Use of MALDI-TOF for identification and surveillance of gram-negative bacteria in captive wild psittacines / Uso do MALDI-TOF para identificação e monitoramento de bactérias Gram-negativas em psitacídeos cativos

Microbiological studies of the sanitary and health status of psittacine birds that will be reintroduced is important in evaluating whether these animals act as carriers of pathogenic agents to other animals and humans. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a faster and more accurate method to identify bacteria than conventional microbiology methods. The aim of this study was to evaluate the health status of psittacines housed in captivity, by assessment of Gram-negative bacteria from fecal microbiota through MALDI- TOF MS identification. The results indicate high frequency of Gram-negative bacteria in feces (96.5%), especially from the Enterobacteriaceae family (88.7%). The most prevalent bacteria were Escherichia coli (39.0%), Proteus vulgaris (12.2%), Klebsiella spp. (12.1%) and Raoultella ornithinolytica (8.7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. and Escherichia hermannii were isolated with lower frequency. . All these agents are potentially pathogenic for parrots and can cause systemic infections in other animals and humans. These findings reinforce that MALDI- TOF MS proved to be a rapid and accurate method of identification of the microorganism and evaluation of the health status of psittacines, providing relevant data to assist decision-making regarding the sanitary protocols in wildlife centers, and possible future reintroduction of wild birds.

Estudos microbiológicos da sanidade de psitacídeos que serão reintroduzidos são importantes para avaliar se esses animais atuam como portadores de agentes patogênicos para outros animais e humanos. A espectrometria de massa por ionização/dessorção de matriz assistida por laser/tempo de vôo (MALDI-TOF MS) é um método mais rápido e preciso para identificar bactérias na comparação com métodos convencionais de microbiologia. O objetivo deste estudo foi avaliar o estado de saúde de psitacídeos cativos, identificando bactérias Gram-negativas da microbiota fecal por MALDI -TOF MS. Os resultados indicaram alta frequência de bactérias Gram-negativas nas fezes (96,5%), principalmente da família Enterobacteriaceae (88,7%). As mais prevalentes foram Escherichia coli (39,0%), Proteus vulgaris (12,2%), Klebsiella spp. (12,1%) e Raoultella ornithinolytica (8,7%). Proteus hauseri, Citrobacter spp., Morganella morgannii, Providencia rettgeri, Enterobacter spp. e Escherichia hermannii foram isolados com menor frequência. Todos esses agentes são potencialmente patogênicos para os papagaios e podem causar infecções sistêmicas em outros animais e seres humanos. Esses achados reforçam que o MALDI- TOF MS é um método rápido e preciso de identificação do microrganismo e avaliação do estado de saúde dos psitacídeos, fornecendo dados relevantes para auxiliar na tomada de decisões sobre os protocolos sanitários em centros de triagem de animais selvagens e sobre a possibilidade de reintrodução futura.

Classificação dos graus de lesões de aerossaculite em perus associadas com enterobactérias / [Classification of the levels of the airsacculitis injuries in turkeys associated with Enterobacteriaceae]

Foram padronizados os graus de lesões dos sacos aéreos em perus com aerossaculite, associadas com a presença de isolados de enterobactérias nesses órgãos. Um total de 110 amostras de sacos aéreos de perus machos com aerossaculite foi coletado para o estudo. Durante o processo de abate, as amostras foram coletadas por meio de swabs e submetidas a três métodos de armazenamento (imediato, congelado ou pré-incubado após congelamento) para posterior comparação das suas eficiências de isolamento. Os gêneros da família Enterobacteriaceae foram identificados pelas séries bioquímicas EPM, MILi e citrato de Simmons. O crescimento bacteriano ocorreu em 43,64% das amostras. Neste estudo, quatro padrões de lesões de aerossaculite foram identificados de acordo com as características patológicas dos sacos aéreos. Os principais gêneros de enterobactérias identificadas foram: Escherichia coli, Citrobacter, Proteus, Edwardsiella, Morganella, Kluyvera, Salmonella e Klebsiella. Foi observado que os graus padronizados como 3 e 4 apresentaram maior variedade de gêneros bacterianos. O armazenamento imediato apresentou maior porcentagem de positividade, 41,82%, no entanto o pré-incubado após congelamento se apresentou mais eficaz em relação à quantidade de colônias.(AU)

