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


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.

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
An. bras. dermatol ; 95(3): 298-306, May-June 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130892


Abstract Background: The increasingly frequent use of dermoscopy makes us think about the possibility of transfer of microorganisms, through the dermatoscope, between doctor and patients. Objectives: To identify the most frequent gram-positive cocci in dermatoscopes and smartphone adapters, as well as the resistance profile, and to evaluate the factors associated with a higher risk of bacterial contamination of the dermatoscopes. Methods: A cross-sectional study was carried out with 118 dermatologists from Porto Alegre/Brazil between September 2017 and July 2018. Gram-positive cocci were identified by MALDI-TOF MS and habits of use of the dermatoscope were evaluated through an anonymous questionnaire. Results: Of the dermatoscopes analysed, 46.6% had growth of gram-positive cocci on the lens and 37.3% on the on/off button. The microorganisms most frequently found were S. epidermidis, S. hominis and S. warneri. Attending a hospital, using the dermatoscope at the hospital, with inpatients and in the intensive care unit were significantly associated with colonisation by gram-positive cocci. The highest resistance rates were observed for penicillin, erythromycin and sulfamethoxazole-trimethoprim. Study limitations: The non-search of gram-negative bacilli, fungi and viruses. Moreover, the small number of adapters did not make it possible to better define if the frequency differences were statistically significant. Conclusion: Coagulase-negative staphylococci were frequently identified. S. aureus was detected only on the lens.

Humans , Male , Female , Adult , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Cocci/isolation & purification , Dermoscopy/instrumentation , Smartphone , Dermatologists/statistics & numerical data , Brazil/epidemiology , Microbial Sensitivity Tests , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Cocci/growth & development , Gram-Positive Cocci/drug effects , Sex Distribution , Age Distribution , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Drug Resistance, Bacterial , Middle Aged , Anti-Bacterial Agents/pharmacology
Braz. j. otorhinolaryngol. (Impr.) ; 86(3): 281-286, May-June 2020. tab
Article in English | LILACS | ID: biblio-1132589


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.

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
Rev. Col. Bras. Cir ; 47: e20202471, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136576


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.

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
Rev. pediatr. electrón ; 16(2): 3-7, ago. 2019.
Article in Spanish | LILACS | ID: biblio-1021327


Los pacientes inmunocomprometidos presentan un riesgo aumentado de colonización e infecciones por microorganismos multirresistentes (MOR), entre ellos Enterococcus spp resistentes a vancomicina (ERV) y bacterias productoras de betalactamasas de espectro extendido (BLEE), las cuales son causa importante de morbimortalidad. OBJETIVO: Describir la prevalencia de MOR en Servicio de Oncología del Hospital Roberto del Río. MÉTODO: Se realizó un estudio descriptivo retrospectivo de los niños hospitalizados en el servicio de oncología desde enero a diciembre del 2016 a los cuales se les realizó vigilancia de portación de ERV y BLEE. RESULTADOS: De los 97 pacientes hospitalizados, se identificó un 8% de portación de ERV, un 13,7% de BLEE y un 6,8% presentó portación de ambos microorganismos. DISCUSIÓN: Entre enero 2012 a diciembre del 2013 se observó en nuestro centro que un 52% de los pacientes hospitalizados en oncología estaban colonizados por ERV, la disminución significativa de la portación podría deberse a la mejor adherencia de normas de prevención de infecciones asociadas a la atención en salud (IAAS), programa de uso racional de antimicrobianos y a la nueva infraestructura del servicio.

