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1.
Cambios rev. méd ; 23(2): 910, 30/11/2024. tabs, ilus.
Article in English | LILACS | ID: biblio-1579726

ABSTRACT

INTRODUCTION. There is an important number of reports in Latin America, but there is a lack of data on acute promyelocytic leukemia (APL) in Ecuador., this is the main reason to carry out this study in the country, a disease that in recent decades has shown a significant improvement in survival. OBJECTIVES. To evaluate the overall survival (OS) and event-free survival (EFS), and also the demography, and the most relevant clinical and laboratorial findings. METHODS. We retrospectively reviewed the medical records of 48 patients with APL, diagnosed between January 2012 and December 2019. We collected the most relevant demographic, clinical and laboratorial characteristics, as well as data related to 30-day mortality, and 5 year­OS (overall survival) and EFS (event-free survival). RESULTS. Among the forty-eight (48) patients with acute promyelocytic leukemia, 44 patients received treatment, the mean number of days for the start of all trans retinoic acid (ATRA) and/or arsenic trioxide (ATO) was of 2.5 days from the moment of the diagnosis. 60.4% of patients were classified as low risk and 39.5% as high risk, according to the national comprehensive cancer network (NCCN). The early death rate was 31.2%, the main cause of which was sepsis, multidrug resistant (MDR) bacterias were isolated in 83% of the patients who took blood cultures and died of early sepsis. after a median follow-up of 35 months only one patient relapsed. the five-year OS and EFS was 51.2%; In the multivariate analysis, only age was identified as an adverse prognostic factor. DISCUSSION. Compared to prospective trials with ATRA-based regimens, we found an inferior OS, mainly because of a high-rate early death. if we compare our findings with other real-world reports, we will also show inferior results probably explained by the high rate of early death due to infection by MDR batteries, in addition to the early deaths caused by hemorrhages. CONCLUSION. The low rate of OS shown in this study, could be improved based on changes to optimize the ac-cess of the patients to an early diagnosis and treatment and the reduction of the unacceptably high rates of multidrug resistance bacterial infections in our setting.


INTRODUCCION. Existe un número importante de reportes en Latinoamérica, pero se carece de datos sobre la leucemia promielocítica aguda (LPA) en Ecuador, ésta es la principal razón para realizar este estudio en el país, enfermedad que en las últimas décadas ha mostrado una importante mejoría en la sobrevida. OBJETIVOS. Evaluar la sobrevida global (SG) y la sobrevida libre de eventos (SLE), así como la demografía y los hallazgos clínicos y laboratoriales más relevantes. MÉTODOS. Se revisaron retrospectivamente las historias clínicas de 48 pacientes con LPA, diagnosticados entre enero de 2012 y diciembre de 2019. Se recogieron las características demográficas, clínicas y datos de laboratorio más relevantes, así como datos relacionados con la mortalidad a 30 días, y a 5 años-OS (supervivencia global) y EFS (supervivencia libre de eventos). RESULTADOS. De los cuarenta y ocho (48) pacientes con leucemia promielocítica aguda, 44 pacientes recibieron tratamiento, la media de días para el inicio de ácido transretinoico total (ATRA) y/o trióxido de arsénico (ATO) fue de 2,5 días desde el momento del diagnóstico. El 60,4% de los pacientes fueron clasificados como de bajo riesgo y el 39,5% de alto riesgo, según la red nacional integral del cáncer (NCCN). La tasa de mortalidad precoz fue del 31,2%, cuya causa principal fue la sepsis, aislándose bacterias multirresistentes (MDR) en el 83% de los pacientes que se sometieron a hemocultivos y fallecieron por sepsis precoz. Tras una mediana de seguimiento de 35 meses, sólo un paciente sufrió una recaída, la SG y la SSC a cinco años fue del 51,2%; en el análisis multivariante, sólo la edad se identificó como factor pronóstico adverso. DISCUSIÓN. En comparación con los ensayos prospectivos con regímenes basados en ATRA, encontramos una SG inferior, principalmente debido a una alta tasa de muerte temprana. Si comparamos nuestros hallazgos con otros informes del mundo real, también mostraremos resultados inferiores probablemente explicados por la alta tasa de muerte temprana debida a infección por baterías MDR, además de las muertes tempranas causadas por hemorragias. CONCLUSIONES. La baja tasa de SG mostrada en este estudio, podría mejorarse en base a cambios para optimizar el acceso de los pacientes a un diagnóstico y tratamiento precoz y la reducción de las inaceptablemente altas tasas de infecciones bacterianas multirresistentes en nuestro medio.


Subject(s)
Humans , Male , Female , Survival , Bacterial Infections , Leukemia, Promyelocytic, Acute , Sepsis , Drug Resistance, Multiple, Bacterial , Carbapenem-Resistant Enterobacteriaceae , Tertiary Healthcare , Ecuador
2.
Med. infant ; 31(3): 240-244, septiembre 2024. Ilus, Tab
Article in Spanish | LILACS, UNISALUD, BINACIS | ID: biblio-1578344

ABSTRACT

Las bacterias del género Aeromonas spp. son una causa habitual de gastroenteritis en niños. En pacientes con compromiso de su inmunidad pueden causar cuadros clínicos severos. La bacteriemia es poco frecuente y habitualmente se observa en pacientes con patología hepatobiliar o hematooncológica. Materiales y Métodos: análisis retrospectivo de los aspectos epidemiológicos, clínicos, microbiológicos y de evolución de niños que presentaron bacteriemia por Aeromonas spp. en el período comprendido entre 01/2015 y 02/2022. Resultados: se registraron 8 episodios. La mitad de los pacientes fueron varones y la mediana de edad fue de 146 meses (RIC: 72-172 meses). En todos los pacientes se constató una patología de base; las más habituales fueron el compromiso de la inmunidad y la afectación hepato-biliar. Las especies identificadas fueron A. hydrophila (n:3), A. caviae (n:3) y A. sobria (n:2). Solo 2 de los 8 aislamientos resultaron no-sensibes a piperacilina-tazobactam, mientras que la mitad resultó resistente a quinolonas. Un paciente falleció en relación a la infección. Conclusión: en esta serie de pacientes, la bacteriemia por Aeromonas spp. se presentó en pacientes con patología de base. La evolución fue favorable en la mayoría de los casos (AU)


