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1.
Arch. argent. pediatr ; 119(1): 11-17, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147054

ABSTRACT

Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.


Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement


Subject(s)
Humans , Male , Female , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Microbial Sensitivity Tests , Epidemiology, Descriptive , Incidence , Prevalence , Cross-Sectional Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Hospitals, Pediatric
2.
Rev. Inst. Nac. Hig ; 50(1-2): 4-13, Diciembre 2019. Tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1118292

ABSTRACT

Las infecciones del tracto urinario afectan al ser humano a lo largo de su vida y son frecuentes tanto en el ámbito comunitario como en el nosocomial. El objetivo de este estudio fue Identificar los principales agentes etiológicos y el perfil de resistencia a los antibióticos, presentado por los microorganismos más frecuentemente aislados de los urocultivos de pacientes con infección urinaria que acudieron al Laboratorio "Luis Razetti" Mérida -Venezuela, entre enero y junio de 2015. Este estudio fue de tipo observacional, de corte transversal y descriptivo. La población y muestra estuvo conformada por 149 pacientes de ambos sexos, cuyas muestras de orina fueron procesadas utilizado el método del asa calibrada y la identificación bacteriana mediante pruebas bioquímicas convencionales. La susceptibilidad antimicrobiana se determinó a través del método de difusión del disco en agar. Escherichia coli predominó en un 84,6 %, seguido de Proteus mirabilis y Enterococcus faecalis, ambos con (4,7 %). Los porcentajes más altos de resistencia para los aislados de E. coli, se observaron para ampicilina (92,06 %), ampicilina/sulbactam (68,25 %), ácido nalidíxico (38,89 %), ciprofloxacina (38,89 %) y trimetroprim­sulfametoxazol (54,76 %); y presentaron altos niveles de sensibilidad a Nitrofurantoína (80,95 %). El 5,15 % de las cepas de E. coli se mostraron fenotípicamente productoras de belalactamasa de espectro extendido y el 35,29 % de las otras Enterobacteriaceae aisladas, presentaron un perfil fenotípico compatible con la producción de la enzima Inhibitory-resistant TEM (IRT). Es importante destacar que estos estudios permiten conocer la etiología a de infecciones urinarias en la comunidad, así como los perfiles de resistencia y sensibilidad a nivel local, datos relevantes para establecer pautas de tratamiento empírico adaptadas a cada medio.


Urinary tract infections affect the human being throughout his life and are among the most frequent in both the community and nosocomial settings. The Aim of this study was to Identify the main etiological agents and antibiotic resistance profile presented by isolated microorganisms in the urocultures of patients with urinary tract infection who attended the Laboratory "Luis Razetti" Mérida -Venezuela, between January and June 2015. This study was observational, cross-sectional and descriptive. The population and sample consisted of 149 patients of both sexes, whose urine samples were processed using the calibrated handle method and bacterial identification through conventional biochemical tests. The antimicrobial susceptibility is determined through the disk diffusion method in agar. Escherichia coli dominated by 84.6 %, followed by Proteus mirabilis and Enterococcus faecalis, both with (4.7 %). The highest percentages of resistance for E. coli were observed for ampicillin (92.06 %), ampicillin/sulbactam (68.25 %), nalidixic acid (38.89 %), ciprofloxacin (38.89 %) trimetroprim-sulfamethoxazole (54.76 %); and had high levels of sensitivity to Nitrofurantoin (80.95 %). 5.15 % of E. coli strains were phenotypically producing extended-spectrum belalactamase and 35.29 % of others Enterobacteriaceae isolated had a phenotypic profile compatible with the production of the Enzyme Inhibitoryresistant TEM (IRT). It is important to note that these studies allow knowing the etiology of urinary tract infections in the community as well as resistance and sensitivity profiles at the local level, relevant data to establish empirical processing guidelines tailored to each medium.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Urinary Tract Infections/microbiology , Urinary Tract Infections/drug therapy , Drug Resistance, Bacterial , Escherichia coli/isolation & purification , Anti-Bacterial Agents/therapeutic use , Phenotype , Cross-Sectional Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Escherichia coli/drug effects , Escherichia coli/genetics , Anti-Bacterial Agents/pharmacology
4.
Braz. j. infect. dis ; 23(2): 134-138, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1039223

ABSTRACT

ABSTRACT This study characterized 30 MRSA isolates from intensive care unit (ICU) environment and equipment surfaces and healthy children. The SCCmec types I, IVa and V were detected in HA-MRSA isolates while CA-MRSA showed the SCCmec type IVa and V. Most isolates were classified as agr group II. All isolates presented the sei gene, and only HA-MRSA were positive for etb e tst genes. Three genotypes were related to Pediatric (ST5/SCCmecIV) and Berlin (ST45/SCCmecIV) clones. The present study showed molecular similarity between CA- and HA-MRSA isolates in hospital and community settings in a Brazilian region.


