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1.
Rev. Soc. Bras. Med. Trop ; 53: e20180498, 2020. tab
Article in English | LILACS | ID: biblio-1057281

ABSTRACT

Abstract INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.


Subject(s)
Humans , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/microbiology , Cross Infection/microbiology , Pseudomonas aeruginosa/isolation & purification , Microbial Sensitivity Tests , Prevalence , Drug Resistance, Multiple, Bacterial , Intensive Care Units , Anti-Bacterial Agents/pharmacology
2.
Rev. chil. infectol ; 36(2): 180-189, abr. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1003666

ABSTRACT

Resumen Dentro de las infecciones nosocomiales más frecuentes asociadas a bacterias multi-resistentes y de peor pronóstico, se encuentran las producidas por Pseudomonas aeruginosa. Esta bacteria posee una alta capacidad de adaptación a condiciones adversas como por ejemplo el pH y la osmolaridad de la orina. Pseudomonas aeruginosa es uno de los principales patógenos implicados en infecciones nosocomiales y de pacientes inmunosuprimidos. Esta bacteria se considera un agente infeccioso oportunista que posee diversos mecanismos de patogenicidad, así como de resistencia a antimicrobianos, lo que contribuye a la dificultad en el tratamiento de estas infecciones. En la presente revisión bibliográfica se analizan la taxonomía, los mecanismos de patogenicidad y genes de resistencia de P. aeruginosa. Así también, se abordan los factores microambientales de la infección urinaria producida por esta bacteria, haciendo un acercamiento al entendimiento de las bases fisiopatológicas de esta infección.


Among the most frequent nosocomial infections associated with polyresistant bacteria and with a worse prognosis, are those produced by Pseudomonas aeruginosa. This bacterium has a high capacity to adapt to adverse conditions such as pH and osmolarity of urine. Pseudomonas aeruginosa is one of the main pathogens involved in nosocomial infections and immunosuppressed patients. This bacterium is considered an opportunistic infectious agent that has diverse mechanisms of pathogenicity, as well as resistance to antimicrobials, which contributes to the difficulty in the treatment of these infections. In the present bibliographic review, the taxonomy, pathogenicity mechanisms and resistance genes of P. aeruginosa are analyzed. Likewise, the micro-environmental factors of the urinary infection produced by this bacterium are approached, making an approach to the understanding of the pathophysiological bases of this infection.


Subject(s)
Humans , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/pathogenicity , Pseudomonas Infections/microbiology , Pseudomonas Infections/drug therapy , Urinary Tract Infections/microbiology , Drug Resistance, Bacterial/drug effects , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/drug effects , Urinary Tract Infections/drug therapy , Biofilms/drug effects , Virulence Factors
4.
Rev. Soc. Bras. Med. Trop ; 52: e20190237, 2019. tab, graf
Article in English | LILACS | ID: biblio-1020446

ABSTRACT

Abstract INTRODUCTION: The increased use of colistin against infections caused by Acinetobacter baumannii and Pseudomonas aeruginosa has resulted in colistin resistance. The purpose of this study was to detect plasmid-mediated mcr-1 gene in colistin-resistant A. baumannii and P. aeruginosa isolates. METHODS: A total of 146 clinical isolates of A. baumannii (n = 62) and P. aeruginosa (n = 84) were collected from the four largest tertiary care hospitals in Peshawar, Pakistan. All bacterial isolates were phenotypically screened for multidrug resistance using the Kirby-Baur disc diffusion method. The minimum inhibitory concentration (MIC) of colistin in all isolates was phenotypically performed using dilution methods. mcr-1 gene was detected through polymerase chain reaction and the nucleotide sequence of amplicon was determined using Sanger sequencing. RESULTS: Approximately 96.7% A. baumannii and 83.3% P. aeruginosa isolates were resistant to multiple antibiotics. Colistin resistance was found in 9.6% (6/62) of A. baumannii and 11.9% (10/84) of P. aeruginosa isolates. Among 16 colistin resistant isolates, the mcr-1 gene was detected in one A. baumannii (1.61% of total isolates; 16.6% of colistin resistant isolates) and one P. aeruginosa strain (1.19% of total isolates; 10% of colistin resistant isolates). Nucleotide BLAST showed 98-99% sequence similarity to sequences of the mcr-1 gene in GenBank. CONCLUSIONS: Our study reports, for the first time, the emergence of plasmid-mediated mcr-1-encoded colistin resistance in multidrug resistant strains of A. baumannii and P. aeruginosa. Further large scales studies are recommended to investigate the prevalence of this mode of resistance in these highly pathogenic bacteria.


