Antimicrobial resistance and plasmid-mediated colistin resistance mechanism of diarrheagenic Escherichia coli recovered from foods in parts of China in 2020 / 中华预防医学杂志

Objective: To investigate the antimicrobial resistance of food-borne diarrheagenic Escherichia coli (DEC) and the prevalence of mcr genes that mediates mobile colistin resistance in parts of China, 2020. Methods: For 91 DEC isolates recovered from food sources collected from Fujian province, Hebei province, Inner Mongolia Autonomous Region and Shanghai city in 2020, Vitek2 Compact biochemical identification and antimicrobial susceptibility testing platform was used for the detection of antimicrobial susceptibility testing (AST) against to 18 kinds of antimicrobial compounds belonging to 9 categories, and multi-polymerase chain reaction (mPCR) was used to detect the mcr-1-mcr-9 genes, then a further AST, whole genome sequencing (WGS) and bioinformatics analysis were platformed for these DEC isolates which were PCR positive for mcr genes. Results: Seventy in 91 isolates showed different antimicrobial resistance levels to the drugs tested with a resistance rate of 76.92%. The isolates showed the highest antimicrobial resistance rates to ampicillin (69.23%, 63/91) and trimethoprim-sulfamethoxazole (59.34%, 54/91), respectively. The multiple drug-resistant rate was 47.25% (43/91). Two mcr-1 gene and ESBL (extended-spectrum beta-lactamase) positive EAEC (enteroaggregative Escherichia coli) strains were detected. One of them was identified as serotype of O11:H6, which showed a resistance profile to 25 tested drugs referring to 10 classes, and 38 drug resistance genes were predicted by genome analysis. The other one was O16:H48 serotype, which was resistant to 21 tested drugs belonging to 7 classes and carried a new variant of mcr-1 gene (mcr-1.35). Conclusion: An overall high-level antimicrobial resistance was found among foodborne DEC isolates recovered from parts of China in 2020, and so was the MDR (multi-drug resistance) condition. MDR strains carrying multiple resistance genes such as mcr-1 gene were detected, and a new variant of mcr-1 gene was also found. It is necessary to continue with a dynamic monitoring on DEC contamination and an ongoing research into antimicrobial resistance mechanisms.

Caracterização fenotípica e molecular de isolados de Salmonella spp. e Escherichia coli Patogênica Extraintestinal resistentes às polimixinas / Phenotypic and molecular characterization of Salmonella spp. and extraintestinal pathogenic Escherichia coli resistant to polymyxins

A resistência antimicrobiana está se tornando um grande desafio para saúde pública devido ao aumento da resistência aos beta-lactâmicos em geral. Os isolados de Salmonella spp. e Escherichia coli são os mais frequentes agentes causadores de doenças de transmissão hídrica e alimentar, mas também podem causar doenças invasivas graves, principalmente em imunodeprimidos, idosos e crianças. Ambos os patógenos vêm apresentando perfis de resistência as principais classes de antibióticos, nestes casos é necessária a busca de uma nova opção terapêutica, como por exemplo, as polimixinas. Em 2015, surgiu o primeiro relato da resistência às polimixinas mediado pelo gene mcr (mobile colistin resistance), que se disseminou por diversos continentes e ocasionou uma grande preocupação global em saúde pública. O objetivo deste trabalho foi identificar e caracterizar os mecanismos que medeiam à resistência à polimixinas em cepas de Salmonella spp. e E. coli Patogênica extraintestinal (ExPEC). Foi realizado a triagem pelo teste da gota e teste da CIM frente a colistina e polimixina B no total de 1026 isolados de Salmonella enterica e 159 isolados de ExPEC. Nos isolados resistentes foi verificado a presença de mutações nos genes (pmrA/B, phoP/Q) associados à resistência às polimixinas, e através da PCR foi feita a identificação dos genes de resistência plasmidial (mcr). Das 124 cepas de Salmonella resistentes a colistina e polimixina B, apenas um isolado foi positivo para o gene mcr-1, e este gene foi detectado em um plasmídeo do grupo IncX4. A cepa 2018.466 foi caracterizada como S. Choleraesuis proveniente de sangue de origem humana. Foram identificados 44 isolados de Salmonella spp. apresentando mutações em pmrA e pmrB. Dos 56 isolados de ExPEC resistentes a colistina, 21 isolados apresentaram o gene mcr-1. Este gene foi detectado em plasmídeos do grupo IncX4 (n=17) e em plasmídeos do grupo IncF (n=4). Cinco isolados de E.coli não apresentaram mutações nos genes estudados,sendo que três eram positivos para o gene mcr-1, enquanto as demais cepas apresentaram mutações em pmrA/B e phoP/Q. A tipagem pela PFGE foi realizada nos isolados de E.coli positivos para o gene mcr-1, com o objetivo de verificar a diversidade genética encontrada entre elas. Foram identificados 18 perfis genéticos, sem um clone principal...(AU)

Antimicrobial resistance is becoming a major public health challenge due to increasing resistance to beta-lactams in general. Salmonella spp. and Escherichia coli are the most frequent causative agents of diseases transmitted by water and food, but they can also cause serious invasive diseases, especially in immunosuppressed individuals, the elderly and children. Both pathogens have shown resistance profiles to the main classes of antibiotics, in these cases it is necessary to search for a new therapeutic option, such as polymyxins. In 2015, the first report of resistance to polymyxins mediated by the mcr gene (mobile colistin resistance) appeared, which spread across several continents and caused a major global concern in public health. The objective of this work was to identify and characterize the mechanisms that mediate resistance to polymyxins in strains of Salmonella spp. and extraintestinal pathogenic E. coli (ExPEC). Screening by drop test and MIC test against colistin and polymyxin B was performed on a total of 1026 Salmonella enterica isolates and 159 ExPEC isolates. In the resistant isolates, the presence of mutations in the genes (pmrA/B, phoP/Q) associated with resistance to polymyxins was verified, and through PCR the plasmid resistance genes (mcr) were identified. Of the 124 Salmonella strains resistant to colistin and polymyxin B, only one isolate was positive for the mcr-1 gene, and this gene was detected in a plasmid from the IncX4 group. Strain 2018.466 was characterized as S. Choleraesuis from blood of human origin. Forty-four Salmonella spp. showing mutations in pmrA and pmrB. Of the 56 colistin-resistant ExPEC isolates, 21 isolates harbored the mcr-1 gene. This gene was detected in plasmids from the IncX4 group (n=17) and in plasmids from the IncF group (n=4). Five E.coli isolates did not show mutations in the genes studied, three of which were positive for the mcr-1 gene, while the other strains showed mutations in pmrA/B and phoP/Q. Typing by PFGE was performed on E.coli isolates positive for the mcr-1 gene, with the objective of verifying the genetic diversity found among them. Eighteen genetic profiles were identified, without a main clone...(AU)

