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1.
Rev. chil. pediatr ; 91(4): 553-560, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138670

ABSTRACT

INTRODUCCIÓN: Las infecciones graves son la principal causa de ingreso a cuidados intensivos pediátricos. El panel FilmArray BCID permite identificar rápidamente a microorganismos causantes de bacteriemias. OBJETIVO: evaluar la eficacia de la identificación rápida de microorganismos asociado a un Programa de Uso Racional de Antibióticos (URA) en reducir los tiempos de terapias antibióticas, en un hospital pediátrico. PACIENTES Y MÉTODO: Estudio retrospectivo, que incluyó 100 pacientes, en su primer episo dio de bacteriemia, divididos en 2 grupos de 50 cada uno: Intervención (FilmArray BCID y programa URA) y Controles históricos pareados para la misma especie del microrganismo identificado (microbiología convencional). Las variables evaluadas fueron los tiempos de identificación microbiana, latencia de la terapia dirigida y de desescalar antibióticos. RESULTADOS: Los grupos fueron comparables en características demográficas, foco de infección y etiología de bacteriemia. El tiempo promedio de identificación de microorganismos fue de 23 h (IC 95% 12,4-26,7) en el grupo intervención, y 70,5 h (IC 95% 65,2-78,6) en el control (p < 0,05), mientras que la latencia de inicio de terapia dirigida fue de 27,9 h (IC 95% 22,3-32,8) y 71,9 h (IC 95% 63,2-77,8) respectivamente (p < 0,05). El tiempo de desescalar o suspender antibióticos fue de 6,4 h (IC 95% 2,76-9,49) y 22 h (IC 95% 6,74-35,6) en los grupos mencionados (p > 0,05). CONCLUSIÓN: El panel FilmArray BCID articulado a un programa URA, contribuye a la identificación de los microorganismos causantes de bacteriemias en menor tiempo que los métodos convencionales, siendo una herramienta que optimiza las terapias antibióti cas en niños críticamente enfermos.


INTRODUCTION: Severe infections are the leading cause of admission to pediatric intensive care. The FilmArray BCID panel quickly identifies microorganisms that cause bacteremia. OBJECTIVE: To evaluate if the rapid identification of the microorganisms that cause bacteremia, along with a Rational Use of Antibio tics (RUA) Program, allows optimizing the time of antibiotic therapy in a pediatric hospital. PATIENTS AND METHOD: Retrospective study which included 100 patients presenting their first episode of bacteremia, divided into 2 groups of 50 each. The first one was Intervention (FilmArray BCID and RUA program) and the second one was Historical Controls (conventional automated ID/AST). The variables evaluated were the time required for microbial identification, duration of appropriate therapy, and antibiotic de-escalation. RESULTS: The groups were comparable in terms of demographic characteristics, focus of infection, and etiology of bacteremia. The average time of microorganisms' identification of the control group was 70.5 hours (IC 95% 65.2-78.6) and 23.0 hours (IC 95% 12.4 -26.7) in the intervention one (p < 0.05). The average time of targeted therapy onset was shorter in the intervention group (27.9 h [IC 95% 22.3-32.8]) than that of the control one (71.9 h [IC 95% 63.2-77.8]) (p < 0.05). Finally, the time to de-escalate or discontinue antibiotics in the intervention group and the control one was 6.4 hours (IC 95% 2.76-9.49) hours and 22.0 hours (IC 95% 6.74-35.6 h) respectively (p > 0.05). CONCLUSION: The FilmArray panel along with the RUA Program allows the identification of the microorganisms causing bacteremia faster than conventional methods, which positions it as a tool that optimizes antibiotic therapy of critical patients.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Bacteremia/diagnosis , Bacteremia/drug therapy , Molecular Typing/methods , Blood Culture/methods , Antimicrobial Stewardship/methods , Anti-Bacterial Agents/administration & dosage , Time Factors , Drug Administration Schedule , Retrospective Studies , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/drug therapy , Bacteremia/microbiology , Hospitals, Pediatric , Anti-Bacterial Agents/therapeutic use
2.
Rev. epidemiol. controle infecç ; 10(2): 151-157, abr.-jun. 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1223692

ABSTRACT

Justificativa e objetivos. Programas de gestão de antimicrobianos (PGA) podem contribuir para otimizar o uso de antimicrobianos em unidades de tratamento intensivo neonatais (UTINEO). O objetivo deste estudo foi mensurar o consumo de antimicrobianos, dentre eles os carbapenêmicos e infecções relacionadas à assistência à saúde (IRAS), especificamente as causadas por bactérias Gram-negativas resistentes a carbapenêmicos (BGN-CR) em neonatos após a implantação de um PGA. Métodos: Estudo prospectivo descritivo do consumo de antimicrobianos, dentre eles os carbapenêmicos; e das taxas de IRAS em uma UTINEO, durante 1 ano de seguimento. O consumo fo i medido em dias de terapia/1000 pacientes-dia (DOT/1000PD). Resultados: Em setembro de 2017 o PGA foi implementado com os seguintes elementos-chave: auditoria de antibióticos/feedback, restrição de antimicrobianos-alvo, medida do consumo de antimicrobianos e maior rapidez na liberação de resultados de culturas. Entre setembro de 2017 e setembro de 2018 admitimos 308 pacientes, totalizando 2223 pacientes-dia. A mediana de consumo total de antimicrobianos foi de 1580 DOT/1000PD (variação de 1180,7 a 2336,6/mês) sem tendência de aumento e a de carbapenêmicos 12 DOT/1000PD (variação de 0 a 163,2/mês). O consumo de carbapenêmicos foi reduzido entre abril a setembro de 2018 (valor de p =0,07) quando comparado com os primeiros seis meses. Oito IRAS foram registradas, correspondendo a uma densidade de incidência de 3,6/1000 pacientes-dia. Não foram reportadas BGN-CR causando IRAS. Conclusões: O consumo total de antimicrobianos não apresentou aumento ao longo do ano após implantação do PGA. No entanto, houve redução significativa do consumo de carbapenêmicos. Não foram verificadas IRAS por BGN-CR no período do estudo.(AU)


