Sensibilidad disminuida a los antibóticos Beta-Lactamicos en estreptococos Beta-Hemolíticos / Decreased sensitivity to beta-lactam antibiotics in beta-hemolytic streptococci

Últimamente, se están detectando mutaciones en las proteínas ligadoras de penicilina (PBP) de los estreptococos beta-hemolíticos que corresponden a sitios que en Streptococcus pneumoniae han determinado sensibilidad disminuida a los antibióticos beta-lactámicos. Primero, se describieron cepas con sensibilidad intermedia a penicilina en Streptococcus agalactiae (estreptococos del grupo B), luego en Streptococcus dysgalactiae subsp. equisimilis (mayormente grupos C y G) y, más recientemente, cepas con sensibilidad disminuida a aminopenicilinas y cefalosporinas de tercera generación en Streptococcus pyogenes (grupo A). El costo biológico de estas modificaciones nos permite pensar que los niveles de resistencia no han de ser tan elevados como para comprometer por ahora la efectividad clínica de los beta-lactámicos (AU)

Recently, mutations in penicillin-binding proteins (PBPs) of beta-hemolytic streptococci have been detected corresponding to sites that in Streptococcus pneumoniae have been determined to have decreased sensitivity to beta-lactam antibiotics. First, strains with intermediate sensitivity to penicillin were described in Streptococcus agalactiae (group B streptococci), subsequently in Streptococcus dysgalactiae subsp. equisimilis (mainly groups C and G) and, more recently, strains with decreased sensitivity to third-generation aminopenicillins and cephalosporins were found in Streptococcus pyogenes (group A). The biological cost of these modifications suggests that, for now, resistance levels are not high enough to compromise the clinical effectiveness of beta-lactams (AU)

Sensibilidad a trimetoprima-sulfametoxazol de Streptococcus pyogenes aislados de infecciones invasivas / Susceptibility of Streptococcus pyogenes isolated from invasive infections to trimethoprim-sulfamethoxazole

Se cree erróneamente que los estreptococos del grupo A (EGA) son universalmente resistentes a trimetoprima-sulfametoxazol (TMS). Esto se debe a que la timidina presente en los medios habitualmente usados para determinar sensibilidad in vitro a antibióticos antagoniza el efecto antibiótico de TMS. El objetivo de este trabajo fue determinar la sensibilidad de EGA a TMS, en presencia y ausencia de timidina. A tal fin, fueron analizados 95 aislamientos clínicos obtenidos de tejidos normalmente estériles con infección invasiva por EGA. La pruebas de sensibilidad por difusión con discos de TMS fueron realizadas en agar Mueller Hinton adicionado ya sea con 5% de sangre de carnero (MH-SC) o con 5% de sangre equina lisada (MH-SEL). La sangre equina lisada contiene timidina fosforilasa, que degrada este nucleósido. Como método de referencia se utilizó la epsilometría (Etest). El control de calidad con la cepa Enterococcus faecalis ATCC 29212 fue satisfactorio para ambos medios. La sensibilidad a TMS por difusión fue 100% en MH-SEL; en agar MH-SC 6 (6.3%) aislamientos resultaron resistentes; por Etest todos fueron sensibles, excepto uno de esos seis que presentó sensibilidad intermedia (CIM = 1.5/28.5 μg/ml). En este aislamiento no se encontraron las mutaciones genéticas de EGA más frecuentemente asociadas a resistencia a TMS. Probablemente, si se establecieran mejores puntos de corte para difusión, específicos para EGA, podría optimizarse la correlación con métodos de dilución o con Etest, aun empleando MH-SC.

It is erroneously believed that group A streptococci (GAS) are universally resistant to trimethoprim-sulfamethoxazole (TMS). This is mainly because media commonly used for in vitro determination of susceptibility to antibiotics contain thymidine, a nucleoside that antagonizes the antibiotic effect of TMS. The objective of this work was to determine EGA sensitivity to TMS in the presence and absence of thymidine. To this aim, 95 GAS isolates obtained from clinical tissues with i nvasive infections were analyzed. Susceptibility tests were performed by diffusion with TMS discs in Mueller Hinton agar supplemented either with 5% sheep blood or with 5% lysed equine blood (MH-LEB). Lysed equine blood contains thymidine phosphorylase, which degrades this nucleoside. Epsilometry (Etest) was used as gold standard. Quality controls with Enterococcus faecalis strain ATCC 29212 were satisfactory with both media. A 100% sensitivity to TMS was found in MH-SEL whereas 6 isolates (6.3%) resulted resistant in MH-SC; only one of them was found to have intermediate susceptibility by Etest (MIC > 1.5/28 μg/ml). The genetic determinants most frequently associated to TMS resistant EGA were not found in this isolate. Probably, if more accurate GAS-specific cut-off points were established for diffusion, the correlation with dilution methods or with the Etest could be improved, even employing MH-SB.

