Impacto clínico del desescalamiento a ertapenem en pacientes críticos con infecciones por Enterobacteriaceae / Clinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections

Resumen Introducción: Ertapenem ha demostrado eficacia frente a Enterobacteriaceae productoras de β-lactamasas de espectro extendido, pero carece de actividad contra bacterias no fermentadoras; el desescalamiento a este antimicrobiano cuando no existe la presencia de P. aeruginosa podría reducir la presión selectiva contra esta bacteria y mejorar los resultados clínicos. Objetivo: Evaluar el impacto clínico del desescalamiento de antimicrobianos con cobertura anti-pseudomonas a ertapenem, un agente sin este espectro, en pacientes críticos con infecciones por Enterobacteriaceae. Métodos: Se realizó un estudio de cohorte prospectivo en adultos admitidos a Unidades de Cuidado Intensivo (UCI) con infecciones por Enterobacteriaceae, que habían sido desescalados de una cobertura anti-pseudomonas, a un antimicrobiano sin la misma (ertapenem). Se realizó un modelo de riesgo proporcional de Cox comparando mortalidad por cualquier causa y duración de estancia hospitalaria entre aquellos pacientes que permanecieron con cobertura anti-pseudomonas versus aquellos que fueron desescalados a ertapenem. Resultados: 105 pacientes en el grupo anti-pseudomonas fueron comparados con 148 pacientes del grupo de desescalamiento a ertapenem. El desescalamiento estuvo asociado con una menor mortalidad por cualquier causa comparado con los pacientes que permanecieron con cobertura anti-pseudomonas (hazard ratio ajustado 0,24; IC 95%: 0,12-0,46). La estancia hospitalaria en UCI fue similar en ambos grupos. Discusión: Los pacientes de UCI con infecciones por Enterobacteriaceae desescalados a terapia con ertapenem, tuvieron mejores resultados clínicos comparados con aquellos que permanecieron en terapia anti-pseudomonas, sugiriendo que el desescalamiento es una práctica segura en esta población.

Background: Ertapenem has proven to be effective for extended-spectrum beta-lactamases-producing Enterobacteriaceae but lacks activity against non-fermenters; de-escalation to this antibiotic may reduce the selection of resistance to Pseudomonas aeruginosa and improve clinical outcomes. Aim: To evaluate the clinical impact of de-escalation from broad-spectrum anti-pseudomonal agents to ertapenem, a non-pseudomonal antibiotics for Enterobacteriaceae infections in critically-ill patients. Methods: We conducted a prospective cohort study in adult patients admitted to intensive care units (ICUs) who had Enterobacteriaceae infections and were de-escalated from empiric anti-pseudomonal coverage to non-pseudomonal antibiotics. Cox proportional hazards models were performed comparing all-cause mortality and length of hospital stay between patients who remained on anti-pseudomonal coverage versus those who were de-escalated to ertapenem. Results: 105 patients in the anti-pseudomonal group were compared to 148 patients in the ertapenem de-escalation group. De-escalation was associated with lower all-cause mortality compared to patients who remained on anti-pseudomonal coverage (adjusted Hazard Ratio 0.24; 95% CI: 0.12-0.46). The length of ICU stay was similar between the groups. Discussion: ICU patients with Enterobacteriaceae infections de-escalated to ertapenem therapy had better outcomes compared to patients who remained on broad-spectrum, anti-pseudomonal therapy, suggesting that de-escalation is a safe approach amongst ICU patients.

Impact of phosphate solubilizing bacteria on wheat (Triticum aestivum ) in the presence of pesticides / Impacto das bactérias solubilizantes de fosfato no trigo (Triticum aestivum ) na presença de pesticidas

Abstract Three phosphate solubilizing bacteria were isolated and identified by 16S rRNA sequencing as Pseudomonas putida, Pseudomonas sp and Pseudomonas fulva . The strains were subjected to plant biochemical testing and all the PGPR attributes were checked in the presence of pesticides (chlorpyrifos and pyriproxyfen). The phosphate solubilizing index of strain Ros2 was highest in NBRIP medium i.e 2.23 mm. All the strains showed acidic pH (ranges from 2.5-5) on both medium i.e PVK and NBRIP. Strain Ros2 was highly positive for ammonia production as well as siderophore production while strain Rad2 was positive for HCN production. The results obtained by the strains Rad1, Rad2 and Ros2 for auxin production were 33.1, 30.67 and 15.38 µg ml-1, respectively. Strain Rad1 showed 16% increase in percentage germination in comparison to control in the presence of pesticide stress. Most promising results for chlorophyll content estimation were obtained in the presence of carotenoids upto 6 mgg-1 without stress by both strains Rad1 and Rad2. Study suggests that especially strain Ros2 can enhance plant growth parameters in the pesticide stress.