Bacteria of the Aeromonas genus are a common cause of gastroenteritis in children. In patients with compromised immunity they can cause severe clinical manifestations. Bacteremia is infrequent and is usually observed in patients with hepatobiliary diseases or cancer. Materials and Methods: retrospective analysis of the epidemiological, clinical, microbiological aspects and outcome of children who presented with Aeromonas spp. bacteremia between 01/2015 and 02/2022. Results: 8 episodes were recorded. Half of the patients were male and the median age was 146 months (IQR: 72-172 months). An underlying condition was found in all patients; the most common were a compromised immune system and hepato-biliary involvement. The species identified were A. hydrophila (n:3), A. caviae (n:3) and A. sobria (n:2). Only 2 of the 8 isolates were resistant to piperacillin-tazobactam, while half were resistant to quinolones. One patient died from the infection. Conclusion: in this series of patients, Aeromonas spp. bacteremia occurred in patients with underlying diseases. The outcome was favorable in most cases (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Bacterial Infections/microbiology , Bacteremia/etiology , Bacteremia/drug therapy , Aeromonas/isolation & purification , Aeromonas/classification , Drug Resistance, Multiple, Bacterial , Anti-Infective Agents/therapeutic use , Retrospective Studies , Immunocompromised Host
3.
Rev. epidemiol. controle infecç ; 13(4): 216-222, out.-dez. 2023. ilus
Article in English, Portuguese | LILACS | ID: biblio-1532318

ABSTRACT

Background and objectives: inanimate surfaces and equipment in the hospital environment are considered reservoirs of resistant and pathogenic microorganisms. In Pediatric Intensive Care Units, the risk of infection is also related to the severity of pathologies associated with the immaturity of the immune system of this population. This study aimed to investigate microbiological environmental contamination in a Pediatric Intensive Care Unit. Method: this is an exploratory cross-sectional study, carried out in a Pediatric Intensive Care Unit of a highly complex university hospital, located in southern Brazil. To assess environmental contamination, sterile swabs were rubbed on surfaces corresponding to the patient unit and in the common area. Results: twenty-eight surfaces were analyzed, 12 of which were located in units occupied by patients at the time of collection and 16 surfaces in the common use area. In the total number of surfaces analyzed by microbiological cultures, the patient unit showed 66.67% contamination by microorganisms, while surfaces in the common area showed 56.25%. Regarding the microbiological profile, all isolated microorganisms were Gram-positive and showed resistance, namely Staphylococcus aureus and coagulase-negative Staphylococcus. Conclusion: there was evidence of a high frequency of contamination on inanimate surfaces and equipment near and far from patients, essentially by pathogenic and multi-resistant microorganisms to antimicrobials.(AU)


Justificativa e objetivos: superfícies e equipamentos inanimados no ambiente hospitalar são considerados reservatórios de microrganismos resistentes e patogênicos. Nas Unidades de Cuidados Intensivos Pediátricos, o risco de infeção também está relacionado com a gravidade das patologias associadas à imaturidade do sistema imunitário desta população. Este estudo teve como objetivo investigar a contaminação microbiológica ambiental em uma Unidade de Terapia Intensiva Pediátrica. Método: trata-se de um estudo exploratório transversal, realizado em uma Unidade de Terapia Intensiva Pediátrica de um hospital universitário de alta complexidade, localizado no Sul do Brasil. Para avaliar a contaminação ambiental, foram esfregados swabs estéreis nas superfícies correspondentes à unidade do paciente e na área comum. Resultados: foram analisadas vinte e oito superfícies, sendo 12 localizadas em unidades ocupadas por pacientes no momento da coleta e 16 superfícies em área de uso comum. No total de superfícies analisadas por culturas microbiológicas, a unidade paciente apresentou 66,67% de contaminação por microrganismos, enquanto as superfícies da área comum apresentaram 56,25%. Quanto ao perfil microbiológico, todos os microrganismos isolados eram Gram-positivos e apresentavam resistência, nomeadamente Staphylococcus aureus e Staphylococcus coagulase-negativa. Conclusão: houve evidência de elevada frequência de contaminação em superfícies inanimadas e equipamentos próximos e distantes dos pacientes, essencialmente por microrganismos patogênicos e multirresistentes aos antimicrobianos.(AU)


Fundamento y objetivos: las superficies y equipos inanimados del ambiente hospitalario son considerados reservorios de microorganismos resistentes y patógenos. En las Unidades de Cuidados Intensivos Pediátricos el riesgo de infección también se relaciona con la gravedad de patologías asociadas a la inmadurez del sistema inmunológico de esta población. Este estudio tuvo como objetivo investigar la contaminación ambiental microbiológica en una Unidad de Cuidados Intensivos Pediátricos. Método: se trata de un estudio exploratorio transversal, realizado en una Unidad de Cuidados Intensivos Pediátricos de un hospital universitario de alta complejidad, ubicado en el sur de Brasil. Para evaluar la contaminación ambiental se frotaron hisopos estériles en las superficies correspondientes a la unidad de pacientes y en el área común. Resultados: se analizaron veintiocho superficies, 12 de las cuales estaban ubicadas en unidades ocupadas por los pacientes en el momento de la recogida y 16 superficies en el área de uso común. Del total de superficies analizadas por cultivos microbiológicos, la unidad de pacientes presentó un 66,67% de contaminación por microorganismos, mientras que las superficies del área común presentaron un 56,25%. En cuanto al perfil microbiológico, todos los microorganismos aislados fueron Gram positivos y presentaron resistencia, concretamente Staphylococcus aureus y Staphylococcus coagulasa negativo. Conclusión: se evidenció alta frecuencia de contaminación en superficies inanimadas y equipos cercanos y lejanos de los pacientes, esencialmente por microorganismos patógenos y multirresistentes a los antimicrobianos.(AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Cross Infection , Equipment Contamination , Cross-Sectional Studies , Drug Resistance, Multiple, Bacterial
4.
Rev. chil. infectol ; Rev. chil. infectol;40(5): 559-563, oct. 2023. tab
Article in Spanish | LILACS | ID: biblio-1521868

ABSTRACT

Los recién nacidos tienen un alto riesgo de morbimortalidad asociada a infecciones durante su estancia en unidades de cuidado intensivo neonatal, a lo que se asocia un aumento progresivo de infecciones por microorganismos multi-resistentes que requiere el uso de nuevos antimicrobianos. Presentamos el caso de una recién nacida de pretérmino de 36 semanas que cursó con una infección del tracto urinario bacteriémica por Klebsiella pneumoniae productora de carbapenemasa tratada de forma efectiva con 14 días de cefazi- dima-avibactam, sin efectos adversos observados. Según nuestro conocimiento, este es el primer caso reportado en nuestro país del uso de este antimicrobiano en población neonatal. Se necesita más información sobre la eficacia y seguridad de ceftazidima-avibactam en este grupo de pacientes.


Neonates are high risk patients regarding morbimortality secondary to infections during their neonatal intensive care unit stay, which is associated to a progressive increase in the report of multidrug resistant organism infections, that require the use of new antimicrobial. We report the case of a 36-week preterm with an urinary tract infection with bacteriemia caused by carbapenemase- producing Klebsiella pneumoniae treated effectively with 14 day of ceftazidime-avibactam, without observed adverse effects. To our knowledge, this is the first case report in our country of the use of this antibiotic in neonatal population. More information is needed regarding efficacy and safety of ceftazidime-avibactam in this group of patients.