Background and objectives: Antimicrobial stewardship programs (ASPs) could contribute to optimize antimicrobial use within neonatal intensive care units (NICUs). The aim of this study was to measure the antimicrobial consumption, including carbapenems and healthcare-associated infections (HAI), specifically infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) in neonates, after implementation of an ASP. Methods: A prospective descriptive study of antimicrobial and carbapenem consumption; and healthcare-associated rate in a NICU, during a one-year follow-up. The consumption was measured in days of therapy /1000 patients-days(DOT/1000PD). Results: In September 2017, the ASP was implemented, with the following core components: antibiotic audit and feedback, restriction of target antimicrobials, measure of antimicrobial consumption and improvement of results from microbiologic laboratory. Between September 2017 and September 2018, we admitted 308 patients, totalizing 2223 patient-days. The median of total antimicrobial consumption was 1580 DOT/1000PD (range from 1180.7 to 2336.6/month and of carbapenems 12 DOT/1000PD (range from 0 to 162.3/month). The carbapenem consumption was reduced between April and September of 2018 (p value=0.07) when we compared the first six months of the study. Eight HAI were detected, corresponding to density of incidence of 3.6/1000 patient-days. No HAI due to CR-GNB was reported. Conclusion: The total antimicrobial consumption did not increase during all the year after the ASP implantation. Although there was a significant reduction of carbapenem consumption. Carbapenem-resistant bacteria was not found in NICU causing HAI.(AU)


Justificación y objetivos: Los programas de optimizatión de uso de antimicrobianos (POA) podrían contribuir a optimizar el uso de antimicrobianos dentro de las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue medir el consumo de antimicrobianos incluidos los carbapenems y las infecciones asociadas a la atención de la salud (IAAs), especificamente las infecciones causadas por bacterias Gram negativas resistentes a carbapenems (CR-GNB) en neonatos, después de la implementación de un POA. Métodos: Un estudio descriptivo prospectivo del consumo de antimicrobianos y carbapenems; y la tasa de IAAs en una UCIN durante un año de seguimiento. El consumo se midió en días de terapia (DOT) / 1000 pacientes-días. Resultados: En septiembre de 2017, se implementó el POA con los siguientes componentes principales: auditoría y retroalimentación de antibióticos, restricción de antimicrobianos objetivo, medición del consumo de antimicrobianos y mejora de los resultados del laboratorio microbiológico. Entre septiembre de 2017 y septiembre de 2018, admitimos 308 pacientes, totalizando 2223 días-paciente. La mediana del consumo total de antimicrobianos fue de 1580 DOT / 1000PD (rango de 1180.7 a 2336.6 / mes y de carbapenems 12 (rango de 0 a 162.3 / mes). El consumo de carbapenem se redujo entre abril y septiembre de 2018 (valor p = 0.07) cuando comparamos los primeros seis meses del estudio, se detectaron ocho IAAs, lo que corresponde a la densidad de incidencia de 3.6 / 1000 días-paciente No se informó ningún IAA debido a CR-GNB. Conclusiones: El consumo total de antimicrobianos no aumentó durante todo el año posterior a la implantación de POA. Aunque hubo una reducción significativa del consumo de carbapenem. No se encontraron bacterias resistentes a carbapenem en la UCIN que causa IAA.(AU)


Subject(s)
Humans , Infant, Newborn , Health Programs and Plans , Intensive Care Units, Neonatal , Cross Infection/microbiology , Delivery of Health Care , Antimicrobial Stewardship , Anti-Infective Agents/therapeutic use , Time Factors , Birth Weight , Carbapenems/therapeutic use , Prospective Studies , Gram-Negative Bacterial Infections/microbiology , Anti-Bacterial Agents/therapeutic use
3.
Braz. j. otorhinolaryngol. (Impr.) ; 86(3): 281-286, May-June 2020. tab
Article in English | LILACS | ID: biblio-1132589

ABSTRACT

Abstract Introduction: Clinicians rely on clinical presentations to select therapeutic agents for acute bacterial rhinosinusitis. Streptococcus pneumoniae and Haemophilus influenzae are common in acute bacterial rhinosinusitis. Drug resistant Streptococcus pneumoniae and Haemophilus influenzae require different antibiotics. Objective: This study aimed to evaluate the associations between clinical features of acute bacterial rhinosinusitis and pathogenic bacteria. Methods: Sixty-four patients with acute bacterial rhinosinusitis were enrolled. Clinical features including nasal obstruction, discolored discharge, facial pain, smell disturbance, fever and laboratory findings of patients with acute bacterial rhinosinusitis were collected. The bacterial cultures of endoscopic middle meatal swabs were used as a reference. Results: Serum C-reactive protein level elevation correlated with the bacterial species (p = 0.03), by which was increased in 80.0% of Haemophilus influenzae rhinosinusitis and 57.1% of Streptococcus pneumoniae rhinosinusitis. The elevated C-reactive protein was the significant predictor for Haemophilus influenzae rhinosinusitis with the Odds Ratio of 18.06 (95% CI 2.36-138.20). The sensitivity of serum C-reactive protein level elevation for diagnosing Haemophilus influenzae rhinosinusitis was 0.80 (95% CI 0.49-0.94). Conclusion: Elevation of serum C-reactive protein level was associated with and predicted acute bacterial rhinosinusitis caused by Haemophilus influenzae.


Resumo: Introdução: Os médicos se baseiam nas características clínicas para a escolha dos agentes terapêuticos para o tratamento da rinossinusite bacteriana aguda. Streptococcus pneumoniae e Haemophilus influenzae são agentes comuns na rinossinusite bacteriana aguda. Streptococcus pneumoniae e Haemophilus influenzae resistentes a antibióticos requerem medicamentos diferentes. Objetivo: Avaliar as associações entre as características clínicas da rinossinusite bacteriana aguda e bactérias patogênicas. Método: O estudo incluiu 64 pacientes com rinossinusite bacteriana aguda. Foram coletadas e registradas as características clínicas, inclusive obstrução nasal, secreção com cor alterada, dor facial, distúrbios do olfato, febre e achados laboratoriais de pacientes com rinossinusite bacteriana aguda. As culturas bacterianas obtidas por swab endoscópico do meato médio foram usadas como referência. Resultados: A elevação do nível sérico de proteína C-reativa estava correlacionada com a espécie bacteriana (p = 0,03); ela estava aumentada em 80,0% das rinossinusites por Haemophilus influenzae e em 57,1% das rinossinusites por Streptococcus pneumoniae. A proteína C-reativa elevada foi um significativo fator preditor de rinossinusite por Haemophilus influenzae, com razão de probabilidade de 18,06 (IC 95% 2,36-138,20). A sensibilidade da elevação dos níveis séricos de proteína C-reativa para o diagnóstico de rinossinusite por Haemophilus influenzae foi de 0,80 (IC 95% 0,49 ± 0,94). Conclusão: A elevação dos níveis séricos de proteína C-reativa é um preditor de rinossinusite bacteriana aguda causada por Haemophilus influenzae.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Sinusitis/microbiology , Rhinitis/microbiology , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Acute Disease , Cross-Sectional Studies
4.
Rev. Col. Bras. Cir ; 47: e20202471, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136576

ABSTRACT

ABSTRACT Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.