The degrees of air sac lesions in turkeys with airsacculitis were standardized, associated with the presence of Enterobacteriaceae isolated from these organs. A total of 110 samples of air sacs from male turkeys with airsacculitis were collected and analyzed. During the slaughtering process, the sample collection was done using swabs and submitted to three storage methods (immediate, frozen, or pre incubated after freezing) for further comparison of their isolated efficiency. The bacterial genera of the family Enterobacteriaceae were identified biochemical series EPM, MILi and Simmons citrate. Bacterial growth occurred in 43.64% of samples. In this study, four patterns of aerossaculitis lesions were identified according to the pathological characteristics of air sacs. The frequencies of the Enterobacteriaceae isolated identified in the samples were: Escherichia coli, Citrobacter, Proteus, Edwardsiella, Morganell, Kluyvera, Salmonella and Klebsiella. Otherwise, it was observed that the levels already standardized as level three and four showed higher variety of genus. The immediate storage showed higher percentage of positivity at 41.82%, however, the pre incubated after freezing showed more efficiency in relation to the quantity of colonies.(AU)

Aislamiento e identificación de bacterias con potencial nosocomial procedentes de ambientes y superficies de una clínica veterinaria Universitaria del Área Metropolitana del Valle de Aburrá, Antioquia-Colombia / Isolation and identification of bacteria with nosocomial potential from environments and surfaces of a veterinary university clinic of Metropolitan area of Aburra Valley Antioquia-Colombia

Introducción: Las infecciones nosocomiales son aquellas adquiridas por los pacientes durante la hospitalización. Son de gran importancia en medicina humana pero aún se desconoce cuál es su papel en medicina veterinaria. Objetivo: Identificar la presencia de bacterias asociadas a infecciones hospitalarias en ambientes y superficies en una clínica veterinaria. Materiales y métodos: Se realizaron dos muestreos, se determinó a través de sedimentación y torunda la presencia de bacterias en el ambiente y las superficies de las 8 unidades de la clínica veterinaria. La presencia de nosocomiales se determinó por el crecimiento y purificación en medios diferenciales, la identificación se hizo por descripción macroscópica de las colonias y tinción de Gram y posteriormente se realizó una caracterización bioquímicamente por medio del API20E y API50 CH/E y un antibiograma en las cepas relacionadas con resistencia a antibióticos. Resultados: Se obtuvo 95 aislados y se logró determinar la presencia de 28 agentes potencialmente nosocomiales, donde se destaca la presencia de Pseudomonas aeruginosa, Proteus sp. y Staphylococcus sp. microorganismos relacionados con infecciones asociadas a hospitales veterinarios. Conclusiones: Se realiza la primera aproximación a este tipo de infecciones en hospitales veterinarios en Antioquia, y se evidencia la circulación en ambiente y superficies de potenciales bacterias nosocomiales en la clínica veterinaria.

Introduction: Care associated infections are of importance in human medicine but few is known in veterinary medicine. Aims: To identify pathogenic bacteria in surfaces of veterinary clinics. Materials and methods: Two samples with cotton hissops were obtained in inert surfaces from 8 veterinary clinics. The presence of pathogenic bacteria was established by growth in agar media, identification of species was performed through colonies morphology and Gram stain and biochemistry identification with API20E and API50 CH/E system and antibiogram. Results: 95 isolates were characterized and within them 28 were pathogenic. The most prevalent were Pseudomonas aeruginosa, Proteus sp. and Staphylococcus sp. Conclusions: This is the first description of pathogenic microorganisms present in veterinary clinics in Antioquia that have potential for clinical consequences for personnel working at this veterinary centers.