Subject(s)
Humans , Female , Infant, Newborn , Urinary Tract Infections/drug therapy , Klebsiella Infections/drug therapy , Ceftazidime/therapeutic use , Azabicyclo Compounds/therapeutic use , beta-Lactamases/biosynthesis , Infant, Premature , Intensive Care, Neonatal , Drug Resistance, Multiple, Bacterial , Drug Combinations , beta-Lactamase Inhibitors/therapeutic use , Klebsiella pneumoniae/enzymology , Anti-Bacterial Agents/therapeutic use
5.
Rev. chil. infectol ; Rev. chil. infectol;40(3): 203-212., jun. 2023. tab, graf
Article in Spanish | LILACS | ID: biblio-1515120

ABSTRACT

RESUMEN: El aumento de la resistencia y la escasez de nuevos antibacterianos ha requerido la reintroducción de antiguos antimicrobianos entre ellos colistín. OBJETIVO: Caracterizar la utilización de colistín durante el año 2017 en un hospital universitario, mediante la descripción de los pacientes, los tratamientos, la microbiología asociada y efectos adversos. PACIENTES Y MÉTODOS: Trabajo observacional retrospectivo. Se revisaron los datos de todos los pacientes que recibieron colistín intravenoso (IV) por al menos 48 horas, durante el año 2017. RESULTADOS: Se incluyeron 53 pacientes, equivalentes a 91 tratamientos. El foco respiratorio fue el principal (46,2%). El 68,1% de los tratamientos fue iniciado en la UCI. La mayoría de los pacientes tenía una hospitalización reciente (83,5%), y presentaban uso previo de antibacterianos (89%). Los dos patógenos mayoritariamente identificados fueron Pseudomonas aeruginosa y Klebsiella spp. El consumo promedio de colistín fue de 2,4 DDD/100 camas/día. El servicio que más consumió colistín fue la UCI, con 45,5 DDD/100 camas/día, usando generalmente la dosis de 3 MUI cada 8 horas IV y con una baja utilización de dosis de carga. CONCLUSIÓN: Colistín corresponde a un antimicrobiano de uso restringido a infecciones sospechadas o confirmadas por agentes bacterianos multi resistentes. En esta serie, su uso inicial fue principalmente empírico, en pacientes con factores de riesgo para resistencia antibacteriana; se usó en forma asociada a otros antimicrobianos, siendo el foco principal el respiratorio.


BACKGROUND: The increase in resistance and the shortage of new antibiotics has led to the reintroduction of old antimicrobials such as colistin. AIM: To evaluate the use of colistin during 2017 in a university hospital, through the characterization of patients and treatment, associated microbiology, response to treatment and adverse effects. METHODS: Retrospective observational design. The data of all patients who received colistin for at least 48 hours during the year 2017 were reviewed. RESULTS: 55 patients were included, equivalent to 144 treatments. The respiratory focus was the main one (57.9%). 64% of the treatments began in the ICU, while 7% in the ward. Most of the patients has a recent hospitalization (86.8%) and has previous use of antibiotics (90.4%). The two main pathogens identified were Pseudomonas aeruginosa and Klebsiella spp. In 87.1% of the cases with microbiological justifications for the use of colistin, a favorable response was obtained. The average consumption of colistin was 2.4 DDD/100 beds/day. The department that consumed the most colistin was the ICU, with 45,5 DDD/100 beds/day, generally using a dose of 3 MIU every 8 hours IV and with low use of loading doses. CONCLUSION: Colistin corresponds to an antibiotic whose use is restricted to infections suspected or confirmed by multi-resistant bacterial agents. Its initial use in this serie was mainly empirical, in patients with risk factors for antibiotics resistance, it was used in association with other antimicrobials, being the respiratory the main infectious focus.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Colistin/administration & dosage , Drug Resistance, Multiple, Bacterial , Anti-Bacterial Agents/administration & dosage , Pseudomonas aeruginosa/isolation & purification , Pseudomonas aeruginosa/drug effects , Bacterial Infections/drug therapy , Microbial Sensitivity Tests , Retrospective Studies , Risk Factors , Colistin/adverse effects , Administration, Intravenous , Klebsiella/isolation & purification , Klebsiella/drug effects , Anti-Bacterial Agents/adverse effects
6.
Article in English | WPRIM | ID: wpr-971083

ABSTRACT

Tuberculosis (TB) is an ancient infectious disease. Before the availability of effective drug therapy, it had high morbidity and mortality. In the past 100 years, the discovery of revolutionary anti-TB drugs such as streptomycin, isoniazid, pyrazinamide, ethambutol and rifampicin, along with drug combination treatment, has greatly improved TB control globally. As anti-TB drugs were widely used, multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis emerged due to acquired genetic mutations, and this now presents a major problem for effective treatment. Genes associated with drug resistance have been identified, including katG mutations in isoniazid resistance, rpoB mutations in rifampin resistance, pncA mutations in pyrazinamide resistance, and gyrA mutations in quinolone resistance. The major mechanisms of drug resistance include loss of enzyme activity in prodrug activation, drug target alteration, overexpression of drug target, and overexpression of the efflux pump. During the disease process, Mycobacterium tuberculosis may reside in different microenvironments where it is expose to acidic pH, low oxygen, reactive oxygen species and anti-TB drugs, which can facilitate the development of non-replicating persisters and promote bacterial survival. The mechanisms of persister formation may include toxin-antitoxin (TA) modules, DNA protection and repair, protein degradation such as trans-translation, efflux, and altered metabolism. In recent years, the use of new anti-TB drugs, repurposed drugs, and their drug combinations has greatly improved treatment outcomes in patients with both drug-susceptible TB and MDR/XDR-TB. The importance of developing more effective drugs targeting persisters of Mycobacterium tuberculosis is emphasized. In addition, host-directed therapeutics using both conventional drugs and herbal medicines for more effective TB treatment should also be explored. In this article, we review historical aspects of the research on anti-TB drugs and discuss the current understanding and treatments of drug resistant and persistent tuberculosis to inform future therapeutic development.


