Restricción programada de cefalosporinas de tercera generación en contexto de un brote de bacilos gramnegativos productores de beta-lactamasas tipo AmpC en unidades críticas: una experiencia de la vida real / Third-generation cephalosporins programmed restriction in the context of an outbreak of AmpC beta-lactamase-producing gram-negative bacilli in critical units: a real-life experience

INTRODUCCIÓN: La restricción programada (RP) de antimicrobianos puede disminuir selectivamente la tasa de infecciones por determinados microorganismos. En este sentido, los bacilos gramnegativos productores de beta-lactamasas AmpC (BGN-blaAmpC) son seleccionados por el sobreuso de cefalosporinas de tercera generación (C3G). Estas bacterias, también adquieren genes y co-producen otras beta-lactamasas, como las de Nueva Delhi (BGN-blaNDM). OBJETIVOS: Disminuir la tasa de aislamiento de BGN-blaAmpC y BGN-blaNDM en cultivos de pacientes de la UCI luego de una RP de C3G en el marco de un brote nosocomial por estos microrganismos. MATERIALES Y MÉTODOS: Estudio cuasi-experimental, previo (P1= 12 meses) y posterior (P2= 12 meses) a una RP de C3G en un hospital de adultos, donde, en el contexto de brote mencionado, se aplicaron medidas de control de infecciones generales. El uso de antimicrobianos se expresó como "porcentaje de los días de tratamiento (%DDT)"/100 camas ocupadas al día (100-COD). Se compararon las tasas de aislamiento de BGN-blaAmpC y BGN-blaNDM en hemocultivos (HC), mini-lavados bronquio-alveolares (mB) y urocultivos (UC) en la UCI. RESULTADOS: En P2 el consumo de C3G fue 2,5% DDT/100-COD. Hubo un descenso en los aislamientos de BGN-blaAmpC en HC (RR 0,48 [0,2-0,9] p < 0,02) y mB (RR 0,52 [0,3-0,9] p < 0,02), así como también de BGN-blaNDM en HC (RR 8,1 [1,6-39,4] p < 0,00). Conclusiones: La RP de C3G se asoció con la reducción de los BGN-blaAmpC y BGN-blaNDM en HC, así como de los BGN-blaAmpC mB.

BACKGROUND: Programmed restriction (PR) of antimicrobials can selectively decrease the rate of infections by certain microorganisms. In this sense, AmpC beta-lactamase-producing gram-negative bacilli (GNB-blaAmpC) are selected for the overuse of third generation cephalosporins (3GC). These bacteria also acquire genes and co-produce other β-lactamases, such as New Delhi ones (GNB-blaNDM). AIM: To decrease the isolation rate of GNB- blaAmpC and GNB- blaNDM in cultures from ICU patients after a PR of 3GC. METHODS: Quasi-experimental study, before (P1= 12 months) and after (P2= 12 months) a PR of 3GC in an adults' hospital. The use of antibiotics was expressed as "percentage days of treatment (%DOT)" /100 beds occupied per day (100-BOD). The rates of GNB-blaAmpC and GNB-blaNDM were compared in blood cultures (BC), mini-bronchio alveolar lavages (mB) and urine cultures (UC) in the ICU. RESULTS: In P2, 3GC consumption was 2.5% DOT/100-COD. There was a decrease in GNB-blaAmpC from BC (RR 0.48 [0.2-0.9] p < 0.02) and mB (RR 0.52 [0.3-0.9] p < 0.02), as well as of GNB-blaNDM from BC (RR 8.1 [1.6-39.4] p < 0.00). Conclusions: PR of 3GC was linked to the reduction of GNB-blaAmpC and GNB-blaNDM in BC, as well as GNB-blaAmpC in mB from ICU patients.

Uso racional de antibióticos y tecnología FilmArray para identificación rápida de bacteriemias en unidad de cuidados intensivos pediátrica / Rational use of antibiotics and FilmArray technology for rapid identification of bacteremias in a pediatric intensive care unit

INTRODUCCIÓN: Las infecciones graves son la principal causa de ingreso a cuidados intensivos pediátricos. El panel FilmArray BCID permite identificar rápidamente a microorganismos causantes de bacteriemias. OBJETIVO: evaluar la eficacia de la identificación rápida de microorganismos asociado a un Programa de Uso Racional de Antibióticos (URA) en reducir los tiempos de terapias antibióticas, en un hospital pediátrico. PACIENTES Y MÉTODO: Estudio retrospectivo, que incluyó 100 pacientes, en su primer episo dio de bacteriemia, divididos en 2 grupos de 50 cada uno: Intervención (FilmArray BCID y programa URA) y Controles históricos pareados para la misma especie del microrganismo identificado (microbiología convencional). Las variables evaluadas fueron los tiempos de identificación microbiana, latencia de la terapia dirigida y de desescalar antibióticos. RESULTADOS: Los grupos fueron comparables en características demográficas, foco de infección y etiología de bacteriemia. El tiempo promedio de identificación de microorganismos fue de 23 h (IC 95% 12,4-26,7) en el grupo intervención, y 70,5 h (IC 95% 65,2-78,6) en el control (p < 0,05), mientras que la latencia de inicio de terapia dirigida fue de 27,9 h (IC 95% 22,3-32,8) y 71,9 h (IC 95% 63,2-77,8) respectivamente (p < 0,05). El tiempo de desescalar o suspender antibióticos fue de 6,4 h (IC 95% 2,76-9,49) y 22 h (IC 95% 6,74-35,6) en los grupos mencionados (p > 0,05). CONCLUSIÓN: El panel FilmArray BCID articulado a un programa URA, contribuye a la identificación de los microorganismos causantes de bacteriemias en menor tiempo que los métodos convencionales, siendo una herramienta que optimiza las terapias antibióti cas en niños críticamente enfermos.