Genotyping Characteristics of Human Fecal Escherichia coli and Their Association with Multidrug Resistance in Miyun District, Beijing / 生物医学与环境科学（英文）

OBJECTIVE@#To explore the genotyping characteristics of human fecal Escherichia coli( E. coli) and the relationships between antibiotic resistance genes (ARGs) and multidrug resistance (MDR) of E. coli in Miyun District, Beijing, an area with high incidence of infectious diarrheal cases but no related data.@*METHODS@#Over a period of 3 years, 94 E. coli strains were isolated from fecal samples collected from Miyun District Hospital, a surveillance hospital of the National Pathogen Identification Network. The antibiotic susceptibility of the isolates was determined by the broth microdilution method. ARGs, multilocus sequence typing (MLST), and polymorphism trees were analyzed using whole-genome sequencing data (WGS).@*RESULTS@#This study revealed that 68.09% of the isolates had MDR, prevalent and distributed in different clades, with a relatively high rate and low pathogenicity. There was no difference in MDR between the diarrheal (49/70) and healthy groups (15/24).@*CONCLUSION@#We developed a random forest (RF) prediction model of TEM.1 + baeR + mphA + mphB + QnrS1 + AAC.3-IId to identify MDR status, highlighting its potential for early resistance identification. The causes of MDR are likely mobile units transmitting the ARGs. In the future, we will continue to strengthen the monitoring of ARGs and MDR, and increase the number of strains to further verify the accuracy of the MDR markers.

Antibiotic susceptibility and fosfomycin resistance characterization in a cohort of children older than 6 years of age with urinary tract infection / Sensibilidad antibiótica y caracterización de la resistencia a fosfomicina en una cohorte de niños mayores de 6 años con infección urinaria

Fosfomycin tromethamol (FT) was reintroduced as an option for the treatment of low urinary tract infection (UTI) in children. In this study, we described the antibiotic sensitivity and mechanisms of resistance to fosfomycin in isolates from children older than 6 years with UTI. Urine culture and antibiotic susceptibility study were performed. In fosfomycin resistant strains, PCR for fos, blaCTX-M was performed followed by classification by phylogenetic group and sequencetyping. Escherichia coli was the most frequent etiological agent (89.2%). The susceptibility percentages were: fosfomycin 97.9%; amoxicillin-clavulanate 92.7%; cefuroxime and ceftriaxone 99%; nitrofurantoin 94.4%. An E. coli strain (ST69, phylogenetic group D) was resistant to fosfomycin (MIC 256mg/l) and carried the blaCTX-M-14 and fosA3 genes in a 45kb IncN-type plasmid.

La fosfomicina-trometamol (FT) se reintrodujo como una opción para el tratamiento de la infección del tracto urinario (ITU) baja en niños. En este estudio describimos la sensibilidad antibiótica y los mecanismos de resistencia a FT en aislamientos de niños mayores de 6 anos con ITU. Se realizaron urocultivos y estudios de sensibilidad antibiótica. En las cepas resistentes a fosfomicina se realizó la técnica de PCR para fos, blaCTX-M, y su identificación según su grupo filogenéticoy secuenciotipo. Escherichiacoli fue el agente etiológico más frecuente (89,2%). Los porcentajes de sensibilidad fueron: fosfomicina 97,9%; amoxicilina-clavulánico 92,7%; cefurox-ima y ceftriaxona 99%; nitrofurantoína 94,9%. Una cepa de E. coli (ST69, grupo filogenético D) fue resistente a fosfomicina (CIM 256mg/l) y portaba los genes blaCTX-M-14 y fosA3 en un plás-mido de 45 kb del tipo IncN. Este es el primer reporte de E. coli ST69 con blaCTX-M-14/fosA3 de origen humano.

Incidence of urinary tract infection after cystography / Incidência de infecção urinária após cistografia

ABSTRACT Objective: Cystography an invasive procedure with potential complications such as urinary infection (UI). There are few studies about the incidence of complications associated with this procedure. The purpose of this study is to evaluate the incidence of post-cystography urinary infection (UI.). Methods: Retrospective study with a review of clinical records of patients under 15 years of age, followed in this hospital, who underwent cystography (radiologic or indirect radionuclide) between 2009 and 2018. Post-cystography UI was defined when it occurred until seven days after the procedure. Descriptive and nonparametric statistics were applied to assess possible predictive factors related with post-cystography UI. Results: In the study period, 531 cystograms were undertaken (55% indirect radionuclide and 45% radiologic). The mean age at the procedure was 11.5 months; 62% were boys. Every patient had a previous negative urine culture; 50% were under antibiotic prophylaxis at the time of the procedure. The most common indication for the procedure was the post-natal study of congenital hydronephrosis/other nephrological malformation (53%), followed by the study of febrile UI (31%). Vesicoureteral reflux (VUR) was diagnosed in 40% of procedures. Post-cystography UI occurred in 23 cases (incidence of 4.3%). The most frequent microorganism was E. coli (52%). The presence of VUR was significantly associated with the occurrence of post-cystography IU. Conclusions: The incidence of post-cystography UI was low in our sample. The presence of VUR was significantly associated with the occurrence of post-cystography UI. The authors highlight the importance of an adequate catheterization technique and the need for clinical surveillance after the procedure.

RESUMO Objetivo: A cistografia é um exame invasivo que apresenta potencial iatrogenia, nomeadamente infecção urinária (IU). Os estudos sobre a incidência de complicações associadas a esse exame são escassos. O objetivo deste trabalho foi avaliar a incidência de IU após realização de cistografia. Métodos: Estudo retrospetivo por consulta dos prontuários clínicos dos doentes com idade inferior a 15 anos, seguidos em consulta nesse hospital, que realizaram cistografia (radiológica ou isotópica) entre 2009 e 2018. Admitiu-se relação de causalidade quando o diagnóstico de IU ocorreu até sete dias após a realização do exame. Foi realizada análise estatística descritiva e utilizados testes não paramétricos para avaliar possíveis fatores preditores da ocorrência de IU após cistografia. Resultados: Realizaram-se 531 cistografias (55% isotópicas e 45% radiológicas). A mediana de idade foi de 11,5 meses; 62% eram do sexo masculino. Todos os doentes efetuaram urocultura prévia (negativa); 50% recebiam profilaxia antibiótica (ATB) à data do exame. A indicação mais frequente foi o estudo pós-natal de hidronefrose (HN) congênita/outra malformação nefrourológica (53%), seguida do estudo da IU febril (31%). Documentou-se refluxo vesicoureteral (RVU) em 40% dos exames. Ocorreu IU após cistografia em 23 casos (incidência de 4,3%). O microrganismo mais frequente foi a E. coli (52%). Verificou-se associação entre a presença de RVU e a ocorrência de IU. Conclusões: A incidência de IU pós-cistografia foi relativamente baixa na amostra deste estudo. Observou-se associação entre a ocorrência de IU após cistografia e a presença de RVU. Sublinha-se a importância de uma técnica adequada de cateterização vesical e da vigilância clínica após o exame.