The inmunosupressed patients are at increased risk of colonization and infection with vancomycin resistant Enterococci (VRE) and extended- spectrum b-lactamase producing Enterobacteriaceae (ESBL), which can cause substantial morbidity and mortality. OBJECTIVE: Describe the prevalence of VRE and ESBL in the Oncology Unit of Roberto del Río Hospital. METHODS: Descriptive and retrospective study of hospitalized children since January to December 2016 in the Oncology Unit, that underwent VRE and ESBL colonization surveillance. RESULTS: From the 97 hospitalized patients, there were 8% of VRE colonization, 13.7% of ESBL and 6.8% of colonization from both microorganism. DISCUSSION: Between January 2012 and December 2013, we observed that 52% of hospitalized patients in the Oncology Unit were colonized by VRE. The significant decrease in colonization may be due to better fulfillment of healthcare-associated infections (HAI) normative, antibiotics stewardship and new infraestructure of our unit.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , beta-Lactamases/metabolism , Cross Infection/epidemiology , Gram-Positive Bacterial Infections/epidemiology , Vancomycin-Resistant Enterococci/enzymology , Cross Infection/microbiology , Cross Infection/prevention & control , Prevalence , Retrospective Studies , Oncology Service, Hospital , Infection Control , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/prevention & control , Hospitals, Pediatric
Medwave ; 19(8): e7694, 2019.
Article in English, Spanish | LILACS | ID: biblio-1021435


INTRODUCCIÓN Las infecciones por Enterococcus sp resistente a la vancomicina se han diseminado y generan un desafío clínico-terapéutico en los pacientes hospitalizados. La amenaza de que la infección por enterococos intratables y la posibilidad que la resistencia a la vancomicina pueda propagarse a neumococos o estafilococos, abogan por la vigilancia atenta de las cepas resistentes. OBJETIVO Determinar los factores de riesgos asociados a la portación de Enterococcus sp resistente a la vancomicina en pacientes pediátricos ingresados en una unidad de cuidados intensivos pediátricos del Paraguay en el periodo entre enero de 2012 y junio de 2013. MÉTODOS Estudio transversal. Se analizaron las historias clínicas previas de 140 pacientes ingresados a terapia intensiva (niños de un mes a 18 años), a quienes se realizaron cultivos de hisopado rectal dentro de las 48 horas del ingreso, para determinar los factores asociados a la portación de Enterococcus sp resistente a la vancomicina en unidad de cuidados intensivos pediátricos. Se calculó el Odd ratio con sus intervalos de confianza y p < 0,05 para las variables de estudio. Posteriormente, se realizó regresión logística múltiple para las variables estadísticamente significativas. RESULTADOS La portación de Enterococcus sp resistente a la vancomicina se observó en 18,6% de los pacientes. Se identificaron como factores asociados: la hospitalización previa durante el último año (Odds ratio: 10,8; intervalo de confianza 95%: 2,43 a 47,8; p = 0,001), uso previo de antibióticos de amplio espectro (Odds ratio: 5,05; intervalo de confianza 95%: 2,04 a 12,5; p = 0,000), uso de dos o más antibióticos de amplio espectro en el último año (Odds ratio: 5,4; intervalo de confianza 95%: 1,5 a 18,4; p = 0,009), internación previa en área de alto riesgo (Odds ratio: 4,91; intervalo de confianza 95%: 1,83 a 13,2; p = 0,000), internación por igual o mayor a seis días en área de alto riesgo (Odds ratio: 5,64; intervalo de confianza 95%: 2,18 a 14,6; p = 0,000) y uso de inmunosupresores (Odds ratio: 4,84; intervalo de confianza 95%: 1,92 a 11,9; p = 0,001). La regresión múltiple señala a la utilización de dos o más antibióticos de amplio espectro (Odds ratio: 4,81; intervalo de confianza 95%: 1,01 a 22,8; p = 0,047) y a la historia de hospitalización previa dentro del año (Odds ratio: 7,84; intervalo de confianza 95%: 1,24 a 49,32; p = 0,028) como factores independientes asociados estadísticamente con la portación de Enterococcus sp resistente a la vancomicina. CONCLUSIÓN Los pacientes pediátricos ingresados en la unidad de cuidados intensivos con historia de internación previa dentro del año y la exposición a dos o más antibióticos de amplio espectro, tienen mayor riesgo de colonización por el enterococo resistente a vancomicina.