Subject(s)
Humans , Pseudomonas aeruginosa/genetics , Pseudomonas Infections/microbiology , Bacterial Proteins/genetics , Acinetobacter Infections/microbiology , Acinetobacter baumannii/genetics , Pakistan , Plasmids/genetics , Pseudomonas aeruginosa , Microbial Sensitivity Tests , Drug Resistance, Bacterial , Acinetobacter baumannii/drug effects
5.
Med. infant ; 25(4): 299-302, diciembre 2018. tab
Article in Spanish | LILACS | ID: biblio-970392

ABSTRACT

Introducción. La bacteriemia por Pseudomonas aeruginosa (PAE) en niños es infrecuente. Objetivo.Describir las características epidemiológicas, clínicas, microbiológicas y evolutivas en niños con bacteriemia por PAE. Métodos. Estudio de cohorte retrospectivo. Resultados. Se incluyeron 100 pacientes (p). La mediana de edad fue de 27 meses (RIC 6-88).Tenían enfermedad de base: 93 p (93%) y 36 de ellos estaban neutropénicos. Ochenta y cinco p (85%) habían recibido antibióticos en el último mes, 60 (60%) tuvieron procedimientos invasivos previos y 81 (81%) tuvieron internaciones previas. Ingresaron con shock séptico 42 p (42%), 56 p (56%) fueron admitidos en unidad de cuidados intensivos (UCI) y 49 (49%) requirieron ventilación mecánica (VM). La bacteriemia fue primaria en 17 p (17%); asociada a catéter en 15 p (15%) y secundaria en 68 p (68%). El foco más frecuente fue mucocutáneo, 21 p, seguido por el pulmonar, 20 p. El tratamiento empírico fue adecuado en 84 p (84%). La resistencia a uno o más grupos de antibióticos se dio en el 38% de los casos, 11% fueron multirresistentes y 15% fueron resistentes sólo a carbapenemes. Fallecieron 31 p (31%). Pseudomonas aeruginosa resistente a carbapenemes en forma exclusiva o combinada con otros antibióticos se relacionó en esta serie a exposición previa a antibióticos, (p≤0,03), tratamiento empírico inicial inadecuado (p≤0,006) y mayor mortalidad (p≤0,01), prolongación de la internación y del tiempo de tratamiento (p≤0,001)


Introduction. Pseudomonas aeruginosa (PAE) associated bacteremia is uncommon in children. Objective. To describe the epidemiological, clinical, and microbiological features and outcome in children with PAE-associated bacteremia. Methods. A retrospective cohort study. Results. 100 patients (p) were included. Median age was 27 months (IQR 6-88). Overall 93 p (93%) had an underlying disease, 36 of whom had neutropenia. Eighty-five p (85%) had received antibiotics over the previous month, 60 (60%) had undergone previous invasive procedures, and 81 (81%) had been previously admitted. Forty-two p (42%) were admitted because of septic shock, 56 p (56%) were admitted to the intensive care unit (ICU), and 49 (49%) required mechanical ventilation (MV). Seventeen p (17%) had primary bacteremia, 15 p (15%) had catheter-related bacteremia, and 68 p (68%) had secondary bacteremia. The most common focus was mucocutaneous (21 p), followed by pulmonary (20 p). Emperical treatment was adequate in 84 p (84%). Resistance to one or more groups of antibiotics was observed in 38% of the cases; 11% were multiresistant and 15% were only resistant to carbapenems. Thirty-one p (31%) died. In our series, Pseudomonas aeruginosa resistant to carbapenems only or combined with other antibiotics was associated with previous exposition to antibiotics (p≤0.03), inadequate initial emperical treatment (p≤0.006), and higher mortality (p≤0.01), and longer hospital stay and treatment duration (p≤0.001)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Pseudomonas aeruginosa/isolation & purification , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/diagnosis , Pseudomonas Infections/microbiology , Pseudomonas Infections/epidemiology , Bacteremia/microbiology , Bacteremia/mortality , Drug Resistance, Multiple, Bacterial/drug effects , Carbapenems/pharmacology , Prospective Studies , Cohort Studies , Anti-Bacterial Agents/pharmacology
6.
Rev. Soc. Bras. Med. Trop ; 51(5): 610-615, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-957455