Flora bacteriana resistente al lavado de manos en estudiantes universitarios / Bacterial Flora Resistant to Hand Washing in University Students

Introducción: En la superficie cutánea residen microorganismos responsables del balance bioquímico, algunas son patógenas y persisten a pesar del lavado de manos. Objetivo: Identificar la flora bacteriana resistente al lavado de manos en estudiantes universitarios. Métodos: Se realizó el estudio observacional analítico de tipo longitudinal, para esto se enrolaron a estudiantes universitarios que recibieron previamente charlas educativas sobre higiene de manos, posteriormente se tomaron muestras antes y después del lavado de las manos. Resultados: De 80 muestras analizadas se identificó a Staphylococcus epidermidis como el más frecuente en 95 por ciento de los estudiantes y con el lavado de manos se redujo a 60 por ciento; el segundo agente fue Staphylococcus saprophyticcus, que estuvo presente en 75 por ciento de los casos y después del lavado, en 35 por ciento; E. coli ocupó el tercer lugar, se encontró en 42,5 por ciento de las muestras y tras la higiene de manos se redujo a 17,5 por ciento. Para los agentes transitorios como Klebsiella (p < 0,05) y Pseudomonas, el lavado de manos fue más efectivo; sin embargo, E. coli fue la enterobacteria que permaneció elevada a pesar de la higiene de manos (p = 0,01). Conclusión: Algunas colonias de E. coli son resistentes al lavado de manos, similar a los agentes residentes como Staphylococcus epidermidis, Staphylococcus saprophyticcus y Staphylococcus aureus(AU)

Introduction: The skin surface is inhabited by microorganisms responsible for the biochemical balance; some are pathogenic and persist despite hand washing. Objective: To identify, in university students, the bacterial flora resistant to hand washing. Methods: A longitudinal, analytical and observational study was carried out, for which university students were included who previously received educational talks on hand hygiene. Samples were taken before and after hand washing. Results: Of 80 samples analyzed, Staphylococcus epidermidis was identified as the most frequent in 95 percent of the students and, with hand washing, it was reduced to 60 percent the second agent was Staphylococcus saprophyticcus, present in 75 percent of the cases and, after hand washing, in 35 percent. E. coli occupied the third position, as it was found in 42.5 percent of the samples and, after hand hygiene, it was reduced to 17.5 percent. For transient agents like Klebsiella (P<0.05) and Pseudomonas, handwashing was more effective; however, E. coli was the enterobacterium that remained elevated despite hand hygiene (P=0.01). Conclusion: Some E. coli colonies are resistant to hand washing, similar to resident agents such as Staphylococcus epidermidis, Staphylococcus saprophyticcus and Staphylococcus aureus(AU)

Escherichia coli enterotoxigénica y enteroagregativa: prevalencia, patogénesis y modelos múridos / Enterotoxigenic and enteroaggregative Escherichia coli: prevalence, pathogenesis and murine models

Resumen Los patotipos de Escherichia coli enterotoxigénica (ETEC) y enteroagregativa (EAEC) son importantes agentes etiológicos causantes de diarrea en niños menores de cinco años de México y países en desarrollo, en quienes causan numerosas muertes. Ambos se han asociado con retraso en el crecimiento infantil y son los principales agentes causales de la "diarrea del viajero". La patogénesis de ambas bacterias se inicia cuando estas se adhieren al epitelio intestinal mediante fimbrias, denominadas factores de colonización en las cepas ETEC aisladas de humano y fimbrias de adherencia agregativa en las cepas de EAEC. Una vez que ETEC se adhiere al enterocito produce una o ambas de sus toxinas e induce la secreción de iones de cloruro, sodio y agua al lumen intestinal, produciendo su característica diarrea acusa. EAEC se une al epitelio intestinal formando una biopelícula, induce la producción de moco, libera sus toxinas y promueve inflamación. Modelos de infección de EAEC y ETEC con ratones C57BL/6 silvestres y deficientes del ligando de CD40 (con microbiotas intactas), respectivamente, revelaron que la desnutrición y la dieta baja en cinc incrementan la infección de EAEC causando retraso en el crecimiento y que ETEC coloniza, persiste e induce respuesta inmune humoral local y sistémica.

Abstract Enterotoxigenic (ETEC) and enteroaggregative Escherichia coli (EAEC) pathotypes are important etiological agents causative of diarrhea in children younger than 5 years of age in Mexico and in developing countries, where they cause numerous deaths. Both have been associated with delayed growth in children and are the main causative agents of traveler's diarrhea. The pathogenesis of both bacteria starts by adhering to the intestinal epithelium by means of fimbriae, called colonization factors in human ETEC isolates and aggregative adherence fimbriae in EAEC isolates. Once ETEC adheres to the enterocyte, it produces one or both of its toxins and induces the secretion of chloride and sodium ions and water into the intestinal lumen, producing its characteristic watery diarrhea. EAEC binds to the intestinal epithelium forming a biofilm, induces the production of mucus, releases its toxins and promotes inflammation. EAEC and ETEC infection models with wild-type C57BL/6 and CD40 ligand-deficient mice (with intact microbiota), respectively, revealed that undernutrition and low-zinc diet increases EAEC infection, causing growth retardation, and that ETEC colonizes, persists and induces local and systemic humoral immune response.

Multidrug resistance and risk factors associated with community-acquired urinary tract infections caused by Escherichia coli in Venezuela / Multirresistencia a medicamentos y factores de riesgo asociados con infecciones urinarias por Escherichia coli adquiridas en la comunidad, Venezuela

Abstract Introduction: The treatment of urinary tract infections has become more challenging due to the increasing frequency of multidrug-resistant Escherichia coli in human populations. Objective: To characterize multidrug-resistant E. coli isolates causing community-acquired urinary tract infections in Cumaná, Venezuela, and associate possible risk factors for infection by extended-spectrum beta-lactamases (ESBL)-producing isolates. Materials and methods: We included all the patients with urinary tract infections attending the urology outpatient consultation and emergency unit in the Hospital de Cumaná, Estado Sucre, Venezuela, from January through June, 2014. blaTEM, blaSHV and blaCTX-M genes detection was carried out by PCR. Results: We found a high prevalence of multidrug-resistant E. coli (25.2%) with 20.4% of the isolates producing ESBL. The ESBL-producing isolates showed a high frequency (66.7%) of simultaneous resistance to trimethoprim-sulphamethoxazole, fluoroquinolones and aminoglycosides compared to non-producing isolates (2.4%). Of the resistant isolates, 65.4% carried the blaTEM gene, 34.6% the blaCTX-M and 23.1% the blaSHV. The blaCTX-M genes detected belonged to the CTX-M-1 and CTX-M-2 groups. Plasmid transfer was demonstrated by in vitro conjugation in 17 of the 26 ESBL-producing isolates. All three genes detected were transferred to the transconjugants. Age over 60 years, complicated urinary tract infections and previous use of a catheter predisposed patients to infection by ESBL-producing E. coli. Conclusions: The high frequency of multidrug-resistant ESBL-producing isolates should alert the regional health authorities to take measures to reduce the risk of outbreaks caused by these types of bacteria in the community.