INTRODUCTION Vancomycin-resistant enterococcus (VRE) infections have become widespread and a challenge in hospitalized patients. The threat of infection by intractable enterococci and the possibility that vancomycin resistance could involve pneumococci or staphylococci advocate for careful surveillance of resistant strains. OBJECTIVE To determine the risk factors associated with VRE colonization in pediatric patients admitted to the Pediatric Intensive Care Unit (PICU) in the period between January 2012 and June 2013. METHODS We conducted a cross-sectional study analyzing the clinical histories of 140 patients admitted to the PICU (children from 1 month to 18 years), who underwent rectal swab cultures within 48 hours of admission. We calculated the odds ratios and confidence intervals of the risk factors for VRE colonization in the PICU, and then we used multiple logistic regression for the statistically significant variables. RESULTS VRE colonization was present in 18.6% of patients. The following were identified as risk factors associated to VRE colonization: hospitalization during the previous year (odds ratio: 10.8, 95% confidence interval: 2.43 to 47.8; p = 0.001), prior use of one broad-spectrum antibiotic (odds ratio: 5.05; 95% confidence interval: 2.04 to 12.5; p = 0.000), use of two or more broad-spectrum antibiotics in the last year (odds ratio: 5.4, 95% confidence interval: 1.5 to 18.4; p = 0.009), prior hospitalization in the risk area (odds ratio: 4.91, 95% confidence interval: 1.83 to 13.2; p = 0.000), hospitalization for more than five days in high-risk area (odds ratio: 5.64, 95% confidence interval: 2.18 to 14.6; p = 0.000), and use of immunosuppressant drugs (odds ratio: 4.84, 95% confidence interval: 1.92 to 11.9; p = 0.001). In a logistic multiple regression the use of two or more broad-spectrum antibiotics (odds ratio: 4.81, 95% confidence interval: 1.01 to 22.8; p = 0.047) and the history of prior hospitalization in the last year (odds ratio: 7.84, 95% confidence interval: 1.24 to 49.32, p = 0.028) were identified as independent factors statistically associated with VRE colonization. CONCLUSION Pediatric patients admitted to the Intensive Care Unit with a history of prior hospitalization in the previous year, and exposure to two or more broad-spectrum antibiotics have a greater risk of colonization by vancomycin-resistant enterococcus.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Intensive Care Units, Pediatric , Gram-Positive Bacterial Infections/epidemiology , Vancomycin-Resistant Enterococci/isolation & purification , Anti-Bacterial Agents/administration & dosage , Paraguay/epidemiology , Cross-Sectional Studies , Risk Factors , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/drug therapy , Hospitalization , Anti-Bacterial Agents/pharmacology
Rev. Soc. Bras. Med. Trop ; 52: e20190081, 2019. graf
Article in English | LILACS | ID: biblio-1013301


Abstract Eggerthella lenta is a gram-positive anaerobic bacillus that has been associated with life-threatening infections. Bacteremia is always clinically significant and is mostly but not always associated with gastrointestinal disease. We present a unique case of abrupt deterioration and rapid development of septic shock secondary to periurethral abscess caused by E. lenta infection. This case highlights the atypical clinical presentation, risk factors, uncommon source of infection, challenges in therapy, and outcome of this infrequent infection. There is still a gap in the understanding of E. lenta pathogenicity, and more literature is needed to establish clear management recommendations.

Humans , Male , Urethral Diseases/diagnostic imaging , Bacteremia/microbiology , Actinobacteria/isolation & purification , Abscess/diagnostic imaging , Urethral Diseases/drug therapy , Tomography, X-Ray Computed , Risk Factors , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Actinobacteria/classification , Pelvic Infection/diagnosis , Pelvic Infection/microbiology , Abscess/microbiology , Abscess/drug therapy , Middle Aged , Anti-Bacterial Agents/therapeutic use
Rev. Soc. Bras. Med. Trop ; 52: e20190205, 2019. tab, graf
Article in English | LILACS | ID: biblio-1020444


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.