Subject(s)
Humans , Cross Infection/microbiology , Community-Acquired Infections/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/genetics , Intensive Care Units/statistics & numerical data , Staphylococcal Infections/genetics , Staphylococcal Infections/microbiology , Brazil , Virulence Factors/isolation & purification , Virulence Factors/genetics , Equipment and Supplies, Hospital/microbiology , Methicillin-Resistant Staphylococcus aureus/pathogenicity , Genotype
5.
Rev. méd. Chile ; 146(12): 1371-1383, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-991346

ABSTRACT

Background: Molecular biological techniques allow the identification of more pathogens associated with community-acquired pneumonia (CAP). Aim: To compare clinical and laboratory parameters of patients with CAP caused by different groups of pathogens. Material and Methods: In a prospective study, immunocompetent adult patients hospitalized with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, polymerase chain reaction, urinary antigen testing and serology. Results: Pathogens were detected in 367 of 935 patients with CAP (39.2%). Streptococcus pneumoniae (10.7%) and influenza virus (6%) were the most frequently identified bacterial and viral pathogens, respectively. Pneumococcal pneumonia predominated in older adults, with multiple comorbidities, with elevation of inflammatory parameters and hypoxemia, like other bacterial pneumonias. Viral pneumonia predominated in elderly patients with multiple comorbidities, with a shorter hospital length of stay and lower mortality. Pneumonia associated with atypical microorganisms predominated in young adults, smokers, with subacute clinical evolution. Their hospital stays and lethality was similar to other bacterial pneumonias. Viral and classical bacterial pneumonias predominated in high risk pneumonia severity index categories. Although several variables were associated with the detection of a pathogen group, substantial overlap avoided the identification of reliable clinical predictors to distinguish etiologies. Conclusions: The clinical and radiographic characteristics were similar in pulmonary infections caused by classical bacteria, respiratory viruses and atypical microorganisms. Therefore, microbial testing for common respiratory pathogens is still necessary to optimize treatment.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia, Viral/virology , Pneumonia, Bacterial/microbiology , Immunocompetence , Pneumonia, Viral/diagnosis , Socioeconomic Factors , Severity of Illness Index , Prospective Studies , Risk Factors , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/virology , Pneumonia, Bacterial/diagnosis , Length of Stay
6.
Braz. j. infect. dis ; 22(5): 371-376, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974237

ABSTRACT

ABSTRACT Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective: To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods: This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients' medical records. Results: We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54-5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16-22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions: CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Staphylococcal Infections/microbiology , Staphylococcal Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Phenotype , Reference Values , Staphylococcal Infections/drug therapy , Time Factors , Brazil/epidemiology , Incidence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Statistics, Nonparametric , Anti-Bacterial Agents/therapeutic use
7.
Rev. Soc. Bras. Med. Trop ; 51(5): 603-609, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-957466

ABSTRACT

Abstract INTRODUCTION: The behavior of methicillin-resistant Staphylococcus aureus (MRSA) isolated from central venous catheter-related infection was evaluated to determine its biofilm potential, antimicrobial resistance, and adhesion genes. METHODS: A total of 1,156 central venous catheters (CVC) were evaluated to screen for pathogens. Antimicrobial sensitivity, biofilm formation potential, and molecular analysis of MRSA were examined following standard guidelines. RESULTS: Of the 1,156 samples, 882 (76%) were colonized by bacteria or candida. Among the infected patients, 69% were male and 36% were female with median age of 32 years. Staphylococcus aureus infected 39% (344/882) of CVCs in patients. Of the 59% (208/344) of patients with MRSA, 57% had community acquired MRSA and 43% had hospital acquired MRSA. Linezolid and vancomycin killed 100% of MRSA; resistance levels to fusidic acid, doxycycline, clindamycin, azithromycin, amikacin, trimethoprim-sulfamethoxazole, gentamycin, tobramycin, and ofloxacin were 21%, 42%, 66%, 68%, 72%, 85%, 95%, 97%, and 98% respectively. Strong biofilm was produced by 23% of samples, moderate by 27%, and weak by 50% of MRSA. The presence of adhesion genes, sdrC and sdrD (90%), eno (87%), fnbA (80%), clfA and sdrE (67%), fnbB, sdrD (61%), and cna (51%), in most MRSA samples suggested that the adhesion genes are associated with biofilm synthesis. CONCLUSIONS: The superbug MRSA is a major cause of CVC-related infection. Antibiotic resistance to major classes of antibiotics and biofilm formation potential enhanced superbug MRSA virulence, leading to complicated infection. MRSA causes infection in hospitals, communities, and livestock.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Staphylococcal Infections/microbiology , Cross Infection/microbiology , Community-Acquired Infections/microbiology , Biofilms/growth & development , Methicillin-Resistant Staphylococcus aureus/physiology , Catheter-Related Infections/microbiology , Anti-Bacterial Agents/pharmacology , Bacterial Adhesion/genetics , Microbial Sensitivity Tests , Biofilms/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/drug effects , Genes, Bacterial/genetics , Middle Aged
8.
Rev. méd. Chile ; 146(7): 839-845, jul. 2018. tab
Article in Spanish | LILACS | ID: biblio-961469

ABSTRACT

Background: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. Aim: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. Patients and Methods: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. Results: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. Conclusions: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pneumonia, Pneumococcal/mortality , Bacteremia/mortality , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/microbiology , Pneumonia, Pneumococcal/drug therapy , Socioeconomic Factors , Streptococcus pneumoniae/isolation & purification , Severity of Illness Index , Ceftriaxone/therapeutic use , Comorbidity , Chile/epidemiology , Risk Factors , Hospital Mortality , Bacteremia/microbiology , Bacteremia/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Community-Acquired Infections/drug therapy , Anti-Bacterial Agents/therapeutic use
9.
Arch. argent. pediatr ; 116(2): 119-125, abr. 2018. tab, graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887457