In vitro analysis of a local polymeric device as an alternative for systemic antibiotics in Dentistry

Abstract The development of a biodegradable material with antimicrobial properties for local applications is required in the prevention and treatment of infectious diseases. The objective of this study was to produce blends of poly-L-lactide acid (PLLA) synthetic polymer associated with several antimicrobials, as an alternative in the prevention and treatment of infections, as well as to evaluate its cytotoxicity, release of antimicrobials and inhibit bacteria growth. Blends of PLLA added with 20% Amoxicillin, Metronidazole, Clindamycin or Azithromicyn were used to produce Films (F) or Meshs (M) by casting and electrospinning methods, respectively. Standardized discs of the films and meshs were stored in buffer solutions (pH 5 or 7.4) and aliquots were analyzed by high performance chromatography (HPLC) during 168 hours. Cytotoxicity on human gingival fibroblasts was tested after 24, 48 and 72h by MTT reaction. The antimicrobial capacity was determined against P. gingivalis and S. pyogenes. The specimens were weighed after 3 and 6 months of storage for degradation analysis. SEM was performed to control interfaces and degradation. Antimicrobials presented a continuous and exponential drug release. Analysis showed that both M and F were able to inhibit S. pyogenes and P. gingivalis growth, indicating the release of active antimicrobial agents. The products were not toxic to the fibroblasts. Amoxicillin-film showed more degradation than PLLA at both pHs (p < 0.05), whereas Azithromycin-meshes were more degraded than PLLA at pH 7.4 (p < 0.05). PLLA association with antimicrobials is biocompatible and may represent a potential tool for the local delivery of antimicrobials.

Actividad antibacteriana y antifúngica de un extracto de Salvia apiana frente a microorganismos de importancia clínica / Antibacterial and antifungal activity of Salvia apiana against clinically important microorganisms

Debido a la gran problemática mundial de la resistencia bacteriana a los antibióticos, es necesaria la búsqueda continua de nuevas moléculas con características antimicrobianas. Este estudio evaluó el efecto antibacteriano y antifúngico de un extracto hexánico proveniente de la raíz de Salvia apiana. Los extractos de salvia a las concentraciones de 27; 13,5; 6,8 y 3,4mg/ml causaron inhibición del crecimiento de Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis y Candida albicans. Sin embargo, no presentaron efecto significativo sobre Escherichia coli y Candida tropicalis al compararse con los valores del vehículo en las valoraciones de difusión en pozo. Se demostró que S. apiana tiene un efecto antimicrobiano significativo sobre patógenos de gran importancia clínica, lo que abre el campo para continuar evaluando a esta lamiácea en vistas a su posible empleo en el futuro como un agente terapéutico

Due to the great global concern regarding bacterial resistance to antibiotics, an ongoing search for new molecules having antibacterial activity is necessary. This study evaluated the antibacterial and anticandidal effects of a hexane extract from the root of Salvia apiana. Salvia extracts at concentrations of 27, 13.5, 6.8 and 3.4mg/ml caused growth inhibition of Staphylococcus aureus, Streptococcus pyogenes, Enterococcus faecalis and Candida albicans. However, no significant effect was observed on Escherichia coli and Candida tropicalis in comparison to vehicle. It was here demonstrated for the first time that Salvia apiana has an important antimicrobial effect on human pathogens of great clinical value, thus opening the field to continue the evaluation of this lamiaceous plant for its future use as a therapeutic agent

Epidemiological Study of Erythromycin-Resistant Streptococcus pyogenes From Korea and Japan by emm Genotyping and Multilocus Sequence Typing