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
Int. j. odontostomatol. (Print) ; 12(4): 355-361, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-975757


RESUMEN: El objetivo del estudio fue determinar el efecto antibacteriano in vitro de la oleorresina de Copaifera reticulata (C. reticulata) "copaiba" y del aceite esencial de Oreganum majoricum (O. majoricum) "orégano" frente a Streptococcus mutans (S. mutans) y Enterococcus faecalis (E. faecalis). Se desarrollaron pruebas de sensibilidad activando primero las cepas bacterias a enfrentar. La oleorresina de copaiba fue diluida con dimetilsulfósido (DMSO), obteniéndose al final concentraciones a probar de 100 %, 50 %, 25 %, y 12,5 %. En relación al aceite esencial de orégano este se probó solamente al 100 %. Para la prueba de difusión en agar con discos, se tomaron inóculos 100 µL de cada cepa bacteriana a una turbidez de 0,5 de Mc Farlam, para ser sembrados por diseminación en placas de tripticasa soya agar, para luego colocar los discos de forma equidistante cargados con las diferentes concentraciones de los productos naturales, se utilizaron como control positivo a la clorhexidina al 0,12 % y al DMSO como control negativo. Se incubaron las placas por el método de la vela en extinción a 37 °C, por un periodo de 24 horas, pasado el tiempo se realizó la lectura de los halos de inhibición. Los resultados obtenidos por la copaiba, determinaron un efecto antibacteriano en sus cuatro concentraciones, siendo los mayores halos de inhibición a la concentración del 100 %, copaiba genero mayores halos promedios para S, mutans de 30,00 ± 0,00 mm y para E. faecalis de 8,3 ± 0,50 mm. Para el caso del orégano se producen halos a la concentración del 100 % con un promedio de 25,3 ± 0,96 mm para S. mutans y para E. faecalis de 9,5 ± 1,29 mm. Se concluye del estudio que tanto copaiba como el orégano presentan un efecto antibacteriano para ambas bacterias, siendo su mayor efecto antibacteriano para ambos productos naturales sobre S. mutans.

ABSTRACT: The objective of the study was to determine the in vitro antibacterial effect of the oleoresin of Copaifera reticulata (C. reticulata) "copaiba" and of the essential oil of Oreganum majoricum (O. majoricum) "oregano" against Streptococcus mutans (S. mutans) and Enterococcus faecalis (E. faecalis). Sensitivity tests were developed by first activating the bacteria strains to be confronted. The oleoresin of copaiba was diluted with dimethylsulphoside (DMSO), obtaining final concentrations to be tested of 100 %, 50 %, 25 %, and 12.5 %. In relation to the essential oil of oregano, it was only 100 % tested. For the disk agar diffusion test, 100 mL of each bacterial strain was taken at a turbidity of 0.5 of Mc Farlam, to be planted by dissecting trypticase soy agar plates, and then placing the disks equidistantly loaded with the different concentrations of natural products; 0.12 % chlorhexidine was used as a positive control and DMSO as negative control. The plates were incubated by the candle method in extinction at 37 °C, for a period of 24 hours, after which time the inhibition halos were read. The results obtained by the copaiba, determined an antibacterial effect in its four concentrations, being the biggest halos of inhibition at the concentration of 100 %, copaiba genus higher average halos for S. mutans of 30.00 ± 0.00 mm and for E. faecalis of 8.3 ± 0.50 mm. In the case of oregano, haloes are produced at a concentration of 100 % with an average of 25.3 ± 0.96 mm for S. mutans and for E. faecalis 9.5 ± 1.29 mm. It is concluded from the study that both copaiba and oregano present an antibacterial effect for both bacteria, being its greater antibacterial effect for both natural products on S. mutans.