Subject(s)
Humans , Pyrazinamide/therapeutic use , Isoniazid/therapeutic use , Antitubercular Agents/therapeutic use , Tuberculosis, Multidrug-Resistant/microbiology , Mycobacterium tuberculosis/genetics , Tuberculosis/drug therapy , Rifampin/therapeutic use , Mutation , Drug Resistance, Multiple, Bacterial/genetics
7.
Biomed. environ. sci ; Biomed. environ. sci;(12): 406-417, 2023.
Article in English | WPRIM | ID: wpr-981069

ABSTRACT

OBJECTIVE@#To explore the genotyping characteristics of human fecal Escherichia coli( E. coli) and the relationships between antibiotic resistance genes (ARGs) and multidrug resistance (MDR) of E. coli in Miyun District, Beijing, an area with high incidence of infectious diarrheal cases but no related data.@*METHODS@#Over a period of 3 years, 94 E. coli strains were isolated from fecal samples collected from Miyun District Hospital, a surveillance hospital of the National Pathogen Identification Network. The antibiotic susceptibility of the isolates was determined by the broth microdilution method. ARGs, multilocus sequence typing (MLST), and polymorphism trees were analyzed using whole-genome sequencing data (WGS).@*RESULTS@#This study revealed that 68.09% of the isolates had MDR, prevalent and distributed in different clades, with a relatively high rate and low pathogenicity. There was no difference in MDR between the diarrheal (49/70) and healthy groups (15/24).@*CONCLUSION@#We developed a random forest (RF) prediction model of TEM.1 + baeR + mphA + mphB + QnrS1 + AAC.3-IId to identify MDR status, highlighting its potential for early resistance identification. The causes of MDR are likely mobile units transmitting the ARGs. In the future, we will continue to strengthen the monitoring of ARGs and MDR, and increase the number of strains to further verify the accuracy of the MDR markers.


Subject(s)
Humans , Escherichia coli/genetics , Escherichia coli Infections/epidemiology , Multilocus Sequence Typing , Genotype , Beijing , Drug Resistance, Multiple, Bacterial/genetics , Anti-Bacterial Agents/pharmacology , Diarrhea , Microbial Sensitivity Tests
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; (12): 1558-1564, 2023.
Article in Chinese | WPRIM | ID: wpr-1045905

ABSTRACT

Objective: To identify the antibiotic resistance, virulence genes, and sequence types of Pseudomonas aeruginosa (P. aeruginosa) strains isolated from blood. Methods: From November 2014 to December 2021, a total of 94 nonrepetitive P. aeruginosa isolates were obtained from blood samples of patients at the First Affiliated Hospital of Shandong First Medical University in Shandong Province, China. The bacteria were identified using matrix-assisted laser desorption ionization time of flight mass spectrometry. Antibiotic resistance of the P. aeruginosa isolates was detected using Vitek 2 Compact system. Polymerase chain reaction (PCR) was conducted for the 18 virulence genes, and multi locus sequence typing (MLST) was performed to identify the sequence types of the P. aeruginosa strains. The resistance rates and distributions of virulence genes between carbapenem resistant pseudomonas aeruginosa (CRPA) and carbapenem susceptible pseudomonas aeruginosa (CSPA) isolates were compared using the Chi-square test. Results: Among 94 P. aeruginosa isolates, 19 (20.2%) isolates were found to be multidrug resistant (MDR) bacteria, of which 17 were CRPA isolates and 2 were CSPA isolates. All strains contained more than 10 virulence genes. Except for exoU gene, the detection rate of other genes was above 83%. MLST analysis revealed a total of 66 different STs, including 59 existing STs and 7 novel STs. Among them, ST244 (n=11, 11.7%) and ST270 (n=7, 7.4%) were the dominant STs. Although these two types of isolates harbored the same virulence genes, the resistance rates to carbapenem were different. 54.5% (6/11) ST244 isolates were CRPA but all 7 ST270 isolates were CSPA. Conclusion: Although the resistance rates of P. aeruginosa strains isolated from blood were at a low level, some MDR and CRPA isolates were detected. As the high virulence gene detection rates and genetic diversity were found for P. aeruginosa strains isolated from blood, close attention should be paid to avoid transmission and outbreaks.


Subject(s)
Humans , Pseudomonas aeruginosa/genetics , Multilocus Sequence Typing , Molecular Epidemiology , Pseudomonas Infections/microbiology , Microbial Sensitivity Tests , Hospitals , Carbapenems/pharmacology , Drug Resistance, Multiple, Bacterial/genetics , Anti-Bacterial Agents/pharmacology , beta-Lactamases
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; (12): 1558-1564, 2023.
Article in Chinese | WPRIM | ID: wpr-1046228

ABSTRACT

Objective: To identify the antibiotic resistance, virulence genes, and sequence types of Pseudomonas aeruginosa (P. aeruginosa) strains isolated from blood. Methods: From November 2014 to December 2021, a total of 94 nonrepetitive P. aeruginosa isolates were obtained from blood samples of patients at the First Affiliated Hospital of Shandong First Medical University in Shandong Province, China. The bacteria were identified using matrix-assisted laser desorption ionization time of flight mass spectrometry. Antibiotic resistance of the P. aeruginosa isolates was detected using Vitek 2 Compact system. Polymerase chain reaction (PCR) was conducted for the 18 virulence genes, and multi locus sequence typing (MLST) was performed to identify the sequence types of the P. aeruginosa strains. The resistance rates and distributions of virulence genes between carbapenem resistant pseudomonas aeruginosa (CRPA) and carbapenem susceptible pseudomonas aeruginosa (CSPA) isolates were compared using the Chi-square test. Results: Among 94 P. aeruginosa isolates, 19 (20.2%) isolates were found to be multidrug resistant (MDR) bacteria, of which 17 were CRPA isolates and 2 were CSPA isolates. All strains contained more than 10 virulence genes. Except for exoU gene, the detection rate of other genes was above 83%. MLST analysis revealed a total of 66 different STs, including 59 existing STs and 7 novel STs. Among them, ST244 (n=11, 11.7%) and ST270 (n=7, 7.4%) were the dominant STs. Although these two types of isolates harbored the same virulence genes, the resistance rates to carbapenem were different. 54.5% (6/11) ST244 isolates were CRPA but all 7 ST270 isolates were CSPA. Conclusion: Although the resistance rates of P. aeruginosa strains isolated from blood were at a low level, some MDR and CRPA isolates were detected. As the high virulence gene detection rates and genetic diversity were found for P. aeruginosa strains isolated from blood, close attention should be paid to avoid transmission and outbreaks.