ABSTRACT

Introducción: Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-ac) son motivo de consulta frecuente en pediatría. La mayoría se presentan como infecciones de piel y partes blandas; sin embargo, en la última década, se ha constatado un aumento de las infecciones invasivas. Objetivos: El objetivo principal es describir las características clínico-epidemiológicas de las infecciones producidas por SAMR-ac. El objetivo secundario es comparar la prevalencia, presentación clínica y susceptibilidad antibiótica con un período previo de estudio (1/2004-12/2007). Material y métodos: Estudio descriptivo, prospectivo, de tipo transversal. Criterios de inclusión: niños con diagnóstico de infección por SAMR-ac admitidos en el Hospital de Niños de Rosario, período de enero de 2008 a diciembre de 2014. Criterios de exclusión: internación reciente, antibiótico o cirugía previa, comorbilidades o inmunocompromiso. Resultados: De 728 niños con infecciones por Staphylococcus aureus, 529 (73%) fueron por SAMR-ac. La tasa de incidencia de infecciones por SAMR-ac varió de 12,2/10 000 egresos hospitalarios de 2004 a 145/10 000 del 2014: 75% (391) fueron infecciones de piel y partes blandas; 8% (43), os teo articular es; 6% (30), pleuropulmonares; 5% (24), sepsis. Se observó un aumento en el número de infecciones invasivas en el 2º período sin significancia estadística (OR= 0,895; IC: 0,52-1,53). La resistencia a gentamicina, clindamicina y eritromicina se mantuvo estable en ambos períodos. Conclusión: Las infecciones por SAMR-ac fueron cada vez más frecuentes, principalmente, las de piel y partes blandas. Se observó un aumento en el número de infecciones invasivas sin significancia estadística. La resistencia antibiótica se mantuvo estable.


Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are a common reason for consultation in pediatrics. Most of them present as skin and soft tissue infections; however, invasive infections have increased during the last decade. Objectives: The main objective was to describe the clinical-epidemiological characteristics of CA-MRSA infections. The secondary objective was to compare prevalence, clinical presentation and antibiotic susceptibility with a pre-study period (1/2004-12/2007). Material and methods: This is a descriptive, prospective, cross-sectional study. Inclusion criteria: children who have been diagnosed with CA-MRSA infection and admitted to Hospital de Niños de Rosario between January 2008 and December 2014. Exclusion criteria: recent hospitalization, previous antibiotic treatment or surgery, comorbidities or immune compromise. Results: Out of 728 cases of children with Staphylococcus aureus infections, 529 (73%) were due to CA-MRSA. The incidence rate of CA-MRSA infections varied from 12.2/10 000 hospital discharges in 2004 to 145/10 000 in 2014: 75% (391) were skin and soft tissue infections; 8% (43) were osteoarticular infections; 6% (30), pleuropulmonary infections; 5% (24), sepsis. There was an increase in the number of invasive infections in the second period, with no statistical significance (OR= 0.895; CI: 0.52-1.53). Gentamicin, clindamycin and erythromycin resistance remained stable throughout both periods. Conclusion: CA-MRSA infections were increasingly more frequent, mainly skin and soft tissue infections. An increase was observed in the number of invasive infections, with no statistical significance. Antibiotic resistance remained stable.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Staphylococcal Infections/drug therapy , Microbial Sensitivity Tests , Incidence , Prevalence , Cross-Sectional Studies , Prospective Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Hospitals, Pediatric , Anti-Bacterial Agents/therapeutic use
10.
J. pediatr. (Rio J.) ; 94(1): 23-30, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-894095

ABSTRACT

Abstract Objective: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. Methods: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n = 249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. Results: Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. Conclusions: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.


Resumo Objetivo: Avaliar o papel do raios X de tórax na identificação de casos de pneumonia adquirida na comunidade (PAC) causada por agentes bacterianos. Métodos: A frequência de infecção por Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis em crianças com PAC não hospitalizadas foi comparada com a presença de confirmação radiológica da pneumonia (n = 249 crianças com pneumonia radiologicamente confirmada e 366 crianças com raios X de tórax normal). Infecção por S. pneumoniae foi diagnosticada com base na resposta sorológica a pelo menos uma dentre oito proteínas pneumocócicas investigadas (aumento ≥ 2 vezes nos níveis de IgG em relação a Ply, CbpA, PspA1 e 2, PhtD, StkP-C e PcsB-N ou aumento≥ 1,5 vez em relação aPcpA). Infecção por H. influenzae e M. catarrhalis foi definida por aumento ≥ 2 vezes nos níveis de IgG específica a antígenos de cada agente. Resultados: Crianças com pneumonia radiologicamente confirmada apresentaram maior taxa de infecção pelo pneumococo. Além disso, a presença de infecção pneumocócica foi um fator preditor de pneumonia radiologicamente confirmada, o que aumenta sua chance de detecção em 2,8 vezes (IC 95%: 1,8-4,3). O valor preditivo negativo do raios X normal para a infecção por S. pneumoniae foi 86,3% (IC95%: 82,4%-89,7%). Não houve diferença nas frequências de infecção por H. influenzae e M. catarrhalis entre crianças com PAC com ou sem confirmação radiológica. Conclusão: Crianças com diagnóstico clínico de PAC submetidas a um raios X de tórax que apresentam confirmação radiológica têm maior taxa de infecção por S. pneumoniae comparadas com as crianças com raios X normal.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Radiography, Thoracic , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/diagnostic imaging , Moraxellaceae Infections/diagnostic imaging , Haemophilus Infections/diagnostic imaging , Immunoglobulin G/immunology , Immunoglobulin G/blood , Haemophilus influenzae/isolation & purification , Haemophilus influenzae/immunology , Moraxella catarrhalis/immunology , Community-Acquired Infections/microbiology , Community-Acquired Infections/diagnostic imaging , Antibodies, Bacterial/blood , Antigens, Bacterial/blood
11.
Rev. chil. infectol ; 35(1): 29-35, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-899774