Humans , Streptococcus mutans/physiology , Plant Extracts/pharmacology , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/pathology , Enterococcus faecalis/pathogenicity , Origanum/chemistry , Peru , Streptococcus mutans/immunology , In Vitro Techniques , Oils, Volatile/analysis , Epidemiology, Experimental , Anti-Bacterial Agents
Braz. j. otorhinolaryngol. (Impr.) ; 84(5): 532-539, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974360


Abstract Introduction: Peritonsillar abscess is the most common deep neck infection. The infectious microorganism may be different according to clinical factors. Objective: To identify the major causative pathogen of peritonsillar abscess and investigate the relationship between the causative pathogen, host clinical factors, and hospitalization duration. Methods: This retrospective study included 415 hospitalized patients diagnosed with peritonsillar abscess who were admitted to a tertiary medical center from June 1990 to June 2013. We collected data by chart review and analyzed variables such as demographic characteristics, underlying systemic disease, smoking, alcoholism, betel nut chewing, bacteriology, and hospitalization duration. Results: A total of 168 patients had positive results for pathogen isolation. Streptococcus viridans (28.57%) and Klebsiella pneumoniae (23.21%) were the most common microorganisms identified through pus culturing. The isolation rate of anaerobes increased to 49.35% in the recent 6 years (p = 0.048). Common anaerobes were Prevotella and Fusobacterium spp. The identification of K. pneumoniae increased among elderly patients (age > 65 years) with an odds ratio (OR) of 2.76 (p = 0.03), and decreased in the hot season (mean temperature > 26 °C) (OR = 0.49, p = 0.04). No specific microorganism was associated with prolonged hospital stay. Conclusion: The most common pathogen identified through pus culturing was S. viridans, followed by K. pneumoniae. The identification of anaerobes was shown to increase in recent years. The antibiotics initially selected should be effective against both aerobes and anaerobes. Bacterial identification may be associated with host clinical factors and environmental factors.

Resumo Introdução: O Abscesso Peritonsilar é a infecção cervical profunda mais comum. O microrganismo infeccioso pode ser diferente de acordo com os fatores clínicos. Objetivo: Identificar o principal agente causador do abscesso peritonsilar e investigar a relação entre o patógeno causador, os fatores clínicos do hospedeiro e a duração da hospitalização. Método: Este estudo retrospectivo incluiu 415 pacientes hospitalizados diagnosticados com abscesso peritonsilar que foram internados em um centro médico terciário de junho de 1990 a junho de 2013. Coletamos dados através da análise dos arquivos médicos dos pacientes e analisamos variáveis como características demográficas, doença sistêmica subjacente, tabagismo, alcoolismo, hábito de mascar noz de betel, bacteriologia e duração da hospitalização. Resultados: Um total de 168 pacientes apresentaram resultados positivos para isolamento de patógenos. Streptococcus viridans (28,57%) e Klebsiella pneumoniae (23,21%) foram os microrganismos mais comuns identificados pela cultura da secreção. A taxa de isolamento de anaeróbios aumentou para 49,35% nos últimos 6 anos (p = 0,048). Os anaeróbios comuns foram Prevotella e Fusobacterium spp. A identificação de K. pneumoniae aumentou em pacientes idosos (idade > 65 anos) com razão de chances (Odds Ratio - OR) de 2,76 (p = 0,03) e diminuiu na estação do calor (temperatura média > 26 °C) (OR = 0,49, p = 0,04). Nenhum microrganismo específico foi associado à hospitalização prolongada. Conclusão: O patógeno mais comumente identificado através da cultura de secreção foi S. viridans, seguido por K. pneumoniae. A identificação de anaeróbios mostrou ter aumentado nos últimos anos. Os antibióticos selecionados inicialmente devem ser efetivos contra aeróbios e anaeróbios. A identificação bacteriana pode estar associada a fatores clínicos e fatores ambientais do hospedeiro.

Humans , Adolescent , Adult , Middle Aged , Young Adult , Peritonsillar Abscess/microbiology , Gram-Positive Bacterial Infections/microbiology , Fusobacterium necrophorum/isolation & purification , Gram-Positive Bacteria/isolation & purification , Klebsiella Infections , Peritonsillar Abscess/diagnosis , Peritonsillar Abscess/therapy , Retrospective Studies , Risk Factors , Gram-Positive Bacterial Infections/therapy , Prevotella , Viridans Streptococci/isolation & purification , Fusobacterium Infections/microbiology , Klebsiella pneumoniae/isolation & purification , Anti-Bacterial Agents/therapeutic use
Rev. Ciênc. Méd. Biol. (Impr.) ; 17(1): 78-83, jul.17,2018.
Article in Portuguese | LILACS | ID: biblio-909998