Evaluación de la actividad antimicrobiana "in vitro" del extracto hidroetanólico de hojas de Origanun majorana en cepas de proteus spp / Evaluation of the "in vitro" antimicrobial activity of the hydroantanolic extract of Origanun majorana leaves in proteus spp strains

La utilización de las plantas medicinales está fundamentado en el conocimiento popular; cada vez se requiere la búsqueda constante de principios activos nuevos que promulguen una manera de combatir la resistencia bacteriana convirtiéndose en una alternativa terapéutica; por tal motivo el objetivo de la investigación fue evaluar la actividad antimicrobiana in vitro del extracto hidroetanólico de hojas de Origanum majorana en cepas de Proteus spp, para lo cual fue necesario complementarlo con etapas previas como un estudio etnobotánico a través de encuestas a 89 informadores clave del sector de San Francisco de la ciudad de Riobamba obteniendo un nivel de uso significativo del 21% que sirvió para la selección de Origanum majorana para el estudio. En una etapa posterior se obtuvo el extracto hidroetanólico y evaluación de parámetros físico químicos y organolépticos; seguido de la caracterización fitoquímica evidenciando la presencia de fenoles, flavonoides, terpenos y saponinas en dicho extracto. Culminando con la evaluación de su actividad antimicrobiana in vitro por la técnica de difusión en disco en cepas de Proteus spp a concentraciones de 25%,50%, 75% y 100% revelando que su actividad es directamente proporcional a la concentración del extracto. Se concluyó que la Origanum majorana es una de las plantas medicinales más usadas por la población estudiada y que el extracto hidroetanólico de sus hojas presentan actividad antimicrobiana. (AU)

Estudio de susceptibilidad a cefalosporinas de primera generación en enterobacterias aisladas de urocultivo, según criterios CLSI y EUCAST / Susceptibility to first-generation Cephalosporins in Enterobacteriaceae isolated from urine culture according to CLSI and EUCAST breakpoints

Resumen Actualmente se recomienda el uso de cefazolina para determinar la susceptibilidad a cefalosporinas orales de primera generación en cepas de enterobacterias en ITU no complicada. Nuestro objetivo fue establecer la susceptibilidad a cefalosporinas orales en cepas urinarias según puntos de corte para cefalotina o cefazolina y la correlación de susceptibilidad entre cefazolina y cefadroxilo. Se estudió la concordancia entre cefalotina y cefazolina en 52 cepas por método de Kirby-Bauer y Vitek XL. En Escherichia coli fue de 0% para VitekXL y 50% para Kirby-Bauer. La concordancia entre cefazolina y cefadroxilo fue 95,6%. En el laboratorio debiera usarse cefazolina para determinar susceptibilidad a cefalosporinas orales de primera generación. La concordancia entre cefazolina y cefadroxilo sugiere que cefazolina podría predecir susceptibilidad para cefadroxilo.

Currently, the use of cefazolin is recommended to determine the susceptibility to first-generation oral cephalosporins in strains of enterobacteria in uncomplicated UTI. We determined susceptibility differences to oral cephalosporins in urinary strains according to cefazolin or cefalotin breakpoints and the correlation of susceptibility between cefazolin and cefadroxil. We studied 52 strains with cefalotin and cefazolin by disk-diffusion and MIC (Kirby-Bauer and Vitek XL) and a subgroup by disk-diffusion for cefadroxil. Agreement among different methods was 100% for K. pneumoniae and Proteus spp. In Escherichia coli, agreement for Vitek and disk-diffusion were 0 and 50% respectively. Susceptibility to first generation cephalosporins in E. coli should be determined with cefazolin. Agreement between cefazolin and cefadroxil suggests that cefazolin could also predict the susceptibility of cefadroxil.

Case Report of Neonatal Proteus mirabilis Meningitis and Brain Abscess with Negative Initial Image Finding: Consideration of Serial Imaging Studies

Proteus mirabilis (P. mirabilis) meningitis in a neonate is rare, but its recognition is important because the disease progresses rapidly and has poor prognosis. A 4-day-old premature female infant born at 36 weeks and 5 days of gestation presented with symptoms of fever and icteric skin. Initial cerebrospinal fluid findings suggested bacterial meningitis, and treatment with antibiotics was started. On the third day, P. mirabilis growth was found in both blood and cerebrospinal fluid cultures and brain computed tomography revealed normal findings. The patient showed improved clinical symptoms, but brain magnetic resonance imaging on hospital day 18 revealed a brain abscess measuring 4.5×3.1×3.1 cm in the right frontal lobe. Cyst drainage was performed immediately and a catheter was inserted. Follow-up computed tomography revealed a tiny abscess remaining in the right frontal lobe, and follow-up magnetic resonance imaging later demonstrated marked interval regression in the size of the abscess. The patient was discharged on day 57 of hospitalization in good condition. Serial brain imaging should be considered in neonatal cases of P. mirabilis meningitis.