Resumo Três bactérias solubilizantes de fosfato foram isoladas e identificadas por seqüenciamento de rRNA 16S como Pseudomonas putida, Pseudomonas sp e Pseudomonas fulva. As estirpes foram submetidas a testes bioquímicos de plantas e todos os atributos PGPR foram verificados na presença de pesticidas (clorpirifos e piriproxifeno). O índice de solubilização de fosfato da estirpe Ros2 foi mais elevado no meio NBRIP, isto é, 2,23 mm. Todas as estirpes apresentaram um pH ácido (varia de 2,5-5) em ambos os meios, isto é PVK e NBRIP. A estirpe Ros2 foi altamente positiva para a produção de amoníaco, bem como a produção de sideróforos enquanto a estirpe Rad2 foi positiva para a produção de HCN. Os resultados obtidos pelas estirpes Rad1, Rad2 e Ros2 para a produção de auxina foram 33,1, 30,67 e 15,38 μg ml-1 , respectivamente. A deformação Rad1 mostrou aumento de 16% na germinação percentual em comparação com o controlo na presença de stress de pesticida. Os resultados mais promissores para a estimativa do teor de clorofila foram obtidos na presença de carotenóides até 6 mgg-1 sem estresse por ambas as cepas Rad1 e Rad2. Estudo sugere que especialmente a estirpe Ros2 pode melhorar parâmetros de crescimento de plantas no estresse de pesticidas.

Prevalence and Sensitivity of Bacilli and Pseudomonas in the Newborn's Oral Cavity

Abstract The aim of this study was to isolate Enterobacteria and Pseudomonas from the oral cavity of hospitalized newborns (NB) and determine their prevalence and the sensitivity profile to most commonly used antibiotics for this age group. Samples from the oral cavity of NB from 24 to 48 h age were collected using swabs. The samples were inoculated on MacConkey agar, incubated and the colonies counted and identified. For each strain, the minimum inhibitory concentration (MIC) was determined using agar dilution test. Tests for enterobacteria producing extended spectrumβ-lactamases (ESBL) were performed using agar diffusion. Descriptive statistics was used for data analysis. Two of the isolated strains were submitted to the susceptibility test in biofilm. Of the collected samples, 8% presented Enterobacteria (mean of 6,141 CFU/mL) and no Pseudomona species was isolated. Positive samples were from NB in accommodation set or in the NB nursery. Enterobacter was the most prevalent genus and some strains were resistant to ampicillin, gentamicin and cephalothin. No ESBL strain was detected. Microorganisms in biofilms were resistant to all antibiotics, with concentrations four times higher than MIC. The presence of enterobacteria in the oral cavity of newborns, especially some strains resistant to normally used antibiotics, warns to the need for care to avoid the early colonization of this niche and the occurrence of a possible hospital infection in this age group.

Resumo O objetivo foi isolar enterobactérias e Pseudomonas da cavidade oral de recém-nascidos hospitalizados (RN) e determinar a prevalência e o perfil de sensibilidade aos antibióticos mais comumente utilizados para este grupo etário. Foram coletadas amostras da cavidade oral de NB com idade de 24-48 horas, usando swab. As amostras foram inoculadas em ágar MacConkey, incubadas e, as colônias contadas e identificadas. Para cada cepa, a concentração inibitória mínima (CIM) foi determinada utilizando teste de ágar diluição. Testes para enterobactérias produtoras de b-lactamases de espectro estendido (ESBL) foram realizados utilizando difusão em ágar. Estatística descritiva foi utilizada para análise dos resultados. Duas das cepas isoladas foram submetidas ao teste de susceptibilidade em biofilme. Das amostras coletadas, 8% apresentaram enterobactérias (média de 6,141 UFC / ml) e nenhuma espécie de Pseudomonas foi isolada. As amostras positivas foram de RN de alojamento conjunto ou RN de berçário. Enterobacter foi o gênero mais prevalente e algumas cepas foram resistentes à ampicilina gentamicina e cefalotina. Não foi detectada cepa ESBL. Micro-organismos em biofilme foram resistentes a todos os antibióticos, em concentrações quatro vezes superiores ao MIC. A presença de enterobactérias em cavidade oral de recém-nascidos, especialmente algumas cepas resistentes aos antibióticos normalmente utilizados, alerta para a necessidade de cuidados, evitando a colonização precoce deste nicho e a ocorrência de possível infecção nosocomial neste grupo etário.