BACKGROUND: We determined the epidemiological characteristics of erythromycin (EM)-resistant Streptococcus pyogenes (group A streptococci, GAS) strains isolated from Korea and Japan, using emm genotyping and multilocus sequence typing (MLST). METHODS: Clinical isolates of GAS had been collected from 1992 to 2012 in Korea and from 2004 to 2009 in Japan. EM resistance was determined by the microdilution method, and resistance genotypes were assessed by PCR. The emm genotyping and MLST were performed by DNA sequencing. RESULTS: The emm genotypes and sequence types (STs) were concordant in 143 (85.1%) of 168 EM-resistant GAS strains from Korea. ST36/emm12 (35.1%), ST52/emm28 (22.6%), and ST49/emm75 (16.1%) were the most common types. Most of the ST36 (93.9%) and ST52 (95.8%) strains harbored erm(B), whereas strains ST49, ST42, and ST15 contained mef(A). The concordance between emm genotypes and STs was 41 (93.2%) among 44 EM-resistant GAS strains from Japan. ST36/emm12 (34.1%), ST49/emm75 (18.2%), and ST28/emm1 (15.9%) were the major types. ST36 isolates harbored either erm(B) (56.3%) or mef(A) (37.5%), whereas isolates ST28, ST49, and ST38 carried only mef(A). The proportion of erm(B) and mef(A) was 66.1% and 33.3% in Korea and 22.7% and 68.2% in Japan, respectively. CONCLUSIONS: The common STs in Korea and Japan were ST36 and ST49, whereas ST52 was present only in Korea and ST28 only in Japan. Genotype erm(B) was predominant in Korea, whereas mef(A) was frequent in Japan. There were differences between Korea and Japan regarding the frequencies of emm genotypes, STs, and EM resistance genes among the EM-resistant GAS.

Estudo comparativo da atividade antibacteriana de extratos vegetais de Senna spectabilis, Rosmarinus officinalis e Eugenia uniflora frente à cepa padrão de Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 6538 e Streptococcus pyogenes ATCC 19615 / Comparative study on the activity of Senna spectabilis, Rosmarinus officinalis and Eugenia uniflora vegetable antibacterial extracts against Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 6538 and Streptococcus pyogenes ATCC 19615 standard strains

O interesse em terapias alternativas e o uso terapêutico por derivados de plantas vêm crescendo nos últimos anos, obtendo um grande avanço científico no aspecto químico e farmacológico, a Organização Mundial da Saúde (OMS), considera as plantas medicinais como importantes instrumentos da assistência farmacêutica. Objetivo: Determinar atividade antibacteriana comparada entre os extratos de Senna spectabilis, Rosmarinus officinalis e Eugenia uniflora frente à cepa padrão de Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 6538 e Streptococcus pyogenes ATCC 19615. As folhas de E. uniflora, R. officinallis e S. spectabilis foram coletadas no Horto de plantas medicinais da Universidade Estadual de Maringá ­ UEM/PR e as cepas foram fornecidas pela Universidade Paranaense ­ Unipar. A atividade antibacteriana foi determinada por meio da técnica do microdiluição em placa, empregando revelador de crescimento Alamar Blue Assay (MABA). A concentração mínima inibitória (CIM) empregando R. officinalis, E. uniflora, frente a cepa de S. aureus ATCC pode revelar resultados de 125 µg/mL, para extratos de S. spectabilis o CIM foi de 250 µg/mL; para S. pyogenes o CIM de 125 µg/mL foi admitido apenas para R. officinalis e S. spectabilis, E. uniflora apresentou resultados de 500 µg/mL, para P. aeruginosa o CIM para os três extratos foi superior a 500 µg/mL. Os extratos são promissores quando empregados contra S. aureus e S. pyogenes, exceto para P. aeruginosa, no entanto cabe buscar novas alternativas para tratamento deste Gram-negativo.

The interest in alternative therapies and therapeutic use of plant extracts has been increasing in recent years, and has had great scientific advances regarding the chemical and pharmacological aspects. The World Health Organization (WHO) considers medicinal plants as important pharmaceutical care instruments. In order to determine the compared antibacterial activity between Senna spectabilis, Rosmarinus officinalis and Eugenia uniflora extracts against standard strains of Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 6538 and Streptococcus pyogenes ATCC 19615, the leaves of E. uniflora, R.officinallis and S. spectabilis were collected in the medicinal plant garden of the State University of Maringa - UEM/PR, and strains were provided by University Paranaense - Unipar. The antibacterial activity was determined by broth microdilution plate technique using Alamar Blue Assay (MABA) growth revelant. The minimum inhibitory concentration (MIC) using R. officinalis, E. uniflora against the S. aureus ATCC strain revealed results of 125 µg/mL, for S. spectabilis extracts, MIC was of 250 µg/mL; S. pyogenes resulted in a MIC of 125 µg/mL was admitted only for R. officinalis and S. spectabilis, E. uniflora results showed 500 µg/mL, and for P. aeruginosa, MIC was greater than 500 µm/mL for the three extracts. The extracts are considered as promising when used against S. aureus and S. pyogenes, but not for P. aeruginosa. However, new alternatives are being sought for treating this gram-negative strain.