Resumen Introducción. El tratamiento de las infecciones urinarias constituye un reto creciente por el aumento de Escherichia coli proveniente de la comunidad multirresistente a los medicamentos. Objetivo. Caracterizar aislamientos de E. coli multirresistente causantes de infecciones urinarias adquiridas en la comunidad en Cumaná, Venezuela, y detectar los posibles riesgos de infección por aislamientos productores de betalactamasas de espectro extendido (BLEE). Materiales y métodos. Se incluyeron todos los pacientes atendidos en la consulta externa de urología y en urgencias del Hospital de Cumaná entre enero y junio de 2014 y que evidenciaban infecciones urinarias. La detección de los genes blaTEM, blaSHV y blaCTX-M se hizo mediante la reacción en cadena de la polimerasa (PCR). Resultados. Se encontró una alta prevalencia de E. coli multirresistente a los medicamentos (25,2 %), con 20,4 % de aislamientos productores de BLEE y una gran frecuencia de resistencia simultánea a trimetoprim-sulfametoxazol, fluoroquinolonas y aminoglucósidos (66,7 %) comparados con los no productores (2,4 %). En el 65,4 % de los aislamientos resistentes, se encontró el gen blaTEM; en 34,6 %, el blaCTX-M, y en 23,1 %, el blaSHV. Los genes blaCTX-M detectados pertenecían a los grupos CTX-M-1 y CTX-M-2. Se demostró la transferencia in vitro de plásmidos por conjugación en 17 de los 26 aislamientos productores de BLEE. Los tres tipos de genes detectados se transfirieron a los transconjugantes. La edad mayor de 60 años, las infecciones urinarias con complicaciones y el uso previo de catéter, predispusieron a la infección por cepas de E. coli productoras de BLEE. Conclusiones. La gran frecuencia de aislamientos multirresistentes productores de BLEE debería alertar a las autoridades sanitarias para tomar medidas que reduzcan el riesgo de epidemias causadas por este tipo de bacterias en la comunidad.

Multirresistencia de Escherichia coli y Klebsiella pneumoniae provenientes de pacientes con infección del tracto urinario adquirida en la comunidad / Escherichia coli and Klebsiellap neumoniae multiresistance from patients with urinary tract infection acquired in the community

Introducción: El incremento de la multirresistencia bacteriana constituye un problema de salud pública a nivel internacional. Objetivos: Determinar la susceptibilidad antimicrobiana y los patrones de multirresistencia en cepas de Escherichia coli y Klebsiella pneumoniae aisladas de urocultivos. Métodos: Se realizó un estudio descriptivo retrospectivo en el Centro Municipal de Higiene, Epidemiología y Microbiología, municipio Güines, provincia Mayabeque, Cuba, en el periodo comprendido de enero a diciembre de 2017. El estudio incluyó 250 cepas de Escherichia coli y 62 de Klebsiella pneumoniae aisladas e identificadas de muestras de orina de pacientes con infección del tracto urinario adquirida en la comunidad. La susceptibilidad antimicrobiana fue evaluada con el método de difusión en agar empleado la técnica de Kirby Bauer. Resultados: En Escherichia coli se observó niveles de resistencia superiores al 60 por ciento a los antimicrobianos ácido nalidíxico, cefotaxima, trimetoprim - sulfametoxazol y ceftazidima. La nitrofurantoína y la amikacina presentaron 88,8 por ciento y 83,8 por ciento de efectividad, respectivamente. Se apreció en Klebsiella pneumoniae altos valores de resistencia a ceftazidima, trimetoprim - sulfametoxazol y ácido nalidíxico. Amikacina, presentó niveles de sensibilidad de un 71 por ciento. La resistencia a las cefalosporinas de tercera generación se detectó en 78 (31,2 por ciento) de Escherichia coli y 26 (41,9 por ciento) de Klebsiella pneumoniae. De los aislados de Escherichia coli 143 (57,2 por ciento) y Klebsiella pneumoniae 35 (56,4 por ciento) presentaron multidrogoresistencia. Conclusiones: Existe la circulación de cepas resistentes a cefalosporinas de tercera generación y multidrogorresistentes causantes de infecciones de las vías urinarias adquiridas en la comunidad y se informa sobre los antibióticos (nitrofurantoína y amikacina) que podrían ser utilizados para combatirlas de forma empírica en esta área geográfica(AU)

Introduction: The increase of bacterial multiresistance constitutes a public health problem at the international level. Objectives: To determine antimicrobial sensitivity and multiresistance patterns in strains of Escherichia coli and Klebsiellapneumoniae isolated from urine cultures. Methods: A retrospective, descriptive study was conducted at the Municipal Center for Hygiene, Epidemiology and Microbiology, Güines municipality, Mayabeque Province, Cuba, in the period from January to December, 2017. The study included 250 Escherichia coli and 62 Klebsiellapneumoniae strains isolated and identified from urine samples from patients with urinary tract infection acquired in the community. Antimicrobial sensitivity was evaluated with the method of diffusion in agar using Kirby Bauer´s technique. Results: In Escherichia coli, resistance levels higher than the 60% were observed in antimicrobial nalidixic acid, cefotaxime, trimethoprim-sulfamethoxazole and ceftazidime. Nitrofurantoin and amikacin presented 88.8 percent and 83.8 percent of effectiveness, respectively. High values of resistance to ceftazidime, trimethoprim-sulfamethoxazole and nalidixic acid were present in Klebsiellapneumoniae. Amikacin presented sensitivity levels of 71 percent. Resistance to third-generation cephalosporins was detected in 78 (31.2 percent) of Escherichia coli and 26 (41.9 percent) Klebsiellapneumoniae. From the Escherichia coli and Klebsiellapneumoniae isolates, 143 (57.2 percent) and 35 (56.4 percent),respectively, presented multidrug resistance. Conclusions: There is circulation of strains which are resistant to third generation cephalosporins and multidrug resistants that cause urinary tract infections acquired in the community and there are reports on antibiotics (nitrofurantoin and amikacin) that might be used to combat them empirically in this geographical area(AU)

Caracterização de Escherichia coli enteroagregativa entre crianças com diarreia na Amazônia ocidental brasileira / Characterization of enteroaggregative escherichia coli among diarrheal childrenin western brazilian amazon

ABSTRACT BACKGROUND: Enteroaggregative Escherichia coli (EAEC) is one of the main acute and chronic diarrhea causes both in children and adults, mainly in developing countries. OBJECTIVE: The aim of the present study is to characterize EAEC strains isolated from faecal samples and to identify genes potentially contributing to virulence, biofilm production and antimicrobial resistance in children admitted to a pediatric hospital in Porto Velho, Rondônia State. METHODS: The total of 1,625 E. coli specimens were isolated from 591 children in the age group 6 years or younger who were hospitalized in Cosme and Damião Children Hospital in Porto Velho, between February 2010 and February 2012, with acute gastroenteritis. Colonies suggestive of E. coli were subjected to polymerase chain reaction testing in order to identify the virulence factors. The in vitro adhesion assays using HEp-2 adherence were tests. Biofilm detection through spectrophotometry and antimicrobial susceptibility tests were conducted in the disk diffusion method. RESULTS: The mentioned study examined 591 stool samples from children with diarrhea. Diarrheogenic E. coli was found in 27.4% (162/591) of the children. EAEC was the diarreagenic E. coli most frequently associated with diarrhea 52.4% (85/162), which was followed by enteropathogenic E. coli 43.8% (71/162), enterotoxigenic E. coli 2.4% (4/162), and enterohemorrhagic E. coli 1.2% (2/162). The aggR gene was detected in 63.5% (54/85) of EAEC isolates; moreover, statistically significant correlation was observed among typical EAEC (aggR) and aatA (P<0.0001), irp2 (P=0.0357) and shf (P=0.0328). It was recorded that 69% (59/85) of the 85 analyzed EAEC strains were biofilm producers; 73% (43/59) of the biofilm producers carried the aggR gene versus 42.3% (11/26) of non-producers (P=0.0135). In addition, there was association between the aatA gene and biofilm production; 61% (36/59) of the samples presented producer strains, versus 19.2% (5/26) of non-producers (P<0.0004). Antibiotic sensitivity test evidenced that most EAEC were ampicillin 70.6% (60/85), sulfamethoxazole 60% (51/85), tetracycline 44.7% (38/85) and cefotaxime 22.4% (19/85) resistant. CONCLUSION: As far as it is known, the present study is pioneer in Northern Brazil to investigate EAEC virulence factors and to show the antimicrobial susceptibility of EAEC strains isolated from children with diarrhea.

RESUMO CONTEXTO: A Escherichia coli enteroagregativa (EAEC) é um dos principais agentes causadores de diarreia aguda e crônica em crianças e adultos, principalmente em países em desenvolvimento. OBJETIVO: Caracterizar cepas de EAEC isoladas de amostras fecais e identificar genes que potencialmente contribuem para a virulência, produção de biofilme e resistência antimicrobiana em crianças internadas em um hospital pediátrico em Porto Velho, Rondônia. MÉTODOS: Um total de 1.625 cepas de E. coli foram isolados de 591 crianças com gastroenterite aguda na faixa etária de 6 anos que foram internadas no Hospital Infantil Cosme e Damião na cidade de Porto Velho, entre fevereiro de 2010 e fevereiro de 2012. Colônias sugestivas de E. coli foram submetidas a reação em cadeia da polimerase para identificação de fatores de virulência. O ensaio de adesão in vitro foi desenvolvido com célula HEp-2. A detecção de biofilme foi realizada através do teste de espectrofotometria e os testes de susceptibilidade aos antimicrobiana foram realizados através do método de difusão em disco. RESULTADOS: A E. coli diarreiogênica foi encontrada em 27,4% (162/591) das crianças e a EAEC foi a E. coli diarreiogênica mais frequentemente associada à diarreia com 52,4% (85/162), seguida pela E. coli enteropatogênica 43,8% (71/162), E. coli enterotoxigênica 2,4% (4/162) e E. coli enterohemorrágica 1,2% (2/162). O gene aggR foi detectado em 63,5% (54/85) dos isolados de EAEC com correlação estatisticamente significante entre esse gene com os genes aatA (P<0,0001), irp2 (P=0,0357) e shf (P=0,0328). Neste estudo 69% (59/85) das cepas de EAEC eram produtoras de biofilme, destas 73% (43/59) possuíam o gene aggR, ao passo que entre as não produtoras 42,3% (11/26) possuíam o gene (P=0,0135). Essa associação também foi observada com o gene aatA, presente em 61% (36/59) das cepas produtoras e em 19,2% (5/26) das não produtoras (P<0,0004). O teste de sensibilidade aos antibimicrobianos evidenciou que a maioria das EAEC eram resistentes a ampicilina 70,6% (60/85), ao sulfametoxazol 60% (51/85), a tetraciclina 44,7% (38/85) e a cefotaxima 22,4% (19/85). CONCLUSÃO: Este é o primeiro estudo no Norte do Brasil sobre a investigação dos fatores de virulência de EAEC mostrando a susceptibilidade antimicrobiana de cepas de EAEC isoladas de crianças com diarreia.

Impacto das mudanças da microbiologia na peritonite bacteriana espontânea em três diferentes períodos ao longo de 17 anos / Impact of microbiological changes on spontaneous bacterial peritonitis in three different periods over 17 years

ABSTRACT BACKGROUND: Spontaneous bacterial peritonitis is a serious complication in cirrhotic patients, and changes in the microbiological characteristics reported in the last years are impacting the choice of antibiotic used for treatment. OBJECTIVE: The aim of the present study is to evaluate the changes in the epidemiology and bacterial resistance of the germs causing spontaneous bacterial peritonitis over three different periods over 17 years. METHODS: All cirrhotic patients with spontaneous bacterial peritonitis and positive culture of ascites fluid were retrospectively studied in a reference Hospital in Southern Brazil. Three periods were ramdomly evaluated: 1997-1998, 2002-2003 and 2014-2015. The most frequent infecting organisms and the sensitivity in vitro to antibiotics were registered. RESULTS: In the first period (1997-1998) there were 33 cases, the most common were: E. coli in 13 (36.11%), Staphylococcus coagulase-negative in 6 (16.66%), K. pneumoniae in 5 (13.88%), S. aureus in 4 (11.11%) and S. faecalis in 3 (8.33%). In the second period (2002-2003), there were 43 cases, the most frequent were: Staphylococus coagulase-negative in 16 (35.55%), S. aureus in 8 (17.77%), E. coli in 7 (15.55%) and K. pneumoniae in 3 (6.66%). In the third period (2014-2015) there were 58 cases (seven with two bacteria), the most frequent were: E. coli in 15 (23.1%), S. viridans in 12 (18.5%), K. pneumoniae in 10 (15.4%) and E. faecium 5 (7.7%). No one was using antibiotic prophylaxis. Considering all staphylococci, the prevalence increased to rates of the order of 50% in the second period, with a reduction in the third period evaluated. Likewise, the prevalence of resistant E. coli increased, reaching 14%. CONCLUSION: There was a modification of the bacterial population causing spontaneous bacterial peritonitis, with high frequency of gram-positive organisms, as well as an increase in the resistance to the traditionally recommended antibiotics. This study suggests a probable imminent inclusion of a drug against gram-positive organisms in the empiric treatment of spontaneous bacterial peritonitis.

RESUMO CONTEXTO: A peritonite bacteriana espontânea é uma complicação séria em pacientes cirróticos e as alterações nas características microbiológicas relatadas nos últimos anos podem afetar a escolha do antibiótico utilizado no tratamento. OBJETIVO: Os objetivos do presente estudo são avaliar as mudanças na epidemiologia e perfil de resistência bacteriana dos germes causadores de peritonite bacteriana espontânea em três períodos diferentes ao longo de 17 anos. MÉTODOS: Todos os pacientes cirróticos com peritonite bacteriana espontânea e cultura positiva de fluido ascítico foram estudados retrospectivamente em um hospital de referência no Sul do Brasil. Foram avaliados três diferentes períodos selecionados de forma randômica: 1997-1998, 2002-2003 e 2014-2015. Os organismos infecciosos mais frequentes e a sensibilidade in vitro a antibióticos foram registados. RESULTADOS: No primeiro período (1997-1998) houve 33 casos; os mais comuns foram: E. coli em 13 (36,1%), Staphylococcus coagulase-negativo em 6 (16,7%), K. pneumoniae em 5 (13,9%), S. aureus em 4 (11,1%) e S. faecalis em 3 (8,3%). No segundo período (2002-2003), houve 43 casos, os mais frequentes foram: Staphylococus coagulase-negativo em 16 (35,5%), S. aureus em 8 (17,8%), E. coli em 7 (15,5%) e K. pneumoniae em 3 (6,7%). No terceiro período (2014-2015), houve 58 casos (sete com duas bactérias), os mais frequentes foram: E. coli em 15 (23,1%), S. viridans em 12 (18,5%), K. pneumoniae em 10 (15,4%) e E. faecium 5 (7,7%). Nenhum paciente estava usando profilaxia antibiótica. Quando considerados todos os estafilococos, a prevalência aumentou para taxas da ordem de 50% no segundo período, apresentando redução no terceiro período avaliado. Do mesmo modo, a prevalência de E coli resistente aumentou, chegando a 14%. CONCLUSÃO: Houve modificação da população bacteriana causadora de peritonite bacteriana espontânea, com alta frequência de organismos gram-positivos, bem como aumento da resistência aos antibióticos tradicionalmente recomendados. Este estudo sugere uma provável inclusão iminente de um medicamento contra organismos gram-positivos no tratamento empírico da peritonite bacteriana espontânea.

Microbiological and serological control of Escherichia coli O157: H7 in kindergarten staff in Buenos Aires city and suburban areas

Shiga toxin (Stx)-producing Escherichia coli (STEC) infections are implicated in the development of the life-threatening hemolytic-uremic syndrome (HUS). Despite the magnitude of the social and economic problems caused by HUS, no licensed vaccine or effective therapy is currently available for human use. Prevention of STEC infections continues being the most important measure to reduce HUS incidence. This is especially true for Argentina where HUS incidence among children is extremely high and shows an endemic pattern. The aim of this work was to investigate serologically adult staff of kindergartens in Buenos Aires city and suburban areas in order to detect possible carriers, and to educate personnel about good practices to reduce HUS transmission. We also assessed the microbiological quality of water and meal samples from the same kindergartens. We tested 67 healthy adults, 13 water supplies and 6 meals belonging to 6 public kindergartens. We analysed hand swabs for isolation of STEC and serum samples for the presence of antibodies against Stx and lipopolysaccharide (LPS) of O157 serogroup. We identified 46 Stx2-positive individuals, but only 7 for O157 LPS. No presence of STEC pathogens was detected in hands of staff, water or meal samples.

Las infecciones bacterianas con Escherichia coli productor de toxina Shiga (Stx) (STEC) están implicadas en el desarrollo del síndrome urémico hemolítico (SUH). A pesar de la magnitud del problema social y económico causado por el SUH, actualmente no existe un tratamiento específico o una vacuna eficaz para uso humano. Por lo tanto, la prevención de las infecciones por STEC es la tarea central para reducir la incidencia del SUH. Esto es especialmente cierto para Argentina en donde el SUH muestra un comportamiento endémico y presenta una incidencia extremadamente alta entre los niños. En efecto, la mediana de casos notificados en menores de 5 años para el periodo 2010-2015 fue 306, mientras que la tasa de notificación fue 8.5 casos cada 100 000 menores/año (http://www.msal.gob.ar/images/stories/boletines/boletin_integrado_vigilancia_N335-SE45.pdf). El objetivo de este trabajo fue analizar serológicamente al personal adulto de jardines de infantes de la ciudad de Buenos Aires y el área suburbana con el fin de detectar portadores, y brindarles formación sobre las buenas prácticas para reducir la transmisión de infecciones con STEC y así evitar el SUH. También se evaluó la calidad microbiológica de las muestras de agua y de la comida elaborada en los mismos jardines. Hemos estudiado 67 adultos, a través del hisopado de manos para la búsqueda de STEC y suero para la presencia de anticuerpos contra Stx y el lipopolisacárido (LPS) de serogrupo O157. También se analizaron 13 suministros de agua y 6 muestras de comida pertenecientes a 6 jardines de infantes públicos. Se identificaron 46 individuos positivos para Stx2, pero solo 7 para LPS-O157. No se detectó presencia de patógenos STEC en las muestras de las manos del personal, ni en los reservorios de agua o muestras de comida.