ABSTRACT

Resumen Introducción Las infecciones del tracto urinario adquiridas en la comunidad (ITUac) causadas por cepas de Escherichia coli productoras de β-lactamasas de espectro extendido (BLEE), principalmente por cepas que contienen el gen blaCTX-M-15, es un fenómeno creciente a nivel mundial. Objetivo Determinar el patrón de susceptibilidad a antimicrobianos de cepas de E. coli productoras de BLEE causantes de ITUac y conocer su patrón molecular. Materiales y Métodos Se realizó un estudio descriptivo en Oaxaca, México, donde se incluyeron 288 cepas de E. coli aisladas de pacientes adultos con posible ITUac. Para obtener los patrones de susceptibilidad antimicrobiana se siguieron los criterios del CLSI y para obtener el análisis molecular se utilizó la técnica de RPC. Resultados Del total de cepas de E. coli aisladas, 31,3% fueron productoras de BLEE, presentando una menor susceptibilidad a antimicrobianos que las cepas no productoras de estas enzimas. El 95,6% de las cepas BLEE estudiadas fueron portadoras del gen blaCTX-M. Conclusiones Un tercio de las ITUac causadas por E. coli en nuestra población fueron causadas por cepas BLEE, mostrando un alto nivel de resistencia a los antimicrobianos comúnmente utilizados en su tratamiento y disminuyendo las opciones terapéuticas para tratamientos empíricos en esta población.


Background Community acquired urinary tract infections (CaUTI) caused by strains of extended-spectrum β-lactamases (ESBL) - producing Escherichia coli, mainly by strains carrying the blaCTX-M-15 gene, is a growing phenomenon worldwide. Aim To determine the antibiotic susceptibility pattern of ESBL-producing E. coli as cause of CaUTI and to identify their molecular pattern. Methods A descriptive study was performed in the city of Oaxaca, Mexico, from where 288 strains of CaUTI-producing strains of E. coli in adults with possible UTI were isolated. The CLSI criteria was followed to determine the antimicrobial susceptibility patterns, and their molecular characterization was performed by using PCR. Results 31.3% of E. coli strains isolated in our population were ESBL producers, which presented higher levels of antibiotic resistance than those of non-producers of these enzymes. 95.6% of the studied strains were carriers of the blaCTX-M gene. Conclusions One-third of the Ca-UTI caused by E. coli in our population are caused by ESBL-producing strains, which present high levels of resistance to the antibiotics widely used in our community. This situation considerably decreases the number of antibiotics available for an empiric treatment against these infections.


Subject(s)
Humans , Male , Female , Middle Aged , Urinary Tract Infections/microbiology , beta-Lactamases/drug effects , beta-Lactamases/genetics , Escherichia coli/drug effects , Escherichia coli/genetics , Anti-Bacterial Agents/pharmacology , beta-Lactamases/isolation & purification , Microbial Sensitivity Tests , Community-Acquired Infections/microbiology , beta-Lactam Resistance , Electrophoresis , Escherichia coli/isolation & purification , Escherichia coli/enzymology , Escherichia coli Infections/microbiology , Genotype , Mexico
12.
Medicina (B.Aires) ; 77(6): 465-468, dic. 2017. map, tab
Article in Spanish | LILACS | ID: biblio-894522

ABSTRACT

La asociación entre diseminación de infecciones comunitarias, pobreza y hacinamiento es bien conocida. En nuestro hospital observamos casos esporádicos de infecciones post-cesárea por cepas de Staphylococcus aureus meticilino resistente de origen comunitario (SAMRCo). En un estudio prospectivo de familias de José C. Paz atendidas en nuestro hospital, investigamos la relación entre antecedentes de infecciones de piel y partes blandas (IPPB) y hacinamiento extremo (hogares con necesidades básicas insatisfechas tipo 3, (NBI 3). Fueron incluidos 264 hogares; 109 (41.3%) tenían historia de IPPB y 59 (22.3%) eran NBI 3. El 61.0% de los hogares NBI 3 y el 35.6% de los hogares no NBI 3 refirieron IPPB (p = 0.00047). Georreferenciamos los domicilios con Google Maps y los ubicamos en un plano de José C. Paz NBI del censo nacional 2010. En barrios con un porcentaje de NBI > 9.7%, el 51.2% de los hogares tuvo antecedentes de IPPB. Cuando este porcentaje era ≤ 9.7% el porcentaje bajó al 31.1% (p = 0.0019). Estos resultados son sugestivos de diseminación comunitaria de estas infecciones asociada a hacinamiento y barrios pobres. Se debe considerar la presencia de SAMRCo en IPPB comunitarias. Por ello, en mujeres procedentes de zonas con alto porcentaje NBI o con antecedentes de IPPB se podría considerar la inclusión de la vancomicina o la clindamicina en la profilaxis de los partos por cesárea.