Tratamento intralesional de malformações linfáticas com ênfase na escleroterapia com picibanil (OK-432): revisão sistemática / Intralesional treatment of lymphatic malformations with emphasis on Picibanil (OK-432) sclerotherapy: a systematic review

INTRODUÇÃO: Conduziu-se revisão sistemática retrospectiva da literatura incluindo estudos relatando o uso de picibanil para tratar malformações linfáticas (ML). MÉTODOS: A pesquisa foi realizada com estudos publicados no PubMed de janeiro de 1990 a 14 de abril de 2013. Na estratégia de busca, usou-se os descritores "OK-432" ou "Picibanil" e "lymphatic malformation". Os seguintes elementos foram comparados aos de outras modalidades relatadas e, então, compilados: mecanismo de ação, indicações, contraindicações, eficácia, administração, efeitos colaterais, complicações, vantagens e desvantagens. RESULTADOS: Foram encontrados 44 estudos, 27 dos quais atenderam aos critérios de inclusão. O picibanil é uma preparação liofilizada de uma cepa de baixa virulência de Streptococcus pyogenes inativada pela penicilina G. Seu mecanismo de ação ainda não definido claramente, mas especula-se que provoque uma resposta inflamatória controlada com adesão das paredes dos cistos. O picibanil é indicado quase que unanimemente para o tratamento da ML macrocística, cuja resposta é mais efetiva do que em lesões microcísticas ou mistas. Em geral, o picibanil é administrado por meio de punção com visualização direta ou guiada por ultrassonografia, com o paciente sob anestesia geral. A preparação comumente utilizada consiste em 0,1 mg de picibanil em 10 ml de soro fisiológico. Os efeitos colaterais são, em geral, leves; sendo dor, inchaço e febre os mais frequentemente relatados. CONCLUSÃO: Os estudos apresentam pouca evidência científica. A revisão sistemática identificou que o picibanil é útil no tratamento da ML de qualquer tipo, mas tem resultados melhores em lesões macrocísticas. A eficácia foi comparável à de outras terapias. Não foi apresentada nenhuma contraindicação específica. Embora o mecanismo de ação ainda não tenha sido determinado, o picibanil trata-se de opção de tratamento.

INTRODUCTION: We performed a retrospective systematic review of studies reporting the use of Picibanil for treatment of lymphatic malformations (LMs). METHODS: We searched the PubMed database for available studies, including those published between January 1990 and April 14, 2013. The search strategy involved the use of the keywords "OK-432" or "Picibanil" and "lymphatic malformation." Information was compiled regarding the reported mechanism of action, indications, contraindications, efficacy, administration, side effects, complications, and advantages and disadvantages compared to those of other modalities. RESULTS: Forty-four studies were found, of which 27 fulfilled the inclusion criteria. Picibanil is a lyophilized preparation of a low-virulence strain of Streptococcus pyogenes inactivated with penicillin G. Its mechanism of action is unclear, but it has been speculated that it causes a controlled inflammatory response with adhesion of cyst walls. Picibanil is almost unanimously indicated for the treatment of macrocystic LMs, which show a greater effectiveness response compared to that shown by microcystic or mixed LMs. Picibanil is usually administered by puncturing, either with direct visualization or guided by ultrasound, with the patient under general anesthesia. The most widely used preparation comprises 0.1 mg of Picibanil in 10 mL of saline. Side effects are mostly mild, with pain, swelling, and fever being the most frequently reported. CONCLUSION: The studies had low scientific evidence. A systematic review found that Picibanil is useful against any LM, with better results in macrocystic lesions. Efficacy was comparable to that of other therapies. No specific contraindication was presented. Although the mechanism of action has not been established, the inclusion of Picibanil as a treatment option is warranted.

Antimicrobial activity of Anonna mucosa (Jacq.) grown in vivo and obtained by in vitroculture

Brazilian flora includes numerous species of medicinal importance that can be used to develop new drugs. Plant tissue culture offers strategies for conservation and use of these species allowing continuous production of plants and bioactive substances. Annona mucosa has produced substances such as acetogenins and alkaloids that exhibit antimicrobial activities. The widespread use of antibiotics has led to an increase in multidrug-resistant bacteria, which represents a serious risk of infection. In view of this problem, the aim of this work was to evaluate the antibacterial potential of extracts of A. mucosa obtained by in vitro techniques and also cultured under in vivo conditions. Segments from seedlings were inoculated onto different culture media containing the auxin picloram and the cytokinin kinetin at different concentrations. The calluses obtained were used to produce cell suspension cultures. The materials were subjected to methanol extraction and subsequent fractionation in hexane and dichloromethane. The antimicrobial activity against 20 strains of clinical relevance was evaluated by the macrodilution method at minimum inhibitory and minimum bactericidal concentrations. The extracts showed selective antimicrobial activity, inhibiting the growth of Streptococcus pyogenes and Bacillus thuringiensis at different concentrations. The plant tissue culture methods produced plant materials with antibacterial properties, as well as in vivo grown plants. The antibacterial activity of material obtained through biotechnological procedures of A. mucosa is reported here for the first time.