RESUMO Objetivo: identificar o perfil sociodemográfico, microbiológico e de resistência bacteriana em pacientes com pé diabético infectado. Métodos: tratou-se de estudo observacional, transversal que avaliou os perfis sóciodemográfico e microbiológico de pacientes portadores de pé diabético infectado internados em Pronto Socorro de referência. Os dados sociodemográficos foram coletados por meio de entrevista. Foram colhidos, durante os procedimentos cirúrgicos, fragmentos de tecidos das lesões podais infectadas para realização de cultura/antibiograma. Resultados: a amostra foi composta por 105 pacientes. O perfil sociodemográfico mais prevalente foi o de pacientes do sexo masculino, acima dos 50 anos, casados e com baixa escolaridade. Das 105 amostras de fragmentos de tecidos colhidos para realização de cultura e antibiograma, 95 foram positivas, com crescimento de um único germe em cada um dos exames. Houve predomínio de germes da família Enterobacteriaceae (51,5%). Germes Gram-negativos foram isolados em 60,0% das culturas e os espécimes mais isolados individualmente foram os cocos Gram-positivos, Staphylococcus aureus (20,0%) e Enterococcus faecalis (17,9%). Considerando-se os perfis de resistência bacteriana, verificou-se alta taxa de Staphylococcus aureus resistente à meticilina (63,0%) e à ciprofloxacino (55,5%); verificou-se, também, que 43,5% dos germes Gram-negativos eram resistentes à ciprofloxacino. Conclusões: o perfil sociodemográfico majoritário, foi o de homens, com mais de 50 anos e com baixa escolaridade. Concluímos que os germes mais prevalentes nas lesões podais dos pacientes diabéticos foram os Gram-negativos, resistentes ao ciprofloxacino e que o germe mais isolado individualmente foi o Staphylococcus aureus resistente à meticilina.


Subject(s)
Humans , Male , Female , Aged , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/drug therapy , Skin Diseases, Bacterial/microbiology , Diabetic Foot/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Anti-Bacterial Agents/therapeutic use , Staphylococcal Skin Infections/microbiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/epidemiology , Drug Resistance, Microbial , Microbial Sensitivity Tests , Skin Diseases, Bacterial/drug therapy , Diabetic Foot/drug therapy , Diabetes Complications , Diabetes Mellitus , Methicillin-Resistant Staphylococcus aureus/drug effects , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Infections , Middle Aged , Anti-Bacterial Agents/pharmacology
5.
Rev. bras. parasitol. vet ; 28(4): 632-643, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057984

ABSTRACT

Abstract This study used serological and molecular methods to investigate the occurrence of vector-borne pathogens (VBP) with zoonotic potential in cats neutered at the University Veterinary Hospital in Canoinhas, Santa Catarina. The combined PCR and serological results revealed that 17 (56.6%) cats were positive for one or more pathogens. The sampled cats had antibodies to Ehrlichia spp. (7/30), Anaplasma phagocytophilum (3/30) and Leishmania infantum (2/30). The PCR assay detected DNA closely related to Ehrlichia canis in 6/30 cats, Mycoplasma haemofelis in 2/30 cats, A. phagocytophilum and Cytauxzoon sp. in one cat each. While Bartonella clarridgeiae and B. henselae were detected in two cats each, and B. koehlerae was detected in one cat.


Resumo Como os felinos podem ser parasitados por diversos patógenos transmitidos por vetores (PTV), alguns com caráter zoonótico, este estudo objetivou detectar por métodos sorológicos e moleculares, patógenos transmitidos por vetores hematófagos, em gatos atendidos em um Hospital Veterinário Universitário em Santa Catarina. Os resultados da PCR e da sorologia combinados, revelaram que 17 (56,6%) gatos foram positivos para um ou mais patógenos. Na sorologia, foram positivos 7/30 gatos para Ehrlichia, 3/30 para Anaplasma phagocytophilum e 2/30 para Leishmania infantum. Na PCR foi detectado DNA filogeneticamente associado a: Ehrlichia canis em 6/30 gatos; Mycoplasma haemofelis, em 2/30 gatos; A. phagocytophilum e Cytauxzoon sp. em 1/30 gatos cada. Enquanto Bartonella clarridgeiae e B. henselae foram detectadas, cada uma, em dois gatos, B. koehlerae foi detectada em um gato.


Subject(s)
Animals , Male , Female , Cats , Babesiosis/diagnosis , Cat Diseases/microbiology , Cat Diseases/parasitology , Gram-Negative Bacterial Infections/veterinary , Babesia/isolation & purification , Babesia/genetics , Babesia/immunology , Babesiosis/transmission , Bartonella/isolation & purification , Bartonella/genetics , Bartonella/immunology , Brazil , Cat Diseases/diagnosis , Cat Diseases/transmission , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/transmission , Ehrlichia/isolation & purification , Ehrlichia/genetics , Ehrlichia/immunology , Anaplasma/isolation & purification , Anaplasma/genetics , Anaplasma/immunology , Insect Vectors , Mycoplasma/isolation & purification , Mycoplasma/genetics , Mycoplasma/immunology
6.
Rev. bras. parasitol. vet ; 28(4): 728-734, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057990

ABSTRACT

Abstract Free-ranging and feral dogs represent a group of unattended companion animals. They impact wild animal populations by predating native species, displacing predators and introducing exotic pathogens. The aim of this work was to describe the molecular occurrence of Rickettsia, Ehrlichia, Anaplasma, Mycoplasma and Bartonella in feral dogs. The study was carried out in the last relict of a protected area in Mexico City. Blood clots samples from 19 dogs were obtained and analyzed for detection of specific fragments of the 16S-rRNA gene for Anaplasma, Ehrlichia and Mycoplasma and citrate synthase (gltA) for Bartonella and Rickettsia. Our results showed that DNA from three bacteria species (Bartonella vinsonii subsp. berkhoffii, Ehrlichia canis and Mycoplasma haemocanis) was present with frequencies ranging from 5.3 to 15.8%. This is the first record of B. vinsonii subsp. berkhoffii and M. haemocanis in dogs from México, and also the first finding of Ehrlichia canis in Mexico City. It is important to perform surveillance of feral dog populations in order to identify the impact of these pathogens on wild animal populations and Public Health in order to establish prevention and protection programs.