Subject(s)
Humans , Pseudomonas aeruginosa/genetics , Multilocus Sequence Typing , Molecular Epidemiology , Pseudomonas Infections/microbiology , Microbial Sensitivity Tests , Hospitals , Carbapenems/pharmacology , Drug Resistance, Multiple, Bacterial/genetics , Anti-Bacterial Agents/pharmacology , beta-Lactamases
10.
Article in English | WPRIM | ID: wpr-977652

ABSTRACT

Aims@#Antimicrobial resistance (AMR) is a significant public health concern of modern civilization. The potential risk of AMR is significant in terms of both human and animal health. This study aims to assess the antimicrobial resistance pattern of selected antimicrobials against Escherichia coli of animal, poultry and human origin in the Cumilla district of Bangladesh.@*Methodology and results@#A total of 200 samples were collected from different sources. Isolation and identification of commensal E. coli were performed following standard bacteriological and molecular techniques. Antimicrobial susceptibility testing was performed following the Kirby-Bauer disc diffusion technique. Ampicillin, tetracycline and sulfamethoxazole-trimethoprim resistance genes were detected by polymerase chain reactions (PCR). A total of 152 (76%; 95% confidence interval (CI) 70-81%) E. coli were isolated from cattle, sheep, chicken and human, where 37.5% of isolates were found to be multidrug-resistant (MDR). In the cultural sensitivity test, E. coli showed the highest resistance to sulfamethoxazole-trimethoprim (71%), tetracycline (63%), ampicillin (62%), where gentamicin (23%) showed the lowest resistance, followed by ceftriaxone (26%). The prevalence of resistance genes like blaTEM, tetA, tetB, tetC, sul1 and sul2 were 100%, 95%, 11%, 8%, 58% and 52%, respectively.@*Conclusion, significance and impact of study@#The emergence of multidrug-resistant commensal E. coli and resistance genes circulating in animals, poultry and humans limit the treatment options for serious infections.


Subject(s)
Escherichia coli , Drug Resistance, Multiple, Bacterial
11.
Braz. j. biol ; 82: e239991, 2022. tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1278503

ABSTRACT

High resistance to antimicrobials is associated with biofilm formation responsible for infectious microbes to withstand severe conditions. Therefore, new alternatives are necessary as biofilm inhibitors to control infections. In this study, the antimicrobial and antibiofilm activities of Fagonia indica extracts were evaluated against MDR clinical isolates. The extract exhibited its antibiofilm effect by altering adherence and disintegration of bacterial cell wall. Fagonia indica has antibacterial effect as minimum inhibitory concentration (MIC) values ranging from 125 to 500 µg mL-1 and minimum bactericidal concentration (MBC) value was 500-3000 µg mL-1 against multidrug resistant (MDR) clinical isolates. The extract exhibited its antibiofilm effect by altering adherence and disintegration of bacterial cell wall. Fagonia indica had antibacterial effect as minimum inhibitory concentration (MIC) values ranging from 125 to 500 µg mL-1 and minimum bactericidal concentration (MBC) value was 500-3000 µg mL-1 against MDR isolates. The maximum inhibitory effects of Fagonia indica chloroform extract on biofilm formation was observed on Staphylococcus aureus (71.84%) followed by Klebsiella pneumoniae (70.83%) after 48 hrs showing that inhibition is also time dependent. Our results about bacterial cell protein leakage indicated that MDR isolates treated with chloroform extract of Fagonia indica showed maximum protein leakage of K. pneumoniae (59.14 µg mL-1) followed by S. aureus (56.7 µg mL-1). Cell attachment assays indicated that chloroform extract resulted in a 43.5-53.5% inhibition of cell adherence to a polystyrene surface. Our results revealed that extracts of Fagonia indica significantly inhibited biofilm formation among MDR clinical isolates, therefore, could be applied as antimicrobial agents and cost effective biofilm inhibitor against these MDR isolates.


A alta resistência aos antimicrobianos está associada à formação de biofilme responsável por micróbios infecciosos para suportar condições severas. Portanto, novas alternativas são necessárias como inibidores de biofilme para controlar infecções. Neste estudo, as atividades antimicrobiana e antibiofilme dos extratos de Fagonia indica foram avaliadas contra isolados clínicos MDR. O extrato exibiu seu efeito antibiofilme ao alterar a aderência e a desintegração da parede celular bacteriana. Fagonia indica tem efeito antibacteriano com valores de concentração inibitória mínima (CIM) variando de 125 a 500 µg mL-1, e valor de concentração bactericida mínima (MBC) de 500-3000 µg mL-1 contra isolados clínicos multirresistentes (MDR). O extrato exibiu seu efeito antibiofilme ao alterar a aderência e a desintegração da parede celular bacteriana. Fagonia indica teve efeito antibacteriano com valores de concentração inibitória mínima (CIM) variando de 125 a 500 µg mL-1, e concentração bactericida mínima (MBC) de 500-3000 µg mL-1 contra isolados MDR. Os efeitos inibitórios máximos do extrato de clorofórmio Fagonia indica na formação de biofilme foi observada em Staphylococcus aureus (71,84%), seguido por Klebsiella pneumoniae (70,83%) após 48 horas, mostrando que a inibição também é dependente do tempo. Nossos resultados sobre extravasamento de proteínas de células bacterianas indicaram que isolados MDR tratados com extrato clorofórmico de Fagonia indica apresentaram vazamento máximo de proteínas de K. pneumoniae (59,14 µg mL-1), seguido por S. aureus (56,7 µg mL-1). Ensaios de fixação de células indicaram que o extrato de clorofórmio resultou em uma inibição de 43,5-53,5% da aderência das células a uma superfície de poliestireno. Nossos resultados revelaram que extratos de Fagonia indica inibiram significativamente a formação de biofilme entre isolados clínicos MDR, portanto, poderiam ser aplicados como agentes antimicrobianos e inibidores de biofilme de baixo custo contra esses isolados MDR.


Subject(s)
Staphylococcus aureus , Plant Extracts/pharmacology , Bacteria , Microbial Sensitivity Tests , Biofilms , Drug Resistance, Multiple, Bacterial
12.
Neumol. pediátr. (En línea) ; 17(4): 126-128, 2022.
Article in Spanish | LILACS | ID: biblio-1438350

ABSTRACT

Las infecciones respiratorias representan una morbilidad y mortalidad significativas, con aumento progresivo de la resistencia a los antibióticos. La escasez de nuevos antibióticos disponibles y la pérdida de eficacia de los antiguos, ha impulsado a investigar otras alternativas de tratamiento. La terapia con bacteriófagos (fagos) representa uno de esos enfoques, la que ha demostrado ser eficaz contra una variedad de patógenos bacterianos, incluidas las cepas resistentes a los medicamentos. La administración puede ser tópica, intravenosa o inhalada, esta última requiere preparaciones estables de fagos y sistemas adecuados para proporcionar partículas que accedan al árbol respiratorio. En esta comunicación se revisan diversos aspectos de los bacteriófagos, los que podrían ser de gran utilidad para el tratamiento de las infecciones pulmonares en pacientes con diagnóstico de fibrosis quística.


Respiratory infections represent a significant morbidity and mortality, with a progressive increase in resistance to antibiotics. The scarcity of new antibiotics available and the loss of efficacy of the old ones has prompted investigation of other treatment alternatives. Bacteriophage (phage) therapy represents one such approach that has been shown to be effective against a variety of bacterial pathogens, including resistant strains to medications. Administration can be topical. Intravenous or inhaled, the latter requiring stable preparations of phages and adequate systems to provide particles that will access the respiratory tree. In this communication various aspects of bacteriophages and their clinical utility are reviewed, which could be very useful for the treatment of pulmonary infections in patients diagnosed with cystic fibrosis.