Emergence of colistin resistance in the largest university hospital complex of São Paulo, Brazil, over five years

Abstract Colistin resistance involving Gram-negative bacilli infections is a challenge for health institutions around of the world. Carbapenem-resistance among these isolates makes colistin the last therapeutic option for this treatment. Colistin resistance among Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp. was evaluated between 2010 and 2014 years, at Hospital das Clínicas, São Paulo, Brazil. Over five years 1346 (4.0%) colistin resistant Gram-negative bacilli were evaluated. Enterobacteriaceae was the most frequent (86.1%) pathogen isolated, followed by Acinetobacter spp. (7.6%), and Pseudomonas spp. (6.3%). By temporal analysis there was a trend for an increase of colistin resistance among Enterobacteriaceae, but not among non-fermentative isolates. Among 1346 colistin resistant isolates, carbapenem susceptibility was observed in 21.5%. Colistin resistance in our hospital has been alarmingly increased among Klebsiella pneumoniae isolates in both KPC positive and negative, thus becoming a therapeutic problem.

Occurrence and antimicrobial susceptibility of enteric rods and pseudomonads isolated from the dental prostheses biofilm

ABSTRACT Aspiration of oral bacteria leads to cardiac and respiratory infectious diseases and dentures can act as a reservoir for pathogenic microorganisms. Objective: To determine the occurrence and the in vitro antimicrobial susceptibility of enteric rods and pseudomonads from the denture biofilm of 52 subjects at the Center for Dental Specialties of Sobral/ Ceara, Brazil. Material and Methods: Denture biofilm was collected and samples plated on MacConkey agar. The isolated bacterial colonies were identified using the BBL Crystal enteric/non-fermenter system. Antibiotic bacterial susceptibility was assessed by the disc diffusion method of amoxicillin, amoxicillin/clavulanic acid, doxycycline, tetracycline, tobramycin, imipenem, cefotaxime, and ciprofloxacin. The Minimum Inhibitory Concentration (MIC) of cefotaxime, tobramycin, doxycycline, imipenem, and ciprofloxacin was determined for 40 species by E-test. Results: 34 subjects (65.4%) harbored enteric rods in their prostheses. Klebsiella pneumoniae (26.5%), Escherichia coli (23.5%), and Enterobacter aerogenes (23.5%) were the most prevalent species. All organisms were susceptible to ciprofloxacin and most species were resistant to amoxicillin or amoxicillin/clavulanic acid, demonstrating variable sensitivity patterns to other antimicrobials. However, the MIC showed the emergence of strains with reduced sensitivity to ciprofloxacin (MIC90≥3 μg/ mL) and cefotaxime (MIC90≥2 μg/mL). Conclusion: The findings show high prevalence of nosocomial diseases-related bacterial species and low susceptibility to antimicrobial drugs. Therefore, these results imply caution against the indiscriminate use of broad spectrum antibiotics in dental practice.

Analysis for the presence of determinants involved in the transport of mercury across bacterial membrane from polluted water bodies of India

Abstract Mercury, which is ubiquitous and recalcitrant to biodegradation processes, threatens human health by escaping to the environment via various natural and anthropogenic activities. Non-biodegradability of mercury pollutants has necessitated the development and implementation of economic alternatives with promising potential to remove metals from the environment. Enhancement of microbial based remediation strategies through genetic engineering approaches provides one such alternative with a promising future. In this study, bacterial isolates inhabiting polluted sites were screened for tolerance to varying concentrations of mercuric chloride. Following identification, several Pseudomonas and Klebsiella species were found to exhibit the highest tolerance to both organic and inorganic mercury. Screened bacterial isolates were examined for their genetic make-up in terms of the presence of genes (merP and merT) involved in the transport of mercury across the membrane either alone or in combination to deal with the toxic mercury. Gene sequence analysis revealed that the merP gene showed 86–99% homology, while the merT gene showed >98% homology with previously reported sequences. By exploring the genes involved in imparting metal resistance to bacteria, this study will serve to highlight the credentials that are particularly advantageous for their practical application to remediation of mercury from the environment.