ABSTRACT

Abstract INTRODUCTION: Health care-associated infections caused by metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa are a significant growing concern in patients with burns worldwide. The aims of this study were to determine the antibiotic susceptibility of and detect the presence of MBLs among P. aeruginosa isolates and assess their clonal relationship using enterobacterial repetitive intergenic consensus (ERIC)-PCR. METHODS: Non-duplicated clinical isolates (160) of P. aeruginosa were collected from patients with burns at the Motahari Hospital in Tehran, Iran. All isolates were identified using standard laboratory methods and further characterized for antimicrobial susceptibility. Any carbapenem-resistant isolates were then examined for MBL production by the E-test and MBL-encoding genes were detected by PCR. The clonal relatedness of MBL-producing isolates was assessed by ERIC-PCR. RESULTS: For multidrug-resistant isolates, the highest rates of susceptibility were observed for colistin 160 (100%), polymyxin B 160 (100%), and ceftazidime 32 (20%). In total, 69 (43.7%) isolates were identified as MBL producers. Twenty-eight (17.5%) isolates were positive for the bla VIM-1 gene followed by the bla IMP-1 (15.6%) and bla SPM-1 (5.6%) genes. ERIC-PCR revealed three separate genotypes, where type A (76.8%) was the most prevalent, followed by B (20.3%), and then C (2.9%). CONCLUSIONS: Our present study found that the bla IMP-1 and bla VIM-1 genes were present at a significant frequency and also detected the bla SPM-1 gene in P. aeruginosa isolates for the first time, highlighting the need for establishing suitable infection control measures to successfully treat patients and prevent further spread of these resistant organisms among patients with burns.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/microbiology , beta-Lactamases/metabolism , Burns/microbiology , Anti-Bacterial Agents/pharmacology , Phenotype , Pseudomonas aeruginosa/enzymology , Microbial Sensitivity Tests , Cross-Sectional Studies , Drug Resistance, Multiple, Bacterial , Middle Aged
7.
Rev. Soc. Bras. Med. Trop ; 51(3): 270-276, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-957426

ABSTRACT

Abstract Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has been considered a major cause of infection and mortality in burn patients, especially in developing countries such as Iran. One of the most common mechanisms of carbapenem resistance is production of metallo-β-lactamases [(MBLs), including Verona Integron-encoded Metallo-beta-lactamase (VIM), imipenemase (IMP), São Paulo metalo-beta-lactamase (SPM), German imipenemase (GIM), New Delhi metallo-beta-lactamase (NDM), Dutch imipenemase (DIM), Adelaide imipenemase (AIM), Seoul imipenemase (SIM), KHM, Serratia metallo-β-lactamase (SMB), Tripoli metallo-β-lactamase (TMB), and Florence imipenemase (FIM)]. Limited information is available on the prevalence of CRPA and MBLs in Iranian burn units. We performed a systematic search by using different electronic databases, including Medline (via PubMed), Embase, Web of Science, and Iranian Database. Of 586 articles published from January 2000 to December 2016, 14 studies reporting the incidence of CRPA and MBLs as detected by molecular methods in burn patients were included in this review. The meta-analyses showed that the prevalence of CRPA, IMP, and VIM was 76.8% (95% CI 67.5-84.1), 13.1% (95% CI 4.7-31.5), and 21.4% (95% CI 14.6-30.1), respectively, in Iranian burn centers and remaining MBLs types have not yet been detected. There was a high prevalence of MBLs and CRPA in Iranian burn centers. Therefore, these measurements should be applied nationally and rigorous infection control measures and antimicrobial stewardship will be the major pillars to control multidrug resistant microorganisms, such as CRPA.


Subject(s)
Humans , Pseudomonas aeruginosa/genetics , Pseudomonas Infections/microbiology , Carbapenems , beta-Lactam Resistance/genetics , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/enzymology , Pseudomonas Infections/epidemiology , DNA, Bacterial/genetics , Microbial Sensitivity Tests , Prevalence , Iran
8.
Braz. j. infect. dis ; 22(2): 129-136, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-951633

ABSTRACT

ABSTRACT Introduction: Biofilm production is an important mechanism for the survival of Pseudomonas aeruginosa and its relationship with antimicrobial resistance represents a challenge for patient therapeutics. P. aeruginosa is an opportunistic pathogen frequently associated to nosocomial infections, especially in imunocompromised hosts. Objectives: Analyze the phenotypic biofilm production in P. aeruginosa isolates, describe clonal profiles, and analyze quorum sensing (QS) genes and the occurrence of mutations in the LasR protein of non-biofilm producing isolates. Methods: Isolates were tested for biofilm production by measuring cells adherence to the microtiter plates. Clonal profile analysis was carried out through ERIC-PCR, QS genes were by specific PCR. Results: The results showed that 77.5% of the isolates were considered biofilm producers. The results of genotyping showed 38 distinct genetic profiles. As for the occurrence of the genes, 100% of the isolates presented the lasR, rhlI and rhlR genes, and 97.5%, presented the lasI gene. In this study nine isolates were not biofilm producers. However, all presented the QS genes. Amplicons related to genes were sequenced in three of the nine non-biofilm-producing isolates (all presenting different genetic similarity profile) and aligned to the sequences of those genes in P. aeruginosa strain PAO1 (standard biofilm-producing strain). Alignment analysis showed an insertion of three nucleotides (T, C and G) causing the addition of an amino acid valine in the sequence of the LasR protein, in position 53. Conclusion: The modeling of the resulting LasR protein showed a conformational change in its structure, suggesting that this might be the reason why these isolates are unable to produce biofilm.


Subject(s)
Humans , Pseudomonas aeruginosa/physiology , Pseudomonas Infections/microbiology , Bacterial Proteins/genetics , Trans-Activators/genetics , Biofilms/growth & development , Biofilms/drug effects , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/chemistry , Pseudomonas Infections/drug therapy , Bacterial Proteins/chemistry , Trans-Activators/chemistry , Polymerase Chain Reaction/methods , Cross Infection , Drug Resistance, Multiple, Bacterial , Anti-Infective Agents/pharmacology , Anti-Bacterial Agents/pharmacology
9.
Rev. bras. ter. intensiva ; 29(3): 310-316, jul.-set. 2017. tab
Article in Portuguese | LILACS | ID: biblio-899522

ABSTRACT

RESUMO Objetivo: Avaliar fenotipicamente a produção de biofilme por isolados clínicos de Pseudomonas aeruginosa de pacientes com pneumonia associada à ventilação mecânica. Métodos: Foram analisados 20 isolados clínicos de P. aeruginosa, sendo 19 provenientes de amostras clínicas de aspirado traqueal e uma de lavado broncoalveolar. A avaliação da capacidade de P. aeruginosa em produzir biofilme foi verificada por duas técnicas, sendo uma qualitativa e outra quantitativa. Resultados: A técnica qualitativa mostrou que apenas 15% dos isolados foram considerados produtores de biofilme, enquanto que a quantitativa demonstrou que 75% dos isolados foram produtores de biofilme. Os isolados produtores de biofilme apresentaram o seguinte perfil de suscetibilidade: 53,3% eram multidroga-resistentes e 46,7% eram multidroga-sensíveis. Conclusão: A técnica quantitativa foi mais eficaz para detecção da produção de biofilme em comparação com a qualitativa. Para a população bacteriana analisada, a produção de biofilme independeu do perfil de suscetibilidade das bactérias, demonstrando que a falha terapêutica pode estar relacionada com a produção de biofilme, por impedir a destruição das bactérias presentes nesta estrutura, ocasionando complicações da pneumonia associada à ventilação mecânica, incluindo infecções extrapulmonares, e dificultando o tratamento da infecção.