Subject(s)
Humans , Cystic Fibrosis/therapy , Phage Therapy/methods , Drug Resistance, Multiple, Bacterial
13.
SALVADOR; s.n; 20220000. 75P p.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1555640

ABSTRACT

As infecções ocasionadas por microorganismos multirresistentes são um problema de saúde pública, considerada uma ameaça à saúde pública mundial, podendo repercutir na morbidadade, mortalidade, prolongamento da internação e aumento dos custos da internação. Dentre os indivíduos acometidos, estão as crianças hospitalizadas, os quais são consideradas vulneráveis devido ao desenvolvimento em formação do sistema imunológico em crianças menores, risco de infecção cruzada transmitida por familiar ou acompanhante, susceptilidade aos antimicrobianos. Além das características das crianças, existem fatores associados às infecções multirresistentes, os quais são necessários conhecer para a tomada de decisão e planejamento de ações de prevenção e controle das infecções. Esse trabalho tem o objetivo geral de identificar os fatores associados às infeções multirresistente em crianças hospitalizadas de um hospital público pediátrico da Bahia. Estudo caso-controle realizado em um hospital público pediátrico da Bahia entre abril de 2021 a novembro de 2022, através de banco de dados da Comissão de Controle de Infecção Hospitalar e de prontuário eletrônico de crianças internados com infecções. Os casos foram definidos como as crianças que desenvolveram infecções multirresistente relacionadas a assistência à saúde e os controles foram as crianças que desenvolveram infecções relacionadas a assistência à saúde causadas por microrganismo não multirresistentes. A análise dos dados foi realizada por meio de estatística descritiva e regressão logística condicional utilizando o Microsoft Excel e o SPSS versão 24.0. Esta pesquisa é formada por 395 infecções, com 114 casos (28,9%) e 281 controles (71,1%), com razão de 1:2,5 entre casos e controles. Dos casos de infecções multirresistentes, predominaram o sexo feminino (n=60; 52,6%), a faixa etária dos lactentes (n=58; 50,9%), as doenças cardíacas (n=22; 19,3%) e as doenças respiratórias (n=19; 16,7%). No grupo caso houve um maior quantitativo de crianças com uso de mais de 1 antibiótico (n=60; 52,6%), predominaram o uso das classes dos antimicrobianos da Penicilina (n=42; 36,8%) e dos Glicopeptídeos (n=39; 34,2%) e as classes dos antimicrobianos com maior resistência foram a Penicilina (n=25; 21,9%) e os B-lactâmicos (n=31; 27,2%). Dentre as infecções, prevaleceram no grupo caso, a IPCS (n=61; 53,5%) e a PAV (n=15; 13,2%). Em relação ao número de IRAS, prevaleceram em ambos os grupos de crianças a ocorrência de 1 IRAS (n=80; 70,2%) e os microrganismos mais predominantes foram a Klebsiella (n=37; 32,5%), seguido do Staphylococcus (n=25; 21,9%). Os fatores associados ao risco de infecções multirresistentes foram o uso da SNG [OR 1,8 (1,01- 3,56), p=0,043] e o tempo de internação. Os fatores de proteção para as infecções multirresistentes foram o sexo [OR 0,5 (0,37-0,91), p=0,017] e as doenças gastrointestinais [OR 0,3 (0,18-0,76), p=0,006]. Nos fatores de riscos, a cirurgia recente e a doença crônica prevaleceram tanto no grupo caso como no grupo controle. Nossos resultados demonstram a importância do conhecimento dos fatores associados às infecções para prevenção e controle das infecções multirresistentes.(AU)


Those tolerated by multidrug-resistant microorganisms are a public health problem, considered a threat to global public health, and may have repercussions on morbidity, mortality, prolonged hospitalization and increased hospitalization costs. Among the affected individuals are hospitalized children, who are considered due to the developing development of the immune system in children, risk of cross-infection transmitted by a family member or companion, susceptibility to antimicrobials. In addition to the characteristics of children, there are factors associated with multidrug-resistant infections, which it is necessary to know for decision-making and planning of infection prevention and control actions. This work has the general objective of identifying the factors associated with multidrug-resistant infections in children hospitalized at a public pediatric hospital in Bahia. Case-control study carried out in a public pediatric hospital in Bahia between April 2021 and November 2022, using the Hospital Infection Control Commission database and electronic medical records of children hospitalized with the community. Cases were defined as children who developed healthcare-related multidrugresistant infections, and controls were children who developed healthcare-associated complications caused by a non-multidrug-resistant microorganism. Data analysis was performed using descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 24.0. This research is made up of 395 treated patients, with 114 cases (28.9%) and 281 controls (71.1%), with a ratio of 1:2.5 between cases and controls. Of the cases of multidrug-resistant vomiting, females predominated (n=60; 52.6%), the age group of infants (n=58; 50.9%), heart diseases (n=22; 19.3%) and respiratory diseases (n=19; 16.7%). In the case group, there was a greater number of children using more than 1 antibiotic (n=60; 52.6%), predominant use of the antimicrobial classes of Penicillin (n=42; 36.8%) and Glycopeptides ( n=39; 34.2%) and the classes of antimicrobials with greater resistance were Penicillin (n=25; 21.9%) and B-lactams (n=31; 27.2%). Among those that survived, IPCS (n=61; 53.5%) and VAP (n=15; 13.2%) prevailed in the case group. Regarding the number of HAIs, the occurrence of 1 HAI prevailed in both groups of children (n=80; 70.2%) and the most predominant microorganisms were Klebsiella (n=37; 32.5%), followed by Staphylococcus (n=25; 21.9%). Factors associated with the risk of multidrug-resistant toxicity were the use of NGT [OR 1.8 (1.01-3.56), p=0.043] and length of stay. The protective factors for multidrug resistant patients were gender [OR 0.5 (0.37-0.91), p=0.017] and gastrointestinal diseases [OR 0.3 (0.18-0.76), p = 0.006]. In risk factors, recent surgery and chronic disease prevailed both in the case and control groups. Our results demonstrated the importance of knowing the factors associated with infections for the prevention and control of multidrug-resistant infections.(AU)


Subject(s)
Humans , Child, Preschool , Child , Adolescent , Child , Risk Factors , Drug Resistance, Multiple, Bacterial , Infections/etiology , Case-Control Studies , Infection Control , Hospitalization
14.
Rev. chil. infectol ; Rev. chil. infectol;38(2): 189-196, abr. 2021. tab
Article in Spanish | LILACS | ID: biblio-1388235

ABSTRACT

Resumen Introducción: La resistencia a carbapenémicos en bacilos gramnegativos es un problema de salud pública mundial, debido a que se asocia con altas tasas de mortalidad, aumento en los niveles de resistencia a otros antimicrobianos, elevación en el potencial de diseminación e incremento en los costos de atención en salud. Objetivo: Caracterizar bacilos gramnegativos multirresistentes, aislados en pacientes hospitalizados en instituciones de salud de Barranquilla (Colombia). Material y Métodos: Estudio descriptivo acerca de la caracterización fenotípica y genotípica de la resistencia bacteriana en las infecciones asociadas a la atención en salud, mediada por carbapenemasas en aislados bacterianos enviados por los laboratorios pertenecientes a la red de laboratorios del Departamento del Atlántico. Resultados: La KPC fue la carbapenemasa más frecuente en las Enterobacterales (27,6%), predominando en Klebsiella pneumoniae (13,1%) sola y asociada a otras carbapenemasas. En Pseudomonas aeruginosa predominó la carbapenemasa VIM (32,8%) y la OXA en Acinetobacter baumannii (17,1%). Conclusión: Se encontró una amplia distribución de cepas multi-resistentes productoras de carbapenemasas en instituciones de salud de Barranquilla, las cuales expresaron los siguientes mecanismos de resistencia: KPC, VIM, NDM, OXA.


Abstract Background: The emergence of carbapenem resistant gramnegative bacilli has become a problem of public health worldwide, because it is associated with high mortality rates, increased levels of resistance to other antimicrobials, increased potential for dissemination transition and increase in health care costs. Aim: To characterize multiresistant gram-negative bacilli, isolated in patients hospitalized in health institutions of Barranquilla (Colombia). Methods: A descriptive study was conducted on the phenotypic and genotypic characterization of bacterial resistance in infections associated with health care, mediated by carbapenemases in bacterial isolates sent by laboratories belonging to the laboratory network of the Department of Atlántico. Results: KPC was the most frequent carbapenemase in Enterobacterales (27.6%), predominantly in Klebsiella pneumoniae (13.1%) alone and associated with other carbapenemases. In Pseudomonas aeruginosa, VIM carbapenemase (32.8%) predominated and OXA in Acinetobacter baumannii (17.1%). Conclusion: A wide distribution of multi-resistant strains producing carbapenemases in Atlantic health institutions was found, which expressed the following resistance mechanisms: KPC, VIM, NDM, OXA.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , beta-Lactamases/genetics , Acinetobacter baumannii , Bacterial Proteins , Carbapenems , Colombia , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria , Klebsiella pneumoniae , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
15.
Rev. cuba. med. trop ; 73(1): e590, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280329

ABSTRACT

Introducción: La tuberculosis persiste como un importante problema de salud mundial. En el 2016 se estimaron 600 000 casos de resistente a rifampicina, y entre estos 490 000 casos multidrogorresistentes. Objetivo: Describir el comportamiento de la resistencia de los aislados de M. tuberculosis de pacientes con tuberculosis pulmonar notificados en Cuba entre los años 2015-2017. Métodos: Se determinó la susceptibilidad a isoniacida y rifampicina mediante el método de la nitratasa. A los aislados resistentes a rifampicina/multidrogorresistentes se les determinó mediante el método proporcional la susceptibilidad a ofloxacina, kanamicina, amikacina y capreomicina. Resultados: El 93,2 por ciento de los aislados fueron sensibles a isoniacida y rifampicina. En 39 se identificó resistencia a isoniacida y 23 fueron resistente a rifampicina. Se identificaron 10 multidrogorresistentes. No se detectó resistencia a fármacos de segunda línea. Conclusiones: Los resultados alertan sobre la necesidad de investigar las causas que han conllevado al incremento de la tuberculosis resistente en Cuba(AU)


Introduction: Tuberculosis continues to be an important health problem worldwide. In the year 2016, as many as 600 000 cases of rifampicin resistance were estimated, among which 490 000 were multi-drug resistant. Objective: Describe the behavior of resistance to M. tuberculosis isolates in patients with pulmonary tuberculosis reported in Cuba in the period 2015-2017. Methods: Susceptibility to isoniazid and rifampicin was determined by the nitratase method. Susceptibility of rifampicin resistant / multi-drug resistant isolates to ofloxacin, kanamycin, amikacin and capreomycin was determined by the proportional method. Results: Of the isolates analyzed, 93.2 percent were sensitive to isoniazid and rifampicin. Isoniazid resistance was identified in 39 and 23 were rifampicin resistant. Ten multi-drug resistant isolates were identified. Resistance to second line drugs was not detected. Conclusions: Results warn about the need to study the factors leading to the increase in resistant tuberculosis in Cuba(AU)


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/prevention & control , Drug Resistance, Multiple, Bacterial/drug effects
16.
Rev. chil. infectol ; Rev. chil. infectol;38(1): 69-80, feb. 2021. tab
Article in Spanish | LILACS | ID: biblio-1388209

ABSTRACT

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


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


Subject(s)
Humans , Pseudomonas aeruginosa , Pseudomonas Infections , Plasmids , Pseudomonas aeruginosa/genetics , Pseudomonas Infections/drug therapy , beta-Lactamases/genetics , Microbial Sensitivity Tests , Drug Resistance, Multiple, Bacterial/genetics , Laboratories , Anti-Bacterial Agents/pharmacology
17.
Braz. j. infect. dis ; Braz. J. Infect. Dis. (Online);25(1): 101038, jan., 2021. tab, graf
Article in English | LILACS | ID: biblio-1249296

ABSTRACT

ABSTRACT Background: Pseudomonas aeruginosa is an important causative agent of nosocomial infections. As pathogen, P. aeruginosa is of increasing clinical importance due to its ability to develop high-level multidrug resistance (MDR). Methods: The aim of the present study was to better understand the intrinsic virulence of circulating strains of Pseudomonas aeruginosa, by surveying and characterizing the antibiotic resistance profiles and prevalence of virulence factors in 51 clinical isolates of P. aeruginosa obtained from children admitted to Hospital del Niño-Panamá during the period of October 2016 until March 2017. Antimicrobial susceptibilities were assessed by determining the minimum inhibitory concentration for 12 antibiotics against P. aeruginosa clinical isolates using the VITEK system (https://www.biomerieux.com). Additionally, all isolates were examined by Polymerase Chain Reaction (PCR) for the presence of components of the MexAB-OprM efflux pump system (mexABR) and pyoverdine receptor genes and betalactamases resistance genes (ESBL) using gene-specific primers. Results: A total of 51 pyoverdine producing clinical isolates were analyzed, all of which expressed resistance genes such as genes of the MexAB-OprM efflux pump system (mexABR) and pyoverdine receptor genes (fpvA). Out of 51 MDR isolates, 22 were ESBL producers. The most common ESBL gene was blaTEM expressed by 43% of the isolates. The isolates tested in this study showed increased resistance to antibiotics in the following categories: (i) penicillins (ampicillin (69%), piperacillin (22%); (ii) pyrimethamines (trimethoprim, 65%); (iii) nitrofurans (nitrofurantoin, 63%), and (iv) third-generation cephalosporin cefotaxime (53%). These results underscore a high prevalence of MDR amongst clinical isolates from Panama. Conclusions: The present study indicates that prevalence of BlaTEM-carrying strains is increasing with subsequent multidrug resistance in Panamá and as well reported worldwide. The virulent factors identified in this study provide valuable information regarding the prevalence of resistance genes and their potential impact on treatments that exploit the unique physiology of the pathogen. To prevent further spread of MDR, the proportions of resistant strains of Pseudomonas aeruginosa should be constantly evaluated on healthcare institutions of Panamá. More importantly, this information can be used to better understand the evolution and dissemination of strains hoping to prevent the development of resistance in Pseudomonas aeruginosa. Future studies quantifying the expression of these virulent genes will emphasize on the acquisition of multidrug resistance.


Subject(s)
Humans , Child , Pseudomonas Infections/epidemiology , Cross Infection , Panama , Membrane Transport Proteins/genetics , Membrane Transport Proteins/pharmacology , Pseudomonas aeruginosa/genetics , Bacterial Outer Membrane Proteins/metabolism , Bacterial Outer Membrane Proteins/pharmacology , Microbial Sensitivity Tests , Prevalence , Drug Resistance, Multiple, Bacterial/genetics , Hospitals , Anti-Bacterial Agents/pharmacology
18.
Braz. j. infect. dis ; Braz. J. Infect. Dis. (Online);25(1): 101544, jan., 2021. tab
Article in English | LILACS | ID: biblio-1249299

ABSTRACT

ABSTRACT Multidrug-resistant tuberculosis (MDR-TB) represents a significant impact in transmission, outcome, and health costs. The World Health Organization recommends implementation of rapid diagnostic methods for multidrug-resistance detection. This study was performed to evaluate the frequency of pre- and extensively drug resistant tuberculosis (pre-XDR-TB and XDR-TB) among MDR-TB patients, the pattern of resistance mutations for fluoroquinolones and the clinical outcome. Adult patients followed at a Brazilian regional reference center for TB, from January 2013 to June 2019 were included. Stored Mycobacterium tuberculosis (Mtb) cultures were recovered, the DNA was extracted, and the susceptibility test was performed using the line probe assay for second line antimycobacterial drugs, Genotype MTBDRsl version 2.0 (Hain Lifescience, CmbH, Germany). Among 33 MDR-TB included patients, we diagnosed XDR-TB or pre-XDR in five (15%) cases. Of these, mutations related to fluoroquinolones resistance were observed in four Mtb isolates, including one who had no phenotypic resistance profile. In two other patients with phenotypic resistance to ofloxacin, genotypic resistance was not found. Case fatality rate was 60% in pre/XDR-TB group, compared to 3.6% in the remaining of patients. This study observed few cases of pre-XDR and XDR-TB among a MDR-TB cohort. Phenotypic and genotypic assays presented good agreement. Clinical outcome was more favorable for patients with susceptibility to fluoroquinolones and injectable drugs.


Subject(s)
Humans , Adult , Pharmaceutical Preparations , Mycobacterium tuberculosis/genetics , Brazil , Microbial Sensitivity Tests , Tuberculosis, Multidrug-Resistant , Drug Resistance, Multiple, Bacterial/genetics , Antitubercular Agents/therapeutic use , Antitubercular Agents/pharmacology
19.
Biomed. environ. sci ; Biomed. environ. sci;(12): 616-622, 2021.
Article in English | WPRIM | ID: wpr-887737

ABSTRACT

Objective@#To evaluate multidrug resistant loop-mediated isothermal amplification (MDR-LAMP) assay for the early diagnosis of multidrug-resistant tuberculosis and to compare the mutation patterns associated with the @*Methods@#MDR-LAMP assay was evaluated using 100 @*Results@#The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDR-LAMP were 85.5%, 93.6%, 96.7%, and 74.4% for the detection of resistance to isoniazid and rifampicin, respectively, and 80.5%, 92.3%, 98.6%, and 41.4% for the detection of @*Conclusion@#MDR-LAMP is a rapid and accessible assay for the laboratory identification of rifampicin and isoniazid resistance of


Subject(s)
Antitubercular Agents , Bacterial Proteins/genetics , Catalase/genetics , DNA, Bacterial/analysis , DNA-Directed RNA Polymerases/genetics , Drug Resistance, Multiple, Bacterial/genetics , Isoniazid , Molecular Diagnostic Techniques/methods , Mutation , Mycobacterium tuberculosis/isolation & purification , Nucleic Acid Amplification Techniques/methods , Oxidoreductases/genetics , Phenotype , Rifampin , Whole Genome Sequencing
20.
Malawi med. j. (Online) ; 33(2): 82-84, 2021.
Article in English | AIM | ID: biblio-1290527

ABSTRACT

Background Stenotrophomonas maltophilia is a significant opportunistic pathogen that is associated with high mortality in immunocompromised individuals. In this study, we describe a multidrug-resistant (MDR) S. maltophilia clinical isolate from Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Methods: A ceftriaxone and meropenem nonsusceptible isolate (Sm-MW08), recovered in December 2017 at KCH, was referred to theNational Microbiology Reference Laboratory for identification. In April 2018, we identified the isolate using MALDI Biotyper mass spectrometry and determined its antimicrobial susceptibility profile using microdilution methods. Sm-MW08 was analysed by S1-PFGE, PCR, and Sanger sequencing, in order to ascertain the genotypes that were responsible for the isolate`s multidrug-resistance (MDR) phenotype. Results Sm-MW08 was identified as S. maltophilia and exhibited resistance to a range of antibiotics, including all ß-lactams, aminoglycosides (except arbekacin), chloramphenicol, minocycline, fosfomycin and fluoroquinolones, but remained susceptible to colistin and trimethoprim-sulfamethoxazole. The isolate did not harbour any plasmid but did carry chromosomally-encoded blaL1 metallo-ßlactamase and blaL2 ß-lactamase genes; this was consistent with the isolate's resistance profile. No other resistance determinants were detected, suggesting that the MDR phenotype exhibited by Sm-MW08 was innate. Conclusion : Herein, we have described an MDR S. maltophilia from KCH in Malawi, that was resistant to almost all locally available antibiotics. We therefore recommend the practice of effective infection prevention measures to curtail spread of this organism


Subject(s)
Stenotrophomonas maltophilia , Therapeutics , Ceftriaxone , Carbapenems , Drug Resistance, Multiple, Bacterial
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