In vitro antimicrobial activity of Luffa operculata / Atividade antimicrobiana in vitro da Luffa operculata

INTRODUCTION:Luffa operculata is probably one of the most popular herbal medicines used in the treatment of rhinitis and rhinosinusitis. However, its specific mechanism of action is still unknown.OBJECTIVE: To evaluate in vitro antibacterial activity of L. operculata against three ordinary agents of upper respiratory tract infection: Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes.METHODS: Different concentrations of L. operculata alcoholic extract were applied to bacterial broth containing reference and community strains of the three described agents. After a 24-h incubation period, the bacterial culture turbidity was measured. The samples were then inoculated onto Mueller-Hinton and human blood agar plates. Bacterial growth was analyzed after 24- and 48-h incubation period. The test was considered negative when there was no environmental turbidity, confirmed by the absence of bacterial growth into the inoculated plates. Tests were considered positive when either turbidity changes were observed on the bacterial broth or when bacterial growth was detected on inoculated plates. Appropriate statistical analysis of the data was performed.RESULTS:L. operculata extracts showed antibacterial activity mainly to S. pyogenes followed by S. pneumoniae and S. aureus.CONCLUSIONS:L. operculata extract showed promising antibacterial activity in vitro against the studied agents.

INTRODUÇÃO: A Luffa operculataé, provavelmente, o fitoterápico mais utilizado no tratamento das rinites e rinossinusites. Apesar de amplamente utilizada pela população, seus mecanismos de ação ainda não estão completamente estabelecidos.OBJETIVO: Avaliar a atividade antimicrobiana in vitroda Luffa operculataem agentes causadores de infecções de vias aéreas superiores: Staphylococcus aureus, Streptococcus pneumoniaee Streptococcus pyogenes.MÉTODOS: Foram utilizadas diferentes concentrações de extrato alcoólico de Luffa operculataem caldo de bactérias dos agentes avaliados. Após incubação de 24 horas foi realizada a leitura de turvação do meio, e posteriormente, semeadura em placas de ágar-sangue e ágar Muller-Hinton, após 24 e 48 horas de incubação. Foram considerados testes negativos aqueles em que não houve a turvação do meio, confirmados pela ausência do crescimento das bactérias nas semeaduras. Foram considerados positivos os testes que apresentaram turvação do caldo ou positividade nas semeaduras de 24 ou 48 horas. Os resultados foram submetidos à análise estatística pertinente.RESULTADOS: Os extratos de Luffa operculataapresentaram atividade antimicrobiana, especialmente para Streptococcus pyogenes, seguido dos Streptococcus pneumoniaee Sthaphylococcus aureus.CONCLUSÃO: O extrato de Luffa operculataapresentou promissora atividade antimicrobiana in vitrocontra os agentes estudados.

Effects of penicillin and erythromycin on adherence of invasive and noninvasive isolates of Streptococcus pyogenes to laminin

This study investigated the possible relationship between the invasiveness of group A Streptococcus (GAS) strains and their abilities to adhere to laminin and assessed the effects of subinhibitory concentrations of penicillin and erythromycin on the ability of GAS to adhere to laminin. The adherence of noninvasive and highly invasive isolates of GAS to laminin was significantly higher than the adherence displayed by isolates of low invasiveness. Antibiotic treatment caused significant reductions in adherence to laminin in all three groups of strains. Penicillin was more successful in reducing the adherence abilities of the tested GAS strains than erythromycin.