Resumo Cães errantes e selvagens representam um grupo de animais de companhia livres. Eles impactam as populações de animais selvagens pela predação de espécies nativas, deslocando predadores e introduzindo patógenos exóticos. O objetivo deste trabalho foi descrever a ocorrência molecular de Rickettsia, Ehrlichia, Anaplasma, Mycoplasma e Bartonella em cães selvagens. O estudo foi realizado no último ecossistema de uma área protegida na Cidade do México. Amostras de coágulos sanguíneos de 19 cães foram obtidas e analisadas para detecção de fragmentos específicos do gene 16S-rRNA para Anaplasma, Ehrlichia e Mycoplasma e citrato sintase (gltA) para Bartonella e Rickettsia. Nossos resultados mostraram que o DNA de três espécies de bactérias (Bartonella vinsonii subsp. berkhoffii, Ehrlichia canis e Mycoplasma haemocanis) estava presente com frequências variando de 5,3 a 15,8%. Este é o primeiro registro de B. vinsonii subsp. berkhoffii e M. haemocanis em cães do México, e também a primeira descrição de Ehrlichia canis na Cidade do México. É importante realizar a vigilância das populações de cães selvagens para identificar o impacto desses patógenos nas populações de animais silvestres e na Saúde Pública, a fim de estabelecer programas de prevenção e proteção.


Subject(s)
Animals , Male , Female , Dogs , Rickettsia/isolation & purification , Bartonella/isolation & purification , Gram-Negative Bacterial Infections/veterinary , Dog Diseases/microbiology , Ehrlichia/isolation & purification , Anaplasma/isolation & purification , Mycoplasma/isolation & purification , Phylogeny , Rickettsia/genetics , Bartonella/genetics , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/epidemiology , Dog Diseases/epidemiology , Ehrlichia/genetics , Anaplasma/genetics , Animals, Wild , Mexico/epidemiology , Mycoplasma/genetics
7.
Med. infant ; 26(3): 276-284, sept. 2019. Tab, ilus
Article in Spanish | LILACS | ID: biblio-1024913

ABSTRACT

Chromobacterium violaceum es una bacteria gram negativa anaerobia facultativa, que se encuentra ampliamente distribuida en el agua y el suelo en regiones tropicales y subtropicales, que se asocia con infecciones respiratorias, gastrointestinales, abscesos hepáticos, meningitis, endocarditis, síndrome hemofagocítico y sepsis fulminante. Se presentan 2 casos en niños: el primero es un varón de 8 años con lesiones en piel, fiebre y adenitis inguinal, que ingresó con un cuadro de sepsis severa, síndrome de distrés respiratorio agudo (SDRA) y falleció a las 3 h del ingreso. De los hemocultivos se aisló Chromobacterium violaceum. El segundo caso, es una niña de 12 años con antecedente de fiebre y adenopatía inguinal secundaria a herida cortopunzante en el pie homolateral, que ingresó con un cuadro de sepsis, con desarrollo de abscesos múltiples profundos. De la colección obtenida de piel y partes blandas y de un aspirado traqueal se aisló Chromobacterium violaceum. Recibió tratamiento antibiótico adecuado y posteriormente fue dada de alta. Se realizó una revisión bibliográfica de esta infección en niños y se encontraron 44 casos en todo el mundo. Algunos de éstos, se relacionaron con inmunodeficiencia de base, como la enfermedad granulomatosa crónica. La infección por esta bacteria es rara y se presenta como un cuadro grave que no responde a antibióticos habituales de uso empírico y tiene una alta tasa de mortalidad (AU)


Chromobacterium violaceum is a facultative anaerobic Gramnegative bacillus, widely distributed in water and soil in tropical and subtropical regions and associated with respiratory and gastrointestinal infections, liver abscesses, meningitis, endocarditis, hemophagocytic syndrome, and fulminant sepsis. Here two pediatric cases are presented: The first was an 8-year-old boy with skin lesions, fever, and inguinal adenitis, who was admitted with severe sepsis, acute respiratory distress syndrome (ARDS) and died three hours after. Chromobacterium violaceum was isolated from blood cultures. The second case was a 12-year-old girl with a history of fever and inguinal adenopathy secondary to a wound in the homolateral foot, who was admitted because of sepsis and multiple deep abscesses. From samples collected from the skin and soft tissues as well as tracheal aspirate Chromobacterium violaceum was isolated. Adequate antibiotic treatment was started and the patient was subsequently discharged. In a review of the literature, 44 cases worldwide were identified. Some of these cases were related to underlying immunodeficiency, such as chronic granulomatous disease. Infection with this bacterium is rare and presents with severe manifestations that do not respond to the common empirical antibiotics and are associated with a high mortality rate (AU)


Subject(s)
Humans , Child , Chromobacterium/isolation & purification , Gram-Negative Bacterial Infections/microbiology , Sepsis/microbiology , Anti-Bacterial Agents/therapeutic use , Mortality , Treatment Outcome , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Sepsis/diagnosis , Sepsis/drug therapy
8.
Rev. Soc. Bras. Med. Trop ; 52: e20190205, 2019. tab, graf
Article in English | LILACS | ID: biblio-1020444

ABSTRACT

Abstract INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Cross Infection/microbiology , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Drug Resistance, Multiple, Bacterial , Intensive Care Units, Neonatal , Cross-Sectional Studies , Gram-Positive Bacterial Infections/classification , Gram-Negative Bacterial Infections/classification , Epidemiological Monitoring
9.
Rev. Soc. Bras. Med. Trop ; 51(5): 709-711, Sept.-Oct. 2018. graf
Article in English | LILACS | ID: biblio-957463

ABSTRACT

Abstract Ralstonia mannitolilytica, a Gram-negative bacterium, is rarely isolated in clinical laboratories. It has been associated with outbreaks due to its ability to survive in liquid media and hospital devices. We describe three cases of bacteremia caused by R. mannitolilytica in a neonatal intensive care unit in Curitiba, Southern Brazil. All isolates presented the same PFGE profile. The common source of infection was undetected in surveillance cultures for the outbreak survey. All patients received antimicrobial treatment and were discharged from the maternity. Due to the characteristics of the microorganism, clinicians and microbiologists should pay attention to the emergence of Ralstonia spp. infections.


Subject(s)
Humans , Male , Female , Infant, Newborn , Intensive Care Units, Neonatal , Cross Infection/microbiology , Gram-Negative Bacterial Infections/microbiology , Bacteremia/microbiology , Ralstonia/isolation & purification , Brazil , Cross Infection/diagnosis , Gram-Negative Bacterial Infections/diagnosis , Bacteremia/diagnosis
10.
Cad. Saúde Pública (Online) ; 34(10): e00193617, oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-952356

ABSTRACT

Bacteria belonging to Anaplasma, Ehrlichia, Rickettsia and Coxiella genera are considered emerging pathogens and livestock is one of the contexts where the transmission of these microorganisms can occur. The goal of this study was to determine serological evidence for the exposure to these bacteria in cattle and humans with occupational exposure to livestock in the subregions North and Magdalena Medio, Antioquia, Colombia, and to explore related factors. A cross-sectional study was conducted in 48 livestock farms distributed in six municipalities from both subregions: Belmira, Entrerríos and San Pedro de los Milagros (North), and Puerto Berrío, Puerto Nare and Puerto Triunfo (Magdalena Medio). Blood samples from 332 people and 384 bovines were evaluated by serology (IgM and IgG) screening for bacteria from the Anaplasma, Ehrlichia, Rickettsia, and Coxiella genera. Seropositivity in humans from both regions was 42.4% (95%CI: 31.2-55.1) for Anaplasma, 74.2% (95%CI: 66.0-84.4) for Ehrlichia, 72.5% (95%CI: 62.1-82.0) for Rickettsia, and 60.7% (95%CI: 59.7-69.1) for Coxiella burnetii. In cattle, seropositivity was 31.6% (95%CI: 19.9-44.2), 66.8% (95%CI: 55.2-78.1), 64.6% (95%CI: 53.8-74.5), and 61.6% (95%CI: 51.9-69.2), respectively. History of biting by ticks, milking, vaccination, having dogs and hens in the residence, as well as the consumption of raw milk derivatives were some factors associated with the infection by the bacteria studied. The results suggest a previous and recent exposure to these zoonotic bacteria genera in people with occupational exposure to livestock, as well as in cattle in the two studied subregions.


Las bacterias pertenecientes a los géneros Anaplasma, Ehrlichia, Rickettsia y Coxiella son consideradas patógenos emergentes y la ganadería es uno de los contextos donde se puede producir la transmisión de este tipo de microorganismos. El objetivo de este estudio fue determinar la evidencia serológica, debida a la exposición a estas bacterias en bovinos y humanos con exposición ocupacional a ganadería en las subregiones Norte y Magdalena Medio, Antioquia, Colombia, además de estudiar los factores relacionados. Se realizó un estudio transversal en 48 fincas ganaderas, distribuidas en seis municipios de ambas subregiones: Belmira, Entrerríos y San Pedro de los Milagros (Norte), y Puerto Berrío, Puerto Nare y Puerto Triunfo (Magdalena Medio). Las muestras de sangre de 332 personas y 384 bovinos fueron evaluadas mediante tamización serológica (IgM e IgG) para la detección de bacterias de los géneros Anaplasma, Ehrlichia, Rickettsia, y Coxiella. La seropositividad en humanos de ambas regiones fue 42,4% (IC95%: 31,2-55,1) en el caso de Anaplasma, un 74,2% (IC95%: 66,0-84,4) en Ehrlichia, un 72,5% (IC95%: 62,1-82,0) en Rickettsia, y un 60,7% (IC95%: 59,7-69,1) en Coxiella burnetii. En los bovinos, la seropositividad fue 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5), y 61,6% (IC95%: 51,9-69,2), respectivamente. El antecedente de haber sido mordido por garrapatas, ordeñar, vacunación, tener perros y gallinas en la residencia, así como el consumo de derivados de leche cruda fueron algunos de los factores asociados con la infección por las bacterias estudiadas. Los resultados sugieren la exposición previa y reciente a estas bacterias en personas con una exposición ocupacional a la ganadería, así como a los bovinos en las dos subregiones estudiadas.


As bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella são considerados patógenos emergentes, e a transmissão desses microrganismos pode ocorrer no contexto da pecuária. O estudo teve como objetivos determinar as evidências sorológicas de exposição a essas bactérias em bovinos e em humanos com exposição ocupacional ao gado nas sub-regiões Norte e Magdalena Médio, Antióquia, Colômbia, e explorar fatores associados. Foi realizado um estudo transversal em 48 fazendas de gado bovino distribuídas em seis municípios nas duas sub-regiões: Belmira, Entrerríos e San Pedro de los Milagros (Norte) e Puerto Berrío, Puerto Nare e Puerto Triunfo (Magdalena Médio). Amostras de sangue de 332 humanos e 384 bovinos foram analisadas com sorologia (IgM e IgG) para bactérias dos gêneros Anaplasma, Ehrlichia, Rickettsia e Coxiella. Os níveis de sorologia positiva em humanos das duas regiões foram de 42,4% (IC95%: 31,2-55,1) para Anaplasma, 74,2% (IC95%: 66,0-84,4) para Ehrlichia, 72,5% (IC95%: 62,1-82,0) para Rickettsia e 60,7% (IC95%: 59,7-69,1) para Coxiella burnetii. Nos bovinos, os níveis foram 31,6% (IC95%: 19,9-44,2), 66,8% (IC95%: 55,2-78,1), 64,6% (IC95%: 53,8-74,5) e 61,6% (IC95%: 51,9-69,2), respectivamente. Os fatores associados às bactérias estudadas foram: história de picada de carrapato, ordenha, vacinação, presença de cães e galinhas no domicílio e consumo de laticínios feitos com leite cru, entre outros. Os resultados sugerem exposição prévia e recente a esses gêneros bacterianos zoonóticos em pessoas com contato ocupacional com gado, assim como nos próprios animais, nas duas sub-regiões estudadas.


Subject(s)
Humans , Animals , Male , Female , Adult , Aged , Aged, 80 and over , Cattle , Zoonoses/transmission , Occupational Exposure/statistics & numerical data , Gram-Negative Bacterial Infections/transmission , Rickettsia/isolation & purification , Zoonoses/microbiology , Zoonoses/blood , Cross-Sectional Studies , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/blood , Coxiella burnetii/isolation & purification , Colombia , Ehrlichia/isolation & purification , Anaplasma/isolation & purification , Middle Aged
11.
Braz. j. infect. dis ; 22(4): 328-337, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-974219

ABSTRACT

ABSTRACT Background Technologies and life support management have enhanced the survival of preterm infants. The immune system of newborns is immature, which contributes to the occurrence of healthcare-associated infections. The overlap of several conditions with neonatal sepsis and the difficulty of diagnosis and laboratory confirmation during this period result in a tendency to over-treat neonatal sepsis. The use of antimicrobial agents is a risk factor for multidrug-resistant bacterial infections. This work aimed to perform a systematic review of the relationship between inadequate use of antimicrobial agents and increase in neonatal sepsis related to healthcare assistance, due to bacterial resistance. Methods Our population, exposition, comparison, outcome and study type was as follows: P: hospitalized neonates with sepsis diagnosis, E: inappropriate use of antimicrobial agents, C: adequate use of antimicrobial agents or no indication of infection, O: resistant bacterial infection, and S: original studies. We performed searches in the PubMed, Scopus, Virtual Health Library (Scielo, LILACS, and MEDLINE), and Embase without limits on time, language, and the references of the articles found. Fourteen studies were included and assessed using the Grading of Recommendations, Assessment, Development, and Evaluation, Newcastle, and the Strengthening the Reporting of Observacional Studies in Epidemiology methodologies. Results All studies found were observational and started with a low-quality evidence level in the Grading of Recommendations, Assessment, Development, and Evaluation. Conclusions Despite their low-quality evidence, the studies demonstrated the association between inadequate use of antimicrobial agents and increase of neonatal resistant bacterial healthcare-associated infections in neonatal units. However, there is significant difficulty in conducting high-quality studies in this population due to ethical issues tied to randomized trials. Therefore, new studies should be encouraged to recommend adequate treatment of newborns without increasing the risk of healthcare-associated infections by multidrug-resistant bacteria.


Subject(s)
Humans , Infant, Newborn , Cross Infection/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Drug Resistance, Multiple, Bacterial , Neonatal Sepsis/drug therapy , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Risk Factors , Gram-Negative Bacterial Infections/microbiology , Evidence-Based Medicine , Neonatal Sepsis/microbiology , Gram-Negative Bacteria/drug effects , Anti-Bacterial Agents/adverse effects
12.
Rev. Ciênc. Méd. Biol. (Impr.) ; 17(1): 78-83, jul.17,2018.
Article in Portuguese | LILACS | ID: biblio-909998

ABSTRACT

Introdução: Microrganismos subsecivos de infecções endodônticas primárias ou secundárias são a causa das infecções persistentes ou refratárias. Objetivo: realizar uma revisão de literatura sobre as infecções endodônticas persistentes, descrevendo a microbiota mais comumente associada ao insucesso da terapia endodôntica, bem como ressaltar o diagnóstico e tratamento dessas infecções. Metodologia: Foram realizadas buscas bibliográficas eletrônicas utilizando base de dados como Pubmed, Lilacs e Bireme que abordassem o tema proposto no período de 2000 a 2016. Para tanto, foram utilizados os seguintes descritores de assunto na língua portuguesa: "Endodontia", "Infecção persistente", "Periodontite apical" e na língua inglesa: "Endodontics", "Persistent infection","Apical Periodontitis". Resultados: Os artigos selecionados foram lidos criteriosamente e mostraram que esses microrganismos resistem aos procedimentos intracanais de desinfecção, resultando em uma periodontite apical persistente, com ou sem sintomatologia clínica e radiográfica evidente. O diagnóstico e tratamento são dificultados devido à complexidade anatômica do sistema de canais radiculares e capacidade de resistência bacteriana e o tratamento envolve um tratamento endodôntico efetivo, com necessidade cirúrgica em alguns casos. Conclusão: A análise desses patógenos é crucial nas infecções refratárias, tornando-se necessário avançar nas pesquisas para a determinação de novas técnicas de desinfecção associadas a novas medicações que tornarão a Endodontia cada vez mais eficaz e com resultados ainda mais previsíveis


Subject(s)
Humans , Periodontal Diseases/microbiology , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Periodontal Diseases/diagnosis , Periodontal Diseases/therapy
13.
Rev. Asoc. Odontol. Argent ; 105(4): 159-164, dic. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-973114

ABSTRACT

Objetivo: identificar el complejo rojo periodontal, formado por Porphyromonas gingivalis, Treponema denticola y Tannerella forsythia, en la infección endodóntica primaria de necrosis pulpar, con cámara abierta y cerrada, utilizando técnicas de reacción en cadena de la polimerasa. Materiales y métodos: se realizó la toma para reacción en cadena de la polimerasa en 27 dientes con necrosis pulpar, 13 con cámara pulpar abierta y 14 con cámara cerrada. Resultados: en las muestras de necrosis abierta se identificaron P. gingivalis en un 92 por ciento, T. denticola en un 76 por ciento, T. forsythia en un 76 por ciento y el complejo rojo en un 61 por ciento. Las tomas de necrosis cerrada mostraron P. gingivalis en un 78 por ciento y T. denticola en un 57 por ciento; no se identificaron T. forsythia ni el complejo rojo. El análisis estadístico evidenció diferencias significativas entre los dos grupos (P<0,05). Conclusión: el sinergismo de las tres bacterias que forman el complejo rojo agravaría la patogénesis de la infección endodóntica y permitiría relacionar la microbiología endodóntica con la microbiología de periodontitis crónica.


Subject(s)
Humans , Dental Pulp Necrosis/microbiology , Dental Pulp Exposure/microbiology , Periodontitis/microbiology , Dental Pulp Diseases/microbiology , Gram-Negative Bacterial Infections/microbiology , Polymerase Chain Reaction/methods , Treponema denticola/isolation & purification , Porphyromonas gingivalis/isolation & purification , Tannerella forsythia/isolation & purification , Statistical Analysis
14.
Rev. bras. cir. cardiovasc ; 32(6): 468-474, Nov.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-897962