INTRODUCTION: Severe infections are the leading cause of admission to pediatric intensive care. The FilmArray BCID panel quickly identifies microorganisms that cause bacteremia. OBJECTIVE: To evaluate if the rapid identification of the microorganisms that cause bacteremia, along with a Rational Use of Antibio tics (RUA) Program, allows optimizing the time of antibiotic therapy in a pediatric hospital. PATIENTS AND METHOD: Retrospective study which included 100 patients presenting their first episode of bacteremia, divided into 2 groups of 50 each. The first one was Intervention (FilmArray BCID and RUA program) and the second one was Historical Controls (conventional automated ID/AST). The variables evaluated were the time required for microbial identification, duration of appropriate therapy, and antibiotic de-escalation. RESULTS: The groups were comparable in terms of demographic characteristics, focus of infection, and etiology of bacteremia. The average time of microorganisms' identification of the control group was 70.5 hours (IC 95% 65.2-78.6) and 23.0 hours (IC 95% 12.4 -26.7) in the intervention one (p < 0.05). The average time of targeted therapy onset was shorter in the intervention group (27.9 h [IC 95% 22.3-32.8]) than that of the control one (71.9 h [IC 95% 63.2-77.8]) (p < 0.05). Finally, the time to de-escalate or discontinue antibiotics in the intervention group and the control one was 6.4 hours (IC 95% 2.76-9.49) hours and 22.0 hours (IC 95% 6.74-35.6 h) respectively (p > 0.05). CONCLUSION: The FilmArray panel along with the RUA Program allows the identification of the microorganisms causing bacteremia faster than conventional methods, which positions it as a tool that optimizes antibiotic therapy of critical patients.

Análise do consumo de antimicrobianos e infecções relacionadas à assistência à saúde após implantação de um programa de gestão de antimicrobianos em unidade de tratamento intensivo neonatal do Rio de Janeiro / Analysis of antimicrobial consumption and healthcare-associated infections after an antimicrobial stewardship program implantation in neonatal intensive care of Rio de Janeiro / Análisis del consumo de antimicrobianos y las infecciones asociadas a la atención de la salud después de la implantación de un programa de administración de antimicrobianos en cuidados intensivos neonatales de Río de Janeiro

Justificativa e objetivos. Programas de gestão de antimicrobianos (PGA) podem contribuir para otimizar o uso de antimicrobianos em unidades de tratamento intensivo neonatais (UTINEO). O objetivo deste estudo foi mensurar o consumo de antimicrobianos, dentre eles os carbapenêmicos e infecções relacionadas à assistência à saúde (IRAS), especificamente as causadas por bactérias Gram-negativas resistentes a carbapenêmicos (BGN-CR) em neonatos após a implantação de um PGA. Métodos: Estudo prospectivo descritivo do consumo de antimicrobianos, dentre eles os carbapenêmicos; e das taxas de IRAS em uma UTINEO, durante 1 ano de seguimento. O consumo fo i medido em dias de terapia/1000 pacientes-dia (DOT/1000PD). Resultados: Em setembro de 2017 o PGA foi implementado com os seguintes elementos-chave: auditoria de antibióticos/feedback, restrição de antimicrobianos-alvo, medida do consumo de antimicrobianos e maior rapidez na liberação de resultados de culturas. Entre setembro de 2017 e setembro de 2018 admitimos 308 pacientes, totalizando 2223 pacientes-dia. A mediana de consumo total de antimicrobianos foi de 1580 DOT/1000PD (variação de 1180,7 a 2336,6/mês) sem tendência de aumento e a de carbapenêmicos 12 DOT/1000PD (variação de 0 a 163,2/mês). O consumo de carbapenêmicos foi reduzido entre abril a setembro de 2018 (valor de p =0,07) quando comparado com os primeiros seis meses. Oito IRAS foram registradas, correspondendo a uma densidade de incidência de 3,6/1000 pacientes-dia. Não foram reportadas BGN-CR causando IRAS. Conclusões: O consumo total de antimicrobianos não apresentou aumento ao longo do ano após implantação do PGA. No entanto, houve redução significativa do consumo de carbapenêmicos. Não foram verificadas IRAS por BGN-CR no período do estudo.(AU)

Background and objectives: Antimicrobial stewardship programs (ASPs) could contribute to optimize antimicrobial use within neonatal intensive care units (NICUs). The aim of this study was to measure the antimicrobial consumption, including carbapenems and healthcare-associated infections (HAI), specifically infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) in neonates, after implementation of an ASP. Methods: A prospective descriptive study of antimicrobial and carbapenem consumption; and healthcare-associated rate in a NICU, during a one-year follow-up. The consumption was measured in days of therapy /1000 patients-days(DOT/1000PD). Results: In September 2017, the ASP was implemented, with the following core components: antibiotic audit and feedback, restriction of target antimicrobials, measure of antimicrobial consumption and improvement of results from microbiologic laboratory. Between September 2017 and September 2018, we admitted 308 patients, totalizing 2223 patient-days. The median of total antimicrobial consumption was 1580 DOT/1000PD (range from 1180.7 to 2336.6/month and of carbapenems 12 DOT/1000PD (range from 0 to 162.3/month). The carbapenem consumption was reduced between April and September of 2018 (p value=0.07) when we compared the first six months of the study. Eight HAI were detected, corresponding to density of incidence of 3.6/1000 patient-days. No HAI due to CR-GNB was reported. Conclusion: The total antimicrobial consumption did not increase during all the year after the ASP implantation. Although there was a significant reduction of carbapenem consumption. Carbapenem-resistant bacteria was not found in NICU causing HAI.(AU)

Justificación y objetivos: Los programas de optimizatión de uso de antimicrobianos (POA) podrían contribuir a optimizar el uso de antimicrobianos dentro de las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue medir el consumo de antimicrobianos incluidos los carbapenems y las infecciones asociadas a la atención de la salud (IAAs), especificamente las infecciones causadas por bacterias Gram negativas resistentes a carbapenems (CR-GNB) en neonatos, después de la implementación de un POA. Métodos: Un estudio descriptivo prospectivo del consumo de antimicrobianos y carbapenems; y la tasa de IAAs en una UCIN durante un año de seguimiento. El consumo se midió en días de terapia (DOT) / 1000 pacientes-días. Resultados: En septiembre de 2017, se implementó el POA con los siguientes componentes principales: auditoría y retroalimentación de antibióticos, restricción de antimicrobianos objetivo, medición del consumo de antimicrobianos y mejora de los resultados del laboratorio microbiológico. Entre septiembre de 2017 y septiembre de 2018, admitimos 308 pacientes, totalizando 2223 días-paciente. La mediana del consumo total de antimicrobianos fue de 1580 DOT / 1000PD (rango de 1180.7 a 2336.6 / mes y de carbapenems 12 (rango de 0 a 162.3 / mes). El consumo de carbapenem se redujo entre abril y septiembre de 2018 (valor p = 0.07) cuando comparamos los primeros seis meses del estudio, se detectaron ocho IAAs, lo que corresponde a la densidad de incidencia de 3.6 / 1000 días-paciente No se informó ningún IAA debido a CR-GNB. Conclusiones: El consumo total de antimicrobianos no aumentó durante todo el año posterior a la implantación de POA. Aunque hubo una reducción significativa del consumo de carbapenem. No se encontraron bacterias resistentes a carbapenem en la UCIN que causa IAA.(AU)