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

Humans , Periodontal Diseases/microbiology , Gram-Positive Bacterial Infections/microbiology , Gram-Negative Bacterial Infections/microbiology , Periodontal Diseases/diagnosis , Periodontal Diseases/therapy
Int. j. odontostomatol. (Print) ; 12(1): 113-119, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-893310


ABSTRACT: Molecular techniques that provide valuable information about the epidemiology of oral strains. The purpose of this study was to determine the genetic relatedness of 83 Enterococcus faecalis strains isolated from treated root canals. These strains were obtained from patients who were treated for persistent endodontic infections. E. faecalis isolates were molecular typed by Pulsed Field Gel Electrophoresis using Smal. Ten clonal groups and 13 pulse types with 38.7 % similarity for the less related strains were identified. Genetic heterogeneity among strains from different patients and a high level of genetic homogeneity among intrapatient strains were observed. Therefore, restriction endonuclease fingerprinting of genomic DNA from E. faecalis strains confirmed the polyclonality of the isolates obtained from the root canals of patients diagnosed with persistent endodontic infections, compared with other reports. These results provide additional data for a better understanding of the epidemiological aspects of root canal infections by E. faecalis.

RESUMEN: Las técnicas moleculares proporcionan información valiosa sobre la epidemiología de aislados orales. El propósito de este estudio fue determinar la relación genética de 83 cepas de Enterococcus faecalis aisladas de conductos radiculares tratados. Estas cepas se obtuvieron de pacientes que fueron tratados por infecciones endodónticas persistentes. Los aislados de E. faecalis se tipificaron molecularmente por electroforesis en gel de campo pulsado usando Smal. Se identificaron diez grupos clonales y 13 pulsotipos con un 38,7 % de similitud para las cepas menos relacionadas. Se observó heterogeneidad genética entre las cepas de diferentes pacientes y un alto nivel de homogeneidad genética entre las cepas intrapacientes. Por lo tanto, la toma de huellas dactilares a traves de restricción de ADN genómico de cepas de E. faecalis confirmó la policlonalidad de los aislados obtenidos de los conductos radiculares de pacientes diagnosticados con infecciones endodónticas persistentes, en comparación con otros informes. Estos resultados proporcionan datos adicionales para una mejor comprensión de los aspectos epidemiológicos de las infecciones del conducto radicular por E. faecalis.

Humans , Periapical Periodontitis/microbiology , Enterococcus faecalis/isolation & purification , Tooth Apex/microbiology , DNA, Bacterial/analysis , Bacterial Typing Techniques , Gram-Positive Bacterial Infections/microbiology , Electrophoresis, Gel, Pulsed-Field , Dental Pulp Cavity/microbiology
Braz. j. microbiol ; 48(4): 782-784, Oct.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-1039266


ABSTRACT Rapid identification of vancomycin-resistant enterococci (VRE) can assist in choosing the appropriate treatment and preventing VRE spread. The performance of chromIDTM VRE agar was evaluated using 184 clinical isolates of Enterococcus spp. and reference strains. The test had a sensitivity of 95.52% but a low specificity of 30%.

Humans , Bacteriological Techniques/methods , Gram-Positive Bacterial Infections/microbiology , Culture Media/chemistry , Vancomycin-Resistant Enterococci/growth & development , Vancomycin-Resistant Enterococci/drug effects , Microbial Sensitivity Tests , Bacteriological Techniques/instrumentation , Culture Media/metabolism , Feces/microbiology , Vancomycin-Resistant Enterococci/metabolism
Braz. j. infect. dis ; 21(6): 656-659, Nov.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-1039207