The association of the spread of community infections with poverty and overcrowding is well known. In our hospital, located in José C. Paz, we assist sporadic cases of post-cesarean infections caused by community acquired methicillin-resistant Staphylococcus aureus (CaMRSA). In a prospective study of families treated at our hospital, we investigated the relationship between a history of skin and soft tissue infections (SSTI) and extreme overcrowding defined as households with unsatisfied basic needs type 3 (NBI 3). A total of 264 households were included in the study; 109 (41.3%) had a history of SSTI and 59 (22.3%) were NBI 3. A total of 61.0% of the NBI 3 households and 35.6% of the non-NBI 3 households reported SSTI (p = 0.00047). Using Google Maps, we georeferenced households and identified them on a NBI map adapted from the 2010 demographic census. In neighborhoods with NBI > 9.7%, 51.2% of the households had a history of SSTI. When NBI was < 9.7%, the percentage fell to 31.1% (p = 0.0019). These results are suggestive of an association of SSTI acquired in the community with overcrowding and poverty. The presence of CaMRSA in community SSTIs should be suspected. Vancomycin or clindamycin prophylaxis could be considered when cesarean deliveries are performed in women from areas with high NBI or with a history of SSTI.


Subject(s)
Humans , Male , Female , Pregnancy , Staphylococcal Infections/epidemiology , Crowding , Skin Diseases, Bacterial/epidemiology , Soft Tissue Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Argentina/epidemiology , Poverty , Staphylococcal Infections/microbiology , Staphylococcal Infections/transmission , Cesarean Section/adverse effects , Family Characteristics , Prospective Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/transmission , Community-Acquired Infections/epidemiology
13.
Mem. Inst. Oswaldo Cruz ; 112(11): 790-792, Nov. 2017. graf
Article in English | LILACS | ID: biblio-1040563

ABSTRACT

Staphylococcus aureus subsp. aureus, commonly referred as S. aureus, is an important bacterial pathogen frequently involved in hospital- and community-acquired infections in humans, ranging from skin infections to more severe diseases such as pneumonia, bacteraemia, endocarditis, osteomyelitis, and disseminated infections. Here, we report the complete closed genome sequence of a community-acquired methicillin-resistant S. aureus strain, USA400-0051, which is a prototype of the USA400 clone.


Subject(s)
Humans , Staphylococcal Infections/virology , DNA, Viral/genetics , Genome, Bacterial/genetics , Methicillin-Resistant Staphylococcus aureus/genetics , Community-Acquired Infections/microbiology
14.
Bol. Hosp. Viña del Mar ; 73(3): 94-96, sept. 2017.
Article in Spanish | LILACS | ID: biblio-948317

ABSTRACT

INTRODUCCIÓN: la meningitis bacteriana es una enfermedad infecciosa aguda grave, que por su letalidad y costos en atención de salud genera un alto impacto en Salud Pública. Los agentes causales más frecuentes son Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae y Listeria monocytogenes, pero poco conocemos de nuestra realidad local. MATERIALES Y MÉTODOS: estudio descriptivo, con revisión de base de datos del laboratorio de microbiología del Hospital Carlos Van Buren, obteniendo datos de los cultivos de líquido céfalo raquídeo de pacientes mayores de 15 años entre marzo de 2013 y noviembre de 2016. RESULTADOS: 128 casos de meningitis bacteriana aguda, de los cuales 17 fueron por los microorganismos objetivos del estudio, siendo el más frecuente S. pneumoniae, clínicamente un 58% se presentó sin signos meníngeos. A 30 días del diagnóstico un 35% había fallecido, la mitad de ellos inició el tratamiento antibiótico pasadas las 24 horas desde su ingreso al hospital. En el 46% la tinción gram no evidenció bacterias. DISCUSIÓN: los microorganismos clásicamente descritos como agentes causales parecen no explicar la totalidad de los cuadros de meningitis bacteriana aguda en la población adulta estudiada, la ausencia de signos meníngeos no permite descartar la sospecha diagnóstica. La mitad de los pacientes fallecidos inició el tratamiento antibiótico pasadas las primeras 24 horas.


INTRODUCTION: bacterial meningitis is a serious acute infectious disease whose lethality and elevated health costs have a serious impact on public health. The most frequent causes are Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenza and Listeria monocytogenes, but we know little of the local situation. MATERIALS AND METHODS: A descriptive study reviewing Carlos van Buren Hospital´s microbiology laboratory data base, and obtaining the details of cerebrospinal fluid cultures of patients over the age of 15 between March 2013 and November 2016. RESULTS: 128 cases of acute bacterial meningitis of which 17% were caused by the micro-organisms of study, the most frequent being Streptococcus pneumoniae. 58% of patients had no meningeal signs. At 30 days from diagnosis 35% had died, half of these having started antibiotic treatment over 24 hours after admission. 46% of the Gram stains showed no bacteria. DISCUSSION: the classical infectious agents do not appear to account for the totality of acute bacterial meningitis in the population studied. The absence of meningeal signs should not rule out the diagnosis. Half of the patients who died started antibiotic treatment after the first 24 hours.


Subject(s)
Humans , Male , Female , Middle Aged , Bacterial Infections/complications , Meningitis, Bacterial/microbiology , Community-Acquired Infections/microbiology , Streptococcus pneumoniae/isolation & purification , Bacterial Infections/epidemiology , Haemophilus influenzae/isolation & purification , Meningitis, Bacterial/cerebrospinal fluid , Meningitis, Bacterial/epidemiology , Haemophilus Infections/complications , Listeriosis/complications , Listeria monocytogenes/isolation & purification , Meningococcal Infections/complications , Neisseria meningitidis/isolation & purification
15.
Braz. j. infect. dis ; 21(4): 464-467, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-1039197

ABSTRACT

Abstract Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) have increasingly been reported in healthy communities. This study aimed to assess the rate of S. aureus in general and MRSA in particular from nasal secretion of children in daycare centers in Vitória da Conquista, Brazil. The isolates were identified based on morphology, biochemical tests and by PCR. Detection of virulence genes, biofilm production, and susceptibility test by disk diffusion agar were performed. MRSA isolates were characterized by spa, SCCmec, and multilocus sequence typing (MLST). S. aureus were recovered from 70 (47.3%) of 148 children. Among the 11 MRSA strains (15.7%), two SCCmec types (IV and V) were detected. MLST identified four STs related to three clonal complexes (CC): 5, 45, and 398. Four spa types were found circulating in this setting. Resistance of S. aureus isolates to ampicillin, erythromycin, ciprofloxacin, clindamycin, and tetracycline was 80%, 32.8%, 7.1%, 7.1% and 4.3%, respectively. One isolate presented intermediate resistance to vancomycin detected by Etest methodology. All strains were biofilm producers. The virulence genes seb, sec, spa, and pvl were detected in some isolates. This study revealed a high rate of children carrying MRSA among healthy attendees in daycare centers in Vitória da Conquista, Brazil.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Staphylococcal Infections/microbiology , Child Day Care Centers , Nose/microbiology , Community-Acquired Infections/microbiology , Biofilms/growth & development , Virulence Factors , Disk Diffusion Antimicrobial Tests , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/pathogenicity , Genotype , Anti-Bacterial Agents/pharmacology
16.
Rev. méd. Maule ; 33(1): 14-20, jun. 2017. tab
Article in Spanish | LILACS | ID: biblio-1283792

ABSTRACT

Urinary tract infection associated to permanent catheterization is the most frequent infection associated to health care. Antibiotic resistance is an increasing problem, thus it is important to know the local pathogenic agents, their resistance and sensibility profiles to use an optimal treatment. OBJECTIVES: Describe the resistance and sensibility profiles in the most frequent microorganisms in urinary tract infections associated to permanent catheterization at the Internal Medicine Service of Hospital Regional de Talca. METHODS: We studied the antibiotic resistance and sensitivity of each microorganism isolated from urinary samples from patients with the antecedent of permanent urinary catheterization at the Internal Medicine Service of Hospital Regional de Talca since January 2013 to December 2016, according to the records at the Cross Infection Unit of this center. OUTCOMES: We collected 69 cases, there were 14 of them with two agents. The highest incidence of urinary tract infections associated to permanent urinary catheterization was at 2014, while the lowest at 2015. The most frequent agents detected were K. pneumoniae (34%), E. coli (20%), P. aeruginosa (20%) and A. baumannii (5%), holding a similar tendency in each year. We found 23 strains of Enterobacteriaceae producing Extended-spectrum ß- Lactamases. In general we found that Carbapenems and Amikacin had the best sensitivity while Nitrofurantoin and Ciprofloxacin had the highest resistance


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Bacterial Infections/epidemiology , Urinary Tract Infections/microbiology , Urinary Tract Infections/epidemiology , Community-Acquired Infections/epidemiology , Catheter-Related Infections/microbiology , Catheter-Related Infections/epidemiology , Bacterial Infections/microbiology , Drug Resistance, Microbial , Community-Acquired Infections/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification
17.
J. pediatr. (Rio J.) ; 93(3): 260-266, May.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-841345

ABSTRACT

Abstract Objective: Urinary tract infection (UTI) caused by resistant strains of bacteria is increasingly prevalent in children. The aim of this study was to investigate the clinical characteristics and risk factors for UTI caused by community-acquired extended-spectrum β-lactamase (CA-ESBL)-producing bacteria in infants. Methods: This was a retrospective study performed over 5 years in a single Korean center. Hospitalized infants with febrile UTI were enrolled and divided into two groups (CA-ESBL vs. CA non-ESBL UTI). The yearly prevalence was calculated. Baseline characteristics and clinical course such as fever duration, laboratory and radiological findings were compared between the two groups. Risk factors associated with the CA-ESBL UTI were investigated. Results: Among the enrolled infants (n = 185), 31 (17%) had CA-ESBL UTI. The yearly prevalence of ESBL of CA-ESBL UTI increased during the study (0% in 2010, 22.2% in 2015). Infants with CA-ESBL UTI had a longer duration of fever after initiating antibiotics (2.0 ± 1.1 vs. 1.5 ± 0.6 days, p = 0.020). Cortical defects on renal scan and early treatment failure were more frequent in CA-ESBL (64.5 vs. 42.2%, p = 0.023; 22.6 vs. 4.5%, p = 0.001). A logistic regression analysis revealed that urinary tract abnormalities and previous UTI were independent risk factors for CA-EBSL UTI (odds ratio, 2.7; p = 0.025; 10.3; p = 0.022). Conclusion: The incidence of UTI caused by ESBL-producing bacteria has increased in Korean infants. Recognition of the clinical course and risk factors for ESLB-producing UTI may help to determine appropriate guidelines for its management.


Resumo Objetivo: A infecção do trato urinário (ITU) causada por cepas de bactérias resistentes está cada vez mais prevalente em crianças. O objetivo deste estudo foi investigar as características clínicas e os fatores de risco de ITU causada por bactérias produtoras de β-lactamases de espectro ampliado adquiridas na comunidade (ESBL CA) em neonatos. Métodos: Estudo retrospectivo feito por mais de cinco anos em um único centro sul-coreano. Neonatos internados com ITU febril foram inscritos e divididos em dois grupos (ITU por ESBL CA em comparação com não ESBL CA). A prevalência anual foi calculada. As características básicas e o curso clínico, como duração da febre e achados laboratoriais e radiológicos, foram comparados entre os dois grupos. Os fatores de risco associados à ITU por ESBL CA foram investigados. Resultados: Entre os neonatos inscritos (n = 185), 31 (17%) apresentaram ITU por ESBL CA. A prevalência anual de ESBL em ITU por ESBL CA aumentou durante o estudo (0% em 2010, 22,2% em 2015). Os neonatos com ITU por ESBL CA apresentaram maior duração de febre após o início dos antibióticos (2 ± 1,1 em comparação com 1,5 ± 0,6 dias, p = 0,020). Os defeitos corticais no exame renal e a falha precoce no tratamento foram mais frequentes em ESBL CA (64,5 em comparação com 42,2%, p = 0,023; 22,6 em comparação com 4,5%, p = 0,001). Uma análise de regressão logística revelou que as anomalias do trato urinário e a ITU anterior eram fatores de risco independentes de ITU por ESBL CA (razão de chance: 2,7; p = 0,025; 10,3; p = 0,022). Conclusão: A incidência de ITU causada por bactérias produtoras de ESBL aumentou em neonatos sul-coreanos. O reconhecimento do curso clínico e dos fatores de risco de ITU por ESBL poderá ajudar a determinar as diretrizes adequadas de manejo.


Subject(s)
Humans , Male , Female , Child, Preschool , Urinary Tract Infections/microbiology , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology , beta-Lactamases/biosynthesis , Drug Resistance , Epidemiologic Methods , Community-Acquired Infections/microbiology , Community-Acquired Infections/epidemiology , Escherichia coli , Republic of Korea/epidemiology , Klebsiella , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use
18.
Rev. chil. infectol ; 33(6): 609-618, dic. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-844414

ABSTRACT

Introduction: The prevalence of Staphylococcus aureus in the community has increased, being the pediatric population the most affected. This fact highlights the need for epidemiological surveillance. Aim: To characterize clinical, phenotypic and genotypic isolates of S. aureus children’s samples with community-acquired infections, collected in hospitals of Asuncion and the Central Department, between November 2009 and December 2010. Materials and Methods: Descriptive and transverse analysis with analytical component. Clinical data collected by medical records, antibiotic susceptibility according to CLSI criteria and detection of mecA (encoding methicillin resistance) and luk-PV genes (encoding Panton Valentine leucocidin) by PCR using specific oligonucleotides. Results: 123 isolates of S. aureus, 76% came from skin and soft tissue infections and 20% from sepsis. 18.7% (n = 23) were resistant to methicillin (MRSA). The presence of the mecA gene, a variant there and the PVL was detected in 12.2 and 48 isolates respectively. 43% of MRSA (n = 10) was carrying luk-PV. The clinical and demographic differences between patients infected with MRSA or MSSA were not statistically significant. Discussion: This study constitutes the first phenotypic and genotypic characterization of S. aureus associated with pediatric patients in Paraguay.


Introducción: La prevalencia de infecciones por Staphylococcus aureus en la comunidad ha aumentado, siendo la población pediátrica la más afectada; poniendo de relieve la necesidad de una vigilancia epidemiológica. Objetivo: Caracterizar clínica, fenotípica y genotípicamente aislados de S. aureus de muestras de niños con infecciones adquiridas en la comunidad, recolectadas en hospitales de Asunción y el Departamento Central, entre noviembre de 2009 y diciembre de 2010. Materiales y Métodos: Estudio descriptivo de corte trasverso. Datos clínicos fueron recabados de fichas, la susceptibilidad a antimicrobianos se hizo según criterio del CLSI y la detección de genes mecA y luk-PV se realizó por RPC empleando oligonucleótidos específicos. Resultados: De 123 aislados de S. aureus, 76% provenían de infecciones de piel y tejidos blandos y 20% de pacientes con bacteriemias. 18,7% (n: 23) fueron resistentes a meticilina (SARM). Se detectó la presencia de genes mecA, una variante del mismo y luk-PV en 9,8%, 1,6 y 39% de los aislados, respectivamente. El 43% de los SARM (n: 10) fue portador de luk-PV. Las diferencias clínicas y demográficas entre pacientes infectados por SARM o SASM no fueron estadísticamente significativas. Discusión: Este estudio constituye la primera caracterización clínica, fenotípica y genotípica de S. aureus asociados a la comunidad en población pediátrica realizada en Paraguay.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/genetics , Bacterial Proteins/genetics , Bacterial Toxins/genetics , Penicillin-Binding Proteins/genetics , Exotoxins/genetics , Leukocidins/genetics , Paraguay , Phenotype , Polymerase Chain Reaction , Prevalence , Cross-Sectional Studies , Community-Acquired Infections/microbiology , Genotype
19.
Rev. chil. infectol ; 33(6): 628-634, dic. 2016. graf, tab
Article in Spanish | LILACS | ID: biblio-844416

ABSTRACT

Background: Urinary tract infections (UTIs) caused by extended-spectrum betalactamases (ESBL) are an increasingly common problem. Aim: To develop an association model to allow an early detection of ESBL-producing microorganisms. Methods: A prospective observational cohort study was undertaken among patients admitted with a diagnosis of culture-proven UTI to the Internal Medicine Ward of the Hospital Naval Almirante Nef between February and November, 2011. Patients with polimicrobial cultures were excluded from analyses, which was undertaken using multiple logistic regression. Results: Two-hundred and forty-nine patients were analysed and 35 (14%) presented an ESBL-producing microorganism. Seventy-one percent were female and the mean age was 70,7 ± 16,9 years. A history of a recent hospitalization (< 3 months) or institutionalization (p = 0.027), previous infections by an ESBL-producing bacteria (p < 0.001), recent antimicrobial use (p = 0.013) and metastatic cancer (p = 0.007) were independently associated with a current UTI with an ESBL-producing pathogen. Discussion: Our findings are similar to those found in other populations. This tool offers assistance to clinicians who need to choose an appropriate antimicrobial therapy. This model needs to be validated prior to implementation.


Introducción: La infección del tracto urinario (ITU) por microorganismos productores de β-lactamasas de espectro extendido (BLEE) es un problema infectológico creciente. Objetivo: Determinar factores de riesgo predisponentes a infecciones por microorganismos productores de BLEE. Pacientes y Método: Cohorte prospectiva de pacientes > 18 años ingresados al Servicio de Medicina Interna del Hospital Naval Almirante Nef de Viña del Mar desde febrero a noviembre de 2011 con diagnóstico de ITU confirmado en un urocultivo. Se excluyeron pacientes con urocultivos polimicrobianos. El análisis se hizo mediante una regresión logística múltiple. Resultados: Se analizaron 249 pacientes, 35 (14%) presentaron un microorganismo productor de BLEE. El 71% fueron mujeres y la edad promedio 70,7 ± 16,9 años. El antecedente de hospitalización en los últimos tres meses o el vivir institucionalizado (p = 0,027), la infección por bacteria productora de BLEE previa (p < 0,001), el uso de antimicrobianos recientes (p = 0,013) y el antecedente de cáncer metastásico (p = 0,007) se asociaron a la producción de BLEE. Discusión: Los factores encontrados en la presente cohorte están de acuerdo a lo descrito en otras poblaciones. Esta herramienta ofrece asistencia para el médico clínico en la selección de la antibioterapia más apropiada. Es necesario validar este modelo previo a su implementación.


Subject(s)
Humans , Male , Female , Aged , Urinary Tract Infections/microbiology , beta-Lactamases/metabolism , Gram-Negative Aerobic Bacteria/enzymology , Gram-Positive Bacteria/enzymology , Prospective Studies , Risk Factors , Community-Acquired Infections/microbiology
20.
Rev. méd. Chile ; 144(12): 1513-1522, dic. 2016. graf, tab
Article in Spanish | LILACS | ID: biblio-845481

ABSTRACT

Background: Community-acquired pneumonia (CAP) is a relevant worldwide cause of morbidity and mortality in adult population, however its etiology is often not identified and therapy is empirical. Aim: To assess the etiology of CAP in immunocompetent adult hospitalized patients using conventional and molecular diagnostic methods. Material and Methods: We prospectively studied 240 adult patients who were hospitalized for CAP to identify the microbial etiology. Sputum and blood cultures were obtained as well as serology testing for Mycoplasma pneumoniae and Chlamydophila pneumoniae, urinary antigen testing for Legionella pneumophila and Streptococcus pneumoniae, and a nasopharyngeal swab for the detection of sixteen respiratory viruses by reverse transcriptase polymerase chain reaction (RT-PCR). Results: In 100 patients (41.7%) a single respiratory pathogen was identified. In 17 (7.1%) cases, a mixed bacterial and viral infection was detected and no pathogen was identified in 123 cases (51%). The most commonly identified pathogens identified were: influenza virus (15.4%), parainfluenza virus (10.8%), rhinovirus (5%), Streptococcus pneumoniae (5%), respiratory syncytial virus (2.9%) and Mycoplasma pneumoniae (2.5%). Infectious agent detection by RT-PCR provided greater sensitivity than conventional techniques. Viral respiratory infections were more prevalent in older patients with comorbidities and high risk patients, according to the Fine index at hospital admission. The clinical severity and outcome were independent of the etiological agents detected. Conclusions: The use of molecular diagnostic techniques expanded the detection of respiratory viruses in immunocompetent adults hospitalized with CAP.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia, Viral/virology , Respiratory Syncytial Viruses/genetics , Immunocompetence , Pneumonia, Viral/microbiology , Respiratory Syncytial Viruses/classification , Seasons , Severity of Illness Index , Prospective Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/virology , Reverse Transcriptase Polymerase Chain Reaction , Coinfection
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