ABSTRACT Objective: To phenotypically evaluate biofilm production by Pseudomonas aeruginosa clinically isolated from patients with ventilator-associated pneumonia. Methods: Twenty clinical isolates of P. aeruginosa were analyzed, 19 of which were from clinical samples of tracheal aspirate, and one was from a bronchoalveolar lavage sample. The evaluation of the capacity of P. aeruginosa to produce biofilm was verified using two techniques, one qualitative and the other quantitative. Results: The qualitative technique showed that only 15% of the isolates were considered biofilm producers, while the quantitative technique showed that 75% of the isolates were biofilm producers. The biofilm isolates presented the following susceptibility profile: 53.3% were multidrug-resistant, and 46.7% were multidrug-sensitive. Conclusion: The quantitative technique was more effective than the qualitative technique for the detection of biofilm production. For the bacterial population analyzed, biofilm production was independent of the susceptibility profile of the bacteria, demonstrating that the therapeutic failure could be related to biofilm production, as it prevented the destruction of the bacteria present in this structure, causing complications of pneumonia associated with mechanical ventilation, including extrapulmonary infections, and making it difficult to treat the infection.


Subject(s)
Humans , Pseudomonas aeruginosa/isolation & purification , Pseudomonas Infections/epidemiology , Biofilms , Pneumonia, Ventilator-Associated/microbiology , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/microbiology , Respiration, Artificial , Bronchoalveolar Lavage Fluid/microbiology , Microbial Sensitivity Tests , Anti-Bacterial Agents/pharmacology
11.
Braz. j. microbiol ; 48(2): 211-217, April.-June 2017. tab, graf
Article in English | LILACS | ID: biblio-839365

ABSTRACT

Abstract Pseudomonas aeruginosa is an opportunistic pathogen that causes frequently nosocomial infections, currently becoming more difficult to treat due to the various resistance mechanisms and different virulence factors. The purpose of this study was to determine the risk factors independently associated with the development of bacteremia by carbapenem-resistant P. aeruginosa, the frequency of virulence genes in metallo-β-lactamases producers and to evaluate their ability to produce biofilm. We conducted a case–control study in the Uberlândia Federal University – Hospital Clinic, Brazil. Polymerase Chain Reaction was performed for metallo-β-lactamases and virulence genes. Adhesion and biofilm assays were done by quantitative tests. Among the 157 strains analyzed, 73.9% were multidrug-resistant, 43.9% were resistant to carbapenems, 16.1% were phenotypically positive for metallo-β-lactamases, and of these, 10.7% were positive for blaSPM gene and 5.3% positive for blaVIM. The multivariable analysis showed that mechanical ventilation, enteral/nasogastric tubes, primary bacteremia with unknown focus, and inappropriate therapy were independent risk factors associated with bacteremia. All tested strains were characterized as strongly biofilm producers. A higher mortality was found among patients with bacteremia by carbapenem-resistant P. aeruginosa strains, associated independently with extrinsic risk factors, however it was not evident the association with the presence of virulence and metallo-β-lactamases genes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pseudomonas aeruginosa/genetics , Pseudomonas Infections/epidemiology , Bacterial Proteins/genetics , beta-Lactamases/genetics , Bacteremia/epidemiology , Biofilms/growth & development , beta-Lactam Resistance , Virulence Factors/genetics , Pseudomonas aeruginosa/isolation & purification , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/enzymology , Pseudomonas Infections/microbiology , Bacterial Proteins/analysis , beta-Lactamases/analysis , Brazil/epidemiology , Case-Control Studies , Survival Analysis , Polymerase Chain Reaction , Risk Factors , Bacteremia/microbiology
12.
Rev. cuba. oftalmol ; 30(1): 0-0, ene.-mar. 2017. ilus
Article in Spanish | LILACS | ID: biblio-901353