ABSTRACT Vancomycin-resistant Enterococcus faecium (VREfm) has emerged as an important global nosocomial pathogen, and this trend is associated with the spread of high-risk clones. Here, we determined the genetic and phenotypic features of 93 VREfm isolates that were obtained from patients in 13 hospitals in Vitória, Espírito Santo, Brazil, during 2012-2013. All the isolates were vancomycin-resistant and harbored the vanA gene. Only 6 (6.5%) of the VREfm isolates showed the ability to form biofilm. The 93 isolates analyzed belong to a single pulsed-field gel electrophoresis lineage and presented six subtypes. MLST genotyping showed that all VREfm belonged to ST412 (the high-risk clone, hospital-adapted). The present study describes the dissemination of ST412 clone in the local hospitals. The clonal spread of these ST412 isolates in the area we analyzed as well as other hospitals in southeastern Brazil supports the importance of identifying and controlling the presence of these microorganisms in health care-related services.

Humans , Cross Infection/microbiology , Gram-Positive Bacterial Infections/microbiology , Enterococcus faecium/genetics , Vancomycin-Resistant Enterococci/genetics , Bacterial Proteins , Brazil , Microbial Sensitivity Tests , Bacterial Typing Techniques , Enterococcus faecium/drug effects , Electrophoresis, Gel, Pulsed-Field , Multilocus Sequence Typing , Vancomycin-Resistant Enterococci/drug effects , Anti-Bacterial Agents/pharmacology
Braz. j. infect. dis ; 21(4): 408-417, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-888893


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.

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
Braz. j. microbiol ; 48(3): 489-492, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-889140


Abstract The aim of this study was to determine the association between Clostridium difficile (C. difficile) and vancomycin-resistant Enterococcus (VRE) and efficacy of screening stools submitted for C. difficile toxin assay for prevalence of VRE. Between April 2012 and February 2014, 158 stool samples submitted for C. difficile toxin to the Marmara University Microbiology Laboratory, were included in the study. Stool samples were analyzed by enzyme immuno assay test; VIDAS (bioMerieux, France) for Toxin A&B. Samples were inoculated on chromID VRE (bioMerieux, France) and incubated 24 h at 37 °C. Manuel tests and API20 STREP (bioMerieux, France) test were used to identify the Enterococci species. After the species identification, vancomycin and teicoplanin MIC's were performed by E test and molecular resistance genes for vanA vs vanB were detected by polymerase chain reaction (PCR). Of the 158 stool samples, 88 were toxin positive. The prevalence of VRE was 17%(n:19) in toxin positives however, 11.4% in toxin negatives(n:70). All VRE isolates were identified as Enterococcus faecium. These results were evaluated according to Fischer's exact chi-square test and p value between VRE colonization and C. difficile toxin positivity was detected 0.047 (p < 0.05). PPV and NPV were 79% and 47% respectively. In our study, the presence of VRE in C. difficile toxin positives is statistically significant compared with toxin negatives (p < 0.05). Screening for VRE is both additional cost and work load for the laboratories. Therefore VRE screening among C. difficile toxin positive samples, will be cost effective for determination of high risk patients in the hospitals especially for developing countries.

Humans , Bacterial Toxins/analysis , Clostridioides difficile/metabolism , Clostridium Infections/microbiology , Vancomycin Resistance , Feces/microbiology , Vancomycin-Resistant Enterococci/isolation & purification , Bacterial Toxins/metabolism , Vancomycin/pharmacology , Microbial Sensitivity Tests , Clostridioides difficile/isolation & purification , Clostridioides difficile/drug effects , Clostridioides difficile/genetics , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Clostridium Infections/diagnosis , Vancomycin-Resistant Enterococci/classification , Vancomycin-Resistant Enterococci/drug effects , Vancomycin-Resistant Enterococci/genetics , Anti-Bacterial Agents/pharmacology
Rev. chil. infectol ; 34(3): 235-242, jun. 2017. graf, tab
Article in Spanish | LILACS | ID: biblio-899706


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.