Antimicrobial susceptibility patterns, emm type distribution and genetic diversity of Streptococcus pyogenes recovered in Brazil

Streptococcus pyogenes is responsible for a variety of infectious diseases and immunological complications. In this study, 91 isolates of S. pyogenes recovered from oropharynx secretions were submitted to antimicrobial susceptibility testing, emm typing and pulsed-field gel electrophoresis (PFGE) analysis. All isolates were susceptible to ceftriaxone, levofloxacin, penicillin G and vancomycin. Resistance to erythromycin and clindamycin was 15.4%, which is higher than previous reports from this area, while 20.9% of the isolates were not susceptible to tetracycline. The macrolide resistance phenotypes were cMLSB (10) and iMLSB (4). The ermB gene was predominant, followed by the ermA gene. Thirty-two emm types and subtypes were found, but five (emm1, emm4, emm12, emm22, emm81) were detected in 48% of the isolates. Three new emm subtypes were identified (emm1.74, emm58.14, emm76.7). There was a strong association between emm type and PFGE clustering. A variety of PFGE profiles as well as emm types were found among tetracycline and erythromycin-resistant isolates, demonstrating that antimicrobial resistant strains do not result from the expansion of one or a few clones. This study provides epidemiological data that contribute to the development of suitable strategies for the prevention and treatment of such infections in a poorly studied area.

Prevalência de Streptococcus β-hemolítico em crianças portadoras de necessidades especiais / Prevalence of β-hemolytic Streptococcus in children with special health care needs

Faringotonsilite causada por Streptococcus β-hemolítico afeta principalmente crianças e imunocomprometidos, sendo Streptococcus pyogenes (Grupo A) o agente mais comum em faringotonsilites bacterianas. OBJETIVO: Este trabalho objetivou a busca por Streptococcus β-hemolítico do Grupo A (SBHGA) e Não A (SBHGNA) na orofaringe de indivíduos com necessidades especiais da APAE (Maceió-AL). MÉTODO:Estudo prospectivo com amostras da orofaringe de pacientes com síndrome de Down e outras desordens mentais (teste) e estudantes de escola privada (controle) de 5-15 anos. Culturas em ágar sangue (5%) foram identificadas através dos testes de Gram/catalase e o método de disco difusão com bacitracina/sulfametoxazol-trimetoprim, aplicando-se o teste Chi-quadrado em análises estatísticas. RESULTADOS: Um total de 222 colônias bacterianas foram isoladas em 74 indivíduos da APAE e 65 no grupo controle. No grupo teste, episódios prévios de faringotonsilites foram relatados por 36,49% (27/74) e 9,46% (7/74) foram diagnosticados com sintomas e/ou sinais sugestivos de infecção orofaríngea. Nenhuma amostra de S. pyogenes foi confirmada na APAE, sendo todas identificadas como SBHGNA, com cinco SBHGA no grupo controle. CONCLUSÃO:A identificação precoce de Streptococcus β-hemolítico é importante para o tratamento rápido de faringotonsilites e a ausência de S. pyogenes evita futuras sequelas supurativas ou não supurativas no grupo da APAE.

Pharyngotonsillitis by β-hemolytic Streptococcus mostly affects children and imunocompromissed, being Streptococcuspyogenes (Group A) the most common agent in bacterial pharyngotonsillitis. AIM:This work targeted the research of β-hemolytic Streptococcus Group-A (SBHGA) and No-A (SBHGNA) in the oropharynx of individuals with special health needs from the APAE (Maceió-AL). METHOD: A prospective study with oropharynx samples from patients with Down syndrome and other mental disorders (test) and students from a private school (control) aged 5-15 years. Cultures in blood agar (5%) were identified through Gram/catalase tests and bacitracin/trimethoprim-sulfamethoxazole disk diffusion method, applying the chi-squared statistical analysis. RESULTS: A total of 222 bacterial colonies were isolated in 74 individuals from APAE and 65 in the control group. In the test group, previous episodes of pharyngotonsillitis were reported by 36.49% (27/74) and 9.46% (7/74) were diagnosed with symptoms and/or signs suggestive of oropharynx infection. No positive sample of S. pyogenes was confirmed at APAE, being all samples classified as SBHGNA, with 5 SBHGA in the control group. CONCLUSION: The early identification of β-hemolytic Steptococcus is important for the fast treatment of pharyngotonsillitis and the absence of S. pyogenes avoid future suppurative or not-suppurative sequels in the group from APAE.

Etiological aspects of penicillin-failure in the treatment of tonsillitis and pharyngitis caused by group A, beta-hemolytic streptococci [GABHS]

To observe and study the cause of penicillin-failure and to see the therapeutic effects of other drugs and find out more effective and better remedy. A Retrospective study. This study was conducted in Microbiology Department, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, National institute of Child Health from April 2004 - June 2005. A total of 300 children attending OPD's and admitted [250 suspected and 50 Normal as control cases] of age group 5 - 15 years were included in this study. Drug sensitivity pattern of streptococcus pyogenes isolated in infected and control children was observed. Antibiotic discs used were Penicillin [10] units and Erythromycin [15 micrograms]. The organism isolated GABHS shows 100% sensitivity to penicillin, while in case of erythromycin, it was sensitive in 24[85.7%] infected cases and resistant to 4[14.3%] cases. Pharyngotonsillitis is a disease of poor community, the therapy with penicillin is economical compared with Cephalosporin group. Penicillin therapy is helpful in preventing the supporative and n supporative complications caused by GABHs

Análisis de los fenotipos y genotipos de resistencia a eritromicina y clindamicina en cepas de Streptococcus pyogenes aisladas en Chile en un período de 10 años / Resistance phenotypes and genotypes of Streptococcus pyogenes clinical isolates in Chile over a 10-year period

Background: Macrolide and lincosamide resistance in Streptococcus pyogenes is due to the acquisition of mef, ermB and ermA genes, which confer different resistance phenotypes, namely M, MLSBconstitutive and MLSBinducible respectively. The last report of resistance in Chile was done in the period 1990-1998, in which resistance to macrolides was 5.4 percent, with M phenotype as the predominant one. Aim: To characterize the evolution of erythromycin and clindamycin resistance and their associated genes in S. pyogenes strains isolated from patients with invasive and non-invasive infections in the period 1996 to 2005. Material and Methods: Resistance to erythromycin and clindamycin was determined in 1,282 clinical isolates using the disk diffusion test. Resistant isolates were analyzed by polymerase chain reaction (PCR) for the presence of the above mentioned resistance genes. Results: Global resistance to erythromycin and clindamycin was 3.5 and 0.7 percent respectively. Eighty percent of the resistant strains possessed the M. phenotype. Conclusions: Resistance levels of S. pyogenes have decreased in Chile in the last years. Most resistant strains have M phenotype in contrast to many countries in which the MLSB constitutive phenotype is the predominant one.

Asymptomatic colonization of upper respiratory tract by potential bacterial pathogens.

Objective. To screen for asymptomatic respiratory carriage of S. pneumoniae, H. influenzae and Group A Streptococcus (GAS) in children attending JIPMER, correlate carriage rate with different socio-demographic factors and to detect antimicrobial resistance among the isolates. Methods. Throat swabs were collected from both in patients and out patients (≤12 yr of age) and processed. Bacteria were identified by standard techniques. Susceptibility to commonly used antimicrobial agents was determined by Kirby Bauer disc diffusion technique. Results. Overall carriage rate of respiratory pathogens was 30% with S. pneumoniae, H. influenzae and GAS accounting for 22%, 5% and 4.5% respectively. Three patients had >1 organism. Antibiotic resistance was highest in S. pneumoniae with 66.7% of strains resistant to penicillin. MDR strains were also encountered. Erythromycin resistance was observed in both H. influenzae (28.4%) and GAS (22%).No statistically significant association was found between the carriage rate of these organisms and different socio-demographic factors. Conclusions. S. pneumoniae carriage rate was comparatively higher in the community and its antimicrobial resistance is an issue to address.

The antibacterial activities of mikanolide and its derivatives / La actividad antibacteriana de la mikanolida y sus derivados

OBJECTIVE: The sesquiterpene, mikanolide, was found to possess antibacterial activity. As a result, a structure-activity relationship study was carried out on mikanolide and eleven of its derivatives. METHODS: Mikanolide and two of its derivatives were isolated from organic extract of Mikania micrantha using chromatographic methods. Nine additional derivatives were synthesized and all were investigated for their antibacterial activity against the Gram positive pathogen Staphylococcus aureus and beta haemolytic Streptococcus group A (BHSA) as well as the Gram negative Escherichia coli using the disk diffusion assay. RESULTS: The investigation revealed that only four of the derivatives displayed antibacterial activity and only pathogens Staphylococcus aureus and beta haemolytic Streptococcus group A were susceptible at a concentration of 100 µg per disk. However, there was an increase in activity for three of the derivatives in comparison to mikanolide. CONCLUSION: This study underscores the potential for phytochemicals from locally available plants to be further investigated and developed as antibacterial agents.

OBJETIVO: Se halló que el sesquiterpene - mikanolida - posee actividad antibacteriana. Como resultado, se llevó a cabo un estudio de la relación estructura-actividad de la mikanolida y once de sus derivados. MÉTODOS: La mikanolida y dos de sus derivados fueron aislados a partir de un extracto orgánico de Mikania micrantha, mediante métodos cromatográficos. Se sintetizaron otros nueve derivados adicionales, y se investigó la actividad antibacteriana de todos sobre el patógeno Gram positivo Staphylococcus aureus y el Streptococcus beta hemolítico grupo A (BHSA) así como Escherichia coli Gram negativo, usando el ensayo de difusión en disco. RESULTADOS: La investigación reveló que sólo cuatro de los derivados mostraban actividad antibacteriana y sólo los patógenos Staphylococcus aureus y Streptococcus beta hemolítico grupo A eran susceptibles a una concentración de 100 µg por disco. Sin embargo, se produjo un aumento en la actividad de tres de los derivados en comparación con la mikanolida. CONCLUSIÓN: Este estudio subraya el potencial que poseen los fotoquímicos a partir de plantas localmente disponibles, para ser objeto de investigación ulterior y ser desarrollados como agentes antibacterianos.

Decline in Erythromycin Resistance in Group A Streptococci from Acute Pharyngitis due to Changes in the emm Genotypes Rather Than Restriction of Antibiotic Use / 대한진단검사의학회지

BACKGROUND: Group A streptococcus (GAS) is the most common cause of bacterial pharyngitis in children. Antibiotic resistance rates and emm genotypes of GAS isolated from patients with acute pharyngitis were studied in 2009. METHODS: Throat cultures were taken from 499 children with acute pharyngitis in Jinju, Korea, in 2008-2009. A total of 174 strains (34.9%) of GAS were isolated, and antimicrobial susceptibility testing was performed using the disk diffusion method. The phenotypes of macrolide resistance and macrolide resistance genes were determined. The emm genotypes were identified using PCR and sequencing. The data were compared with those acquired in 2002 in the same region. Data on the annual macrolide production were collected between 1999 and 2008. RESULTS: The resistance rates of GAS to erythromycin, clindamycin, and tetracycline were 4.6%, 2.9%, and 2.3%, respectively. The constitutive resistance rate was 62.5% for the erm(B) gene and 37.5% for the M phenotype of the mef(A) gene. emm4 was most frequently detected (28.2%), followed by emm89 (20.1%). Most of the erythromycin resistant strains had the emm28 genotype. We noted a gradual increase in macrolide production during the study period. CONCLUSIONS: The erythromycin resistance rate of GAS isolated from children with acute pharyngitis was significantly lower in 2009 (4.6%) than in 2002 (44.8%). We observed a remarkable change in the distribution of emm genotypes during the 7-yr period. The significant decline in erythromycin resistance in 2009 might be associated with a prominent decrease in the resistant genotype emm12 (3.4% in 2009 vs. 28.0% in 2002) rather than restriction of macrolide use.

In vitro ciprofloxacin resistance patterns of gram-positive bacteria isolated from clinical specimens in a teaching hospital in Saudi Arabia

Over the last few decades the ever-increasing level of bacterial resistance to antimicrobials has been a cause of worldwide concern. Fluoroquinolones, particularly ciprofloxacin has been used indiscriminately for both gram-positive and gram-negative bacterial infections. The increased use of ciprofloxacin has led to a progressive loss of bacterial susceptibility to this antibiotic. Therefore it is necessary to have update knowledge of resistance pattern of bacteria to this antibiotic so that alternate appropriate antibiotics can be used for ciprofloxacin-resistant bacterial infections. To evaluate the trends of ciprofloxacin resistance pattern in commonly isolated gram-positive bacteria over time in a Saudi Arabian teaching hospital. a retrospective analysis was carried out for ciprofloxacin susceptibility patterns of 5534 isolates of gram-positive bacteria isolated from clinical specimens submitted to microbiology laboratories at King Fahd Hospital of the University [KFHU], Al-Khobar, Saudi Arabia during the period from January 2002 to August 2005. Increase in ciprofloxacin resistance rates with some fluctuations, among these isolates, were observed. For Staphylococcus aureus, it varied from 4.62, 1.83, 7.01 and 3.98%, methicillin resistant staphylococcus aureus [MRSA] 97.92, 97.75, 87.01 and 88.26%, Streptococcus pyogenes 5.35, 4.47, 14.44 and 3.53% during the years 2002, 2003, 2004 and 2005 respectively. Cirprofloxacin resistance 30.23, 23.02 and 26.47%; enterococcus group D, 43.05, 20.68 and 57.03% and non-enterococcus group D, 62.96, 76.92 and 87.50% respectively. Ciprofloxacin resistance in gram-positive bacterial clinical isolates particularly Staphylococcus aureus, methicillin resistant increased and ciprofloxacin no more remains the drug of choice of these infections