Proteus vulgaris and Proteus mirabilis Decrease Candida albicans Biofilm Formation by Suppressing Morphological Transition to Its Hyphal Form

PURPOSE: Candida albicans (C. albicans) and Proteus species are causative agents in a variety of opportunistic nosocomial infections, and their ability to form biofilms is known to be a virulence factor. In this study, the influence of co-cultivation with Proteus vulgaris (P. vulgaris) and Proteus mirabilis (P. mirabilis) on C. albicans biofilm formation and its underlying mechanisms were examined. MATERIALS AND METHODS: XTT reduction assays were adopted to measure biofilm formation, and viable colony counts were performed to quantify yeast growth. Real-time reverse transcriptase polymerase chain reaction was used to evaluate the expression of yeast-specific genes (rhd1 and rbe1), filament formation inhibiting genes (tup1 and nrg1), and hyphae-related genes (als3, ece1, hwp1, and sap5). RESULTS: Candida biofilm formation was markedly inhibited by treatment with either living or heat-killed P. vulgaris and P. mirabilis. Proteus-cultured supernatant also inhibited Candida biofilm formation. Likewise, treatment with live P. vulgaris or P. mirabilis or with Proteus-cultured supernatant decreased expression of hyphae-related C. albicans genes, while the expression of yeast-specific genes and the filament formation inhibiting genes of C. albicans were increased. Heat-killed P. vulgaris and P. mirabilis treatment, however, did not affect the expression of C. albicans morphology-related genes. CONCLUSION: These results suggest that secretory products from P. vulgaris and P. mirabilis regulate the expression of genes related to morphologic changes in C. albicans such that transition from the yeast form to the hyphal form can be inhibited.

Principais patógenos envolvidos em casos de sepse em pacientes queimados: uma revisão de literatura / Main pathogens involved in the cases of sepsis in burned patients: a review on the literature / Principales patógenos en los casos de sepsis em pacientes quemados: una revisión de literatura

Objetivo: Buscou-se no presente trabalho identificar os principais patógenos envolvidos em infecções em pacientes queimados, bem como enfatizar a relevância do diagnóstico adequado para o tratamento de sepse. Método: Para a realização do presente trabalho, foi feito levantamento bibliográfico de caráter exploratório e obtidos 33 estudos relevantes. A coleta de informações ocorreu nos meses de março a novembro de 2016. Resultados: Dentre os principais patógenos presentes em queimados, que podem gerar quadro de sepse, estão Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter sp, Candida albicans e Proteus sp. Esses podem, ou não, estar relacionados à própria microbiota do paciente. O processo de infecção, com perda da primeira linha de defesa imunológica, deixa o organismo suscetível à entrada e instalação de microrganismos. O tratamento da sepse depende de fatores relevantes, que incluem a gravidade da lesão e o agente causador da infecção. Conclusão: O risco de ocorrência de sepse, associada às infecções em queimados nas unidades de tratamento intensivo, pode ser reduzido com o diagnóstico adequado e acompanhamento do paciente.

Objective: This article aimed to identify the main pathogens involved in infections in burned patients, as well as to emphasize the relevance of the appropriate diagnosis for the treatment of sepsis. Methods: For the accomplishment of the present work, it was carried out a bibliographic survey of exploratory character and 33 relevant studies were obtained. Data collection was carried out from March to November 2016. Results: Among the main pathogens present in burnt patient related with sepsis are Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter sp, Candida albicans and Proteus sp. These pathogens may or may not be related to the patients microbiota. The infection process, with loss of the first line of immune defense, leaves the organism susceptible to the entry and installation of microorganisms. Treatment of sepsis depends on relevant factors including the severity of the lesion and the agent of the infection. Conclusion: The risk associated with sepsis in burned patients may be reduced with appropriate diagnosis and monitoring.

Objetivo: El objetivo de este artículo fue identificar los principales patógenos asociados en infecciones en pacientes com quemaduras, así como enfatizar la relevancia del diagnóstico adecuado para el tratamiento de la sepsis. Métodos: Para el desarrollo del presente trabajo, se realizó una búsqueda bibliográfica de caracter exploratório, siendo considerados relevantes 33 estudios. La búsqueda de datos se realizó de marzo a noviembre de 2016. Resultados: Entre los principales patógenos presentes en pacientes quemados relacionados con la sepsis se destacaron Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter sp, Candida albicans y Proteus sp. Estos patógenos pueden o no estar relacionados con la microbiota del paciente. El proceso de infección, con la pérdida de la primera línea de defensa inmunológica, deja el organismo susceptible a la entrada e instalación de microorganismos. El tratamiento de la sepsis depende de factores relevantes, incluyendo la gravedad de la lesión y el agente de la infección. Conclusión: El riesgo asociado con la sepsis en pacientes quemados puede reducirse con un diagnóstico y seguimiento adecuados.

Bronchoscopic concerns in Proteus syndrome: a case report / 대한마취과학회지

Proteus syndrome (PS) is a rare congenital hamartomatous disorder with multisystem involvement. PS shows highly clinical variability due to overgrowth of the affected areas, and several features can make anesthetic management challenging. Little is known about the airway problem associated with anesthesia in PS patients. An 11-year-old girl with PS was scheduled for ear surgery under general anesthesia. She had features complicating intubation including facial asymmetry and disproportion, abnormal teeth, limitation of neck movement due to torticollis, and thoracolumbar scoliosis. This study reports on a case of deformed airway of a PS patient under fiberoptic bronchoscopy.

A Rare Case of Ecthyma Gangrenosum Caused by Proteus vulgaris and Candida albicans in a Patient with Castleman Disease

No abstract available.

Pulmonary Pneumatocele in a Pneumonia Patient Infected with Extended-Spectrum beta-Lactamase Producing Proteus mirabilis / 결핵및호흡기질환

Pulmonary pneumatoceles are air-filled thin-walled spaces within the lung and are rare in adult cases of pneumonia. We report the case of a 74-year-old male who was admitted with a cough and sputum production. He had been treated with oral dexamethasone since a brain tumorectomy 6 months prior. Contrast-enhanced computed tomography (CT) of the chest revealed a large pneumatocele in the right middle lobe and peripheral pneumonic consolidation. Bronchoalveolar lavage was performed; cultures identified extended-spectrum beta-lactamase (ESBL) producing Proteus mirabilis. A 4-week course of intravenous ertapenem was administered, and the pneumatocele with pneumonia resolved on follow-up chest CT. To the best of our knowledge, this is the first reported case of pulmonary pneumatocele caused by ESBL-producing P. mirabilis associated with pneumonia.

Resistance pattern of clinical isolates involved in surgical site infections

Wound infections due to the incursion of microbes need to be averted or to heal the wounds by antibiotics. Antibiotics are not only aid in cure of infections but also help to prevent the flourishing and production of one or more species of microorganism, resultant in purulent discharge. This current study was carried out to evaluate the resistance pattern of clinical isolates from surgical site infections by the Kirby Bauer disc diffusion method. A total of 257 clinical isolates were collected from different hospitals in Karachi and evaluated by using fifteen antibiotics belonging to different groups. Staphylococcus aureus [n=87], Escherichia coli [n=76], Pseudomonas aeruginosa [n=56], Proteus [n=21] and Klebsiella [n=17] species are the most common clinical isolates of surgical site infections. Among the semi-synthetic penicillins, ampicillin was found to be resistant to nearly all clinical isolates but amoxicillin was moderately sensitive to S. aureus. Combinations of semi-synthetic penicillins are more sensitive than the penicillin alone. Co-amoxiclave exhibits superior sensitivity to all the surgical infection isolates except Pseudomonas aeruginosa which showed 68.75% resistance. Pseudomonas aeruginosa was highly resistant to cephalosporin except ceftraixone which showed 21.88% resistance. S. aureus was slightly responsive to cefazolin, cephradine, cefaclor, ceftizoxime, cefuroxime and ceftriaxone. E. coli, Gram-negative clinical isolate was showed 25% and 31.25% resistance to ceftriaxone and cefuroxime. In the Klebsiella species, 71.42% and 64.29% resistance to cefazolin and cefuroxime respectively, was observed. Aminoglycosides such as gentamycin and tobramycin were found to be more susceptible to all the clinical isolates. Quinolones like ofloxacin and enoxacin were showed good sensitivity to nearly all the clinical isolates. On the basis of the present study, it is recommended to adopt a rational use of antibiotics in prophylaxis and the utilization of a coordinated scheme of surgical wound inspections.

Annual Report on External Quality Assessment Scheme in Clinical Microbiology in Korea (2013) / 임상검사와정도관리

Annual external quality assessment was performed three times for clinical microbiology division of The Korean Association of Quality Assurance for Clinical Laboratory. For each trial, three sets composed of different combinations of four bacteria and one yeast were distributed for culture, identification, and antimicrobial susceptibility tests. A total of 340 laboratories were enrolled and 330 (97.0%), 331(97.4%), and 331(97.4%) returned the results on trial I, II, and III, respectively. For bacterial identification, the correct identification of gram-negative bacilli, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, Streptococcus agalactiae, Listeria monocytogenes, and Candida species was greater than 95%. However, correct identification of Staphylococcus lugdunensis, Corynebacterium striatum, Vibrio vulnificus, Aeromonas hydrophila, Cryptococcus neoformans, and Malassezia pachydermatis was relatively less accurate, with values of 95.4%, 89.9%, 50.7%, 91.3%, 93.6%, and 93.9%, respectively. Surveillance cultures for vancomycin-resistant enterococci and methicillin-resistant S. aureus were correctly determined by 95.4% and 93.9% of the respondents, respectively. False carbapenem-resistance due to AmpC beta-lactamase, disk diffusion testing for vancomycin in Staphylococcus species, oxacillin and penicillin susceptibility testing in S. lugdunensis and false imipenem-resistance in Proteus species were common sources of inaccurate results. The accuracy of species identification for Corynebacterium species and Vibrio species requires improvement. Consistent problems occurred with antimicrobial susceptibility testing of vancomycin for Staphylococcus species using the disk diffusion method.

Annual Report on External Quality Assessment Scheme in Clinical Microbiology in Korea (2013) / 임상검사와정도관리

Annual external quality assessment was performed three times for clinical microbiology division of The Korean Association of Quality Assurance for Clinical Laboratory. For each trial, three sets composed of different combinations of four bacteria and one yeast were distributed for culture, identification, and antimicrobial susceptibility tests. A total of 340 laboratories were enrolled and 330 (97.0%), 331(97.4%), and 331(97.4%) returned the results on trial I, II, and III, respectively. For bacterial identification, the correct identification of gram-negative bacilli, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, Streptococcus agalactiae, Listeria monocytogenes, and Candida species was greater than 95%. However, correct identification of Staphylococcus lugdunensis, Corynebacterium striatum, Vibrio vulnificus, Aeromonas hydrophila, Cryptococcus neoformans, and Malassezia pachydermatis was relatively less accurate, with values of 95.4%, 89.9%, 50.7%, 91.3%, 93.6%, and 93.9%, respectively. Surveillance cultures for vancomycin-resistant enterococci and methicillin-resistant S. aureus were correctly determined by 95.4% and 93.9% of the respondents, respectively. False carbapenem-resistance due to AmpC beta-lactamase, disk diffusion testing for vancomycin in Staphylococcus species, oxacillin and penicillin susceptibility testing in S. lugdunensis and false imipenem-resistance in Proteus species were common sources of inaccurate results. The accuracy of species identification for Corynebacterium species and Vibrio species requires improvement. Consistent problems occurred with antimicrobial susceptibility testing of vancomycin for Staphylococcus species using the disk diffusion method.

The Story of Serratia Marcescens: Pathologic Risk Factors in Breast Implant Surgery

Serratia marcescens (S. marcescens) emerged as an opportunist in the setting of immunodeficiency in the 1970s, when serious infections occurred in San Francisco hospitals after USA. Navy experiments had aerosolized the bacteria to study biologic warfare. We investigate the risks of S. marcescens in San Franciscans who undergo mastectomy with implant reconstruction. From 2007 to 2011, the senior author took breast capsule cultures for all patients at the time of tissue expander exchange/explant. Of the 142 women who had reconstruction, 23 had positive cultures. Only the two patients who were positive for S. marcescens developed clinical infections that required explantation. Both had postoperative chemotherapy with transient neutropenia, and both had close ties to San Francisco. Clinical signs of infection emerged for both patients months after initial surgery, despite having previously well healed incisions. Other patients were culture positive for Pseudomonas, Proteus, Enterococcus and MRSA and did not develop require explant. While the link between San Francisco and S. marcescens is controversial, a patient's geography is a simple screening tool when considering postoperative risks, especially in the immunocompromised. Closer monitoring for neutropenia during chemotherapy, and a lower threshold to administer S. marcescens targeted antibiotics may be warranted in these patients.

Epidemiology and Resistance Patterns of Bacterial Pathogens in Urinary Tract Infections in the Northern Gyeonggi-do Area during 2007-2011

BACKGROUND: Bacteria that cause urinary tract infections (UTIs) are found with different frequencies in different regions; moreover, antibiotic susceptibility can also vary by region. We retrospectively studied and compared the species and antimicrobial susceptibility of bacterial pathogens isolated from patients with UTIs in the northern Gyeonggi-do area. METHODS: We analyzed urine specimens collected from patients who visited the Myongji Hospital between 2007 and 2011. The urine specimens were cultured, and bacteria were identified by biochemical examination with an API kit (bioMerieux Inc., USA). Antimicrobial susceptibility was determined by the disc diffusion method and the Vitek II system (bioMerieux Inc., USA). RESULTS: A total of 11,818 (31.4%) urine specimens were culture positive. The most common species identified were Escherichia coli (37.1%), Klebsiella pneumoniae (7.4%), Enterococcus faecium (6.1%), and Candida spp. (5.5%). The proportion of isolates producing extended-spectrum beta-lactamases significantly increased during the study period. CONCLUSIONS: E. coli, K. pneumoniae, and E. faecium were the 3 most common organisms identified. Of note, however, was the increasing frequency of Pseudomonas spp. and Proteus spp. isolated during the more recent years. Further studies are required from other centers in the northern Gyeonggi-do area.

Bacteriological findings and antibiotic susceptibility profile of chronic suppurative otitis media in Mukalla, Yemen

Chronic suppurative otitis media [CSOM] is one of the most common diseases of all age groups, especially on childhood. To identify bacterial isolates and determine their antibiotic susceptibility patterns. This retrospective study was carried out at a private Ear, Nose and Throat Clinic in Mukalla. The bacteriological reports of ear swabs of all patients with CSOM during the period 2004 to 2010 were included in the study. Isolates were tested for their susceptibility to 15 antibiotics. Data analysis was carried out using SPSS 17. A total of 218 bacteriological reports were with a single isolate. Male to female ratio was 1.2:1. peak-age incidence of CSOM was mostly in children younger than 15 years of age, [p > 0.05]. Most common bacteria isolated were, Proteus species [46.7%], Pseudomonas aeruginosa [37.2%] and Saphylococcus aureus [11%]. Both gram positive and negative isolated bacteria were resistant with a range of intermediate to high-level, to ampicillin, amoxicillin, augmentin, cefotaxime, bactrim, erythromycin, ofloxacin and gentamicin but were sensitive to amikacin, chloramphinicol, ciprofloxacin, norfloxacillin, lincomycin and cephaclor,. Most of the patients in the series were children less than 15 years of age and gram negative bacteria were predominant. More comprehensive studies are required to define the true magnitude of CSOM.

Asymptomatic bacteriuria in antenatal patients in Ilorin, Nigeria

To determine the prevalence of asymptomatic bacteriuria, bacteriology and sensitivity pattern in Ilorin using the gold standard of urine culture. A prospective study was carried out from 1st July to 31st October 2007, at the University of Ilorin Teaching Hospital [UITH] on 125 consenting asymptomatic pregnant women, A structured proforma was used to collect information from the women and a midstream urine specimen collected for bacteriological culture, Of the 125 pregnant women, 50 had bacteriuria on urine culture giving a prevalence of 40%. The mean age of the women was 28.5 years with a standard deviation of 4.95. The age ranged between 14 and 40 years. Staphylococcus aureus was the commonest pathogen isolated [72%], followed by Proteus spp [14%]. Most of the organisms showed good sensitivity to Nitrofurantoin and gentamicin. The prevalence of asymptomatic bacteriuria in Ilorin is high and routine urine culture is advocated for all pregnant women at booking

A Case of Botryomycosis Caused by Staphylococcus lugdunensis in a Chronic Alcoholic / 대한피부과학회지

Botryomycosis is a chronic bacterial granulomatous and suppurative disease, which may be similar to the fungal disease, clinically and histologically. It is commonly caused by Staphylococcus aureus, but Pseudomonas aeruginosa, Escherichia coli, and Proteus spp. have been rarely involved. The known predisposing factors are trauma, postoperative complication, diabetes mellitus, chronic alcoholic, and so on. We present the botryomycosis caused by Staphylococcus lugdunensis, which is a rare virulent pathogen of botryomycosis, in a chronic alcoholic.

Caracterización clínica y molecular de bacteriemias causadas por enterobacterias productoras de β -lactamasas de espectro extendido: 2004-2007 / Clinical and molecular characterization of ESBL-producing enterobacteria isolated from bacteremia in a university hospital

Introduction: Extended-spectrum-β-lactamases (ESBL) are plasmid-encoded enzymes that confer resistance to multiple antimicrobials. ESBL-producing enterobacteria that cause bacteremia limit therapeutic options and increase mortality. Objective: To perform a clinical and molecular description of bacteremia caused by ESBL-producing enterobacteria. Method: We retrospectively studied the cases of bacteremia due to ESBL-producing Escherichia coli, Klebsiella pneumoniae and Proteus spp in adults admitted to a university hospital during the years 2004-2007. We reviewed the clinical records and antimicrobial susceptibility patterns. Molecular typing was performed by polymerase chain reaction and study of clonality by pulsed-field electrophoresis. Results: We found a prevalence of 9.8 percent ESBL in enterobacteria causing bacteremia. Decreased susceptibility to quinolones and aminoglycosides was observed, without resistance to carbapenems. The predominant ESBL types were CTX-M (96 percent), TEM (62 percent) and GES (28 percent). 79 percent of the strains presented more than one type of ESBL. Clinical analysis revealed high prevalence of risk factors, previous use of antimicrobials and of invasive devices. There was no significant clonality. Conclusion: The presence of ESBLs in bloodstream infections is a clinical problem that must be considered when choosing empiric therapy.

Introducción: β-lactamasas de espectro extendido (BLEE) son enzimas plasmidiales que confieren resistencia a múltiples antimicrobianos. Las bacteriemias por enterobacterias productoras de BLEE restringen las opciones terapéuticas y aumentan la mortalidad. Objetivo: Realizar una descripción clínica y molecular de las bacteriemias causadas por enterobacterias productoras de BLEE. Método: Se estudiaron retrospectivamente los casos de bacteriemia por Escherichia coli, Klebsiella pneumoniae y Proteus spp. confirmadas para BLEE, en adultos ingresados en un hospital universitario durante los años 2004-2007. Se revisaron los registros clínicos y de susceptibilidad. Se realizó tipificación molecular por reacción de polimerasa en cadena y estudio de clonalidad por electroforesis de campo pulsado. Resultados: Se identificó una prevalencia de BLEE de 9,8 por ciento en enterobacterias causantes de bacteriemias. Se observó susceptibilidad disminuida a quinolonas y aminoglucósidos, sin resistencia a carbapenémicos. Los tipos de BLEE predominantes fueron CTX-M (96 por ciento), TEM (62 por ciento) y GES (28 por ciento). El 79 por ciento de las cepas presentó más de un tipo de BLEE. El análisis clínico reveló alta frecuencia de patologías de riesgo, uso previo de antimicrobianos y uso de dispositivos invasores. No se encontró clonalidad significativa. Conclusión: La presencia de BLEE en bacteriemias constituye un problema clínico que debe ser considerado al elegir la terapia empírica.