Predicting bacteria causing acute bacterial rhinosinusitis by clinical features / Predição de bactérias causadoras de rinossinusite bacteriana aguda por características clínicas

Abstract Introduction: Clinicians rely on clinical presentations to select therapeutic agents for acute bacterial rhinosinusitis. Streptococcus pneumoniae and Haemophilus influenzae are common in acute bacterial rhinosinusitis. Drug resistant Streptococcus pneumoniae and Haemophilus influenzae require different antibiotics. Objective: This study aimed to evaluate the associations between clinical features of acute bacterial rhinosinusitis and pathogenic bacteria. Methods: Sixty-four patients with acute bacterial rhinosinusitis were enrolled. Clinical features including nasal obstruction, discolored discharge, facial pain, smell disturbance, fever and laboratory findings of patients with acute bacterial rhinosinusitis were collected. The bacterial cultures of endoscopic middle meatal swabs were used as a reference. Results: Serum C-reactive protein level elevation correlated with the bacterial species (p = 0.03), by which was increased in 80.0% of Haemophilus influenzae rhinosinusitis and 57.1% of Streptococcus pneumoniae rhinosinusitis. The elevated C-reactive protein was the significant predictor for Haemophilus influenzae rhinosinusitis with the Odds Ratio of 18.06 (95% CI 2.36-138.20). The sensitivity of serum C-reactive protein level elevation for diagnosing Haemophilus influenzae rhinosinusitis was 0.80 (95% CI 0.49-0.94). Conclusion: Elevation of serum C-reactive protein level was associated with and predicted acute bacterial rhinosinusitis caused by Haemophilus influenzae.

Resumo: Introdução: Os médicos se baseiam nas características clínicas para a escolha dos agentes terapêuticos para o tratamento da rinossinusite bacteriana aguda. Streptococcus pneumoniae e Haemophilus influenzae são agentes comuns na rinossinusite bacteriana aguda. Streptococcus pneumoniae e Haemophilus influenzae resistentes a antibióticos requerem medicamentos diferentes. Objetivo: Avaliar as associações entre as características clínicas da rinossinusite bacteriana aguda e bactérias patogênicas. Método: O estudo incluiu 64 pacientes com rinossinusite bacteriana aguda. Foram coletadas e registradas as características clínicas, inclusive obstrução nasal, secreção com cor alterada, dor facial, distúrbios do olfato, febre e achados laboratoriais de pacientes com rinossinusite bacteriana aguda. As culturas bacterianas obtidas por swab endoscópico do meato médio foram usadas como referência. Resultados: A elevação do nível sérico de proteína C-reativa estava correlacionada com a espécie bacteriana (p = 0,03); ela estava aumentada em 80,0% das rinossinusites por Haemophilus influenzae e em 57,1% das rinossinusites por Streptococcus pneumoniae. A proteína C-reativa elevada foi um significativo fator preditor de rinossinusite por Haemophilus influenzae, com razão de probabilidade de 18,06 (IC 95% 2,36-138,20). A sensibilidade da elevação dos níveis séricos de proteína C-reativa para o diagnóstico de rinossinusite por Haemophilus influenzae foi de 0,80 (IC 95% 0,49 ± 0,94). Conclusão: A elevação dos níveis séricos de proteína C-reativa é um preditor de rinossinusite bacteriana aguda causada por Haemophilus influenzae.

Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections / Perfil microbiológico e de resistência bacteriana no pé diabético infectado

ABSTRACT Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.

RESUMO Objetivo: identificar o perfil sociodemográfico, microbiológico e de resistência bacteriana em pacientes com pé diabético infectado. Métodos: tratou-se de estudo observacional, transversal que avaliou os perfis sóciodemográfico e microbiológico de pacientes portadores de pé diabético infectado internados em Pronto Socorro de referência. Os dados sociodemográficos foram coletados por meio de entrevista. Foram colhidos, durante os procedimentos cirúrgicos, fragmentos de tecidos das lesões podais infectadas para realização de cultura/antibiograma. Resultados: a amostra foi composta por 105 pacientes. O perfil sociodemográfico mais prevalente foi o de pacientes do sexo masculino, acima dos 50 anos, casados e com baixa escolaridade. Das 105 amostras de fragmentos de tecidos colhidos para realização de cultura e antibiograma, 95 foram positivas, com crescimento de um único germe em cada um dos exames. Houve predomínio de germes da família Enterobacteriaceae (51,5%). Germes Gram-negativos foram isolados em 60,0% das culturas e os espécimes mais isolados individualmente foram os cocos Gram-positivos, Staphylococcus aureus (20,0%) e Enterococcus faecalis (17,9%). Considerando-se os perfis de resistência bacteriana, verificou-se alta taxa de Staphylococcus aureus resistente à meticilina (63,0%) e à ciprofloxacino (55,5%); verificou-se, também, que 43,5% dos germes Gram-negativos eram resistentes à ciprofloxacino. Conclusões: o perfil sociodemográfico majoritário, foi o de homens, com mais de 50 anos e com baixa escolaridade. Concluímos que os germes mais prevalentes nas lesões podais dos pacientes diabéticos foram os Gram-negativos, resistentes ao ciprofloxacino e que o germe mais isolado individualmente foi o Staphylococcus aureus resistente à meticilina.

Molecular detection of vector-borne agents in cats in Southern Brazil / Detecção molecular de agentes transmitidos por vetores em felinos domésticos no Sul do Brasil

Abstract This study used serological and molecular methods to investigate the occurrence of vector-borne pathogens (VBP) with zoonotic potential in cats neutered at the University Veterinary Hospital in Canoinhas, Santa Catarina. The combined PCR and serological results revealed that 17 (56.6%) cats were positive for one or more pathogens. The sampled cats had antibodies to Ehrlichia spp. (7/30), Anaplasma phagocytophilum (3/30) and Leishmania infantum (2/30). The PCR assay detected DNA closely related to Ehrlichia canis in 6/30 cats, Mycoplasma haemofelis in 2/30 cats, A. phagocytophilum and Cytauxzoon sp. in one cat each. While Bartonella clarridgeiae and B. henselae were detected in two cats each, and B. koehlerae was detected in one cat.

Resumo Como os felinos podem ser parasitados por diversos patógenos transmitidos por vetores (PTV), alguns com caráter zoonótico, este estudo objetivou detectar por métodos sorológicos e moleculares, patógenos transmitidos por vetores hematófagos, em gatos atendidos em um Hospital Veterinário Universitário em Santa Catarina. Os resultados da PCR e da sorologia combinados, revelaram que 17 (56,6%) gatos foram positivos para um ou mais patógenos. Na sorologia, foram positivos 7/30 gatos para Ehrlichia, 3/30 para Anaplasma phagocytophilum e 2/30 para Leishmania infantum. Na PCR foi detectado DNA filogeneticamente associado a: Ehrlichia canis em 6/30 gatos; Mycoplasma haemofelis, em 2/30 gatos; A. phagocytophilum e Cytauxzoon sp. em 1/30 gatos cada. Enquanto Bartonella clarridgeiae e B. henselae foram detectadas, cada uma, em dois gatos, B. koehlerae foi detectada em um gato.

Molecular detection of Bartonella, Ehrlichia and Mycoplasma in feral dogs of El Pedregal de San Angel Ecological Reserve in Mexico City / Detecção molecular de Bartonella, Ehrlichia e Mycoplasma em cães selvagens da Reserva Ecológica El Pedregal de San Angel, na Cidade do México

Abstract Free-ranging and feral dogs represent a group of unattended companion animals. They impact wild animal populations by predating native species, displacing predators and introducing exotic pathogens. The aim of this work was to describe the molecular occurrence of Rickettsia, Ehrlichia, Anaplasma, Mycoplasma and Bartonella in feral dogs. The study was carried out in the last relict of a protected area in Mexico City. Blood clots samples from 19 dogs were obtained and analyzed for detection of specific fragments of the 16S-rRNA gene for Anaplasma, Ehrlichia and Mycoplasma and citrate synthase (gltA) for Bartonella and Rickettsia. Our results showed that DNA from three bacteria species (Bartonella vinsonii subsp. berkhoffii, Ehrlichia canis and Mycoplasma haemocanis) was present with frequencies ranging from 5.3 to 15.8%. This is the first record of B. vinsonii subsp. berkhoffii and M. haemocanis in dogs from México, and also the first finding of Ehrlichia canis in Mexico City. It is important to perform surveillance of feral dog populations in order to identify the impact of these pathogens on wild animal populations and Public Health in order to establish prevention and protection programs.

Resumo Cães errantes e selvagens representam um grupo de animais de companhia livres. Eles impactam as populações de animais selvagens pela predação de espécies nativas, deslocando predadores e introduzindo patógenos exóticos. O objetivo deste trabalho foi descrever a ocorrência molecular de Rickettsia, Ehrlichia, Anaplasma, Mycoplasma e Bartonella em cães selvagens. O estudo foi realizado no último ecossistema de uma área protegida na Cidade do México. Amostras de coágulos sanguíneos de 19 cães foram obtidas e analisadas para detecção de fragmentos específicos do gene 16S-rRNA para Anaplasma, Ehrlichia e Mycoplasma e citrato sintase (gltA) para Bartonella e Rickettsia. Nossos resultados mostraram que o DNA de três espécies de bactérias (Bartonella vinsonii subsp. berkhoffii, Ehrlichia canis e Mycoplasma haemocanis) estava presente com frequências variando de 5,3 a 15,8%. Este é o primeiro registro de B. vinsonii subsp. berkhoffii e M. haemocanis em cães do México, e também a primeira descrição de Ehrlichia canis na Cidade do México. É importante realizar a vigilância das populações de cães selvagens para identificar o impacto desses patógenos nas populações de animais silvestres e na Saúde Pública, a fim de estabelecer programas de prevenção e proteção.

Septicemia por Chromobacterium Violaceum en pediatría / Septicemia due to Chromobacterium Violaceum in pediatrics

Chromobacterium violaceum es una bacteria gram negativa anaerobia facultativa, que se encuentra ampliamente distribuida en el agua y el suelo en regiones tropicales y subtropicales, que se asocia con infecciones respiratorias, gastrointestinales, abscesos hepáticos, meningitis, endocarditis, síndrome hemofagocítico y sepsis fulminante. Se presentan 2 casos en niños: el primero es un varón de 8 años con lesiones en piel, fiebre y adenitis inguinal, que ingresó con un cuadro de sepsis severa, síndrome de distrés respiratorio agudo (SDRA) y falleció a las 3 h del ingreso. De los hemocultivos se aisló Chromobacterium violaceum. El segundo caso, es una niña de 12 años con antecedente de fiebre y adenopatía inguinal secundaria a herida cortopunzante en el pie homolateral, que ingresó con un cuadro de sepsis, con desarrollo de abscesos múltiples profundos. De la colección obtenida de piel y partes blandas y de un aspirado traqueal se aisló Chromobacterium violaceum. Recibió tratamiento antibiótico adecuado y posteriormente fue dada de alta. Se realizó una revisión bibliográfica de esta infección en niños y se encontraron 44 casos en todo el mundo. Algunos de éstos, se relacionaron con inmunodeficiencia de base, como la enfermedad granulomatosa crónica. La infección por esta bacteria es rara y se presenta como un cuadro grave que no responde a antibióticos habituales de uso empírico y tiene una alta tasa de mortalidad (AU)

Chromobacterium violaceum is a facultative anaerobic Gramnegative bacillus, widely distributed in water and soil in tropical and subtropical regions and associated with respiratory and gastrointestinal infections, liver abscesses, meningitis, endocarditis, hemophagocytic syndrome, and fulminant sepsis. Here two pediatric cases are presented: The first was an 8-year-old boy with skin lesions, fever, and inguinal adenitis, who was admitted with severe sepsis, acute respiratory distress syndrome (ARDS) and died three hours after. Chromobacterium violaceum was isolated from blood cultures. The second case was a 12-year-old girl with a history of fever and inguinal adenopathy secondary to a wound in the homolateral foot, who was admitted because of sepsis and multiple deep abscesses. From samples collected from the skin and soft tissues as well as tracheal aspirate Chromobacterium violaceum was isolated. Adequate antibiotic treatment was started and the patient was subsequently discharged. In a review of the literature, 44 cases worldwide were identified. Some of these cases were related to underlying immunodeficiency, such as chronic granulomatous disease. Infection with this bacterium is rare and presents with severe manifestations that do not respond to the common empirical antibiotics and are associated with a high mortality rate (AU)

Delftia acidovorans pneumonia with lung cavities formation / Neumonia con formación de cavidades pulmonares causada por Delftia acidovorans

Abstract Case Description: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. Clinical Finding: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. Treatment and outcomes: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. Clinical Relevance: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.

Resumen Descripción del caso: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. Hallazgo clínico: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. Tratamiento y resultados: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. Relevancia clínica: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.

Distribución y caracterización molecular de betalactamasas en bacterias Gram negativas en Colombia, 2001-2016 / Distribution and molecular characterization of beta-lactamases in Gram-negative bacteria in Colombia, 2001-2016

Resumen Las betalactamasas, enzimas con capacidad hidrolítica frente a los antibióticos betalactámicos, son responsables del principal mecanismo de resistencia en bacterias Gram negativas; las de mayor impacto clínico y epidemiológico en los hospitales, son las betalactamasas de espectro extendido (BLEE), las de tipo AmpC y las carbapenemasas. El incremento en su frecuencia y su diseminación a nivel mundial ha limitado cada vez más las opciones terapéuticas tanto en infecciones adquiridas en los hospitales como las que se generan en la comunidad. En Colombia, las redes de vigilancia y los grupos de investigación iniciaron su estudio desde finales de los años 90 y, así, se logró la caracterización molecular de las diferentes variantes; además, se reportó una gran prevalencia y diseminación en los hospitales de mediana y alta complejidad, y se describió el impacto clínico de las infecciones que causan. Dichos estudios han evidenciado el alto grado de endemia de algunas de estas betalactamasas y, en consecuencia, la necesidad de una inmediata implementación de programas para inducir el uso prudente de los antibióticos y de medidas de vigilancia, que permitan controlar y prevenir su diseminación, con el fin de disminuir la morbimortalidad en los pacientes y preservar las opciones terapéuticas disponibles en la actualidad. En esta revisión, se recopiló la información sobre las variantes, la distribución geográfica y la caracterización molecular de las betalactamasas en Colombia, así como los estudios llevados a cabo desde finales de la década de 90 hasta el 2016, lo cual permitió tener un panorama de las betalactamasas que circulan en diferentes regiones, su incremento en el tiempo y sus implicaciones clínicas.

Abstract Beta-lactamases are enzymes with hydrolytic activity over beta-lactam antibiotics and they are the main resistance mechanism in Gram-negative bacteria. Extended-spectrum beta-lactamases (ESBL), AmpC, and carbapenemases have the greatest clinical and epidemiological impact in hospital settings. The increasing frequency and worldwide spread of these enzymes have limited the therapeutic options in hospital-acquired infections and those originating in the community. In Colombia, surveillance networks and research groups began studying them in the late 90s. Different variants of these enzymes have been molecularly characterized and their high prevalence and dissemination in medium and high complexity hospitals, along with a high clinical impact, have been reported. Furthermore, many studies in Colombia have evidenced high endemicity for some of these beta-lactamases, which requires an urgent implementation of antimicrobial stewardship programs in order to preserve the few therapeutic options and infection control strategies to prevent and limit their dissemination. In this publication, we carried out a review of the different enzyme variants, geographic distribution, and molecular characterization of these beta-lactamases in Colombia. Additionally, we describe the available information in the literature regarding studies conducted between the late 1990s and 2016, which provide an overview of the beta-lactamases circulating in different regions of Colombia, their increase over time, and their clinical implications.

Surveillance of multidrug-resistant bacteria in pediatric and neonatal intensive care units in Rio de Janeiro State, Brazil

Abstract INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.

Ralstonia mannitolilytica bacteremia in a neonatal intensive care unit

Abstract Ralstonia mannitolilytica, a Gram-negative bacterium, is rarely isolated in clinical laboratories. It has been associated with outbreaks due to its ability to survive in liquid media and hospital devices. We describe three cases of bacteremia caused by R. mannitolilytica in a neonatal intensive care unit in Curitiba, Southern Brazil. All isolates presented the same PFGE profile. The common source of infection was undetected in surveillance cultures for the outbreak survey. All patients received antimicrobial treatment and were discharged from the maternity. Due to the characteristics of the microorganism, clinicians and microbiologists should pay attention to the emergence of Ralstonia spp. infections.

Serological evidence of exposure to some zoonotic microorganisms in cattle and humans with occupational exposure to livestock in Antioquia, Colombia / Evidencia serológica de exposición a algunos microorganismos zoonóticos en bovinos y humanos con exposición ocupacional a ganadería en Antioquia, Colombia / Evidências sorológicas de exposição a alguns microrganismos zoonóticos em bovinos e em humanos com exposição ocupacional ao gado na Antióquia, Colômbia

Bacteria belonging to Anaplasma, Ehrlichia, Rickettsia and Coxiella genera are considered emerging pathogens and livestock is one of the contexts where the transmission of these microorganisms can occur. The goal of this study was to determine serological evidence for the exposure to these bacteria in cattle and humans with occupational exposure to livestock in the subregions North and Magdalena Medio, Antioquia, Colombia, and to explore related factors. A cross-sectional study was conducted in 48 livestock farms distributed in six municipalities from both subregions: Belmira, Entrerríos and San Pedro de los Milagros (North), and Puerto Berrío, Puerto Nare and Puerto Triunfo (Magdalena Medio). Blood samples from 332 people and 384 bovines were evaluated by serology (IgM and IgG) screening for bacteria from the Anaplasma, Ehrlichia, Rickettsia, and Coxiella genera. Seropositivity in humans from both regions was 42.4% (95%CI: 31.2-55.1) for Anaplasma, 74.2% (95%CI: 66.0-84.4) for Ehrlichia, 72.5% (95%CI: 62.1-82.0) for Rickettsia, and 60.7% (95%CI: 59.7-69.1) for Coxiella burnetii. In cattle, seropositivity was 31.6% (95%CI: 19.9-44.2), 66.8% (95%CI: 55.2-78.1), 64.6% (95%CI: 53.8-74.5), and 61.6% (95%CI: 51.9-69.2), respectively. History of biting by ticks, milking, vaccination, having dogs and hens in the residence, as well as the consumption of raw milk derivatives were some factors associated with the infection by the bacteria studied. The results suggest a previous and recent exposure to these zoonotic bacteria genera in people with occupational exposure to livestock, as well as in cattle in the two studied subregions.

Las bacterias pertenecientes a los géneros Anaplasma, Ehrlichia, Rickettsia y Coxiella son consideradas patógenos emergentes y la ganadería es uno de los contextos donde se puede producir la transmisión de este tipo de microorganismos. El objetivo de este estudio fue determinar la evidencia serológica, debida a la exposición a estas bacterias en bovinos y humanos con exposición ocupacional a ganadería en las subregiones Norte y Magdalena Medio, Antioquia, Colombia, además de estudiar los factores relacionados. Se realizó un estudio transversal en 48 fincas ganaderas, distribuidas en seis municipios de ambas subregiones: Belmira, Entrerríos y San Pedro de los Milagros (Norte), y Puerto Berrío, Puerto Nare y Puerto Triunfo (Magdalena Medio). Las muestras de sangre de 332 personas y 384 bovinos fueron evaluadas mediante tamización serológica (IgM e IgG) para la detección de bacterias de los géneros Anaplasma, Ehrlichia, Rickettsia, y Coxiella. La seropositividad en humanos de ambas regiones fue 42,4% (IC95%: 31,2-55,1) en el caso de Anaplasma, un 74,2% (IC95%: 66,0-84,4) en Ehrlichia, un 72,5% (IC95%: 62,1-82,0) en Rickettsia, y un 60,7% (IC95%: 59,7-69,1) en Coxiella burnetii. En los bovinos, la seropositividad fue 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5), y 61,6% (IC95%: 51,9-69,2), respectivamente. El antecedente de haber sido mordido por garrapatas, ordeñar, vacunación, tener perros y gallinas en la residencia, así como el consumo de derivados de leche cruda fueron algunos de los factores asociados con la infección por las bacterias estudiadas. Los resultados sugieren la exposición previa y reciente a estas bacterias en personas con una exposición ocupacional a la ganadería, así como a los bovinos en las dos subregiones estudiadas.

As bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella são considerados patógenos emergentes, e a transmissão desses microrganismos pode ocorrer no contexto da pecuária. O estudo teve como objetivos determinar as evidências sorológicas de exposição a essas bactérias em bovinos e em humanos com exposição ocupacional ao gado nas sub-regiões Norte e Magdalena Médio, Antióquia, Colômbia, e explorar fatores associados. Foi realizado um estudo transversal em 48 fazendas de gado bovino distribuídas em seis municípios nas duas sub-regiões: Belmira, Entrerríos e San Pedro de los Milagros (Norte) e Puerto Berrío, Puerto Nare e Puerto Triunfo (Magdalena Médio). Amostras de sangue de 332 humanos e 384 bovinos foram analisadas com sorologia (IgM e IgG) para bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella. Os níveis de sorologia positiva em humanos das duas regiões foram de 42,4% (IC95%: 31,2-55,1) para Anaplasma, 74,2% (IC95%: 66,0-84,4) para Ehrlichia, 72,5% (IC95%: 62,1-82,0) para Rickettsia e 60,7% (IC95%: 59,7-69,1) para Coxiella burnetii. Nos bovinos, os níveis foram 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5) e 61,6% (IC95%: 51,9-69,2), respectivamente. Os fatores associados às bactérias estudadas foram: história de picada de carrapato, ordenha, vacinação, presença de cães e galinhas no domicílio e consumo de laticínios feitos com leite cru, entre outros. Os resultados sugerem exposição prévia e recente a esses gêneros bacterianos zoonóticos em pessoas com contato ocupacional com gado, assim como nos próprios animais, nas duas sub-regiões estudadas.

Inadequate use of antibiotics and increase in neonatal sepsis caused by resistant bacteria related to health care assistance: a systematic review

ABSTRACT Background Technologies and life support management have enhanced the survival of preterm infants. The immune system of newborns is immature, which contributes to the occurrence of healthcare-associated infections. The overlap of several conditions with neonatal sepsis and the difficulty of diagnosis and laboratory confirmation during this period result in a tendency to over-treat neonatal sepsis. The use of antimicrobial agents is a risk factor for multidrug-resistant bacterial infections. This work aimed to perform a systematic review of the relationship between inadequate use of antimicrobial agents and increase in neonatal sepsis related to healthcare assistance, due to bacterial resistance. Methods Our population, exposition, comparison, outcome and study type was as follows: P: hospitalized neonates with sepsis diagnosis, E: inappropriate use of antimicrobial agents, C: adequate use of antimicrobial agents or no indication of infection, O: resistant bacterial infection, and S: original studies. We performed searches in the PubMed, Scopus, Virtual Health Library (Scielo, LILACS, and MEDLINE), and Embase without limits on time, language, and the references of the articles found. Fourteen studies were included and assessed using the Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle, and the Strengthening the Reporting of Observacional Studies in Epidemiology methodologies. Results All studies found were observational and started with a low-quality evidence level in the Grading of Recommendations, Assessment, Development, and Evaluation. Conclusions Despite their low-quality evidence, the studies demonstrated the association between inadequate use of antimicrobial agents and increase of neonatal resistant bacterial healthcare-associated infections in neonatal units. However, there is significant difficulty in conducting high-quality studies in this population due to ethical issues tied to randomized trials. Therefore, new studies should be encouraged to recommend adequate treatment of newborns without increasing the risk of healthcare-associated infections by multidrug-resistant bacteria.

Infecções endodônticas persistentes: causas, diagnóstico e tratamento / Persistent endodontic infections: causes, diagnostic and treatment

Introdução: Microrganismos subsecivos de infecções endodônticas primárias ou secundárias são a causa das infecções persistentes ou refratárias. Objetivo: realizar uma revisão de literatura sobre as infecções endodônticas persistentes, descrevendo a microbiota mais comumente associada ao insucesso da terapia endodôntica, bem como ressaltar o diagnóstico e tratamento dessas infecções. Metodologia: Foram realizadas buscas bibliográficas eletrônicas utilizando base de dados como Pubmed, Lilacs e Bireme que abordassem o tema proposto no período de 2000 a 2016. Para tanto, foram utilizados os seguintes descritores de assunto na língua portuguesa: "Endodontia", "Infecção persistente", "Periodontite apical" e na língua inglesa: "Endodontics", "Persistent infection","Apical Periodontitis". Resultados: Os artigos selecionados foram lidos criteriosamente e mostraram que esses microrganismos resistem aos procedimentos intracanais de desinfecção, resultando em uma periodontite apical persistente, com ou sem sintomatologia clínica e radiográfica evidente. O diagnóstico e tratamento são dificultados devido à complexidade anatômica do sistema de canais radiculares e capacidade de resistência bacteriana e o tratamento envolve um tratamento endodôntico efetivo, com necessidade cirúrgica em alguns casos. Conclusão: A análise desses patógenos é crucial nas infecções refratárias, tornando-se necessário avançar nas pesquisas para a determinação de novas técnicas de desinfecção associadas a novas medicações que tornarão a Endodontia cada vez mais eficaz e com resultados ainda mais previsíveis

The evaluation of nosocomial infections in pediatric patients with extracorporeal membrane oxygenation support

Abstract Introduction: Extracorporeal membrane oxygenation (ECMO) has become a standard technique over the past few decades in intensive care unit (ICU). Objective: A review of pediatric patients who received ECMO support in the pediatric cardiac ICU was conducted to determine the incidence, risk factors and causal organisms related to acquired infections and assess the survival rates of ECMO patients with nosocomial infections. Methods: Sixty-six patients who received ECMO support in the pediatric cardiac ICU between January 2011 and June 2014 were included in the study. Demographic, echocardiographic, hemodynamic features and surgical procedures were reviewed. Results: Sixty-six patients received a total of 292.5 days of venoarterial ECMO support. Sixty were postoperative patients. Forty-five patients were weaned from ECMO support with an ECMO survival rate of 68.2%. The rate of infection was 116.2/1000 ECMO days. Prolonged ICU stay, duration of ventilation and ECMO were found associated with development of nosocomial infection and only the duration of ECMO was an independent risk factor for nosocomial infections in ECMO patients. Conclusion: The correction of the underlying process leading to ECMO support and shortening the length of ECMO duration together with stricter application of ECMO indications would improve the infection incidence and hospital surveillance of the patient group.

Identificación del complejo rojo en la necrosis pulpar abierta y cerrada con técnicas moleculares / Red complex identification in exposed and unexposed necrotic pulp with molecular techniques

Objetivo: identificar el complejo rojo periodontal, formado por Porphyromonas gingivalis, Treponema denticola y Tannerella forsythia, en la infección endodóntica primaria de necrosis pulpar, con cámara abierta y cerrada, utilizando técnicas de reacción en cadena de la polimerasa. Materiales y métodos: se realizó la toma para reacción en cadena de la polimerasa en 27 dientes con necrosis pulpar, 13 con cámara pulpar abierta y 14 con cámara cerrada. Resultados: en las muestras de necrosis abierta se identificaron P. gingivalis en un 92 por ciento, T. denticola en un 76 por ciento, T. forsythia en un 76 por ciento y el complejo rojo en un 61 por ciento. Las tomas de necrosis cerrada mostraron P. gingivalis en un 78 por ciento y T. denticola en un 57 por ciento; no se identificaron T. forsythia ni el complejo rojo. El análisis estadístico evidenció diferencias significativas entre los dos grupos (P<0,05). Conclusión: el sinergismo de las tres bacterias que forman el complejo rojo agravaría la patogénesis de la infección endodóntica y permitiría relacionar la microbiología endodóntica con la microbiología de periodontitis crónica.

Resultados de la vigilancia nacional de la resistencia antimicrobiana de enterobacterias y bacilos Gram negativos no fermentadores en infecciones asociadas a la atención de salud, Colombia, 2012-2014 / Results of the national surveillance of antimicrobial resistance of Enterobacteriaceae and Gram negative bacilli in health care-associated infections in Colombia, 2012-2014

Resumen Introducción. En el tercer trimestre de 2012, comenzó a operar el Sistema Nacional de Vigilancia de Resistencia Antimicrobiana en las infecciones asociadas a la atención en salud, con el fin de recabar y analizar la información referente al problema en Colombia. Objetivo. Describir los perfiles de resistencia y los resultados de la vigilancia por el laboratorio con base en los datos recolectados en el Sistema. Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo con base en la información del Sistema Nacional de Vigilancia en Salud Pública, Sivigila, 1 de septiembre de 2012 a 31 de diciembre de 2014, así como de las bases de datos Whonet con los datos notificados por las unidades primarias generadoras de datos y los resultados de la confirmación por el laboratorio de la caracterización fenotípica y genotípica de la resistencia a carbapenemasas en 1.642 aislamientos (927 de enterobacterias, 614 de Pseudomonas spp. y 101 de Acinetobacter spp.). Resultados. La resistencia de Escherichia coli a las cefalosporinas de tercera generación presentó un incremento significativo, alcanzando 26,3 % en unidades de cuidados intensivos y 22,5 % en otras áreas de hospitalización. La resistencia a ertapenem de Klebsiella pneumoniae registró un incremento y alcanzó 14,6 % en unidades de cuidados intensivos. La resistencia de Acinetobacter baumannii a los carbapenémicos superó el 50 % en dichas unidades, en tanto que en Pseudomonas aeruginosa se presentaron porcentajes más bajos (38,8 %). Las carbapenemasas más frecuentes en enterobacterias fueron la KPC (n=574), seguida de la NDM (n=57); en P. aeruginosa, la VIM (n=229) y la KPC (n=114), y en A. baumannii, la OXA-23 (n=87). Se detectaron varias combinaciones de carbapenemasas, siendo la de KPC y VIM la más frecuente en Pseudomonas spp., y en enterobacterias. Conclusión. La información obtenida a partir del Sistema Nacional de Vigilancia ha permitido conocer los perfiles y los mecanismos de resistencia a carbapenémicos de las cepas que están circulando en las instituciones de salud del país.

Abstract Introduction: The Colombian National Antimicrobial Resistance Monitoring System for the surveillance of healthcare-associated infections was set up to meet this problem in the third quarter of 2012. Objective: To describe resistance profiles and laboratory-based surveillance based on the information collected by the System. Materials and methods: We conducted a retrospective and descriptive study of the information notified to the Colombian Public Health Surveillance System (Sivigila), and in the Whonet databases covering the period from July 2012 to December 2014 provided by the primary data-generating units in the country, as well as laboratory surveillance results from 1,642 phenotypic and genotypic tests on carbapenemase isolates (927 from Enterobacteriaceae, 614 from Pseudomonas spp. and 101 from Acinetobacter spp.). Results: There was a significant increase in Escherichia coli resistance to third-generation cephalosporins (reaching 26.3% in ICUs and 22.5% in other hospital wards), and Klebsiella pneumoniae resistance to ertapenem also increased (reaching 14.6% in ICUs). Acinetobacter baumannii carbapenem resistance exceeded 50% in ICUs whereas Pseudomonas aeruginosa had lower carbapenem resistance (38.8%). KPC (n = 574) and NDM (n=57) were the most frequently occurring carbapenemases in Enterobacteriaceae, VIM (n=229) and KPC (n=114) in P. aeruginosa, and OXA-23 in A. baumannii (n=87); several carbapenemase combinations were identified, KPC + VIM being the most common in Pseudomonas spp. and Enterobacteriaceae. Conclusion: The data from the surveillance of healthcare-associated infections revealed significant carbapenem resistance profiles and antimicrobial resistance mechanisms circulating in Colombian healthcare institutions.

Microbiota periodontal y microorganismos aislados de válvulas cardiacas en pacientes sometidos a cirugía de reemplazo de válvulas en una clínica de Cali, Colombia / Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia

Resumen Introducción. La periodontitis es una enfermedad infecciosa que afecta los tejidos de soporte del diente y se asocia con diferentes enfermedades sistémicas, incluida la enfermedad cardiovascular. Los estudios microbiológicos permiten detectar microorganismos a partir de muestras subgingivales y cardiovasculares. Objetivo. Describir la microbiota periodontal cultivable y la presencia de microorganismos en válvulas cardiacas de pacientes sometidos a cirugía de reemplazo valvular en una clínica de Cali. Materiales y métodos. Se analizaron 30 muestras subgingivales y de tejidos valvulares mediante cultivo en medio bifásico, agar de sangre con suplemento y agar tripticasa de soya con antibiótico. Las muestras de las válvulas se analizaron mediante reacción en cadena de la polimerasa (PCR) convencional. Resultados. Los patógenos periodontales aislados de bolsas periodontales fueron Fusobacterium ( 50 % ), Prevotella intermedia/nigrescens (40 %), Campilobacter rectus (40 %), Eikenella corrodens (36,7 %), bacilos entéricos Gram negativos (36,7 %), Porphyromonas gingivalis (33,3 %) y Eubacterium (33,3 %). Los agentes patógenos aislados de la válvula aórtica fueron Propionibacterium acnes (12 %), bacilos entéricos Gram negativos (8 %), Bacteroides merdae (4 %) y Clostridium bifermentans (4 %), y de la válvula mitral, P. acnes y Clostridium beijerinckii. La PCR convencional no arrojó resultados positivos para agentes patógenos orales y solo se detectó ADN bacteriano en dos muestras. Conclusiones. La microbiota periodontal de pacientes sometidos a cirugía de reemplazo valvular estaba conformada por especies Gram negativas que han sido relacionadas con infecciones en tejidos extraorales; sin embargo, no se encontraron agentes patógenos periodontales en los tejidos de las válvulas. Aunque hubo muestras de estos tejidos y subgingivales, positivas para bacilos entéricos Gram negativos, no es posible asegurar que tuvieran el mismo origen filogenético.

Abstract Introduction: Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples. Objective: To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali. Materials and methods: We analyzed 30 subgingival and valvular tissue samples by means of twophase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue. Results: The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples. Conclusions: Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

Activity of Brazilian propolis against Aeromonas hydrophila and its effect on Nile tilapia growth, hematological and non-specific immune response under bacterial infection

ABSTRACT The effect of the ethanolic extract of propolis (EEP) on Aeromonas hydrophila was analyzed by determination of minimum inhibitory concentration (MIC). Then, the effects of crude propolis powder (CPP) on growth, hemato-immune parameters of the Nile tilapia, as well as its effects on resistance to A. hydrophila challenge were investigated. The CPP (0.5, 1.0, 1.5, 2.0, 2.5 and 3.0%) was added to the diet of 280 Nile tilapia (50.0 ± 5.7 g fish-1). Hemato-immune parameters were analyzed before and after the bacterial challenge. Red blood cell, hematocrit, hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and hydrogen peroxide (H2O2) and nitric oxide (NO) were evaluated. The MIC of the EEP was 13% (v/v) with a bactericidal effect after 24 hours. Growth performance was significantly lower for those fish fed diets containing 2.5 and 3% of CPP compared to the control diet. Differences in CPP levels affected fish hemoglobin, neutrophils number and NO following the bacterial challenge. For others parameters no significant differences were observed. Our results show that although propolis has bactericidal properties in vitro, the addition of crude propolis powder to Nile tilapia extruded diets does not necessarily lead to an improvement of fish health.