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

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

Percepção dos receptores sanguíneos quanto ao processo transfusional / Blood transfusion receivers' perception of the transfusion process / Percepción de transfusión de sangre en el caso de los receptores

Pesquisa qualitativa, exploratória descritiva, que objetivou conhecer a percepção dos receptores sanguíneos quanto ao processo transfusional. A pesquisa foi realizada em uma unidade de hemoterapia de um município da região sul do Brasil e os dados foram analisados por meio do Discurso do Sujeito Coletivo. Foram entrevistados, por meio de instrumento semiestruturado, onze pacientes, homens e mulheres entre 30 e 95 anos, em recuperação pós-cirúrgica de cirurgia cardíaca, submetidos à transfusão sanguínea. Emergiram quatro Ideias Centrais: Perda e reposição sanguínea; Preservação da vida; Reconhecimento do processo transfusional e Segurança transfusional. A percepção sobre a mudança que os pós-transfundidos começam a vivenciar a partir do processo transfusional traz à tona uma ressignificação da própria vida. Este estudo mostrou que os pacientes transfundidos percebem o processo transfusional como uma alternativa de sobrevivência e, mesmo tendo conhecimento sobre o processo e seus significados, permanecem receios e angústias que podem ser minimizados pela equipe multiprofissional.

Qualitative research, descriptive exploratory, aimed to know the perception of blood transfusion recipients as to the process. The research was carried out at a blood bank in a city in southern Brazil, and the data were analyzed using the Collective Subject Discourse. Were interviewed using a semistructured instrument, eleven patients, men and women between 30 and 95 years, post-surgical recovery of cardiac surgery, underwent blood transfusion. Four central ideas emerged: loss and blood replacement; Preservation of life; Recognition of the transfusion process; and transfusion safety. The perception about the change that post-transfusion begin to live from the transfusion process raises a reframing of life itself. This study showed that transfused patients perceive the transfusion process as a means of survival, and even having knowledge about the process and their meanings, there is the permanence of fears and anxieties that can be minimized by the multidisciplinary team.

Investigación cualitativa, de tipo exploratorio descriptivo, con el objetivo de conocer la percepción de los receptores de transfusiones de sangre en cuanto al proceso. La investigación se llevó a cabo en un banco de sangre en una ciudad en el sur de Brasil, y los datos fueron analizados utilizando el Discurso del Sujeto Colectivo. Fueron entrevistados mediante un instrumento semi-estructurado, once pacientes, hombres y mujeres de entre 30 y 95 años de recuperación post-quirúrgica de la cirugía cardíaca, se sometió a una transfusión de sangre. Cuatro ideas centrales surgieron: la pérdida y reemplazo de sangre; La preservación de la vida; Reconocimiento del proceso de transfusión; y seguridad de las transfusiones. La percepción sobre el cambio que después de la transfusión comenzar a vivir desde el proceso de transfusión plantea una reformulación de la vida misma. Este estudio mostró que los pacientes transfundidos perciben el proceso de transfusión como un medio de supervivencia, e incluso tener conocimiento sobre el proceso y sus significados, no es la permanencia de los temores y ansiedades que pueden minimizarse por el equipo multidisciplinario.

Antimicrobial susceptibility profile of Pseudomonas spp. isolated from a swine slaughterhouse in Dourados, Mato Grosso do Sul State, Brazil / Antimicrobial susceptibility profile of Pseudomonas spp. isolated from a swine slaughterhouse in Dourados, Mato Grosso do Sul State, Brazil.

The present work sought to detect the presence of Pseudomonas spp. at different stages of an effluent treatment plant using the Australian system of stabilization ponds, and to determine the susceptibility of those isolates to different antimicrobials. Thirty-four isolates of Pseudomonas spp. derived from effluent treatment station water samples were collected near the transfer ducts between the ponds in November/2008 and december/2009. Among the Pseudomonas spp. isolates, 47.05

showed susceptibility to all antimicrobials tested, 20.58

were resistant to cefepime, and 24

showed intermediate resistance to streptomycin. No Pseudomonas spp. isolates were found in the final pond, or in post-treatment effluents. The Pseudomonas spp. isolates did not exhibit multiresistance to the antimicrobials tested.

Reliability of Kirby-Bauer disk diffusion method for detecting meropenem resistance among non-fermenting gram-negative bacilli.

Background: Meropenem is empirically used as a last resort for the treatment of infections by non-fermenting gram-negative bacilli (NFGNB). Minimum inhibitory concentration (MIC) determined using agar or broth dilution methods is widely used for testing meropenem resistance. However, it is not possible in resource-poor settings. Aim: A prospective study was performed to evaluate the reliability of Kirby-Bauer disk diffusion (KBDD) method for detecting meropenem resistance among NFGNB. Materials and Methods: A total of 146 NFGNB consisting of 56 Acinetobacter baumannii, 24 Acinetobacter lwoffii, 48 Pseudomonas aeruginosa and 18 Pseudomonas spp. were included in the study. All the isolates were tested simultaneously by both KBDD method and agar dilution method. Results: Very major errors were not observed with A. baumannii, A. lwoffii and P. aeruginosa, while other Pseudomonas spp. showed a very major error rate of about 5.6%. The major error rates observed with A. baumannii, A. lwoffii, P. aeruginosa and Pseudomonas spp. were 1.8%, 0%, 2.1% and 28.6%, respectively. All the isolates showed a good correlation between zone diameters (KBDD method) and MICs (agar dilution method). The sensitivity and specificity of KBDD method for detecting meropenem resistance was above 90% for all the NFGNB except Pseudomonas spp. Conclusions: The KBDD method can be reliably used for routine testing of meropenem resistance in A. baumannii, A. lwoffii and P. aeruginosa. However, further studies are needed before employing this technique for detecting meropenem resistance in Pseudomonas spp.

Antibiobitc susceptibility pattern of bacterial isolates from patients admitted to a tertiary care hospital in Lahore

To determine the antimicrobial sensitivity pattern of bacterial isolates from patients admitted in a tertiary care hospital of Lahore. The study was carried out in Department of Pathology, Postgraduate Medical Institute, Lahore from January 2010 to June 2010. The samples from the hospital were sent to microbiology laboratory for bacteriological examination. They were cultured onto Blood and MacConkey agar plates; organisms were identified by their colonial morphology, Gram Staining and appropriate biochemical tests using standard recommended protocol. Antimicrobial susceptibility pattern of the bacterial isolates recovered from different clinical specimens against penicillins,, cephalosporins, fluoroquinolones, carbapenems, aminoglycosides and trimethoprim sulphmethoxazole was determined using modified Kirby Bauer method. Among the 925 different clinical samples, 379 organisms were isolated. Escherichia coli and Klebsiella species were the most prevalent isolates followed by Pseudomonas and Staphylococcus spp. High degree of resistance was observed among gram negative organisms to all groups of antibiotics. Resistance to amikacin ranged from 12- 18% among different species of Gram negative isolates whereas the range of carbapenem resistance was 1.4 - 9.5%. The percentage of oxacillin resistance among staphylococcal isolates was 33.1%, but all were sensitive to vancomycin. High frequency of resistance observed in the present study indicates that antibiotic resistance among nosocomial isolates is a serious problem. There is a continuous need of surveillance of sensitivity patterns of antimicrobial agents in our set up to know about the trend of this problem

Etiology and antimicrobial susceptibility pattern of bacterial conjunctivitis in children at Princess Rahmah Hospital in Jordan

bacterial conjunctivitis, chiefly affecting young children, is generally caused by different pathogens. Therefore, this study aims to investigate microorganisms causing bacterial conjunctivitis in children and to assess their sensitivity to various groups of antimicrobial. A retrospective study was conducted on positive cultures taken from 39 children aged below 15 years, who attended as outpatient or inpatient at Princess Rahmah Hospital between January and December/ 2008. The obtained data were analyzed and the results were tabulated. A total of 39 isolates were recovered from cultures obtained from children patients. The male and female isolates ratio was [1.6: 1.0]. The most frequent pathogen found was S. aureus [56.4%], followed by Klebsielia spp. [18.0%], Streptococcus spp. [12.8%], Pseudomonas spp [5.1%], E. coli [5.1%] and Moraxella was found in only one culture [2.6%]. Ciprofloxacin had the highest susceptibility rate [90.4%] for all the tested isolates, followed by cefotaxime [72.7%] and vancomycin [71.4%]. Whereas, cefixime showed the lowest susceptibility rate [0.0%] for all the tested isolates. S. aureus was the main isolate of conjunctivitis in children, which almost all isolates were susceptible to ciprofloxacin, cefotaxime, and vancomycin. Overall cefixime resistance rate was 100%. This information should be considered when empirical therapy is recommended or prescribed for children with bacterial conjunctivitis

Etiology and antimicrobial susceptibility pattern of otitis media in children at Princess Rhamah Hospital in Jordan

Otitis media is one of the most common infections in children. Recently it was noticed that there is a marked increase in relapse of otitis media in children. Therefore, this study conducted to investigate microorganisms causing otitis media in children and to assess their sensitivity to various groups of antimicrobial. A retrospective study was conducted on positive cultures taken from 173 children aged below 15 years, who attended as outpatient or inpatient at Princess Rahmah Hospital between January and December/ 2008. The obtained data were analyzed and the results were tabulated. A total of 173 isolates were recovered from cultures obtained from children patients. The male and female isolates ratio was [1.24:1.0]. The most frequent pathogen found was S. aureus [68.2%], followed by Streptococcus spp. [12.1%], H. influenzae [9.3%], Psudomonas spp [6.9%] and Klebsiella spp. [3.9%]. The susceptibility rate of S. aureus was recorded the highest [95.9%] for vancomycin, and the lowest susceptibility rate [31.8%] was recorded for oxacillin. S. aureus was the main isolate of otitis media in children, which almost all isolates were susceptible to cefotaxime, ciprofloxacin and vancomycin. Overall oxacillin resistance was near 67%. This information should be considered when empirical therapy is recommended or prescribed for children with otitis media

Resistance to tetracycline and β-lactams and distribution of resistance markers in enteric microorganisms and pseudomonads isolated from the oral cavity

This study evaluated the occurrence of enteric bacteria and pseudomonads resistant to tetracycline and β-lactams in the oral cavity of patients exhibiting gingivitis (n=89), periodontitis (n=79), periodontally healthy (n=50) and wearing complete dentures (n=41). Microbial identification and presence of resistance markers associated with the production of β-lactamases and tetracycline resistance were performed by using biochemical tests and PCR. Susceptibility tests were carried out in 201 isolates of enteric cocci and rods. Resistance to ampicillin, amoxicillin/clavulanic acid, imipenem, meropenem and tetracycline was detected in 57.4 percent, 34.6 percent, 2.4 percent, 1.9 percent and 36.5 percent of the isolates, respectively. β-lactamase production was observed in 41.2 percent of tested microorganisms, while the most commonly found β-lactamase genetic determinant was gene blaTEM. Tetracycline resistance was disseminated and a wide scope of tet genes were detected in all studied microbial genus.

[Prevalence of pathogens and antimicrobial susceptibility patterns in urine cultures of patients referred to Avesina medical center in Qazvin]

Knowledge of antimicrobial susceptibility is a suitable method in empirical use of antimicrobial agents. This study was designed to detect the prevalence and antimicrobial susceptibility patterns of urinary tract infections. This prospective study investigated the positive urine cultures of out-patients and inpatient of Avesina Teaching hospital in Qazvin during 3 months from July to September 2007. The antimicrobial Susceptibility Testing was performed by disk diffusion method. Among 224 urine samples, E coli was the most common species [61.2%] followed by Pseudomonas [10.3%], Kelebsiella [8.9%], and coagulase negative staphylococci [6.3%]. Nitrofurantoin [72.4%] and Amikacin [77%] were shown to be the most effective drugs on E coli species with Amikacin showing the highest efficacy on Pseudomonas species [50%]. E coli was the most common pathogen with maximum susceptibility to Nitrofurantoin. Hence, the administration of this drug in treatment of indoor and uncomplicated forms of UTI is recommended. Intravenously, Amikacin was found to be the most effective agent for such clinical complications

Contact lens-associated microbial keratitis / Ceratites microbianas relacionadas a lente de contato

PURPOSE: Contact lens-associated microbial keratitis is a severe condition with sight-threatening potential and increasing incidence. Information regarding the etiological agents is essential in guiding management and may vary geographically. The aim of this study was to analyze the microbiological results of corneal scrapings collected from patients presenting with contact lens-associated microbial keratitis. METHODS: Retrospective analysis of the records of all patients who were clinically diagnosed with contact lens-associated microbial keratitis and had corneal scrapings sent to the Laboratory of Ocular Microbiology, UNIFESP/EPM during a 5-year period from January 2002 to December 2007. RESULTS: The etiological agent was identified in 239 patients. Bacterial isolates accounted for 166 (69.46 percent) cases, Acanthamoeba for 95 (39.75 percent) cases and fungi for 4 (1.67 percent) cases. Among the bacterial infections, coagulase-negative Staphylococcus was demonstrated in 74 cases, while Pseudomonas spp was found in 32 patients. All coagulase negative Staphylococcus and Pseudomonas were susceptible to ciprofloxacin and ofloxacin. Resistance to gentamicin was documented in a single case of Pseudomonas. Fourth-generation flouoroquinolone resistance was not observed among Pseudomonas cases. CONCLUSION: Coagulase-negative Staphylococcus was the most frequent isolate, and such data must be considered when determining empiric treatment. Second-generation fluoroquinolones ciprofloxacin and ofloxacin and fourth-generation fluoroquinolones moxifloxacin and gatifloxacin showed a good antibacterial profile and therefore could be good options for initial management.

OBJETIVO: A ceratite microbiana associada ao uso de lente de contato é uma condição clínica grave, com risco de perda visual e cuja incidência vem aumentando progressivamente. Os principais agentes etiológicos podem variar geograficamente e informações referentes aos agentes causais são essenciais para tratamento apropriado. Este estudo se propõe a analisar os resultados microbiológicos de raspados de córnea coletados de pacientes usuários de lente de contato com quadro de ceratite microbiana. MÉTODOS: Foi realizada análise retrospectiva de todos os estudos microbiológicos de pacientes usuários de lente de contato com diagnóstico clínico de ceratite microbiana que tiveram material corneal enviado para o Laboratório de Microbiologia Ocular UNIFESP durante o período de 5 anos de janeiro de 2002 a dezembro de 2007. RESULTADOS: Dos 239 pacientes em que foi possível identificação, o agente era bactéria em 166 (69,46 por cento), Acanthamoeba em 95 (39,75 por cento) e fungo em 4 (1,67 por cento). Staphylococcus coagulase negativo foi encontrado em 74 casos, dos quais todos eram sensíveis tanto a ciprofloxacino quanto a ofloxacino. Dois casos de resistência a quinolonas de quarta geração (gatifloxacino e moxifloxacino) foram identificados entre os casos de Staphylococcus coagulase negativo. Pseudomonas spp foi isolada em 32 pacientes, dos quais todos eram sensíveis a quinolonas de segunda geração (ciprofloxacino e ofloxacino) e de quarta geração. Foi encontrado um único caso de Pseudomonas resistente a gentamicina. CONCLUSÃO: Staphylococcus coagulase negativo foi isolado em um número de casos superior a Pseudomonas, o agente tradicionalmente considerado o principal de ceratites microbianas associadas ao uso de lente de contato. Aminoglicosídeos, fluorquinolonas de segunda e de quarta geração apresentaram um perfil antibiótico satisfatório para o tratamento empírico de ceratites microbianas em usuários de lente de contato.

Antibiotic susceptibility pattern of urinary isolates in Imphal (Manipur), India.

The present study was conducted to detect aerobic causative agents of urinary tract infection (UTI) and their antibiogram pattern. This study was carried out in the Department of Microbiology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. A total of 1,109 clean catched midstream urine samples were collected, out of which 459 (40.4%) samples grew potential pathogens causing UTI. Escherichia coli were the predominant 334 (72.8%) bacterial pathogen followed by Klebsiella species 66 (14.4%), non lactose fermenters 19 (4.1%), Pseudomonas species 16 (3.5%) and others. Most of the strains of E. coli were resistance to Ciprofloxacin whereas sensitive to Aminoglycoside. Most of the urinary isolates showed high degree of resistance to Tetracycline, Norfloxacin and Cotrimoxazole. Gentamycin was the drug of choice for most of the strains.

Microorganisms present in discharging otitis media in a group of patients in Kathmandu.

Discharge from the ear is one of the commonest symptoms of infections of the ear. To study the major strains of bacteria encountered in ear discharges, this study was conducted from July 1999, to June 2001 in the microbiology laboratory of Om Hospital. A total of 115 patients, of 6-35 years of age clinically diagnosed as discharging otitis media were studied. In 60.9% single organism and in 26.08% two organisms were isolated. Results revealed that, Staphylococcus aureus (34.3%), Klebsiella pneumoniae (24.3%), Pseudomons aeruginosa (22.8%), Enterobacter sps (7.1%), Esch coli (4.3%), Citrobacter sps (1.4%), Proteus sps (1.4%), Acinetobacter sps (1.4%) and Pneumococci (1.4%) were the common organisms in the discharge. Candida albicans (2.8%) was the pathogen in two cases. In 27.8% of cases the causative agent was not demonstrated. About sixty percent (65.9%), 64.8% and 56.0% of the isolates were sensitive to amikacin, ciprofloxacin and gentamycin respectively.

Sensitivity pattern of gram negative bacilli to three beta-lactam/beta-lactamase inhibitor combinations using the automated API system.