Infección del tracto urinario causada por Enterobacteriaceae y su relación con reflujo vésico-ureteral en recién nacidos / Urinary tract infection caused by Enterobacteriaceae and its relationship with vesicoureteral reflux

Resumen: Introducción: La primera infección del tracto urinario puede ser un marcador de una anomalía del tracto urinario, principalmente de reflujo vésico-ureteral. El objetivo de este trabajo fue determinar la asociación entre microorganismos de la familia Enterobacteriaceae con la presencia y grado de reflujo vésico-ureteral en pacientes neonatales quienes debutaron con infección del tracto urinario. Métodos: Se realizó un estudio retrospectivo, observacional y analítico de recién nacidos con infección del tracto urinario, quienes ingresaron en el Servicio de Neonatología del Hospital Pediátrico Universitario ''Juan Manuel Márquez'', La Habana, Cuba, desde 1992 hasta 2013, y en quienes el microorganismo causal era de la familia Enterobacteriaceae. Se realizaron estudios por imagen y se analizó la asociación entre la presencia y grado de reflujo vésico-ureteral con el microorganismo causal de la infección del tracto urinario. Resultados: Se estudiaron 450 recién nacidos. Los aislamientos bacterianos en los urocultivos correspondieron a E. coli en 316 casos (70.2%). La prevalencia de reflujo vésico-ureteral resultó del 18.2%. Se comprobó que el microorganismo causal -otras bacterias diferentes a E. coli correspondientes a la familia Enterobacteriaceae- se asoció significativamente con el riesgo (OR 2.02; p < 0.01) y el grado de reflujo vésico-ureteral (para los de más alto grado, p < 0.01). Conclusiones: E. coli es el agente causal más frecuente de la infección del tracto urinario neonatal. Sin embargo, existe una asociación entre la presencia de un microorganismo de la familia Enterobacteriaceae diferente a E. coli y el reflujo vésico-ureteral, principalmente los de mayor grado.

Abstract: Background: The first urinary tract infection can be a marker of a urinary tract anomaly, mainly vesicoureteral reflux. The aim of this work was to determine the association between isolated enterobacteria with the presence and grade of vesicoureteral reflux in neonatal patients with their first urinary tract infection. Methods: A retrospective, observational and analytic study of newborns, who were admitted to the Neonatal Department, University Pediatric Hospital ''Juan Manuel Márquez,'' in Havana, Cuba, from 1992 to 2013 was conducted. The causal microorganism of urinary tract infection was from the Enterobacteriaceae family. They were evaluated by radio imaging. The association between the presence and grade of vesicoureteral reflux with the causal microorganism of the urinary tract infection was analyzed. Results: Newborn infants with urinary tract infection (450) were studied. Bacterial isolations in the urine cultures corresponded to E. coli in 316 cases (70.2%). The prevalence of vesicoureteral reflux was 18.2%. The presence of bacteria corresponding to the Enterobacteriaceae family (other than E. coli) had significant risk association with vesicoureteral reflux (OR: 2.02; p < 0.01) and vesicoureteral reflux classification (for higher grades, p < 0.01). Conclusions: E. coli is the most frequent causal microorganism in neonatal urinary tract infection. However, an association between the isolation of a microorganism of the Enterobacteriaceae family different to E. coli with the presence of vesicoureteral reflux and mainly with higher grades of vesicoureteral reflux exists.

Early-onset neonatal sepsis and the implementation of group B streptococcus prophylaxis in a Brazilian maternity hospital: a descriptive study

Abstract Objectives: To describe early-onset neonatal sepsis (EOS) epidemiology in a public maternity hospital in Brasilia, Brazil. Methods: We defined EOS as a positive blood culture result obtained from infants aged ≤72 hours of life plus treatment with antibiotic therapy for ≥5 days. Incidence was calculated based on the number of cases and total live births (LB). This is a descriptive study comparing the period of 2012-2013 with the period of 2014-September 2015, before and after implementation of antibiotic prophylaxis during labor for group B streptococcus (GBS) prevention, respectively. Results: Overall, 36 infants developed EOS among 21,219 LB (1.7 cases per 1000 LB) and 16 died (case fatality rate of 44%). From 2014, 305 vaginal-rectal swabs were collected from high-risk women and 74 (24%) turned out positive for GBS. After implementation of GBS prevention guidelines, no new cases of GBS were detected, and the EOS incidence was reduced from 1.9 (95% CI 1.3-2.8) to 1.3 (95% CI 0.7-2.3) cases per 1000 LB from 2012-2013 to 2014-September 2015 (p = 0.32). Conclusions: Although the reduction of EOS incidence was not significant, GBS colonization among pregnant women was high, no cases of neonatal GBS have occurred after implementation of prevention guidelines.

Diarrheagenic Escherichia coli

ABSTRACT Most Escherichia coli strains live harmlessly in the intestines and rarely cause disease in healthy individuals. Nonetheless, a number of pathogenic strains can cause diarrhea or extraintestinal diseases both in healthy and immunocompromised individuals. Diarrheal illnesses are a severe public health problem and a major cause of morbidity and mortality in infants and young children, especially in developing countries. E. coli strains that cause diarrhea have evolved by acquiring, through horizontal gene transfer, a particular set of characteristics that have successfully persisted in the host. According to the group of virulence determinants acquired, specific combinations were formed determining the currently known E. coli pathotypes, which are collectively known as diarrheagenic E. coli. In this review, we have gathered information on current definitions, serotypes, lineages, virulence mechanisms, epidemiology, and diagnosis of the major diarrheagenic E. coli pathotypes.

Diarrheagenic Escherichia coli

Most Escherichia coli strains live harmlessly in the intestines and rarely cause disease in healthy individuals. Nonetheless, a number of pathogenic strains can cause diarrhea or extraintestinal diseases both in healthy and immunocompromised individuals. Diarrheal illnesses are a severe public health problem and a major cause of morbidity and mortality in infants and young children, especially in developing countries. E. coli strains that cause diarrhea have evolved by acquiring, through horizontal gene transfer, a particular set of characteristics that have successfully persisted in the host. According to the group of virulence determinants acquired, specific combinations were formed determining the currently known E. coli pathotypes, which are collectively known as diarrheagenic E. coli. In this review, we have gathered information on current definitions, serotypes, lineages, virulence mechanisms, epidemiology, and diagnosis of the major diarrheagenic E. coli pathotypes.

Prevalencia de uropatógenos y sensibilidad antimicrobiana en lactantes menores de 2 años provenientes de la comunidad con diagnóstico de infección de vías urinarias / Prevalence of uropathogens and antimicrobial susceptibility in infants younger than 2 years of age from the community with a diagnosis of urinary tract infection

RESUMEN Introducción: la infección urinaria (IU) es una patología frecuente en los niños. La prevalencia de los uropatógenos varía de acuerdo a las regiones geográficas e incluso entre los diferentes centros asistenciales. El conocimiento de dicha prevalencia y de la sensibilidad a los antimicrobianos ayuda a la elección de la antibioticoterapia empírica inicial, permitiendo de esa manera, el control del cuadro agudo y evitando la resistencia bacteriana. Objetivo determinar la sensibilidad de los uropatógenos a los antimicrobianos obtenidos de urocultivos de niños menores de 24 meses con diagnóstico de IU provenientes de la comunidad. Material y métodos: estudio observacional, descriptivo, retrospectivo, de corte transverso. Se analizaron los expedientes clínicos y resultados de urocultivos de lactantes menores de 24 meses internados en el Departamento de Pediatría del Hospital Nacional en el período comprendido entre enero de 2012 a diciembre de 2014 , con diagnóstico de IU. Resultados: los uropatógenos más frecuentemente obtenidos fueron: Escherichia coli (67,6%) seguido de Klebsiella pneumoniae (18,3%), Enterobacter cloacae (8,4%), Pseudomonas aeruginosa (2,8%) y otros en 2,9%. La sensibilidad de la E. coli a la ciprofloxacina, las cefalosporinas y aminoglucósidos fue alta. El 14,6% de Escherichia coli fue productora de betalactamasa de espectro extendido (BLEE). El 100% de las cepas de Klebsiella pneumoniae fuer sensible a amikacina, ciprofloxacina y acidonalidíxico. Conclusiones: el germen más frecuentemente encontrado fue E. coli, seguido de la Klebsiella pneumoniae. El tratamiento de elección recomendado es la combinación de cefalospinas de primera generación asociado a aminoglucósidos, ya que con este esquema se cubrirá más del 95% de los uropatógenos causantes de infección de vías urinarias de la comunidad. Los gérmenes productores de infección urinaria atípica, deberán ser investigados.

