultivos en un Servicio Asistencial Privado de Asunción / In vitro sensitivity of Escherichia coli to fosfomycin in urine cultures in a private healthcare service in Asunción

La fosfomicina es un antibiótico natural, que actúa sobre la síntesis de la pared celular, con actividad bactericida y de amplio espectro. En este trabajo se evaluó la sensibilidad in vitro de aislados de Escherichia coli (E. coli), incluidos aquellos que producen Beta Lactamasa de Espectro Extendido (BLEE) obtenidos a partir de urocultivos, tomados en diferentes lapsos de colección de datos, en personas de ambos sexos. Fueron incluidos 260 muestras de orina con desarrollo de E. coli provenientes de pacientes que concurrieron al Laboratorio San Roque. El aislamiento e identificación bacteriana se realizó según métodos convencionales y la sensibilidad a los antimicrobianos por el método de difusión de disco. Para la detección de la sensibilidad frente a fosfomicina fueron utilizados discos de 200 µg con el agregado de 50 µg de glucosa 6-fosfato. Se observó frente a los antibióticos evaluados mayor sensibilidad a fosfomicina (98,5%) y nitrofurantoína (97,7%). Ciprofloxacina, trimetoprima y la combinación sulfametoxazol/trimetoprima exhibieron frente a los mismos aislados sensibilidad menor y muy similar entre ellos, con 64,2%, 61,2% y 61,2% respectivamente. En 44 (16,9%) de los aislados de E. coli se detectó la presencia de BLEE y es destacable la alta sensibilidad que mostraron fosfomicina y nitrofurantoína, aún frente a los aislados BLEE positivos, con frecuencias de 90,9% y 93,2%, respectivamente. En resumen, la alta sensibilidad demostrada en el presente estudio por E. coli ante la fosfomicina, abre la posibilidad de considerar a este antibiótico de primera elección en las infecciones urinarias bajas, aún en los casos de gérmenes productores de BLEE, en la población de nuestro país.

Fosfomycin is a natural antibiotic, which acts on the synthesis of the cell wall, with broad spectrum bactericidal activity. In this study, the in vitro sensitivity of Escherichia coli (E. coli) isolates was evaluated, including those that produce Extended Spectrum Beta Lactamase (ESBL) obtained from urine cultures taken at different data collection times, in people of both sexes. Were included 260 urine samples with development of E. coli from patients who attended the San Roque laboratory. Bacterian isolation and identification was carried out according to conventional methods and antimicrobial sensitivity by the disk diffusion method. For detection of sensitivity to fosfomycin, 200 µg discs were used with the addition of 50 µg of glucose 6-phosphate. A greater sensitivity for fosfomycin (98.5%) and nitrofurantoin (97.7%) was observed against the evaluated antibiotics. Ciprofloxacin, trimethoprim and the sulfamethoxazole / trimethoprim combination exhibited in front of the same isolated lower sensitivity and very similar among them, with 64.2%, 61.2% and 61.2% respectively. In 44 (16.9%) of the E. coli isolates the presence of ESBL was detected and the high sensitivity shown by fosfomycin and nitrofurantoin is noteworthy, even compared to the positive ESBL isolates, with frequencies of 90.9% and 93,2%, respectively. In summary, the high sensitivity demonstrated in the present study by E. coli to fosfomycin opens the possibility of considering this first-choice antibiotic in lower urinary infections, even in ESBL-producing germs, in the population of our country.

Critical points and potential pitfalls of outbreak of IMP-1-producing carbapenem-resistant Pseudomonas aeruginosa among kidney transplant recipients: a case-control study

Background Carbapenem-resistant Pseudomonas aeruginosa (CRPA) infection after kidney transplantation (KT) is associated with high mortality. Methods We analysed an outbreak of infection/colonization with IMP-1-producing CRPA on a KT ward, conducting a case-control study. Cases were identified through routine surveillance culture and real-time polymerase chain reaction (PCR) for carbapenemase performed directly from rectal swab samples. Controls were randomly selected from patients hospitalized on the same ward during the same period, at a ratio of 3:1. Strain clonality was analysed through pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing was performed for additional strain characterization. Results CRPA was identified in 37 patients, in 51.4% through surveillance cultures and in 49.6% through clinical cultures. The median persistence of culture positivity was 42.5 days. Thirteen patients (35.1%) presented a total of 15 infections, of which 7 (46.7%) were in the urinary tract, among those, 30-day mortality rate was 46.2%. PFGE analysis showed that all of the strains shared the same pulsotype. Multilocus sequence typing analysis identified the sequence type as ST446. Risk factors for CRPA acquisition were hospital stay > 10 days, re-transplantation, urological surgical re-intervention after KT, use of carbapenem or ciprofloxacin in the last three months and low median lymphocyte count in the last three months. Conclusions KT recipients remain colonised by CRPA for long periods and could be a source of nosocomial outbreaks. In addition, a high proportion of such patients develop infection. During an outbreak, urine culture should be added to the screening protocol for KT recipients.

Resistência aos antimicrobianos e diversidade genética de variantes fenotípicas de Pseudomonas aeruginosa não sensíveis aos carbapenêmicos recuperadas de pacientes com fibrose cística com infecção pulmonar crônica: uma análise temporal / Antimicrobial resistance and genetic diversity of phenotypic variants of carbapenem non susceptible Pseudomonas aeruginosa recovered from patients with cystic fibrosis with chronic lung infection: a temporal analysis

Pseudomonas aeruginosa, bactéria ubíqua e versátil, pode se comportar como um patógeno oportunista, com ampla capacidade adaptativa, por múltiplos fatores de virulência e resistência. Como agente patogênico nas infecções pulmonares em pacientes com fibrose cística (FC), é motivo de prognóstico ruim, aumento de hospitalizações e altas taxas de morbimortalidade, sendo quase impossível a sua erradicação, ao evoluírem para a cronicidade. Globalmente, é notável o aumento nos índices de amostras não sensíveis aos carbapenêmicos e a múltiplos antimicrobianos, essenciais à terapêutica. Assim, avaliamos temporalmente a susceptibilidade aos antimicrobianos e a presença de amostras hipermutáveis (HPM) em P. aeruginosa de diferentes morfotipos, não sensíveis aos carbapenêmicos (PANSC), obtidas de pacientes FC com infecção pulmonar crônica, acompanhados em dois centros de referência no Rio de Janeiro. De 2007 a 2016, a análise retrospectiva, através dos resultados obtidos no teste de disco-difusão (TDD), permitiu selecionar amostras de PANSC incluídas neste trabalho. Usando os resultados obtidos no TDD, foi definida a susceptibilidade a outros antimicrobianos, bem como os fenótipos de resistência, multi-(MDR), extensivo-(XDR) e pandroga resistentes (PDR). Adicionalmente, determinou-se a concentração inibitória mínima (CIM) para imipenem (IPM), meropenem (MEM), doripenem (DOR) e polimixina (POL). Através de teste fenotípico, foi calculada a frequência de mutação espontânea e as amostras hipermutáveis foram caracterizadas. O sequenciamento de genoma total (SGT) foi realizado em seis amostras de diferentes morfotipos, incluindo uma variante fenotípica rara, a small colony variant (SCV). Essas amostras foram recuperadas em dois episódios de exacerbação do paciente. Foram investigadas a clonalidade, resistência a antimicrobianos e virulência. Das 143 amostras, de 18 pacientes (9 pediátricos e 9 adultos), os resultados do TDD apontaram taxas de não susceptibilidade superiores a 44% para gentamicina, amicacina, tobramicina e ciprofloxacina, e maiores de 30 % para POL. Pela determinação da CIM, quase a totalidade (96%) das amostras foram não sensíveis a IMP, seguidos de 56% para MEM e 44% para DOR. Analisando-se a distribuição dos valores da CIM50 e CIM90 nos dois grupos de pacientes, os valores para IMP foram maiores entre as amostras dos pacientes pediátricos, equivalendo a 32 µg/mL e 64 µg/mL, respectivamente. Cerca de 25%, 37% e 6% eram MDR, XDR e PDR, respectivamente. Aproximadamente 12% eram HPM, e mais da metade destas foram XDR. Após o SGT, as seis amostras, recuperadas do caso clínico foram classificadas em um novo sequence type (ST2744), com a presença de genes de resistência adquiridos blaPAO, blaOXA-50, aph(3')-Iib, fosA, catB7 e crpP, apresentando mutações em genes codificadores de porinas e bombas de efluxo. Entretanto, não foram observados marcadores genéticos clássicos exclusivos para os fenótipos SCV e HPM. Este é o primeiro relato de P. aeruginosa SCV na FC, no Brasil. A vigilância epidemiológica de P. aeruginosa é crucial para a conduta terapêutica, bem como para o sucesso da resposta do paciente e erradicação da infecção pulmonar, justificando o uso de técnicas fenotípicas e moleculares na detecção dos mecanismos de resistência e virulência desse microrganismo na FC.

Pseudomonas aeruginosa, a ubiquitous and versatile bacterium, can behave as an opportunistic pathogen, with strong adaptive capacity, due to multiple virulence and resistance factors. As a pulmonary infection pathogen in patients with cystic fibrosis (CF), it is related with poor prognosis, increased hospitalizations and high rates of morbidity and mortality, and the eradication is almost impossible, especially after chronicity. The increase rates of isolates non-susceptible to carbapenem and multiple antimicrobials, essentials to therapy, have been observed worldwide. Therefore, we assessed the antimicrobial susceptibility and the presence of hypermutability (HPM) in non-susceptible to carbapenem P. aeruginosa (PANSC) isolates from different morphotypes, obtained from CF patients with chronic pulmonary infection, followed at two reference centers in Rio de Janeiro. Using the results obtained by disk-diffusion test (DDT) between 2007 to 2016, we select 143 PANSC and susceptibility to other antimicrobials was defined, as well as the resistance phenotypes, multi- (MDR), extensive- (XDR) and pandrug resistant (PDR). Additionally, the minimum inhibitory concentration (MIC) for imipenem (IPM), meropenem (MEM), doripenem (DOR) and polymyxin (POL) was determined. Hypermutable isolates were characterized by determination of mutation frequency. Whole genome sequencing (WGS) was performed in six morphotypes isolates, including the small colony variant (SCV), a rare variant phenotype. These isolates were recovered in two exacerbation episodes. Clonality, antimicrobial resistance and virulence were investigated. Of the total (143 isolates) isolated from 18 patients (9 pediatric and 9 adults), non-susceptibility rates above than 44% for gentamicin, amikacin, tobramycin and ciprofloxacin, and more than 30% for POL were observed. Almost all (96%) of the isolates were non-susceptible to IPM by MIC determination, followed by 56% for MEM and 44% for DOR. MIC50 (32 µg/mL) and MIC90 (64 µg/mL) rates for IPM were higher among pediatric patient isolates and 25%, 37% and 6% were MDR, XDR and PDR, respectively. 12% of all isolates were classified as HPM and more than half were categorized as XDR. Using WGS, the six isolates recovered from the clinical case, were identified as a new sequence type (ST2744). Acquired resistance genes blaPAO, blaOXA-50, aph (3')-Iib, fosA, catB7 and crpP and mutations in encoding genes for porins and efflux pumps, was annotated. None exclusive classic genetic markers related to SCV and HPM phenotypes were not observed. This is the first Brazilian report of P. aeruginosa SCV in CF. Our results highlight the importance of epidemiological surveillance in P. aeruginosa. The application of phenotypic and molecular techniques to investigate resistance and virulence mechanisms, can contribute to therapeutic success in CF.

Endometrite crônica e infertilidade / Chronic endometritis and infertility

A endometrite crônica (EC) é uma doença que, apesar de ainda pouco investigada, tem sido associada a resultados reprodutivos desfavoráveis. Estudos têm mostrado que a EC pode prejudicar a receptividade endometrial, levando a falhas de implantação e perdas gestacionais recorrentes. Os métodos padronizados para diagnóstico incluem histeroscopia, histologia para pesquisa de plasmócitos e cultura endometrial para identificação de agentes bacterianos. O tratamento com antibióticos para EC parece melhorar as taxas de gestação e nascidos vivos em pacientes com falhas de implantação e perdas gestacionais recorrentes sem causa conhecida. Esta publicação tem por objetivo fazer uma revisão da etiologia, fisiopatologia, diagnóstico e tratamento da EC, seu impacto no microambiente endometrial e sua associação com infertilidade. Esta revisão narrativa da literatura atualizada sintetiza os achados encontrados em bases de dados computadorizadas.(AU)

Chronic endometritis (CE) is a poorly investigated disease, which has been related to adverse reproductive outcomes. Published studies have shown that CE can impair endometrial receptivity, which is associated with implantation failure and recurrent pregnancy loss. The standard tools for diagnosis include hysteroscopy, histology to identification of plasma cells and endometrial culture for identification of bacterial pathogens. Effective antibiotic treatment for CE seems to improve the pregnancy and live birth rates in patients with implantation failure and unexplained recurrent pregnancy loss. This paper intends to provide an overview of etiology, pathophysiology, diagnosis and treatment of CE, its impact on endometrial microenvironment and its association with infertility. This narrative review of the current literature synthesizes the findings retrieved from searches in computerized databases.(AU)

Resistencia a antibióticos del Staphylococcus aureus en estudiantes de una facultad de odontología / Antibiotic resistance of Staphylococcus aureus in students of a dental school

Introducción: el Staphylococcus aureus es un coco gram positivo que causa diferentes tipos de infecciones; circula no solo en la comunidad sino también en centros hospitalarios. El profesional de odontología está en contacto continuo y por largos periodos durante la atención clínica, lo que incrementa el riesgo de infección. Objetivo: evaluar la resistencia a algunos antibióticos del Staphylococcus aureus en estudiantes de una facultad de odontología. Material y métodos: estudio de corte transversal en estudiantes de 9° y 10° semestre de clínica odontológica de la ciudad de Medellín, Colombia (n=62) que cumplieran con los criterios de inclusión: estar realizando práctica clínica y no estar en tratamiento con antibiótico en los últimos tres meses, y como criterios de exclusión: no haber presentado fiebre, tos, dificultad para respirar, erupciones cutáneas, ni haber estado sometido a procedimientos quirúrgicos y hospitalizaciones en los últimos seis meses. Se recolectaron datos sociodemográficos y la presencia de S. aureus mediante la toma de muestras de fosas nasales. La identidad de la bacteria se verificó mediante la coloración de gram, pruebas de catalasa, coagulasa y crecimiento en manitol sal. A los aislamientos positivos se les realizó tamizaje con los siguientes antibióticos: cefoxitin, oxacilina, vancomicina, eritromicina y ciprofloxacina. Resultados: del total de muestras analizadas el 67,7 por ciento resultaron positivas para S. aureus y de estas el 28,5 por ciento resultaron resistentes a cefoxitina, 35,7 por ciento a oxacilina y el 7,14 por ciento a ciprofloxacina. Conclusiones: la presencia del S. aureus superó el 60 por ciento en la población de estudio y mostró mayor resistencia y su presencia estaba relacionada con haber tenido sintomatología respiratoria. En el presente estudio S. aureus resultó ser más resistente a la cefoxitina y a la oxacilina que a la ciprofloxacina(AU)

Introduction: Staphylococcus aureus is a gram-positive coccus that causes different types of infections. It spreads not only in the community but also in hospital centers. Dental professionals are in continuous contact with this bacterium for long periods of time during clinical care, which increases the risk of infection. Objective: To evaluate antibiotic resistance of Staphylococcus aureus in students of a dental school. Materials and methods: A cross-sectional study was conducted in ninth and tenth semester students of a dental clinic in Medellin, Colombia (n = 62) that met the inclusion criteria: carrying out clinical practice and not receiving antibiotic treatment during the last three months; they also met the following exclusion criteria: not having fever, cough, shortness of breath or skin rashes as well as not having undergone surgical procedures or been hospitalized during the last six months. Sociodemographic data were collected. The presence of S. aureus was detected by taking samples from the nostrils. The identity of bacteria was verified by gram staining, catalase and coagulase tests and growth on mannitol salt. Positive samples were screened using the following antibiotics: cefoxitin, oxacillin, vancomycin, erythromycin, and ciprofloxacin. Results: Of the total of samples analyzed, 67.7 percent were positive for S. aureus and of these, 28.5 percent were resistant to cefoxitin, 35.7 percent to oxacillin and 7.14 percent to ciprofloxacin. Conclusions: Staphylococcus aureus was present in 60 percent of the study population, showing great resistance and being associated with respiratory symptoms. In this study, S. aureus was found to be more resistant to cefoxitin and oxacillin than to ciprofloxacin(AU)

Infecciones del Tracto Urinario: métodos diagnósticos, tratamiento empírico y multirresistencia en una Unidad de Adultos Área de Emergencias / Urinary Tract Infections: diagnostic methods, empirical treatment and multidrug resistance in an Adult Emergency Area Unit

INTRODUCCIÓN. Las infecciones del tracto urinario por variedad de bacterias uropatógenas multiresistentes se deben al uso de tratamiento empírico o automedicación. OBJETIVO. Describir en las infecciones de tracto urinario los métodos diagnósticos, tratamiento empírico y la multirresistencia. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población y muestra de 73 Historias Clínicas de pacientes atendidos en la Unidad de Adultos Área de Emergencias del Hospital de Especialidades Carlos Andrade Marín en el período enero a diciembre 2018. Se incluyeron pacientes mayores de 18 años, de ambos sexos, con diagnóstico clínico y por laboratorio de infección del tracto urinario superior e inferior. La información se obtuvo mediante la base de datos AS400, y se procesó en Epi-info y Excel. RESULTADOS. El 71,23% (52; 73) de mujeres tuvieron infección del tracto urinario. Escherichia coli fue frecuente en un 48,39% (15; 31), con mayor resistencia al Clotrimoxazol. El tratamiento empírico con Ciprofloxacino fue utilizado en 27,40% (20; 73). DISCUSIÓN: Se observó controversia en los tipos de estudios de imagen solicitados para el diagnóstico acorde a la clase de infección de tracto urinario así como el tratamiento empírico por factores propios de cada localidad que evitaron resistencia. CONCLUSIÓN. Escherichia coli se aisló de manera frecuente y registró mayor resistencia al Clotrimoxazol; el principal antibiótico prescrito como tratamiento empírico fue la Ciprofloxacina; el examen más solicitado fue la Urotomografía.

INTRODUCTION. Urinary tract infections due to a variety of multi-resistant uropathogenic bacteria are due to the use of empirical treatment or self-medication. OBJECTIVE. Describe diagnostic methods, empirical treatment and multidrug resistance in urinary tract infections. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population and sample of 73 Medical Records of patients treated in the Emergency Area Adult Unit of the Carlos Andrade Marín Specialty Hospital in the period january to december 2018. Patients older than 18 years of age, of both sexes, with clinical diagnosis and due to upper and lower urinary tract infection laboratory. The information was obtained through the AS400 database, and was processed in Epi-info and Excel. RESULTS. 71,23% (52; 73) of women had urinary tract infection. Escherichia coli was frequent in 48,39% (15; 31), with greater resistance to Clotrimoxazole. Empirical treatment with Ciprofloxacin was used in 27,40% (20; 73). DISCUSSION: Controversy was observed in the types of imaging studies requested for diagnosis according to the class of urinary tract infection as well as the empirical treatment due to factors specific to each locality that prevented resistance. CONCLUSION. Escherichia coli was frequently isolated and showed greater resistance to Clotrimoxazole; the main antibiotic prescribed as empirical treatment was Ciprofloxacin; the most requested examination was the Urotomography.

Quinolones resistance in Salmonella spp. isolated from broilers and chickens carcasses under federal inspection / Resistência à quinolonas em Salmonella spp. isoladas de frangos vivos e carcaças sob inspeção federal

We analyzed 77 Salmonella spp. strains, from which 20 were isolated from broilers (cloacal swabs) and 57 from chickens from slaughterhouses under federal inspection. The following serotypes were identified: Salmonella Saint Paul (29), Salmonella Heidelberg (27), Salmonella Anatum (9), Salmonella Cerro (5), Salmonella Senftenberg (5), Salmonella enterica (O: 4,5) (1) and Salmonella enterica (O: 9.12) (1). Fifteen strains (19.5%) were resistant to enrofloxacin, six (7.8%) to ciprofloxacin, and 26 (33.8%) to nalidixic acid in the Disk Diffusion Test. The fifteen enrofloxacin resistant strains were selected for the PCR to detect the genes gyrA, gyrB, parC, and parE, and genetic sequencing to identify mutations in these genes. Five strains (33.3%) had point mutations in the gyrA gene, and one (6.7%) presented a point mutation in the parC gene. None of the 15 strains had mutations in the gyrB and parE genes, and none had more than one mutation in the gyrA gene or the other genes. The presence of point mutations in the strains studied corroborates with the phenotypic resistance observed to nalidixic acid. However, it did not explain the resistance to fluoroquinolones found in the 15 strains. Other mechanisms may be related to the fluoroquinolones resistance, highlighting the need for additional mutation screening.(AU)

Foram analisadas neste estudo 77 estirpes de Salmonella spp., 20 isoladas de frangos vivos (suabes de cloaca) e 57 isoladas de carcaças, provenientes de abatedouros frigoríficos sob Inspeção Federal. Foram identificados os seguintes sorotipos: Salmonella Saint Paul (29), Salmonella Heidelberg (27), Salmonella Anatum (9), Salmonella Cerro (5), Salmonella Senftenberg (5), Salmonella enterica (O: 4,5) (1) e Salmonella enterica (O: 9,12) (1). Do total de estirpes estudadas, 15 (19,5%) se mostraram resistentes à enrofloxacina, seis (7,8%) à ciprofloxacina e 26 (33,8%) ao ácido nalidíxico no Teste de Difusão em Disco. Foram selecionadas as 15 estirpes resistentes à enrofloxacina para a realização da PCR para detecção dos genes gyrA, gyrB, parC e parEe para sequenciamento genético do produto da PCR para identificação de mutações nesses genes. Cinco estirpes (33,3%) apresentaram mutações pontuais no gene gyrA e uma (6,7%) apresentou mutação pontual no gene parC. Nenhuma das 15 estirpes apresentou mutações nos genes gyrB e parE e nenhuma apresentou mais de uma mutação no gene gyrA ou nos outros genes. A existência apenas de mutações pontuais em alguns genes das estirpes analisadas está de acordo com a resistência fenotípica observada ao ácido nalidíxico, mas não explica a resistência às fluoroquinolonas encontrada nas 15 estirpes. Outros mecanismos de resistência podem estar relacionados à resistência encontrada às fluoroquinolonas e estudos adicionais são necessários para investigar sua presença.(AU)

Ciprofloxacin-induced esophageal ulcers / Úlceras esofágicas inducidas por ciprofloxacino

Los medicamentos que con mayor frecuencia se asocian a lesiones esofágicas son los antibióticos, pero hay pocas publicaciones sobre el tema en nuestro medio; por lo anterior, reportamos el caso de una mujer de 71 años que tomó Ciprofloxacino por una infección de vías urinarias. Setenta y dos horas después de su ingesta presentó dolor torácico súbito, en la esofagogastroduodenoscopia se hallaron úlceras en el tercio medio e inferior del esófago. Al suspender el medicamento y recibir inhibidores de bomba de protones la paciente mejoró. Doce semanas después se realizó el control endoscópico y se encontró cicatrización de las úlceras.