PURPOSE: To evaluate the spectrum of activity of three beta-lactamase inhibitors such as amoxicillin/ clavulanic acid, ticarcillin/ clavulanic acid and piperacillin/ tazobactam in comparison to cephalosporins against gram negative bacilli. METHODS: Gram-negative bacilli isolated from the clinical specimens received in the laboratory were included in the study. Using the API system (bioMiotarieux) during a one-year period, a total of 1,252 Enterobacteriaceae and 385 non-fermenters were evaluated. RESULTS: The percentage resistance of the Enterobacteriaceae isolates was 82.92% to amoxicillin/ clavulanic acid, 58.22% to ticarcillin/clavulanic acid and 22.44% to piperacillin/tazobactam respectively. Pseudomonas aeruginosa showed resistance of 96% to ticarcillin/ clavulanic acid and 61% to piperacillin/ tazobactam and Acinetobacter baumannii showed 49% resistance to ticarcillin/ clavulanic acid and 77% resistance to piperacillin/ tazobactam respectively. The isolates exhibited high resistance to all the generations of cephalosporins and the other groups of antibiotics except carbapenems. CONCLUSIONS: Piperacillin/tazobactam was found to be the most active combination of the three against Enterobacteriaceae and Pseudomonas spp. and ticarcillin/clavulanic acid against Acinetobacter spp. and Stenotrophomonas maltophilia.

In vitro minocycline activity on superinfecting microorganisms isolated from chronic periodontitis patients / Atividade in vitro de minociclina sobre microrganismos superinfectantes isolados de pacientes com periodontite crônica

Chronic periodontitis is the most common type of periodontitis and it is associated with various species of microorganisms. Enteric rods, Pseudomonas, Staphyloccocus and Candida have been retrieved from periodontal pockets of patients with chronic periodontitis and correlated to cases of superinfection. Local or systemic antibiotic therapy is indicated to reinforce the effects of the conventional mechanical therapy. Minocycline has been suggested as one of the most effective drugs against periodontal pathogens. The aim of this work was to evaluate the minimal inhibitory concentration (MIC) of minocycline on superinfecting microorganisms isolated from the periodontal pocket and the oral cavity of individuals with chronic periodontitis. Isolates of Enterobacteriaceae (n = 25), Staphylococcus spp. (n = 25), Pseudomonas aeruginosa (n = 9) and Candida spp. (n = 25) were included in the study. Minimal inhibitory concentrations (MIC) of minocycline were determined using the Müeller-Hinton agar dilution method. Staphylococcus spp. isolates were the most sensitive to minocycline with a MIC of 8 µg/mL, followed by Enterobacteriaceae with a MIC of 16 µg/mL. The concentration of 16 µg/mL inhibited 96 percent of Candida spp. isolates. The MIC for 88.8 percent of the isolates of Pseudomonas aeruginosa was 128 µg/mL. A concentration of 1,000 µg/mL was not enough to inhibit 100 percent of the tested isolates.

Periodontite crônica é a forma mais comum de periodontite e está associada a diversas espécies de microrganismos. Enterobactérias, Pseudomonas, Staphyloccocus e Candida têm sido recuperados de bolsas periodontais de indivíduos com periodontite crônica e implicados em casos de superinfecção. A terapia antimicrobiana local ou sistêmica pode ser utilizada para reforçar os efeitos da terapia mecânica convencional, e a minociclina tem sido sugerida como antimicrobiano eficaz frente a periodontopatógenos. O objetivo deste trabalho foi avaliar a concentração inibitória mínima (CIM) de minociclina sobre microrganismos superinfectantes isolados de bolsas periodontais e cavidade bucal de indivíduos com periodontite crônica. Foram utilizadas 84 cepas de microrganismos, incluindo Enterobacteriaceae (n = 25), Staphylococcus spp. (n = 25), Pseudomonas aeruginosa (n = 9) e Candida spp. (n = 25). A CIM foi determinada pelo método de diluição em ágar Müeller-Hinton. Staphylococcus foram os microrganismos mais sensíveis a minociclina com CIM de 8 µg/mL, seguidos por Enterobacteriaceae com CIM de 16 µg/mL. Entre as espécies de Candida, 96 por cento foram inibidas na concentração de 16 µg/mL. Para 88,8 por cento das cepas de Pseudomonas aeruginosa a CIM foi de 128 µg/mL. A concentração de 1.000 µg/mL não foi suficiente para inibir 100 por cento das cepas testadas.