ABSTRACT Introduction Urinary tract infection (UTI) is a common pathology in children. The prevalence of uropathogens varies according to geographic regions and even between different care centers. Knowledge of this prevalence and antimicrobial susceptibility helps to choose the initial empirical antibiotic therapy, thus allowing the control of the acute condition and avoiding bacterial resistance. Objective to determine the sensitivity of uropathogens to antimicrobials obtained from urine cultures of children younger than 24 months with diagnosis of UTI from the community. Material and methods: observational, descriptive, retrospective, cross-sectional study. We analyzed the clinical records and results of urine cultures of infants under 24 months admitted to the Department of Pediatrics of the National Hospital in the period between January 2012 and December 2014, diagnosed as UI. Results: the most frequent uropathogen was Escherichia coli (67.6%) followed by Klebsiella pneumoniae (18.3%), Enterobacter cloacae (8.4%), Pseudomonas aeruginosa (2.8%) and others in 2, 9%. The sensitivity of E. coli to ciprofloxacin, cephalosporins and aminoglycosides was high. 14.6% of Escherichia coli was a producers of extended spectrum betalactamase (ESBL). 100% of Klebsiella pneumoniae strains was a sensitive to amikacin, ciprofloxacin and acidonaldehyde. Conclusions: the more frequent germ found was E. coli, followed by Klebsiella pneumoniae. The recommended treatment of choice is the combination of first-generation cephalosporins associated with aminoglycosides, as this scheme will cover more than 95% of the uropathogens that cause urinary tract infection in the community. Germs producing atypical urinary infection should be investigated.

Prevalencia de infecciones intrahospitalarias en el Servicio de Clínica Médica del Hospital Regional de Encarnación 2014-2015 / Prevalence of intrahospital infections in the Internal Medicine Service of the Regional Hospital of Encarnación 2014-2015

RESUMEN Introducción: las infecciones asociadas a cuidados de la salud, conocidas también como infecciones nosocomiales (IN), son un problema relevante de salud pública, se asocian con altas tasas de morbilidad y mortalidad, lo que se traduce en un incremento en los días de hospitalización y los costos de atención. Objetivos: determinar los gérmenes intrahospitalarios más frecuentes y su sensibilidad antibiótica en la sala de Clínica Médica del Hospital Regional de Encarnación periodo 2014-2015. Metodología: estudio descriptivo, observacional de corte transversal, prospectivo, de prevalencia y con componente analítico. Resultados: se evaluaron pacientes hospitalizados encontrándose 114 (6%) pacientes con infecciones intrahospitalarias. El perfil epidemiológico se caracterizó por predomino del sexo femenino (53%), con edad media 56,5 ± 22,5 años y una estancia hospitalaria prolongada. Los aislamientos fueron más frecuentes en orina. Las comorbilidades más frecuentes fueron la hipertensión arterial y la diabetes mellitus. El germen más frecuente aislado fue Klebsiella pneumoniae, con una sensibilidad solo a amikacina y cabapenemes, con 64% BLEE(+) y 20% KPC, seguido por Echerichia coli y Staphylococcus aureus con buena sensibilidad a oxacilina. Conclusión: se halló 6% de infecciones intrahospitalarias y el germen más frecuente fue K. pneumoniae

ABSTRACT Introduction: infectious related to health care, also known as nosocomial infections (NI) are an important public health problem, are associated with high rates of morbidity and mortality, resulting in an increase in days of hospitalization and costs. Objectives: to determine the most frequent nosocomial germs and antibiotic sensitivity in a Medical Ward of the Regional Hospital of Encarnación 2014-2015. Methodology: descriptive, observational cross-sectional study with prospective approach, and analytical component. Results: Hospitalized patients were evaluated and were found 114 (6%) patients with nosocomial infections, below the global average. The epidemiological profile, were characterized by predominance of females 53%, aged 56.5 ± 22.5 years. And a prolonged hospital stay. The germs more common commouly isolated were in urine, the more frequent comorbidities were hypertension and diabetes mellitus. The most frequent isolated germ was Klebsiella pneumoniae, with a sensitivity only to amikacin and Cabapenemes, followed by a Escherichia coli and Staphylococcus aureus oxacillin with good sensitivity. Conclusions: 6% of nosocomial infections were found and the more frequent isolated germ was K. pneumoniae

Isolation of Escherichia coli and Salmonella spp. from free-ranging wild animals

Increasing interactions between humans, domestic animals and wildlife may result in inter-species transmission of infectious agents. To evaluate the presence of pathogenic E. coli and Salmonella spp. and to test the antimicrobial susceptibility of isolates, rectal swabs from 36 different free-ranging wild mammals were taken from two distinct natural sites in Brazil: Cantareira State Park (CSP, state of São Paulo) and Santa Isabel do Rio Negro Region (SIRNR, state of Amazonas). The swabs were randomly collected and processed for bacterial isolation, identification, characterization and antimicrobial resistance. Eighteen E. coli strains from CSP and 20 from SIRNR were recovered from 14 and 22 individuals, respectively. Strains from animals captured in CSP, the site with the greatest anthropization, exhibited a higher range and percentage of virulence genes, including an eae+/bfpA+ strain. Antimicrobial resistance was verified in strains originating from both sites; however, in strains from SIRNR, aminopenicillins were almost the exclusive antimicrobial class to which strains exhibited resistance, whereas in CSP there were strains resistant to cephalosporins, sulfonamide, aminoglycoside, tetracycline and fluoroquinolone, in addition to strains exhibiting multidrug resistance. Two strains of Salmonella enterica that are known to be associated with reptiles, serotypes Belem and 60:r:e,n,z15, were recovered only from Amazonian animals and showed susceptibility to all classes of antimicrobials that were tested. Although the potential impact of these pathogens on wildlife remains unknown, bacteria isolated from free-ranging wild animals may provide relevant information about environmental health and should therefore be more deeply studied.