ABSTRACT

Abstract Introduction: Extracorporeal membrane oxygenation (ECMO) has become a standard technique over the past few decades in intensive care unit (ICU). Objective: A review of pediatric patients who received ECMO support in the pediatric cardiac ICU was conducted to determine the incidence, risk factors and causal organisms related to acquired infections and assess the survival rates of ECMO patients with nosocomial infections. Methods: Sixty-six patients who received ECMO support in the pediatric cardiac ICU between January 2011 and June 2014 were included in the study. Demographic, echocardiographic, hemodynamic features and surgical procedures were reviewed. Results: Sixty-six patients received a total of 292.5 days of venoarterial ECMO support. Sixty were postoperative patients. Forty-five patients were weaned from ECMO support with an ECMO survival rate of 68.2%. The rate of infection was 116.2/1000 ECMO days. Prolonged ICU stay, duration of ventilation and ECMO were found associated with development of nosocomial infection and only the duration of ECMO was an independent risk factor for nosocomial infections in ECMO patients. Conclusion: The correction of the underlying process leading to ECMO support and shortening the length of ECMO duration together with stricter application of ECMO indications would improve the infection incidence and hospital surveillance of the patient group.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Extracorporeal Membrane Oxygenation/adverse effects , Cross Infection/etiology , Extracorporeal Membrane Oxygenation/mortality , Extracorporeal Membrane Oxygenation/statistics & numerical data , Intensive Care Units, Pediatric , Cross Infection/microbiology , Cross Infection/prevention & control , Cross Infection/epidemiology , Epidemiologic Methods , Gram-Negative Bacterial Infections/classification , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/prevention & control , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacteria/isolation & purification
15.
An. acad. bras. ciênc ; 89(3): 1785-1799, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-886736

ABSTRACT

ABSTRACT The effect of the ethanolic extract of propolis (EEP) on Aeromonas hydrophila was analyzed by determination of minimum inhibitory concentration (MIC). Then, the effects of crude propolis powder (CPP) on growth, hemato-immune parameters of the Nile tilapia, as well as its effects on resistance to A. hydrophila challenge were investigated. The CPP (0.5, 1.0, 1.5, 2.0, 2.5 and 3.0%) was added to the diet of 280 Nile tilapia (50.0 ± 5.7 g fish-1). Hemato-immune parameters were analyzed before and after the bacterial challenge. Red blood cell, hematocrit, hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and hydrogen peroxide (H2O2) and nitric oxide (NO) were evaluated. The MIC of the EEP was 13% (v/v) with a bactericidal effect after 24 hours. Growth performance was significantly lower for those fish fed diets containing 2.5 and 3% of CPP compared to the control diet. Differences in CPP levels affected fish hemoglobin, neutrophils number and NO following the bacterial challenge. For others parameters no significant differences were observed. Our results show that although propolis has bactericidal properties in vitro, the addition of crude propolis powder to Nile tilapia extruded diets does not necessarily lead to an improvement of fish health.


Subject(s)
Animals , Propolis/administration & dosage , Gram-Negative Bacterial Infections/veterinary , Aeromonas hydrophila/drug effects , Cichlids/microbiology , Fish Diseases/diet therapy , Propolis/therapeutic use , Microbial Sensitivity Tests , Gram-Negative Bacterial Infections/diet therapy , Gram-Negative Bacterial Infections/microbiology , Dietary Supplements , Cichlids/blood , Fish Diseases/microbiology , Immunity, Innate
16.
Braz. j. infect. dis ; 21(4): 408-417, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-888893

ABSTRACT

Abstract Objective: In India, Elores (CSE-1034: ceftriaxone + sulbactam + disodium edetate) was approved as a broad spectrum antibiotic in year 2011 and is used for management of Extended Spectrum Beta Lactamases/Metallo Beta lactamases infections in tertiary care centers. The objective of this study was to investigate the efficacy of this drug in patients with Extended Spectrum Beta Lactamases/Metallo Beta lactamases infections and identify the incidence of adverse events in real clinical settings. Methods: This Post Marketing Surveillance study was conducted at 17 centers across India and included 2500 patients of all age groups suffering from various bacterial infections and treated with Elores (CSE1034). Information regarding demographic, clinical and microbiological parameters, dosage and treatment duration, efficacy and adverse events (AEs) associated with the treatment were recorded. Results: A total of 2500 patients were included in the study and efficacy was evaluated in 2487 patients. In total, 409 AEs were reported in 211 (8.4%) patients. The major AEs reported were vomiting (3.0%), pain at injection site (2.5%), nausea (2.3%), redness at site (1.96%), thrombophlebitis (1.4%). Of total reported AEs, 40 (5.3%) AEs were reported in pediatric, 310 (20.6%) in adult, and 59 (23.6%) in geriatric group. No AE belonging to grade IV or V was reported in any patient. In terms of efficacy, 1977 (79.4%) patients were cured, 501 (20.1%) patients showed clinical improvement and 5 (0.2%) patients were complete failure. The treatment duration varied from 5 to 7 days in different patients depending on the infection type. Conclusion: In this post-marketing surveillance study, CSE-1034 was found to be an effective and safe option against Pip tazo and meropenem in management of patients with multi-drug resistant (MDR) bacterial infections under routine ward settings.


Subject(s)
Humans , Child , Adult , Aged , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Ceftriaxone/administration & dosage , Ceftriaxone/adverse effects , Sulbactam/administration & dosage , Sulbactam/adverse effects , Gram-Positive Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Edetic Acid/administration & dosage , Edetic Acid/adverse effects , Drug Resistance, Bacterial , Drug Combinations , Disk Diffusion Antimicrobial Tests , Gram-Negative Bacteria/classification , Gram-Positive Bacteria/classification , India , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/chemistry
17.
Rev. chil. infectol ; 34(3): 235-242, jun. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-899706

ABSTRACT

Background: The most frequent osteoarticular infections (OAI) etiological agent is Staphylococcus aureus. The prevalence of other microorganisms has changed after the introduction of new vaccines. Aim: To describe the etiology and evolution of the OAIs in children hospitalized in Pediatric Hospital Pereira Rossell between 2009 and 2015. Patients and Methods: Joint fluid and bone puncture studies of hospitalized children suspected of OAI. Epidemiological characteristics, isolated microorganisms, complementary tests, initial treatment, complications, and days of hospitalization were analyzed. Results: 335 patients; the etiology was established in 113. Clinical data could be analyzed in 87 cases. The average age was 6.1 years. They corresponded to: methicillin-sensitive S. aureus (n: 47), community-acquired methicillin-resistant S. aureus (CA-MRSA) (n: 11), Streptococcus pyogenes (n: 6), Streptococcus pneumoniae (n: 1), Haemophilus influenzae type b (n: 2), Gram-negative bacilli (n: 9), Kingella kingae (n: 1) others (n: 6). In 4 cases, more than one microorganism was isolated. CA-MRSA infections were more serious. Discussion: A decrease is observed in the number of CA-MRSA isolates. A fact to be highlighted is the impact of universal vaccination against S. pneumoniae and H. influenzae type b. It is a finding to be monitored the increasing number of Gram-negative bacilli isolates.


Introducción: El agente etiológico más frecuente de las infecciones osteoarticulares (IOA) es Staphylococcus aureus. Luego de la introducción de nuevas vacunas la prevalencia de otros microorganismos ha cambiado. Objetivo: Describir la etiología y evolución de las IOA en niños internados en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell entre los años 2009 y 2015. Pacientes y Métodos: Se identificaron los cultivos de muestras de líquido articular y punción ósea de niños con sospecha de IOA. Se analizaron sus características epidemiológicas, microorganismos aislados, exámenes complementarios, tratamiento inicial, complicaciones y días de hospitalización. Resultados: Se estudiaron 335 pacientes, se aisló microorganismo en 113. Se analizó 87 casos. Edad media 6,1 años. Correspondieron a S. aureus sensible a meticilina (n: 47), S. aureus resistente a meticilina adquirido en la comunidad (SARM-AC) (n: 11), Streptococcus pyogenes (n: 6), Streptococcus pneumoniae (n: 1), Haemophilus influenzae tipo b (n: 2), bacilos gramnegativos (n: 9): Kingella kingae (n: 1), otros (n: 6). En 4 casos se aisló más de un microorganismo. Las infecciones por SARM-AC fueron más graves. Discusión: Se observa un descenso de aislados de SARM-AC. Se destaca el impacto de la vacunación universal contra S. pneumoniae y H. influenzae tipo b. Se debe vigilar el aumento de aislamiento de bacilos gramnegativos.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Osteomyelitis/microbiology , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Prognosis , Retrospective Studies , Hospitalization , Length of Stay
18.
Braz. j. infect. dis ; 21(3): 343-348, May-June 2017. tab
Article in English | LILACS | ID: biblio-1039193

ABSTRACT

ABSTRACT Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are important etiologic agents of nosocomial infection that are frequently resistant to broad-spectrum antimicrobial agents. Gram-negative ESKAPE pathogens were collected from hospitalized patients in 11 Latin American countries from 2013 to 2015 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) global surveillance program. In total, 2113 isolates from intra-abdominal infections (IAI) and 970 isolates from urinary tract infections (UTI) were tested against antimicrobial agents using standardized CLSI broth microdilution methodology. Of the agents tested, amikacin demonstrated the highest rates of susceptibility (%) for K. pneumoniae (92.2, 92.3), Enterobacter spp. (97.5, 92.1), and P. aeruginosa (85.3, 75.2) isolates from both IAI and UTI, respectively. Ertapenem (68.5, 62.6) and imipenem (79.2, 75.9) showed substantially higher rates of susceptibility (%) than other β-lactams, including piperacillin-tazobactam (35.9, 37.4) against ESBL-positive isolates of K. pneumoniae from IAI and UTI, respectively. Rates of susceptibility to all agents tested against A. baumannii were ≤30.9%. Gram-negative ESKAPE pathogens isolated from Latin America demonstrated compromised in vitro susceptibility to commonly prescribed broad-spectrum, parenteral antimicrobial agents. Continued surveillance is warranted. New antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are urgently needed.


Subject(s)
Humans , Urinary Tract Infections/microbiology , Cross Infection/microbiology , Gram-Negative Bacterial Infections/microbiology , Intraabdominal Infections/microbiology , Gram-Negative Bacteria/classification , Anti-Bacterial Agents/pharmacology , Microbial Sensitivity Tests , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacteria/drug effects , Latin America
19.
Braz. j. infect. dis ; 21(2): 171-175, Mar.-Apr. 2017. tab
Article in English | LILACS | ID: biblio-1039185

ABSTRACT

Abstract The purpose of this study was to identify the risk factors that predispose patients who are hospitalized with pressure ulcers (PUs) colonized by Gram-negative bacilli (GNB) to develop bacteremia. In addition, we also detected main phenotypes of resistance in infected and uninfected PUs. A prospective cohort study was conducted at the Clinical Hospital of the Federal University of Uberlândia including patients with Stage II or greater PUs, colonized or not with GNB, from August 2009 to July 2010. Infected ulcers were defined based on clinical signs and on positive evaluation of smears of wound material translated by a ratio of polymorphonuclear cells to epithelial cells ≥2:1, after Giemsa staining. A total of 60 patients with Stage II PUs were included. Of these 83.3% had PUs colonized and/or infected. The frequency of polymicrobial colonization was 74%. Enterobacteriaceae and GNB non-fermenting bacteria were the most frequent isolates of PUs with 44.0% of multiresistant isolates. Among patients who had infected PUs, six developed bacteremia by the same microorganism with a 100% mortality rate. In addition, PUs in hospitalized patients were major reservoir of multiresistant GNB, also a high-risk population for the development of bacteremia with high mortality rates.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Gram-Negative Bacterial Infections/microbiology , Bacteremia/microbiology , Pressure Ulcer/microbiology , Gram-Negative Bacteria/genetics , Phenotype , Severity of Illness Index , Disease Reservoirs/microbiology , Prospective Studies , Risk Factors
20.
Rev. Soc. Bras. Med. Trop ; 50(2): 243-247, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-1041402

ABSTRACT

Abstract INTRODUCTION: We compared the prevalence and antimicrobial susceptibility of non-fermenting gram-negative bacilli (NFGNB) isolated from clinical samples at a Brazilian tertiary care hospital in 2008 and 2013. METHODS: Collected data included patient's name, age, sex, inpatient unit, laboratory record number, type of biological material, culture test result, and antimicrobial susceptibility of isolated strains. RESULTS: Out of 19,112 culture tests analyzed, 926 (4.8%) were positive for NFGNB. Among these, 45.2% were metallo-beta-lactamase (MBL) producing strains. CONCLUSION: Between 2008 and 2013, the number of MBL-producing NFGNB isolates increased by 21.5%, which was accompanied by a consequent reduction in susceptibility to antimicrobials.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Gram-Negative Bacterial Infections/microbiology , Gram-Negative Bacteria/drug effects , Anti-Bacterial Agents/pharmacology , beta-Lactamases/biosynthesis , Microbial Sensitivity Tests , Prevalence , Tertiary Care Centers , Gram-Negative Bacteria/isolation & purification , Gram-Negative Bacteria/enzymology , Middle Aged
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