Morganella sp. infection in scent gland of corn snake (Pantherophis guttatus) - case report / Infecção por Morganella sp. em glândula de cheiro de corn snake (Pantherophis guttatus) - relato de caso

The corn snake (Pantherophis guttatus) is a non-venomous snake from the Colubridae family. The pair of scent glands is indispensable in the physiology of reproduction and defense of the species. This structure is located caudal to the cloaca. It is responsible for releasing a thick material based on lipids containing pheromones that perform functions associated with animal behavior and survival. This work aims to report infection by Morganella sp. in a scent gland in a female corn snake, evidencing the diagnosis and treatment. An increase in volume was seen in the final third, proximal to the cloaca, firm consistency, immobile, and approximately 4 cm long and painful to touch. Samples of the material were collected for bacterial culture and antibiogram examination, being positive for bacteria of the genus Morganella. Based on the result of the antibiogram, it was possible to determine the most appropriate therapeutic protocol, with the referral to perform the surgical procedure to remove the tissue compromised by the infection, remaining stable until the removal of the stitches 40 days after the procedure, with total surgical wound healing.(AU)

A corn snake (Pantherophis guttatus) é uma serpente não peçonhenta, da família Colubridae. Na fisiologia da reprodução e defesa da espécie, o par de glândulas de cheiro é indispensável. Essa estrutura está localizada caudal à cloaca e é responsável pela liberação de um material espesso à base de lipídeos, contendo feromônios que exercem funções associadas ao comportamento animal e à sua sobrevivência. O objetivo desse trabalho é relatar uma infecção por Morganella sp. em glândula de cheiro em uma fêmea de corn snake, evidenciando o diagnóstico e tratamento. Observou-se um aumento de volume no terço final, proximal a cloaca, de consistência firme, imóvel e com aproximadamente 4 cm de comprimento e sensibilidade dolorosa ao toque. Foram coletadas amostras do material para cultura bacteriana e exame de antibiograma, sendo positivo para bactérias do gênero Morganella. Com base no resultado do antibiograma, foi possível determinar o protocolo terapêutico mais adequado, como o encaminhamento para realização do procedimento cirúrgico para remoção do tecido comprometido pela infecção, se mantendo estável até a remoção dos pontos, 40 dias após o procedimento, com total cicatrização da ferida cirúrgica.(AU)

Primeros aislados de Enterobacter cloacae complex co-productores de KPC y NDM en un hospital de segundo nivel en la Cuidad de Panamá / First isolates of Enterobacter cloacae complex co-producing KPC and NDM in a second level hospital in City of Panama

Resumen La aparición de Enterobacterales co-productores de dos o más carbapenemasas han despertado las alertas sanitarias en Latinoamérica. Las enterobacterias co-productoras de carbapenemasas KPC y NDM-1 son resistentes a casi todos los antibacterianos existentes. Panamá ha reportado la presencia de carbapenemasas KPC desde 2010 y NDM desde 2011; sin embargo, Enterobacterales con doble producción de carbapenemasas es un fenómeno reciente en nuestros hospitales. Presentamos los dos primeros aislados de Enterobacter cloacae complex co-productores de KPC y NDM, en un hospital de segundo nivel de la Ciudad de Panamá. El reforzamiento de los sistemas de vigilancia epidemiológica en los hospitales permite realizar una detección oportuna de estas nuevas combinaciones de mecanismos de resistencia; para así, implementar medidas de prevención y control de brotes.

Abstract Enterobacterales co-producing carbapenemases have awakened health alerts in Latin America. Carbapenemase-producing Enterobacterales harboring KPC and NDM-1 are resistant to almost all existing antibiotics. Panama reports KPC since 2010, and NDM since 2011, however, Enterobacterales with double carbapenemase production is new to our hospitals. We present the first two isolates of Enterobacter cloacae complex co-producing KPC and NDM, in a second level hospital in Panama City. Strengthening epidemiological surveillance systems in hospitals allows to carry out timely detection of these new combinations of resistance; to implement outbreak prevention and control measures.

Detection of beta-lactamase-producing Enterobacteriaceae in a veterinary hospital environment / Detecção de Enterobactérias produtoras de beta-lactamases em ambiente hospitalar veterinário

Due to the strong selective pressure resulting from the misuse of antibiotics, the natural process of bacterial resistance has been accelerated, leading to the increasingly constant appearance of multiresistant isolates. The high number of multi-resistant bacteria is a one health problem. Enterobacteriaceae are usually commensal bacteria of the gastrointestinal tract. However, they can cause infections, and the most important resistance characteristic among them is the production of ß-lactamases. This study aimed to identify ESBL-producing Enterobacteriaceae of types of TEM, SHV, and the CTX-Mgroups. To isolate the enterobacteria, swabs were collected by swiping objects that had contact with the patients and professionals, and the water of the hospital environment. Ten collections were carried out, yielding 306 samples, from which 118 enterobacteria were identified: Escherichia coli, Enterobacter spp., Klebsiella spp., Proteus mirabilis, Serratiaspp., and Citrobacter spp. Isolates. The genes TEM and CTX-M, for the production of ß-lactamases, were detected in 12.7% of the 118 enterobacterial isolates. It is very important to know the bacterial population circulating in the veterinary hospital environment and its resistance to antimicrobials so that professionals can take appropriate measures to minimize the risks of transmission, especially from cages and consultation tables. In addition, the correct control of the microbiological quality of the supply water, as well as environmental cleaning procedures, are essential to prevent the transmission of these microorganisms.(AU)

Devido à grande pressão seletiva decorrente do uso indevido de antibióticos, tem se acelerado o processo natural de resistência das bactérias, levando ao aparecimento cada vez mais constante de isolados multirresistentes. O elevado número de bactérias multirresistentes identificadas é um problema da saúde única. As enterobactérias são bactérias geralmente comensais do trato gastrointestinal, entretanto podem causar infecções, e a característica de resistência mais importante entre elas é a produção de ß-lactamases. Buscando caracterizar melhor os microrganismos circulantes e potencialmente causadores de infecções em ambiente hospitalar veterinário, este estudo objetivou identificar as enterobactérias produtoras de ESBL do tipo TEM, SHV e os cinco grupos de CTX-M presentes em isolados circulantes em hospital veterinário. Foi realizada coleta de suabes de arrasto de objetos que entram em contato com os pacientes e com os profissionais que ali trabalham, bem como de água, para a identificação das enterobactérias. Foram realizadas 10 coletas, obtendo-se 306 amostras, dessas, 118 enterobactérias foram identificadas: Escherichia coli, Enterobacter, Klebsiella, Proteus mirabilis, Serratia e Citrobacter. Dentre as enterobactérias identificadas, alguns isolados possuíam genes para a produção de ß-lactamases, do tipo TEM e CTX-M. É de grande importância conhecer a população bacteriana circulante no ambiente hospitalar veterinário, e a sua resistência aos antimicrobianos, para que os profissionais possam tomar medidas apropriadas para minimizar os riscos de transmissão, principalmente a partir de gaiolas e mesas de atendimento. Além disso, o correto controle da qualidade microbiológica da água de abastecimento, bem como dos procedimentos de higienização do ambiente, são fundamentais para evitar a transmissão destes microrganismos.(AU)

Marcadores hematológicos y bioquímicos para el diagnóstico precoz de bacteriemiascausadas por Enterobacteriaceae resistentes a los carbapenémicos / Haematological and biochemical markers for the early diagnosis of bacteremias caused bycarbapenem-resistant Enterobacteriaceae

INTRODUCCIÓN. Las bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos se asocian con altas tasas de mortalidad a diferencia de las bacteriemias causadas por Enterobacteriaceae sensibles a carbapenémicos. Los hallazgos clínicos y de laboratorio son importantes para determinar los esquemas terapéuticos y su pronóstico; su diagnóstico precoz resulta esencial para un manejo adecuado. OBJETIVO. Relacionar valores de marcadores sanguíneos y bioquímicos en bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 427 y muestra de 224 datos de hemocultivos positivos para Enterobacteriaceae de pacientes atendidos en el Hospital de Especialidades Carlos Andrade Marín en el periodo mayo 2016 a julio 2018. Criterios de inclusión: i) al menos un hemocultivo positivo; ii) recuperación del aislado de CRE o CSE y iii) recolección simultanea de muestras de sangre y pruebas de laboratorio. Criterios de exclusión: i) bacteriemias polimicrobianas; ii) valores fuera de rango y iii) reportes sin valores numéricos. El análisis de datos se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences versión 24.0. RESULTADOS. Se demostró que el recuento de leucocitos [OR 1,21 (95% IC: 1,03-1,43)], el recuento de plaquetas [OR 1,65 (95% IC: 1,37-1,98)] y el tiempo parcial de tromboplastina [OR 1,29 (95% IC: 1,04-1,60)] fueron buenas variables predictoras independientes, mediante análisis de regresión logística multivariante. CONCLUSIÓN. La trombocitopenia y el tiempo parcial de tromboplastina prolongado se asociaron con bacteremia causada por Enterobacteriaceae resistentes a carbapenémicos.

INTRODUCTION. Bacteremias caused by carbapenem-resistant Enterobacteriaceae are associated with high mortality rates in contrast to bacteremias caused by carbapenem-sensitive Enterobacteriaceae. Clinical and laboratory findings are important in determining therapeutic regimens and prognosis; early diagnosis is essential for appropriate management. OBJECTIVE. To relate blood and biochemical marker values in bacteremia caused by carbapenem-resistant Enterobacteriaceae. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 427 and sample of 224 blood culture data positive for Enterobacteriaceae from patients attended at the Carlos Andrade Marín Specialties Hospital in the period May 2016 to July 2018. Inclusion criteria: i) at least one positive blood culture; ii) recovery of CRE or CSE isolate and iii) simultaneous collection of blood samples and laboratory tests. Exclusion criteria: i) polymicrobial bacteremia; ii) out-of-range values and iii) reports without numerical values. Data analysis was performed using the statistical program International Business Machines Statistical Package for the Social Sciences version 24.0. RESULTS. Leukocyte count [OR 1.21 (95% CI: 1.03-1.43)], platelet count [OR 1.65 (95% CI: 1.37- 1.98)] and partial thromboplastin time [OR 1.29 (95% CI: 1.04-1.60)] were shown to be good independent predictor variables, by multivariate logistic regression analysis. CONCLUSION. Thrombocytopenia and prolonged partial thromboplastin time were associated with bacteremia caused by carbapenem-resistant Enterobacteriaceae.

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.

Caractérisation phénotypique des bétalactamases de souches d'enterobacteries multi résistantes isolées de divers produits pathologiques

Introduction: Les entérobactéries constituent les principales causes d'infections bactériennes.Ce sont des Bactéries Multi- résistantes (BMR)fréquentes par production de BLSE(Bêtalactamases à spectre élargi).Ceci constitue un problème de santé publique majeur car cette résistance est à l'origine d'une impasse thérapeutique et conduit à une prescriptiond'antibiotiques à large spectre (carbapénèmes). Notre étude prospective allant du 01 janvier au 31 décembre 2017 a porté sur 50 souches d'entérobactéries isolées au laboratoire et a pour but de caractériser les types de bêtalactamases.Méthodologie : Les souches ont été ré-isolées d'abord sur milieu Mueller Hinton, ensuite identifiées par la morphologie et les caractères biochimiques des entérobactéries. Les méthodes suivantes ont été réalisées pour la mise en évidence des classes de BLSE. - Méthode de rapprochement des disques (synergie entre un disque Amoxicilline + Acide clavulanique (AMC) et les disques de Céphalosporine de 3ieme (C3G) : BLSE de classe A. - Méthode de Dongeun Yong et al. utilisant l'EDTA (Ethylène Diamine Tétra-acétique) 0,5 M, PH 7 (Inhibition du zinc présent sur le site actif de l'enzyme par l'EDTA): BLSE de classe B. Résultat : Les souches d'entérobactéries étaient réparties ainsi : Enterobacter spp : 40%, Escherichia coli : 32%, Klebsiella pneumoniae : 24% et Klebsiella oxytoca : 4%. Cinquante-six pour cent 56% des souches produisaient une BLSE de classe A (image « bouchon de champagne ») et 14% une BLSE de classe B avec restauration de l'activité de l'imipenème après association de l'EDTA. Enterobacter spp était la souche la plus représentée avec 12 souches sécrétrices d'une BLSE de classe A et 5 souches de classe B, suivie d'E. coli avec 08 souches sécrétrices d'une BLSE de classe A et 01 souche de classe B. K. pneumoniae et K. oxytoca comptaient respectivement 06 et 02 souches sécrétrices de BLSE de classe A. Conclusion : L'acquisition par les entérobactéries et la transmission de résistance, par production de BLSE de classe A ou B est un problème majeur de santé publique causant une véritable impasse thérapeutique. Aujourd'hui, la prévalence de la résistance par production de Métallo-bêtalactamase (MBL) est faible comparée à celle de BLSE de classe A. Ainsi, des stratégies de diagnostic et de maîtrise de la diffusion doivent être appliquées rigoureusement

Enfermedad granulomatosa crónica: infecciones múltiples como forma de presentación. Caso clínico pediátrico / Chronic granulomatous disease: multiple infections as clinical presentation. Pediatric case report

La enfermedad granulomatosa crónica es una inmunodeficiencia primaria infrecuente, debida a un defecto en la actividad microbicida de los fagocitos, originada por mutaciones en los genes que codifican alguna de las subunidades del complejo enzimático nicotinamida adenina dinucleótido fosfato oxidasa. La incidencia estimada es 1 en 250 000 recién nacidos vivos. Puede presentarse desde la infancia hasta la adultez, por lo general, en menores de 2 años. Las infecciones bacterianas y fúngicas, en conjunto con las lesiones granulomatosas, son las manifestaciones más habituales de la enfermedad. Los microorganismos aislados más frecuentemente son Aspergillus spp., Staphylococcus aureus, Serratia marcescens, Nocardia spp. Se reporta el caso clínico de un varón de 1 año de vida en el que se diagnosticó enfermedad granulomatosa crónica a partir de infecciones múltiples que ocurrieron simultáneamente: aspergilosis pulmonar invasiva, osteomielitis por Serratia marcescens y granuloma cervical por Enterobacter cloacae.

Chronic granulomatous disease is an uncommon primary immunodeficiency due to a defect of the killing activity of phagocytes, caused by mutations in any of the genes encoding subunits of the superoxide-generating phagocyte NADPH oxidase system. The incidence is 1 in 250 000 live births. It can occur from infancy to adulthood, usually in children under 2 years. Bacterial and fungal infections in association with granuloma lesions are the most common manifestations of the disease. Aspergillus species, Staphylococcus aureus, Serratia marcescens, Nocardia species are the most common microorganisms isolated. We describe here a case of a 1-year-old boy with chronic granulomatous disease and invasive pulmonary aspergillosis, Serratia marcescens osteomyelitis and Enterobacter cloacae cervical granuloma.

Performance of rapid tests for carbapenemase detection among Brazilian Enterobacteriaceae isolates

ABSTRACT The global emergence of carbapenemases led to the need of developing new methods for their rapid detection. The aim of this study was to evaluate the performance of the rapid tests for carbapenemase-producing and non-producing Enterobacteriaceae. Carbapenem non-susceptible Enterobacteriaceae from a surveillance study submitted to a multiplex real time PCR for carbapenemase detection were included in this study. The isolates were subjected to the rapid phenotypic tests Carba NP, Blue-Carba and Carbapenem Inactivation Method (CIM). A total of 83 carbapenemase-producing (43) and non-producing (40) isolates were included in the study. The sensitivity/specificity were 62.7%/97.5%, 95.3%/100%, and 74.4%/97.5% for Carba NP, Blue-Carba and CIM, respectively. Both Carba NP and Blue-Carba presented their final results after 75 min of incubation; the final results for CIM were obtained only after 8 h. Failure to detect OXA-370 carbapenemase was the main problem for Carba NP and CIM assays. As the Blue-Carba presented the highest sensitivity, it can be considered the best screening test. Conversely, CIM might be the easiest to perform, as it does not require special reagents. The early detection of carbapenemases aids to establish infection control measures and prevent carbapenemases to spread reducing the risk of healthcare associated infections and therapeutic failure.

Evaluación de tres métodos de tamizaje para detección de Enterobacteriaceae productoras de carbapenemasas en hisopados rectales / Evaluation of three screening methods for detection of carbapenemase-producing Enterobacteriaceae in rectal swabs

Resumen Introducción: Las Enterobacteriaceae productoras de carbapenemasas (EPC) han tomado gran importancia en salud pública a una escala global, haciendo necesario implementar test rápidos para su detección oportuna. Objetivo: Evaluar tres metodologías para el tamizaje de EPC en hisopados rectales. Materiales y Métodos: Estudio prospectivo transversal. Se evaluaron 73 hisopados rectales por tres metodologías. Se realizó identificación y evaluación de susceptibilidad por sistemas automatizados y la producción de carbapenemasas se confirmó por test de Hodge modificado, sinergia con ácido borónico y EDTA. Resultados: Método 1 (ChromID CARBA®): detectó 20 muestras positivas (27,4%), 5 falsos positivos (6,9%), con índice de concordancia de 93,2%, sensibilidad 100% y especificidad de 90%. Método 2 (HB&L Carbapenemase®): detectó 17 muestras positivas (23,3%) y 3 falsos negativos (4,1%). La sensibilidad y especificidad fue 85 y 100% respectivamente, con concordancia de 95,9%. Método 3 (Xpert Carba-R®): detectó 19 muestras positivas (57,5 %) y 1 falso negativo (3,1%), sensibilidad 95%, especificidad 100% e índice de concordancia de 97%. Discusión: Existe amplia variedad de metodologías para búsqueda y detección rápida de microorganismos productores de carbapenemasas. La elección del método debe tener como requisito una buena sensibilidad y especificidad, rapidez y costo efectividad.

Background: Carbapenemase-producing Enterobacteriaceae (CPE) have taken great importance on public health at global scale, which makes it necessary to implement rapid test for its prompt detection. Aim: To evaluate three screening methods to detect CPE in rectal swabs. Material and Methods: Transverse study, prospective. Seventy three rectal swabs were evaluated by three methodologies. Microorganism identification and susceptibility testing were made using automated systems. Carbapenemase production was confirmed by modified Hodge test and synergy tests using boronic acid and EDTA. Results: The method 1 (ChromID CARBA®) detected 20 positive samples (27.4%), 5 false positives (6.9 %), with concordance index of 93.2%, sensitivity 100% and specificity of 90%. Method 2 (HB&L Carbapenemase®) detected 17 positive samples (23.3%) and 3 false negatives (4.1%). The sensitivity and specificity of the assay were 85% and 100%, with concordance index of 95.9%. Method 3 (Xpert Carba-R®) detected 19 positive samples (57.5%) and 1 false negatives (3.1%), sensitivity 95%, specificity 100% and concordance index of 97%. Discussion: There is a wide variety of methodologies for rapid detection of carbapenemase-producing microorganisms. Choosing the best method must have as requirement a good sensitivity, specificity, and cost-effectiveness.

Estudio clínico y microbiológico de la infección urinaria asociada a catéter, en los servicios de medicina interna de un hospital universitario venezolano / Clinical and microbiological study of catheter-associated urinary tract infections in internal medicine services of a Venezuelan university hospital

RESUMEN Objetivos Determinar las características clínicas y microbiológicas de las infecciones del tracto urinario asociadas a catéter (ITUAC) en pacientes hospitalizados en los servicios de Medicina Interna del Hospital Universitario de Los Andes (HULA), Mérida, Venezuela y establecer la distribución clonal de Enterobacteriaceae multirresistentes productoras de esta infección. Materiales y métodos Se estudiaron 73 pacientes adultos con cateterismo vesical, durante enero a julio de 2015. El procesamiento microbiológico de las muestras de orina se realizó por métodos convencionales y automatizados. Las β-lactamasas de espectro extendido (BLEE) y carbapenemasas fueron detectadas fenotípicamente. La tipificación clonal se determinó por la amplificación de secuencias repetitivas por PCR. Resultados El 53,4% de los pacientes eran varones, con una edad media de 50,6 años. El promedio de permanencia del catéter fue de 10,9 + 6,5 días/paciente. El 54,8% de los pacientes tuvo urocultivos positivos. Las levaduras fueron el principal agente etiológico (44,7%), seguido por las enterobacterias (29,8%). Las enterobacterias, Pseudomonas aeruginosa y Acinetobacter baumannii produjeron BLEE y carbapenemasas asociadas a otros marcadores de resistencia. Dos grupos clonales fueron identificados en cepas de E. coli y K. pneumoniae multirresistentes, los cuales circularon en la unidad de trauma shock de la emergencia de adulto. Conclusiones Los hallazgos de este estudio permiten evidenciar la necesidad de adoptar estrictos criterios que justifiquen el uso del catéter vesical y la duración del mismo, así como el implementar programas para prevenir y controlar la diseminación de clonas bacterianas multirresistentes en pacientes con ITUAC en los servicios de medicina interna del HULA.

ABSTRACT Objectives To determine the clinical and microbiological characteristics of catheter-associated urinary tract infections (CA-UTI) in patients admitted to the Internal Medicine services of the Hospital Universitario de Los Andes (HULA), Mérida, Venezuela and to establish the clonal distribution of multi-resistant Enterobacteriaceae that produce this infection. Materials and Methods Seventy-three adult patients with bladder catheterization were studied between January and July 2015. The microbiological processing of the urine samples was performed using conventional and automatized methods. Extended- spectrum beta-lactamase (ESBL) and carbapenemase were detected phenotypically. Clonal classification was determined using repetitive element sequence-based PCR. Results A total of 53.4% of the patients were male, and the average age was 50.6 years. The average time the catheter remained in the patient was 10.9 ± 6.5 days and 54.8% of patients had positive urine cultures. Yeasts were the main etiological agent (44.7%), followed by enterobacteria (29.8%). Enterobacteria, Pseudomonas aeruginosa, and Acinetobacter baumannii produced ESBL and carbapenemase associated with other resistance markers. Two clonal groups were identified in multi-resistant Escherichia coli and Klebsiella pneumoniae strains that circulated in the shock trauma unit in the adult emergency department. Conclusions The findings in this study show the need to adopt strict criteria justifying the use of bladder catheterization and its duration, as well as the implementation of programs to prevent and control the spread of multi-resistant bacterial clones in patients with CA-UTI in the HULA Internal Medicine department.

Prevalence and Molecular Characteristics of Carbapenemase-Producing Enterobacteriaceae From Five Hospitals in Korea

BACKGROUND: The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem because these bacteria are resistant to most antibiotics. CPE remain relatively uncommon in Korea. We report the prevalence, clinical characteristics, and molecular epidemiology of CPE isolates collected from five university hospitals in Korea. METHODS: Between January and December 2015, 393 non-duplicated isolates that were nonsusceptible to ertapenem were analyzed. Production of carbapenemase, extended-spectrum β-lactamase, and AmpC β-lactamase was determined by genotypic tests. Antimicrobial susceptibility profiles were determined by using an Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC)-2-producing and oxacillinase (OXA)-232-producing Klebsiella pneumoniae isolates was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Of the 393 isolates tested, 79 (20.1%) were CPE. Of these 79 isolates, 47 (59.5%) harbored the bla(OXA-232) gene while the remaining isolates carried genes bla(KPC-2) (n=27), bla(IMP-1) (n=4), and bla(NDM-1) (n=1). Among the 24 KPC-2 K. pneumoniae isolates from hospital B, 100% were resistant to carbapenems, 8% to colistin, and 0% to tigecycline. Among the 45 OXA-232 K. pneumoniae at hospital C, 95% were resistant to ertapenem, 68% to imipenem, 95% to meropenem, 10% to colistin, and 24% to tigecycline. PFGE analysis revealed a unique pattern for KPC-2 K. pneumoniae and identified 30 isolates belonging to the dominant pulsotypes (PT)1 and PT2 among 41 OXA-232 K. pneumoniae isolates. CONCLUSIONS: CPE strains are present in Korea, with the majority of K. pneumoniae isolates producing OXA-232 and KPC-2. The prevalence and predominant genotypes of CPE show hospital-specific differences.

Clinico-microbiological study of Citrobacter isolates from various clinical specimens and detection of β-lactamase production.

Citrobacter species have been reported to cause a wide spectrum of infections in humans and invasive infections are associated with a high mortality rate, with 33 to 48% of patients succumbing to Citrobacter bacteraemia. The high mortality rate associated with Citrobacter infections may be due in part to ineffective empirical antibiotic therapy. Citrobacter has been found to produce SHV and TEM derived Extended spectrum beta lactamases in addition to chromosomal inducible AmpC beta - lactamases which could be contributing to increasing drug resistance. The aims of the study were to detect the prevalence of Citrobacter infections with its associated risk factors, antibiotic susceptibility patterns and determination of beta-lactamase activity- both extended spectrum beta - lactamase and AmpC beta-lactamase activity among Citrobacter isolates. The isolates were identified by standard microbiological procedures. ESBL detection was by double disc diffusion method and AmpC beta-lactamase detection was done using Cefotaxime and Cefoxitin discs. C. braakii (33.3%) was the commonest genomospecies identified followed by C. freundii (21.3%) and C. amalonaticus (16.66 %) among 150 Citrobacter isolates. Diabetes mellitus was the major risk factor. Imipenem (100%)was most effective whereas 98% showed resistance to Ampicillin; carbapenems and fourth generation Cefipime showed better sensitivity than third generation cephalosporins. The study highlights the need for informed antibiotic treatment guided by routine antimicrobial susceptibility and knowledge of the ESBL status of the isolate, the outcome of which undoubtedly will be better patient care.

Concordância dos resultados do sistema BD Phoenix com provas bioquímicas manuais na identificação de enterobactérias em amostras clínicas / Agreement of results of the BD Phoenix system and manual biochemical tests in the identification of Enterobacteriaceae from clinical samples

Enterobactérias pertencem a um grupo grande e heterogêneo de bacilos Gram-negativos cujo habitat natural é o cólon de humanos e animais, sendo microrganismos amplamente distribuídos na natureza. Devido a essas características são frequentemente responsáveis por infecções hospitalares. O principal objetivo desse estudo foi avaliar a concordância entre as provas bioquímicas manuais e o sistema automatizado BD Phoenix 100 na identificação de enterobactérias, a partir da análise de registros de pacientes hospitalizados. Métodos: No período de agosto de 2011 a abril de 2012, foram realizados 303 exames no Laboratório Exame de Análises Clinicas pelos métodos manual e automatizado, os quais foram submetidos a análise dos dados. Resultados: Do total, 27,7% foram positivos para enterobactérias. Os microrganismos mais frequentes isolados foram a Klebsiella pneumoniae (36,9%) e Escherichia coli (29,8%). O estudo apresentou uma alta concordância entre os métodos, principalmente na identificação dos gêneros, caso em que a concordância chegou a 97% dos registros. Na identificação das espécies, as bactérias dos gêneros Klebsiella spp. e Serratia spp. não tiveram suas espécies identificadas pelo método manual em sete dos registros observados, sendo identificadas somente pela automação. Da mesma forma, algumas amostras de Escherichia coli não foram detectadas pelo método manual, que as identificou como indeterminadas em quatro dos registros analisados. Conclusão: Verificou-se uma boa concordância entre os métodos na identificação das principais enterobactérias isoladas de amostras clínicas...

Enterobacteriaceae are microorganisms that are widely distributed in nature and belong to a large and heterogeneous group of Gram-negative bacilli whose natural habitat is the colon of human beings and animals and are. Because of these characteristics they are often responsible for hospital infections. The main objective of this study was to assess the agreement between manual biochemical tests and the BD Phoenix 100 automated system in the identification of the Enterobacteriaceae, based on an analysis of hospitalized patients’ records. Methods: In the period between August 2011 and April 2012, 303 tests were made at Laboratório Exame de Análises Clinicas by the manual and automated methods, which were subjected to analysis. Results: Results revealed that 27.7% of the tests were positive for Enterobacteriaceae. The most commonly isolated microorganisms were Klebsiella pneumoniae (36.9%) and Escherichia coli (29.8%). The study showed a high agreement between the methods, especially in the identification of genders, in which case agreement reached 97% of records. When it comes to identifying the species, seven samples of Klebsiella spp. and Serratia spp. bacteria had their species identified only by the automated method and not by the manual method. Similarly, some samples of Escherichia coli, were not detected by the manual, which identified them as indeterminate in four of the records analyzed. Conclusions: There was a good agreement between both methods in identifying the major Enterobacteriaceae isolated from clinical samples...

Clinical and microbiological features of Providencia bacteremia: experience at a tertiary care hospital

BACKGROUND/AIMS: Providencia species frequently colonize urinary catheters and cause urinary tract infections (UTIs); however, bacteremia is uncommon and not well understood. We investigated the clinical features of Providencia bacteremia and the antibiotic susceptibility of Providencia species. METHODS: We identified cases of Providencia bacteremia from May 2001 to April 2013 at a tertiary care hospital. The medical records of pertinent patients were reviewed. RESULTS: Fourteen cases of Providencia bacteremia occurred; the incidence rate was 0.41 per 10,000 admissions. The median age of the patients was 64.5 years. Eleven cases (78.6%) were nosocomial infections and nine cases (64.3%) were polymicrobial bacteremia. The most common underlying conditions were cerebrovascular/neurologic disease (n = 10) and an indwelling urinary catheter (n = 10, 71.4%). A UTI was the most common source of bacteremia (n = 5, 35.7%). The overall mortality rate was 29% (n = 4); in each case, death occurred within 4 days of the onset of bacteremia. Primary bacteremia was more fatal than other types of bacteremia (mortality rate, 75% [3/4] vs. 10% [1/10], p = 0.041). The underlying disease severity, Acute Physiologic and Chronic Health Evaluation II scores, and Pitt bacteremia scores were significantly higher in nonsurvivors (p = 0.016, p =0.004, and p = 0.002, respectively). Susceptibility to cefepime, imipenem, and piperacillin/tazobactam was noted in 100%, 86%, and 86% of the isolates, respectively. CONCLUSIONS: Providencia bacteremia occurred frequently in elderly patients with cerebrovascular or neurologic disease. Although Providencia bacteremia is uncommon, it can be rapidly fatal and polymicrobial. These characteristics suggest that the selection of appropriate antibiotic therapy could be complicated in Providencia bacteremia.

Combined Use of the Modified Hodge Test and Carbapenemase Inhibition Test for Detection of Carbapenemase-Producing Enterobacteriaceae and Metallo-beta-Lactamase-Producing Pseudomonas spp

BACKGROUND: We evaluated the combined use of the modified Hodge test (MHT) and carbapenemase inhibition test (CIT) using phenylboronic acid (PBA) and EDTA to detect carbapenemase-producing Enterobacteriaceae (CPE) and metallo-beta-lactamase (MBL)-producing Pseudomonas spp. METHODS: A total of 49 isolates of CPE (15 Klebsiella pneumoniae carbapenemase [KPC], 5 Guiana extended-spectrum beta-lactamase [GES]-5, 9 New Delhi metallo-beta-lactamase [NDM]-1, 5 Verona integron-encoded metallo-beta-lactamase [VIM]-2, 3 imipenem-hydrolyzing beta-lactamase [IMP], and 12 oxacillinase [OXA]-48-like), 25 isolates of MBL-producing Pseudomonas spp. (14 VIM-2 and 11 IMP), and 35 carbapenemase-negative controls were included. The MHT was performed for all isolates as recommended by the Clinical and Laboratory Standards Institute. Enhanced growth of the indicator strain was measured in mm with a ruler. The CIT was performed by directly dripping PBA and EDTA solutions onto carbapenem disks that were placed on Mueller-Hinton agar plates seeded with the test strain. RESULTS: Considering the results of the MHT with the ertapenem disk in Enterobacteriaceae and Pseudomonas spp., the CIT with the meropenem disk in Enterobacteriaceae, and the imipenem disk in Pseudomonas spp., three combined disk tests, namely MHT-positive plus PBA-positive, EDTA-positive, and MHT-positive plus PBA-negative plus EDTA-negative, had excellent sensitivity and specificity for the detection of KPC- (100% sensitivity and 100% specificity), MBL- (94% sensitivity and 100% specificity), and OXA-48-like-producing isolates (100% sensitivity and 100% specificity), respectively. CONCLUSIONS: Combined use of the MHT and CIT with PBA and EDTA, for the detection of CPE and MBL-producing Pseudomonas spp., is effective in detecting and characterizing carbapenemases in routine laboratories.

A comparison of the clinical characteristics of elderly and non-elderly women with community-onset, non-obstructive acute pyelonephritis

BACKGROUND/AIMS: Acute pyelonephritis (APN) is the most common cause of community-onset bacteremia in hospitalized elderly patients. The objectives of this study were to investigate the differences in the clinical and microbiological data of hospitalized elderly and non-elderly women with community-onset APN. METHODS: Women with community-onset APN as a discharge diagnosis were identified from January 2004 to December 2013 using an electronic medical records system. We compared the clinical and microbiologic data in elderly and non-elderly women with community-onset APN due to Enterobacteriaceae. RESULTS: Of the 1,134 women with community-onset APN caused by Enterobacteriaceae, 443 were elderly and 691 were non-elderly women. The elderly group had a lower frequency of upper and lower urinary tract symptoms/signs than the non-elderly. The incidence of bacteremia, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, patients with a C-reactive protein (CRP) level > or = 15 mg/dL, and patients with a leukocyte count > or = 15,000/mm3 in the blood, were significantly higher in the elderly group than in the non-elderly group. The proportion of patients requiring hospitalization for 10 days or more was significantly higher in the elderly group compared to the non-elderly group (51.5% vs. 26.2%, p < 0.001). The clinical cure rates at 4 to 14 days after the end of therapy were 98.3% (338/344) and 97.4% (519/533) in the elderly and non-elderly groups, respectively (p = 0.393). CONCLUSIONS: Elderly women with APN exhibit higher serum CRP levels, a higher frequency of bacteremia, a higher proportion of ESBL-producing uropathogens, and require a longer hospitalization than non-elderly women, although these patients may not complain of typical urinary symptoms.

Development of a multiplex PCR assay to detect Edwardsiella tarda, Streptococcus parauberis, and Streptococcus iniae in olive flounder (Paralichthys olivaceus)

A multiplex PCR protocol was established to simultaneously detect major bacterial pathogens in olive flounder (Paralichthys olivaceus) including Edwardsiella (E.) tarda, Streptococcus (S.) parauberis, and S. iniae. The PCR assay was able to detect 0.01 ng of E. tarda, 0.1 ng of S. parauberis, and 1 ng of S. iniae genomic DNA. Furthermore, this technique was found to have high specificity when tested with related bacterial species. This method represents a cheaper, faster, and reliable alternative for identifying major bacterial pathogens in olive flounder, the most important farmed fish in Korea.

Pantoea dispersa: an unusual cause of neonatal sepsis

Neonatal septicemia is the most important cause of neonatal mortality. A wide variety of bacteria both aerobic and anaerobic can cause neonatal sepsis. Genus Pantoea is a member of Enterobacteriaceae family that inhabits plants, soil and water and rarely causes human infections, however, Pantoea dispersa has not been reported as a causative organism for neonatal sepsis. We hereby report two neonates with early onset sepsis caused by Pantoea dispersa. Early detection and appropriate antibiotic therapy can improve overall outcome of this rare infection in neonates.

First reported case of pneumonia caused by Cedecea lapagei in America

Cedecea represents a genus in the Enterobacteriaceae family that has been rarely associated with human infection. The clinical relevance of Cedecea lapagei has yet to be elucidated. This is the first reported case of pneumonia due to C. lapagei in a patient with acute promyelocytic leukemia.

Infección de herida traumática por Cedecea lapagei: Comunicación de un caso y revisión de la literatura / Cedecea lapagei traumatic wound infection: Case report and literature review

Cedecea lapagei is a gram-negative, facultative anaerobic, non-spore-forming bacteria, belonging to the family Enterobacteriaceae. It has been reported as a pathogen in few cases of bacterial peritonitis, wound infection, chemicals burns and pneumonia. We report a case of traumatic wound infection by this pathogen with a pertinent review.

Cedecea lapagei es un bacilo gramnegativo, anaerobio facultativo, no formador de esporas, perteneciente a la familia Enterobacteriaceae. Se han comunicado escasos casos en la literatura científica entre los cuales se destacan una peritonitis bacteriana, una infección de herida por quemadura química y una neumonía. A continuación se presenta el caso de una infección por este patógeno en una herida traumática. Se realiza una revisión bibliográfica del tema.