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
Braz. j. microbiol ; 47(3): 691-696, July-Sept. 2016. tab
Article in English | LILACS | ID: lil-788958


ABSTRACT This study highlights the prevalence of aminoglycoside-modifying enzyme genes and virulence determinants among clinical enterococci with high-level aminoglycoside resistance in Inner Mongolia, China. Screening for high-level aminoglycoside resistance against 117 enterococcal clinical isolates was performed using the agar-screening method. Out of the 117 enterococcal isolates, 46 were selected for further detection and determination of the distribution of aminoglycoside-modifying enzyme-encoding genes and virulence determinants using polymerase chain reaction -based methods. Enterococcus faecium and Enterococcus faecalis were identified as the species of greatest clinical importance. The aac(6')-Ie-aph(2")-Ia and ant(6')-Ia genes were found to be the most common aminoglycoside-modifying enzyme genes among high-level gentamicin resistance and high-level streptomycin resistance isolates, respectively. Moreover, gelE was the most common virulence gene among high-level aminoglycoside resistance isolates. Compared to Enterococcus faecium, Enterococcus faecalis harbored multiple virulence determinants. The results further indicated no correlation between aminoglycoside-modifying enzyme gene profiles and the distribution of virulence genes among the enterococcal isolates with high-level gentamicin resistance or high-level streptomycin resistance evaluated in our study.

Male , Female , Gene Expression Regulation, Bacterial/drug effects , Gene Expression Regulation, Enzymologic/drug effects , Enterococcus/drug effects , Enterococcus/physiology , Drug Resistance, Bacterial , Aminoglycosides/metabolism , Aminoglycosides/pharmacology , Virulence/genetics , Microbial Sensitivity Tests , China/epidemiology , Prevalence , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/epidemiology , Enterococcus/metabolism , Genes, Bacterial , Anti-Bacterial Agents/metabolism
Clinics ; 71(5): 271-275, May 2016. tab, graf
Article in English | LILACS | ID: lil-782841


OBJECTIVES: Delay in the treatment of pleural infection may contribute to its high mortality. In this retrospective study, we aimed to evaluate the diagnostic accuracy of pleural adenosine deaminase in discrimination between Gram-negative and Gram-positive bacterial infections of the pleural space prior to selecting antibiotics. METHODS: A total of 76 patients were enrolled and grouped into subgroups according to Gram staining: 1) patients with Gram-negative bacterial infections, aged 53.2±18.6 years old, of whom 44.7% had empyemas and 2) patients with Gram-positive bacterial infections, aged 53.5±21.5 years old, of whom 63.1% had empyemas. The pleural effusion was sampled by thoracocentesis and then sent for adenosine deaminase testing, biochemical testing and microbiological culture. The Mann-Whitney U test was used to examine the differences in adenosine deaminase levels between the groups. Correlations between adenosine deaminase and specified variables were also quantified using Spearman’s correlation coefficient. Moreover, receiver operator characteristic analysis was performed to evaluate the diagnostic accuracy of pleural effusion adenosine deaminase. RESULTS: Mean pleural adenosine deaminase levels differed significantly between Gram-negative and Gram-positive bacterial infections of the pleural space (191.8±32.1 U/L vs 81.0±16.9 U/L, p<0.01). The area under the receiver operator characteristic curve was 0.689 (95% confidence interval: 0.570, 0.792, p<0.01) at the cutoff value of 86 U/L. Additionally, pleural adenosine deaminase had a sensitivity of 63.2% (46.0-78.2%); a specificity of 73.7% (56.9-86.6%); positive and negative likelihood ratios of 2.18 and 0.50, respectively; and positive and negative predictive values of 70.6% and 66.7%, respectively. CONCLUSIONS: Pleural effusion adenosine deaminase is a helpful alternative biomarker for early and quick discrimination of Gram-negative from Gram-positive bacterial infections of the pleural space, which is useful for the selection of antibiotics.

Humans , Male , Female , Adult , Middle Aged , Aged , Adenosine Deaminase/analysis , Clinical Enzyme Tests , Gram-Negative Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/diagnosis , Pleural Effusion/enzymology , Biomarkers/analysis , Diagnosis, Differential , Gram-Negative Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/microbiology , Pleural Effusion/microbiology , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity