Síndrome de la uña verde: revisión actualizada de una patología emergente en la era COVID-19 / 19Green nail syndrome: updated review of an emerging disease in the era of COVID-19

El síndrome de la uña verde o cloroniquia corresponde a la infección por Pseudomonas aeruginosa de una lámina ungueal dañada en pacientes con algún factor de riesgo identificable, siendo los más frecuentes la inmunosupresión, el ambiente húmedo constante y la patología ungueal preexistente. Su diagnóstico es relativamente sencillo si se logra observar la tríada característica de coloración verdosa de la lámina ungueal, paroniquia proximal crónica y onicolisis distal; en casos de duda diagnóstica se puede enviar una muestra de la uña afectada para cultivos o estudio histopatológico. El pilar de su tratamiento corresponde al uso de antibióticos tópicos o sistémicos en conjunto con medidas generales que protejan de la humedad. Es muy importante enfatizar la prevención de esta patología en el personal de salud, especialmente en el contexto del lavado de manos frecuente y riguroso implementado durante la pandemia COVID-19, ya que existen reportes de transmisión nosocomial de P. aeruginosa por profesionales de la salud con infección ungueal.(AU)

Green nail syndrome or chloronychia is the infection of a damaged nail plate by Pseudomonas aeruginosa in a patient with an identifiable risk factor; the most frequently described are immunosuppression, a persistent moist environment and preexisting nail disease. Its diagnosis is relatively simple if the characteristic triad of green discoloration of the nail plate, chronic proximal paronychia and distal onycholysis can be observed, in cases of doubt a sample of the affected nail can be sent for cultures or histopathology. The cornerstone of treatment is the use of topical or systemic antibiotics along with measures to protect the nail from moisture. Prevention of this disease must be emphasized in health care personnel, especially in the context of frequent and rigorous handwashing practices implemented during the COVID-19 pandemic, since there are reports of nosocomial transmission of P. aeruginosaby health care professionals with nail infection.(AU)

Resistencia enzimática en Pseudomonas aeruginosa, aspectos clínicos y de laboratorio / Enzymatic resistance in Pseudomonas aeruginosa, clinical and laboratory aspects

Resumen Pseudomonas aeruginosa es uno de los principales patógenos que causa infecciones asociadas a la atención en salud (IAAS). Su capacidad de adaptación, diseminación, resistencia intrínseca a los antimicrobianos y de adquirir nuevos mecanismos a través de elementos genéticos móviles, hacen que el tratamiento de las infecciones por este microorganismo sea un desafío para el médico clínico. Intrínsecamente, P. aeruginosa, presenta una reducida permeabilidad en la membrana externa, debido a la expresión de bombas de expulsión, y una cefalosporinasa tipo AmpC inducible. Además, P. aeruginosa es capaz de adquirir nuevos determinantes de resistencia por transferencia horizontal en forma de casetes situados en integrones, y a su vez, localizados en transposones o plásmidos. Dentro de la resistencia enzimática que presenta P. aeruginosa destacan las β-lactamasas, incluyendo aquellas de espectro extendido (BLEE) y las carbapenemasas. Pero también enzimas modificadoras de los aminoglucósidos, haciendo que este microorganismo pueda presentar fenotipos de multi-resistencia (MDR), resistencia extrema (XDR) y panresistencia (PDR) a los antimicrobianos denominados antipseudomonas, incluyendo a las nuevas cefalosporinas con inhibidores de beta-lactamasas.

Abstract Pseudomonas aeruginosa is one of the major pathogens causing healthcare-associated infections (HAI). Its capacity of adaptation, dissemination, intrinsic resistance to antimicrobials and of acquiring new mechanisms through mobile genetic elements, make the treatment of infections by this microorganism a challenge for the clinician. Intrinsically, P. aeruginosa, presents a reduced permeability in the external membrane, due to the expression of efflux pumps, and an inducible AmpC-type cephalosporinase. In addition, P. aeruginosa is able to acquire new resistance determinants by horizontal transfer in the form of cassettes located in integrons, and in turn located in transposons or plasmids. Within the enzymatic resistance that P. aeruginosa presents, betalactamases, including extended spectrum (ESBL) and carbapenemases. But also aminoglycoside modifying enzymes, stand out, causing this microorganism to present multi-resistance phenotypes (MDR), extreme resistance (XDR) and pan-resistance (PDR) to the called antipseudomonal antibiotics, including the new cephalosporins with betalactamase inhibitors.

Isolation of and risk factors for airway infection with Pseudomonas aeruginosa in patients with non-cystic fibrosis bronchiectasis / Isolamento de Pseudomonas aeruginosa e fatores de risco de infecção das vias aéreas pela bactéria em pacientes com bronquiectasias não fibrocísticas

ABSTRACT Objective: To identify microorganisms in sputum samples of patients with stable non-cystic fibrosis bronchiectasis and to determine risk factors related to the isolation of Pseudomonas aeruginosa (PA) in those patients. Methods: Consecutive patients were recruited from a tertiary hospital outpatient clinic in the city of Fortaleza, Brazil. The patients were submitted to spirometry, six-minute walk test, HRCT, and sputum collection. Data on serum fibrinogen levels, disease severity, sputum color, and history of azithromycin treatment were collected. Results: The study included 112 patients, and females predominated (68%). The mean age was 51.6 ± 17.4 years. Most patients presented with mild-to-moderate disease (83%). The mean six-minute walk distance was 468.8 ± 87.9 m. Mean FEV1 and FVC, in % of predicted values, were 60.4 ± 21.8% and 69.9 ± 18.5%, respectively. The mean serum fibrinogen level was 396.1 ± 76.3 mg/dL. PA was isolated in 47 patients, other potentially pathogenic microorganisms (PPMs) were isolated in 31 patients, and non-PPMs were isolated in 34 patients. Purulent sputum was identified in 77 patients (68%). The patients with PA, when compared with those without it, presented with more severe disease, higher serum fibrinogen levels, and lower FVC%. In addition, purulent sputum and long-term azithromycin treatment were more common in those with PA. The multivariate regression analysis showed that the independent factors associated with PA were serum fibrinogen level > 400 mg/dL (OR = 3.0; 95% CI: 1.1-7.7) and purulent sputum (OR = 4.3; 95% CI: 1.6-11.3). Conclusions: In our sample, the prevalence of PA in sputum was 42%. Sputum color and inflammatory markers were able to predict the isolation of PA, emphasizing the importance of routine sputum monitoring.

RESUMO Objetivo: Identificar microrganismos em amostras de escarro de pacientes com bronquiectasia não fibrocística estável e determinar os fatores de risco relacionados com o isolamento de Pseudomonas aeruginosa (PA) nesses pacientes. Métodos: Pacientes consecutivos foram recrutados em um ambulatório de um hospital terciário em Fortaleza (CE). Os pacientes foram submetidos a espirometria, teste de caminhada de seis minutos, TCAR e coleta de escarro. Foram coletados dados referentes ao fibrinogênio sérico, gravidade da doença, cor do escarro e histórico de tratamento com azitromicina. Resultados: O estudo incluiu 112 pacientes, com predomínio do sexo feminino (68%). A média de idade foi de 51,6 ± 17,4 anos. A maioria dos pacientes apresentou doença leve a moderada (83%). A média da distância percorrida no teste de caminhada de seis minutos foi de 468,8 ± 87,9 m. A média do VEF1 em % do previsto foi de 60,4 ± 21,8%, e a da CVF em % do previsto foi de 69,9 ± 18,5%. A média do fibrinogênio sérico foi de 396,1 ± 76,3 mg/dL. PA foi isolada em 47 pacientes; outros microrganismos potencialmente patogênicos (MPP) foram isolados em 31; não MPP foram isolados em 34. Escarro purulento foi identificado em 77 pacientes (68%). Os pacientes com PA, em comparação com aqueles sem, apresentaram doença mais grave, fibrinogênio sérico mais elevado e menor CVF%. Além disso, escarro purulento e tratamento prolongado com azitromicina foram mais comuns naqueles com PA. A análise de regressão multivariada mostrou que os fatores independentes relacionados com PA foram fibrinogênio sérico > 400 mg/dL (OR = 3,0; IC95%: 1,1-7,7) e escarro purulento (OR = 4,3; IC95%: 1,6-11,3). Conclusões: Em nossa amostra, a prevalência de PA no escarro foi de 42%. A cor do escarro e os marcadores inflamatórios foram capazes de prever o isolamento de PA, o que enfatiza a importância do monitoramento rotineiro do escarro.

Effectiveness of a multistep Pseudomonas aeruginosa eradication treatment protocol in children with cystic fibrosis in Brazil / Efetividade de um protocolo de tratamento de erradicação em fases de Pseudomonas aeruginosa em crianças com fibrose cística no Brasil

ABSTRACT Objective: Although various strategies have been proposed for eradicating Pseudomonas aeruginosa in patients with cystic fibrosis (CF), only a few employ multistep treatment in children colonized by that pathogen for the first time. The aim of this study was to describe the effectiveness of a three-phase eradication protocol, initiated after the first isolation of P. aeruginosa, in children with CF in Brazil. Methods: This was a retrospective real-life study in which we reviewed the medical records of pediatric CF patients in whom the eradication protocol was applied between June of 2004 and December of 2012. The three-phase protocol was guided by positive cultures for P. aeruginosa in airway secretions, and the treatment consisted of inhaled colistimethate and oral ciprofloxacin. Success rates were assessed after each phase, as well as cumulatively. Results: During the study period, 47 episodes of P. aeruginosa colonization, in 29 patients, were eligible for eradication. Among the 29 patients, the median age was 2.7 years, 17 (59%) were male, and 19 (65%) had at least one F508del allele. All 29 patients completed the first phase of the protocol, whereas only 12 and 6 completed the second and third phases, respectively. Success rates for eradication in the three treatment phases were 58.6% (95% CI: 40.7-74.5), 50.0% (95% CI: 25.4-74.6), and 66.7% (95% CI: 30.0-90.3), respectively. The cumulative success rate was 93.1% (95% CI: 78.0-98.1). Treatment failure in all three phases occurred in only 2 patients. Conclusions: In this sample of patients, the multistep eradication protocol was effective and had a high success rate.

RESUMO Objetivo: Embora várias estratégias de erradicação de Pseudomonas aeruginosa tenham sido propostas para pacientes com fibrose cística (FC), apenas algumas usaram um tratamento em fases e incluíram crianças na primeira colonização por esse patógeno. O objetivo deste estudo foi descrever a eficácia de um protocolo de erradicação em três fases em crianças com FC a partir do primeiro isolamento de P. aeruginosa no Brasil. Métodos: Estudo retrospectivo de vida real que avaliou prontuários de pacientes pediátricos com FC submetidos ao protocolo de erradicação entre junho de 2004 e dezembro de 2012. O protocolo em três fases foi orientado pela cultura positiva para P. aeruginosa de secreções das vias aéreas, utilizando-se colistimetato inalatório e ciprofloxacina oral no tratamento. As taxas de sucesso após cada fase e a de sucesso acumulado foram avaliadas. Resultados: Durante o período do estudo, 47 episódios de colonização por P. aeruginosa, em 29 pacientes, foram elegíveis para erradicação. Todos os 29 pacientes foram submetidos à primeira fase do protocolo (mediana de idade de 2,7 anos, 17 pacientes (59%) do sexo masculino e 19 (65%) com pelo menos um alelo F508del), sendo que 12 e 6 pacientes foram submetidos a segunda e terceira fases, respectivamente. As taxas de sucesso de erradicação nas três fases de tratamento foram de 58,6% (IC95%: 40,7-74,5), 50,0% (IC95%: 25,4-74,6) e 66,7% (IC95%: 30,0-90,3), respectivamente. A taxa de sucesso acumulado foi de 93,1% (IC95%: 78,0-98,1). Apenas 2 pacientes apresentaram falha do tratamento de erradicação. Conclusões: O primeiro isolamento de P. aeruginosa ocorreu em crianças de baixa idade. O protocolo de erradicação em fases foi efetivo com alta taxa de sucesso.

Pseudomonas aeruginosa: patogenicidad y resistencia antimicrobiana en la infección urinaria / Pseudomonas aeruginosa: pathogenicity and antimicrobial resistance in urinary tract infection

Resumen Dentro de las infecciones nosocomiales más frecuentes asociadas a bacterias multi-resistentes y de peor pronóstico, se encuentran las producidas por Pseudomonas aeruginosa. Esta bacteria posee una alta capacidad de adaptación a condiciones adversas como por ejemplo el pH y la osmolaridad de la orina. Pseudomonas aeruginosa es uno de los principales patógenos implicados en infecciones nosocomiales y de pacientes inmunosuprimidos. Esta bacteria se considera un agente infeccioso oportunista que posee diversos mecanismos de patogenicidad, así como de resistencia a antimicrobianos, lo que contribuye a la dificultad en el tratamiento de estas infecciones. En la presente revisión bibliográfica se analizan la taxonomía, los mecanismos de patogenicidad y genes de resistencia de P. aeruginosa. Así también, se abordan los factores microambientales de la infección urinaria producida por esta bacteria, haciendo un acercamiento al entendimiento de las bases fisiopatológicas de esta infección.

Among the most frequent nosocomial infections associated with polyresistant bacteria and with a worse prognosis, are those produced by Pseudomonas aeruginosa. This bacterium has a high capacity to adapt to adverse conditions such as pH and osmolarity of urine. Pseudomonas aeruginosa is one of the main pathogens involved in nosocomial infections and immunosuppressed patients. This bacterium is considered an opportunistic infectious agent that has diverse mechanisms of pathogenicity, as well as resistance to antimicrobials, which contributes to the difficulty in the treatment of these infections. In the present bibliographic review, the taxonomy, pathogenicity mechanisms and resistance genes of P. aeruginosa are analyzed. Likewise, the micro-environmental factors of the urinary infection produced by this bacterium are approached, making an approach to the understanding of the pathophysiological bases of this infection.

Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: a meta-analysis

Abstract Pseudomonas aeruginosa is the leading cause of nosocomial infections with high mortality rates owing to the limited therapeutic options for multidrug-resistant Pseudomonas aeruginosa (MDRPA) and metallo-beta-lactamase (MBL)-producing strains. Herein, we present a meta-analysis exploring the association between MDRPA and São Paulo MBL-1 (SPM-1)-producing strains vs. mortality. Online databases were screened to identify studies published between 2006 and 2016. A total of 15 studies, comprising 3,201 cases of P. aeruginosa infection, were included. Our results demonstrated a higher mortality rate among patients infected with MDRPA (44.6%, 363/813) than those with non-MDRPA infection (24.8%, 593/2,388) [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.70-3.36, p <0.00001]. The risk of mortality in patients with non-SPM-1 strains was four times higher than that observed in the patients of the SPM-1 group; however, no statistically significant difference was observed (p = 0.43). In conclusion, the results of our study demonstrated that patients infected with MDRPA had a significantly higher mortality rate than that of patients infected with non-MDRPA strains, especially patients with bloodstream infection (BSI), immunosuppression, and inadequate antimicrobial therapy. The absence of studies on the molecular aspects of blaSPM-1 and its association with mortality limited the analysis; therefore, our results should be interpreted with caution. Our findings also highlight the need for more studies on the molecular aspects of resistance and the peculiarities of different nosocomial settings.

Biofilm production by clinical isolates of Pseudomonas aeruginosa and structural changes in LasR protein of isolates non biofilm-producing

ABSTRACT Introduction: Biofilm production is an important mechanism for the survival of Pseudomonas aeruginosa and its relationship with antimicrobial resistance represents a challenge for patient therapeutics. P. aeruginosa is an opportunistic pathogen frequently associated to nosocomial infections, especially in imunocompromised hosts. Objectives: Analyze the phenotypic biofilm production in P. aeruginosa isolates, describe clonal profiles, and analyze quorum sensing (QS) genes and the occurrence of mutations in the LasR protein of non-biofilm producing isolates. Methods: Isolates were tested for biofilm production by measuring cells adherence to the microtiter plates. Clonal profile analysis was carried out through ERIC-PCR, QS genes were by specific PCR. Results: The results showed that 77.5% of the isolates were considered biofilm producers. The results of genotyping showed 38 distinct genetic profiles. As for the occurrence of the genes, 100% of the isolates presented the lasR, rhlI and rhlR genes, and 97.5%, presented the lasI gene. In this study nine isolates were not biofilm producers. However, all presented the QS genes. Amplicons related to genes were sequenced in three of the nine non-biofilm-producing isolates (all presenting different genetic similarity profile) and aligned to the sequences of those genes in P. aeruginosa strain PAO1 (standard biofilm-producing strain). Alignment analysis showed an insertion of three nucleotides (T, C and G) causing the addition of an amino acid valine in the sequence of the LasR protein, in position 53. Conclusion: The modeling of the resulting LasR protein showed a conformational change in its structure, suggesting that this might be the reason why these isolates are unable to produce biofilm.

Ventriculitis post-quirúrgica por Pseudomonas aeruginosa extensamente resistente tratada con colistina intratecal. Comunicación de un caso pediátrico y revisión de la literatura científica / Post-surgical ventriculitis due to extensively resistant Pseudomonas aeruginosa treated with intrathecal colistin. Pediatric case report and literature review

Resumen El uso de colistina por vía intratecal se ha consolidado como una opción terapéutica para el manejo de infecciones del sistema nervioso central causadas por bacilos gramnegativos multi-resistentes. La evidencia del éxito terapéutico y del perfil de seguridad es creciente, particularmente en infecciones por Acinetobacter baumanii multi-resistente en adultos. La evidencia en niños es escasa. Se presenta el caso clínico de una niña de 11 años de edad, con una ventriculitis post-quirúrgica por Pseudomonas aeruginosa extensamente resistente tratada con colistina intravenosa e intratecal. Se revisa su uso en niños con meningitis nosocomial causada por bacilos gramnegativos multi-resistentes.

Use of Intrathecal colistin has increased in recent years and has become an alternative for the management of infections of the central nervous system caused by multidrug resistant (MDR) bacteria. Evidence of therapeutic success and safety profile is increasing, particularly in MDR Acinetobacter baumanii infections in adults. Conversely, evidence in children is limited. We present a case of an 11-year-old female with postsurgical meningitis caused by an extensively resistant Pseudomonas aeruginosa strain and treated with venous and intrathecal colistin. The evidence of its use in children with nosocomial meningitis by MDR Gram negative bacteria is reviewed.

Mielosupresión inducida por linezolid: un caso pediátrico / Myelosupression induced by linezolid: a pediatric case

El linezolid es un antibiótico de la familia de las oxazolidinonas, que actúa inhibiendo la síntesis proteica. Se emplea en infecciones graves por cocos Gram-positivos multirresistentes. Sus principales efectos secundarios son los gastrointestinales y, con menor frecuencia, la neuropatía periférica, la acidosis láctica y la mielosupresión. Se presenta el caso clínico de un niño de 12 años con diagnóstico de osteoartritis séptica de cadera derecha con osteomielitis femoral en tratamiento con linezolid, que presentó un cuadro de intolerancia digestiva, asociado a astenia y pérdida de peso. Presentaba, además, anemia normocítica, junto con leucopenia y trombopenia leves, con datos sugestivos de alteración de la hematopoyesis en el frotis sanguíneo, sugerente de toxicidad por fármacos. El cuadro se resolvió con la interrupción de la administración del fármaco. La mielosupresión reversible asociada a linezolid se relaciona con tratamientos prolongados (> 28 días), por lo que son necesarios los controles hematológicos periódicos durante ellos.

Linezolid is an antibiotic of oxazolidinones family that inhibits proteical synthesis. It is used in several Gram-positive multirresistent infections. Its more frequent side effects are gastrointestinal, followed by peripheral neuropathy and myelosuppression. We report the case of a 12-year-old boy diagnosed with septic osteoarthritis of the hip and femoral osteomyelitis, following treatment with linezolid, who complained about digestive intolerance and weight loss. He showed severe normocytic anemia and mild leukopenia and thrombocytopenia with data of hematopoiesis disorder in the blood smear that suggested drug toxicity. These findings reverted when the treatment was discontinued. Reversible myelosuppression associated with linezolid is related to long treatments (more than 28 days). So it is necessary to check the blood count during long treatments.

Atividade moduladora sobre antibióticos pelo extrato aquoso das folhas de Bauhinia ungulata L / Actividad modulador acerca de antibióticos por el extracto acuoso de las hojas de Bauhinia ungulata l / Modulatory activity about antibiotics by aqueous extract of the leaves of Bauhinia ungulata l

Introdução: cepas de Staphylococcus aureus, Escherichia coli e Pseudomonas aeruginosa são caracterizadas como importantes causadores de infeções bacterianas e destacam-se como um preocupante problema de saúde pública. A atividade antibacteriana de várias plantas tem sido estudada com a finalidade de diminuir a resistência microbiana existente com relação aos fármacos já industrializados. O gênero Bauhinia compreende cerca de 300 espécies que são conhecidas no Brasil como pata-de-vaca. A espécie Bauhinia ungulata Lin é bastante utilizada no controle glicêmico, mas, também, apresenta outras atividades, dentre elas é relatado uma ação antibacteriana. Objetivo: verificar o potencial modulador da espécie B. ungulata em associação a outros medicamentos já testados contra cepas de S. aureus, E. coli e P. aeruginosa. Métodos: as folhas da B. ungulata Lin foram coletadas no distrito de Arajara, Chapada do Araripe, estado do Ceará, Brasil. Foi utilizado o extrato aquoso das folhas de Bauhinia ungulata em associação aos antibióticos Amicacina, Gentamicina, Imipenem e Ciprofloxacino, esperando que o extrato agisse com antagonismo ou sinergismo frente ao efeito dos antibióticos. Resultados: o extrato das folhas de B. ungulata Lin apresentou relevante atividade sinérgica sobre os antibióticos utilizados (amicacina, gentamicina, imipenem e ciprofloxacino). Conclusão: portanto, o extrato em associação com os fármacos potencializou o efeito destes, revelando uma atividade antibacteriana significante(AU)

Introducción: las cepas de Staphylococcus aureus, Escherichia coli e Pseudomonas aeruginosa son causa importante de infecciones bacterianas y se destacan como un problema de salud pública. La actividad antibacteriana de varias plantas se ha estudiado con el fin de reducir la resistencia microbiana existente con respecto a los medicamentos ya industrializados. El género Bauhinia comprende alrededor de 300 especies que se les conoce en Brasil como pata-de-vaca. La especie Bauhinia ungulata Lin es ampliamente utilizada en control de la glucemia, pero también ofrece otras actividades, entre ellas es divulgado una acción antibacteriana. Objetivo: verificar el potencial modulador de las especies B. ungulata en asociación con otros fármacos probados contra cepas de S. aureus, E. coli y P. aeruginosa. Métodos: las hojas de B. ungulata Lin fueron recolectados en el distrito de Arajara, Chapada do Araripe, estado de Ceará, Brasil. Se utilizó el extracto acuoso de hojas de B. ungulata en asociación con antibióticos amikacina, gentamicina imipinem y ciprofloxacina, con la esperanza de que el extracto actúa con antagonismo o sinergismo, delantero de los efectos de los antibióticos. Resultados: el extracto de las hojas de B. ungulata Lin presenta relevante actividad sinérgica de los antibióticos utilizados (amikacina, gentamicina, ciprofloxacina y imipinem). Conclusión: el extracto en asociación con las drogas aumentó el efecto de estos, revelando una significativa actividad antibacteriana(AU)

Introduction: strains of Staphylococcus aureus, Escherichia coli e Pseudomonas aeruginosa are characterized as important causes of bacterial infections and stand out as a worrying public health problem. The antibacterial activity of several plants has been studied for the purpose of reducing the existing microbial resistance with respect to drugs already industrialized. The genus Bauhinia it comprises about 300 species they are known in Brazil as pata-de-vaca. The specie Bauhinia ungulata Lin is widely used in glycemic control, but also features other activities, among them is reported an antibacterial action. Objective: to verify the potential modulator of the species B. ungulata in association with other drugs tested against strains of S. aureus, E. coli and P. aeruginosa. Methods: The leaves of B. ungulata Lin were collected in the District of Arajara, Chapada do Araripe, Ceará state, Brazil. We used the water extract of leaves of B. ungulata in association with antibiotics amikacin, gentamicin, imipinem and ciprofloxacin, hoping that the extract acted with antagonism or synergism, front of the effects of antibiotics. Results: the extract of the leaves of B. ungulata Lin presented relevant synergistic activity about the antibiotics used (amikacin, gentamicin, ciprofloxacin and imipinem). Conclusion: therefore, the extract in association with the drugs increased the effect of these, revealing a significant antibacterial activity(AU)

Atividade antimicrobiana de produtos obtidos de espécies de Piper (Piperaceae) / Actividad antimicrobiana de productos obtenidos a partir de especies de Piper (Piperaceae) / Antimicrobial activity of products obtained from Piper species (Piperaceae)

Introdução: espécies do gênero Piper são encontradas nas regiões tropicais do globo e possuem inúmeras indicações terapêuticas. Objetivos: avaliar a atividade antimicrobiana de extratos e frações de quatro espécies de Piper, além de dois flavonoides isolados de Piper montealegreanum e determinar a concentração inibitória mínima dos produtos ativos. Métodos: o material vegetal foi coletado em diferentes regiões do estado da Paraíba e na cidade de Belém (Pará) submetido à extração com etanol e partição com solventes em grau crescente de polaridade. Os flavonoides foram isolados por meio de técnicas cromatográficas. A avaliação da atividade antimicrobiana foi realizada pelo método de disco-difusão frente a três espécies bacterianas: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 e três espécies fúngicas: Candida albicans ATCC 76645, Candida tropicalis ATCC 13803 e Candida glabrata ATCC 15545. Resultados: quase metade dos produtos testados foi capaz de inibir o crescimento de S. aureus com halos de inibição variando entre 8-16 mm. O extrato etanólico bruto e as frações hexânica e CHCl3 das folhas de P. mollicomum mostraram atividade antibacteriana frente as três linhagens testadas. As frações hexânicas de P. arboreum, de P. caldense e de P. mollicomum apresentaram atividade antifúngica, enfatizando a formação do halo de inibição de 28 mm para a fração de P. mollicomum. Os dois flavonoides isolados de P. montealegreanum não apresentaram atividade antimicrobiana. Conclusões: os resultados preliminares deste estudo sugerem que alguns dos produtos obtidos das espécies de Piper são uma fonte promissora de compostos com atividade antimicrobiana(AU)

Introducción: el género Piper se encuentra en las regiones tropicales del mundo y numerosas indicaciones terapéuticas. Objetivos: evaluar la actividad antimicrobiana de extractos y fracciones de cuatro especies de Piper, además de dos flavonoides aislados de Piper montealegreanum y determinar la concentración inhibitoria mínima de los productos activos. Métodos: el material vegetal fue recolectado en diferentes regiones del estado de Paraíba y en Belém (Pará) y sometido a extracción con etanol y partición com disolventes en grado creciente de polaridad. Los flavonoides fueron aislados por medio de técnicas cromatográficas. La evaluación de la actividad antimicrobiana se realizó por el método de difusión en disco frente a tres especies bacterianas:Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 y três especies de hongos: Candida albicans ATCC 76645, Candida tropicalis ATCC 13803 y Candida glabrata ATCC 15545. Resultados: casi la mitad de los productos ensayados fueron capaces de inhibir el crecimiento de S. aureus con zonas de inhibición entre 8-16 mm. Los extractos etanolicos crudo y fracciones hexano y CHCl3 de las hojas de P. mollicomum mostraron actividad antibacteriana contra todas las cepas probadas. Las fracciones hexano de P. arboreum, P. caldense y P. mollicomum mostraron actividad antifúngica, con énfasis en la zona de inhibición de 28 mm para la fracción de P. mollicomum. Los dos flavonoides aislados de P. montealegreanum no mostraron actividad antimicrobiana. Conclusiones: los resultados preliminares de este estudio sugieren que algunos de los productos obtenidos de especies de Piper son una fuente prometedora de compuestos con actividad antimicrobiana(AU)

Introduction: The species of the genus Piper are widely found in the tropical regions of the globe and have numerous therapeutic indications. Objective: To evaluate the antimicrobial activity of extracts and fractions of four species of Piper and two flavonoids isolated from Piper montealegreanum and determine the minimum inhibitory concentration of the active products. Methods: The plant material was collected in different regions of the state of Paraíba and in Belém (Pará) and subjected to extraction with ethanol and partition with solvents in increasing degree of polarity. Flavonoids were isolated through chromatographic techniques. The evaluation of antimicrobial activity was performed by disk diffusion method front the three bacterial species: Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853 and three fungi species: Candida albicans ATCC 76645, Candida tropicalis ATCC 13803 and Candida glabrata ATCC 15545. Results: Almost half of the products tested were able to inhibit the growth of S. aureus with inhibition zones between 8-16 mm. The crude ethanolic extract and hexane fractions and CHCl3 of P. mollicomum leaves showed antibacterial activity against all the tested strains. The hexane fractions of P. arboreum, P. caldense and P. mollicomum showed antifungal activity, emphasizing the formation of 28 mm inhibition zone for the fraction of P. mollicomum. The two flavonoids isolated from P. montealegreanum showed no antimicrobial activity. Conclusions: preliminary results suggest that some the products obtained from Piper species are a promising source of compounds with antimicrobial activity(AU)

Avaliação da atividade antimicrobiana e moduladora do extrato etanólico de Libidibia ferrea (Mart. ex Tul.) L.P. Queiroz / Evaluación de la actividad antimicrobiana y modulatória del extracto etanólico de Libidibia ferrea (Mart. ex Tul.) L.P. Queiroz / Evaluation of antimicrobial and modulatory activity of the ethanol extract of Libidibia ferrea (Mart. ex Tul.) L.P. Queiroz

Introdução: Staphylococcus aureus é mencionada na literatura como um importante patógeno, algumas espécimes acarretam infecções oportunistas em muitos animais e homens. Escherichia coli é uma das principais causas de doenças infecciosas humanas. Pertencente à família das Enterobacteriaceae, compartilham diversos fatores de virulência descrita por sua resistência a vários antibióticos, as contaminações são provavelmente iniciadas por modificações de defesas do hospedeiro. Pseudomonas aeruginosaé conhecida por causar infecção aguda pela produção de toxinas. Objetivo: avaliar o efeito antimicrobiano do extrato etanólico de Libidibia ferrea (Mart. ex Tul.) L.P. Queiroz, e modulação da atividade antibiótica. Métodos: o material botânico de Libidibia ferrea foi coletado no município de Penaforte, Ceará, Brasil. Para a obtenção dos extratos foram coletadas entrecasca e vagem frescas, submersos em etanol separadamente por 72 h, sendo após esse período, filtrado e concentrado em condensador rotativo a vácuo. Foram realizados testes de atividade antimicrobiana e modulação da atividade antimicrobiana com cepas padrões e multirresistentes de bactérias. Resultados: o extrato demonstrou atividade moduladora quando combinados com alguns antimicrobianos contra algumas linhagens testadas. Conclusões: portanto, é sugerido que o extrato de L. ferrea pode ser utilizada como uma fonte de produtos naturais na terapêutica antimicrobiana e no combate a multirresistência bacteriana(AU)

Introducción: Staphylococcus aureus se menciona en la literatura como un patógeno importante, algunos provocan infecciones oportunistas en animales y hombres. Escherichia coli es una de las principales causas de enfermedades infecciosas humanas. Ambas pertenecen a la familia Enterobacteriaceae, comparten muchos factores de virulencia y se caracterizan por su resistencia a múltiples antibióticos, su contaminación tal vez iniciada por la modificación de las defensas del hospedero. Pseudomonas aeruginosa causa de infección aguda mediante la producción de toxinas. Objetivo: evaluar el efecto antimicrobiano del extracto de etanol de Libidibia ferrea (Mart ex Tul.) LP Queiroz, y la modulación de la actividad antibiótica. Métodos: L. ferrea fue recopilada en el municipio de Penaforte, Ceará, Brasil. Para obtener los extractos se recogieron corteza y frutos frescos, sumergidos en etanol por separado durante 72 h, después se filtraron y se concentraron en un condensador rotatorio. Se realizaron pruebas de actividad antimicrobiana y la modulación de la actividad antimicrobiana con cepas multirresistentes de bacterias. Resultados: los extractos mostraron actividad moduladora cuando se combina con algunos antibióticos contra algunas cepas ensayadas. Conclusión: por lo tanto, se sugiere que el extracto de L. ferrea puede ser utilizado como una fuente de productos naturales en la terapia antimicrobiana y en la resistencia a múltiples fármacos bacteriana combate(AU)

Introduction: Staphylococcus aureus is mentioned in the literature as an important pathogen, some opportunistic bacteria may cause several problems in many animals and humans. Escherichia coli is a leading cause of human infectious diseases. Belonging to the family Enterobacteriaceae, share many virulence factors described by their resistance to multiple antibiotics, the contamination is probably initiated by modifications in the host defenses. Pseudomonas aeruginosa is known to cause acute infection by producing toxins. Objective: evaluate the antimicrobial effect of the ethanol extract of Libidibia ferrea (Mart ex Tul.) LP Queiroz, and modulation of antibiotic activity. Methods: L. ferrea was collected in the municipality of Penaforte, Ceará, Brazil. To obtain the extracts were collected bark and fruits, submerged in ethanol separately for 72 h, after this period, filtered and concentrated in a rotary vacuum condenser. Antimicrobial activity tests were performed and modulation of antimicrobial activity with standards and multiresistant strains of bacteria. Results: the extract showed antibacterial activity when combined with some antibiotics against the assayed strains, demonstrating a modulatory potential. Conclusion: therefore, it is suggested that L. ferrea extract can be used as a source of natural products in the antimicrobial therapy and in the combat bacterial multidrug resistance(AU)

Comparación de la actividad antimicrobiana de meropenem genérico y meropenem innovador por la técnica de micro dilución en cepas resistentes / Comparison of the antimicrobial activity of meropenem generic and innovative meropenem in resistant strains by micro dilution method

Objetivo: comparar la actividad antimicrobiana de meropenem genérico y meropenem innovador, frente a cepas resistentes de interés clínico mediante la técnica de micro dilución. Método: se determinó la concentración mínima inhibitoria y la concentración máxima bactericida según el protocolo de micro dilución del Clinical and Laboratory Standars Institute. Resultado: se determinó una concentración mínima inhibitoria de 320 µg/mL y una concentración máxima bactericida de 640 µg/mL para Staphylococcus aureus con ambos antibióticos, Escherichia coli presentó una concentración mínima inhibitoria de 640 µg/mL y una concentración máxima bactericida de 1 280 µg/mL con los dos antibióticos y por último Klebsiella pneumoniae tuvo una concentración mínima inhibitoria de 5 120 µg/mL y una concentración máxima bactericida de 2 0480 µg/mL con ambos antibióticos. Conclusión: no existen diferencias significativas en las concentración máxima bactericida y la concentración mínima inhibitoria de meropenem genérico y meropenem innovador(AU)

Objective: To compare the antimicrobial activity of generic meropenem and innovative meropenem on resistant strains of clinical interest by using the microdilution technique. Method: The minimum inhibitory concentration and maximum bactericidal concentration were determined by the microdilution according to the protocol set by the Clinical and Laboratory Standards Institute (CLSI). Result: Minimum inhibitory concentration (MIC) of 320 µg / mL and a maximum bactericidal concentration (MBC) of 640 µg/mL for both antibiotics against Staphylococcus aureus. MIC reached 640 µg/mL and MBC of 1 280 µg/mL in both antibiotics for Escherichia coli whereas the MIC was 5 120 µg/mL and WBC of 20 480 µg /mL with both antibiotics against Klebsiella pneumoniae. Conclusion: No significant differences were observed in minimum inhibitory concentration and maximum bactericidal concentration between generic meropenem and innovative meropenem(AU)

Efecto del tratamiento antibiótico inicial adecuado sobre la mortalidad en pacientes en estado crítico con bacteriemia por Pseudomonas aeruginosa / Effect of adequate initial antimicrobi al therapy on mortality in critical patients with Pseudomonas aeruginosa bacteremia

Introducción. La bacteriemia es una de las infecciones hospitalarias de mayor mortalidad, especialmente en las unidades de cuidados intensivos, donde es más frecuente. Pseudomonas aeruginosa es uno de los causantes de bacteriemia más agresivos. Objetivo. Evaluar la asociación entre el tratamiento antibiótico inicial y la mortalidad hospitalaria en estos pacientes. Materiales y métodos. Se trata de un estudio de cohorte retrospectivo multicéntrico realizado entre 2005 y 2008. Se consideró tratamiento adecuado aquel iniciado en las primeras 48 horas del diagnóstico que incluyera, al menos, una dosis de antibiótico intravenoso al que P. aeruginosa fuera sensible y hubiera sido suministrado en la dosis y frecuencia recomendadas. El desenlace principal fue la mortalidad hospitalaria en un lapso de 30 días. Se hizo pareo según grado de exposición usando índices de propensión y, posteriormente, análisis paramétrico de supervivencia. Resultados. Se incluyeron 164 pacientes. La mediana de edad y la clasificación del APACHE II ( Acute Physiology and Chronic Health Evaluation II ) fue de 56 y 13, respectivamente. Se identificó la fuente de la bacteriemia en 68,3 % de los casos, y la más frecuente fue el tracto respiratorio; 44 % de los pacientes recibió tratamiento inadecuado, y la resistencia bacteriana fue la principal variable asociada. La proporción de incidencia de sepsis grave, choque séptico, falla orgánica múltiple y muerte en el lapso de 30 días fue de 67,7, 50, 41,5 y 43,9 %, respectivamente. El tratamiento adecuado se asoció a una prolongación del tiempo hasta el evento (razón de tiempo ajustada, 2,95, IC 95%, 1,63 a 5,33). Conclusión. El tratamiento antibiótico inicial adecuado es un factor protector contra la mortalidad hospitalaria en pacientes con bacteriemia por P. aeruginosa .