Hallazgos microbiológicos y susceptibilidad antimicrobiana en cirugía abdominal de urgencia / Microbiological findings and antimicrobial susceptibility in emergency abdominal surgery

Resumen Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial. Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la susceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan líquido libre intraperitoneal entre noviembre de 2017 y abril de 2018. Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica. Resultados: De 63 pacientes 55% fueron hombres, edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococcus faecium y Streptococcus anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii. Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

Introduction: It is important to maintain bacterial surveillance programs to decrease resistance and define adequate pharmacological schemes. Patients with abdomen represent a special microbiological group. Objetives: Make a review of pathogens in adult patients operated in our Emergency Service for abdominal pathology with free fluid and analyze the results obtained from cultures with respect to the strains and susceptibility to antibiotics. Materials and Method: Prospective cohort study with descriptive statistics. We include consecutive patients, older than 18 years old, operated on by abdomen who present free intraperitoneal fluid between November 2017 and April 2018. Cases with antimicrobial therapy, hospitalization and/or surgery 3 months prior are excluded. Positive cultures, isolated strains, antimicrobial susceptibility, demographic data and clinical evolution are recorded. Results: Of 63 patients, 55% were men and the average age was 52.2 years. The most frequent pathologies were of appendicular origin (62%) and of enteric origin (30%). In 44% the crop was positive and in 36% with more than one germ. Escherichia coli was the most frequent pathogen (64.2%) followed by Enterococcus faecium and Streptococcus anginosus (7.1%). Of the others, cultivated pathogens have only observed multiple resistance in an isolated case of Morganella Morganii. Conclusions: These data include the local microbiological reality in acute abdomen. Escherichia coli is still the most frequent germ that must be faced with the profile and the appropriate treatment. It is necessary to maintain local microbiology surveillance for a proper management.

Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3. 479 prostate biopsy cases

ABSTRACT Objectives: To investigate the characteristics of cases of NIH category I acute prostatitis developed after transrectal prostate biopsy and clarifiy the risk factors and preventive factors. Materials and Methods: We retrospectively reviewed the medical records of 3.479 cases of transrectal ultrasound-guided needle biopsies performed with different prophylactic antibiotherapy regimens at two different institutions between January 2011 and February 2016. The patients of Group I have received ciprofl oxacin (n=1.523, 500mg twice daily) and the patients of Group II have received ciprofl oxacin plus ornidazole (n=1.956, 500mg twice daily) and cleansing enema combination as prophylactic antibiotherapy. The incidence, clinical features and other related microbiological and clinical data, were evaluated. Results: Mean age was 62.38±7.30 (47-75), and the mean prostate volume was 43.17±15.20 (21-100) mL. Of the 3.479 patients, 39 (1.1%) developed acute prostatitis after the prostate biopsy procedure. Of the 39 cases of acute prostatitis, 28/3.042 occurred after the first biopsy and 11/437 occurred after repeat biopsy (p=0.038). In Group I, 22 of 1.523 (1.4%) patients developed acute prostatitis. In Group II, 17 of 1.959 (0.8%) patients developed acute prostatitis. There was no statistical difference between the two groups according to acute prostatitis rates (X2=2.56, P=0.11). Further, hypertension or DM were not related to the development of acute prostatitis (P=0.76, X2=0.096 and P=0.83, X2=0.046, respectively). Conclusions: Repeat biopsy seems to increase the risk of acute prostatitis, while the use of antibiotics effective for anaerobic pathogens seems not to be essential yet.