Introduction: Among hospital-acquired infections, bacteremia is one of the leading causes of mortality worldwide, especially among intensive care unit patients, where it is more frequent. Pseudomonas aeruginosa is one of the most aggressive agents causing bacteremia. Objective: To evaluate the association between initial antimicrobial therapy and hospital mortality in these patients. Materials and methods: A multicenter and retrospective cohort study was conducted between 2005 and 2008. Antimicrobial therapy was considered adequate if it included at least one intravenous antibiotic to which the P. aeruginosa isolate was susceptible in vitro, was administered at the recommended dose and frequency for bacteremia, and initiated within the first 48 hours from diagnosis. The main outcome was 30-day hospital mortality. Patients were paired according to exposure level using propensity score matching, and then a parametric survival model was fitted. Results: One hundred and sixty four patients were included. Median age and the APACHE II score were 56 and 13, respectively. The source of bacteremia was identified in 68.3 % of cases, the respiratory tract being the most frequent. Forty-four percent of patients received inadequate therapy, with bacterial resistance as the main associated variable. The incidence of severe sepsis, septic shock, multiple organ failure and death within the first 30 days was 67.7, 50, 41.5 and 43.9%, respectively. Adequate therapy was associated with a longer time to the event (adjusted time ratio, 2.95, 95% CI, 1.63 to 5.33). Conclusion: Adequate initial antimicrobial therapy is a protective factor against hospital mortality in patients with P. aeruginosa bacteremia.

Pseudomonas aeruginosa infection in patients with cystic fibrosis: scientific evidence regarding clinical impact, diagnosis, and treatment / Infecção por Pseudomonas aeruginosa em pacientes com fibrose cística: evidências científicas sobre o impacto clínico, diagnóstico e tratamento

Evidence-based techniques have been increasingly used in the creation of clinical guidelines and the development of recommendations for medical practice. The use of levels of evidence allows the reader to identify the quality of scientific information that supports the recommendations made by experts. The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis. For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO–an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question. The questions were designed so that each of the authors could write a response. A first draft was prepared and discussed by the group. Recommendations were then made on the basis of the level of scientific evidence, in accordance with the classification system devised by the Oxford Centre for Evidence-Based Medicine, as well as the level of agreement among the members of the group. .

As técnicas de medicina baseada em evidências são cada vez mais utilizadas para a construção de diretrizes clínicas e recomendações para a prática médica. O uso de níveis de evidências permite que o leitor identifique a qualidade da informação científica que sustenta as recomendações feitas pelos especialistas. Esta revisão teve por objetivo abordar conceitos atuais sobre o impacto clínico, diagnóstico e tratamento das infecções por Pseudomonas aeruginosa em pacientes com fibrose cística. Para a elaboração desta revisão, o grupo de autores definiu as perguntas que seriam respondidas, seguindo os preceitos de PICO, acrônimo baseado em perguntas referentes aos Pacientes de interesse, Intervenção a ser estudada, Comparação da intervenção e Outcome (desfecho) de interesse. Para cada pergunta, uma revisão estruturada da literatura foi realizada nas bases de dados do Medline, buscando identificar os estudos com desenho metodológico mais adequado para responder à questão. As perguntas foram designadas para que cada um dos autores redigisse uma resposta, e um primeiro rascunho foi elaborado e discutido pelo grupo em uma reunião presencial. Após essa discussão, recomendações foram emitidas com base na força das evidências e na concordância entre os membros do grupo segundo o sistema de classificação do Oxford Centre for Evidence Based Medicine. .

Risk factors for pan-resistant Pseudomonas aeruginosa bacteremia and the adequacy of antibiotic therapy

INTRODUCTION: The aim of this study was to determine risk factors for acquiring carbapenemresistant Pseudomonas aeruginosa bacteremia (CR-PA) and factors associated with in-hospital mortality. METHODS: Seventy-seven cases of bacteremia caused by P. aeruginosa were evaluated in a hospital with high incidence of CR-PA. Clinical and laboratorial factors, and previous use of antibiotics were also evaluated. In one analysis, CR-PA and carbapenem-susceptible P. aeruginosa (CS-PA) bacteremia were compared. A second analysis compared patients who died with survivors. RESULTS: Among 77 P. aeruginosa bacteremia, 29 were caused by CR-PA. Admission to the intensive care unit, higher number of total leukocytes, and previous use of carbapenem were statistically associated with CR-PA. In the multivariate analysis, only previous use of carbapenem (including ertapenem) turned out to be a risk factor for CR-PA (p = 0.014). The 30-day mortality of patients with P. aeruginosa bloodstream infection was 44.8% for CS-PA and 54.2% for patients with CR-PA (p = 0.288). Chronic renal failure, admission to the intensive care unit, mechanical ventilation, and central venous catheter were risk factors for mortality. Incorrect treatment increased mortality of patients with bacteremia caused by CS-PA, but not for CR-SA. The odd ratio of mortality associated with incorrect therapy in patients with CS-PA was 3.30 (1.01-10.82; p = 0.043). The mortality of patients with bacteremia caused by CR-PA was unexpectedly similar regardless of antimicrobial treatment adequacy. CONCLUSION: Appropriate treatment for CS-PA bacteremia initiated within the first 24 hours was associated with lower mortality, but this cannot be extrapolated for CR-PA.

Doripenem vs meropenem against Pseudomonas and Acinetobacter.

Recently, doripenem has been approved for the treatment of nosocomial pneumonia (NP), including ventilator-associated pneumonia (VAP). The E-test was performed to determine the MICs of doripenem and meropenem in 203 endotracheal aspirate isolates that consisted of 140 Acinetobacter calcoaceticus-Acinetobacter baumannii complexes and 63 Pseudomonas aeruginosa. Doripenem showed minimum concentration necessary for inhibition of 50% (MIC 50 ) of P. aeruginosa isolates at 0.38 mg/L which is several times (84.2 times) lower than the corresponding MIC 50 value of >32 mg/L for meropenem. The MIC 50 and MIC 90 were similar for both the drugs against A. baumannii. Thus, P. aeruginosa was consistently more susceptible than the A. baumannii.