ABSTRACT

Se describe el caso de un paciente varón de 22 años, miope, sometido a vitrectomía pars plana 23 G en ojo único (valioso), por desprendimiento de retina regmatógeno. A las 24 horas presentó pérdida de visión, dolor, signos inflamatorios en globo y anejos oculares. Acudió al Servicio de Emergencias, donde se decidió su ingreso hospitalario para la toma de muestra y la aplicación de inyección intravítrea de vancomicina (1 mg/0,1 mL) y ceftazidima (2 mg/0,1 mL), con lo que mostró mejoría clínica. El estudio microbiológico reportó Pseudomona aeruginosa sensible a la ceftazidima y a la ciprofloxacina. La mejor visualización fundoscópica al quinto día posintravítrea permitió observar depósitos blanquecinos en la interfaz aceite de silicona-retina, y se decidió la extracción de aceite por incisiones mixtas 23 g y 20 g (infusión, endoiluminación y extracción respectivamente), lavado de cámara anterior, cámara vítrea, reposición de aceite de silicón y segunda dosis de ceftazidima, con evolución posoperatoria favorable. Se dio el alta una semana después, con la retina aplicada y una mejor visión corregida de 0,1(AU)


This is the report about a male 22 years-old myopic patient who underwent a pars plana 23 G vitrectomy in one eye (valuable) due to regmatogen retinal detachment. Twenty four hours after the surgery, he presented with vision loss, pain, eye bulb inflammation and ocular adnexa. He went to the emergency service where it was decided to admitted him to the hospital for sample taking and application of intravitreal injection of vancomycin (1 mg/0,1 mL) and ceftazidime (2 mg/0,1 mL) which brought about clinical improvement. The microbiological test reported the presence of ceftazidime and ciprofloxacine-susceptible Pseudomona aeruginosa. The fundus oculi performed five days after vitrectomy allowed observing whitish deports in the silicon oil/retina interface, so it was decided to remove the oil by making mixed incisions of 23 and 20 g (infusion, endoilumination and extraction, respectively), washing the anterior chamber, the vitreal chamber, returning the silicon oil and a second dosage of ceftazidime, all of which caused favorable postoperative progress. One week later, he was discharged from the hospital with replaced retina and better corrected vision of 0.1(AU)


Subject(s)
Humans , Male , Adult , Endophthalmitis/drug therapy , Intravitreal Injections/methods , Pseudomonas Infections/microbiology , Vancomycin/therapeutic use , Vitrectomy/adverse effects
13.
Rev. Soc. Bras. Med. Trop ; 50(1): 135-137, Jan.-Feb. 2017.
Article in English | LILACS | ID: biblio-842816

ABSTRACT

Abstract: Metallo-beta-lactamase production is an important mechanism for carbapenem resistance of Pseudomonas aeruginosa , which represents an emerging public health challenge. We report the case of a patient admitted to an intensive care unit, with sepsis caused by multidrug-resistant São Paulo Metallo-beta-lactamase-1-producing P. aeruginosa . This is the first case of infection by this pathogenic strain in the State of Mato Grosso do Sul, Brazil. Thus, infection control measures are required for preventing future spread and outbreaks.


Subject(s)
Humans , Male , Pseudomonas aeruginosa/enzymology , Pseudomonas Infections/microbiology , beta-Lactamases/biosynthesis , Cross Infection/microbiology , beta-Lactam Resistance , Pseudomonas aeruginosa/isolation & purification , Brazil , Fatal Outcome , Middle Aged
14.
Braz. j. microbiol ; 47(4): 925-930, Oct.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-828207

ABSTRACT

Abstract The aim of this study was to examine mutations in the quinolone-resistance-determining region (QRDR) of gyrA and parC genes in Pseudomonas aeruginosa isolates. A total of 100 clinical P. aeruginosa isolates were collected from different university-affiliated hospitals in Tabriz, Iran. Minimum inhibitory concentrations (MICs) of ciprofloxacin and levofloxacin were evaluated by agar dilution assay. DNA sequences of the QRDR of gyrA and parC were determined by the dideoxy chain termination method. Of the total 100 isolates, 64 were resistant to ciprofloxacin. No amino acid alterations were detected in gyrA or parC genes of the ciprofloxacin susceptible or ciprofloxacin intermediate isolates. Thr-83 → Ile substitution in gyrA was found in all 64 ciprofloxacin resistant isolates. Forty-four (68.75%) of them had additional substitution in parC. A correlation was found between the number of the amino acid alterations in the QRDR of gyrA and parC and the level of ciprofloxacin and levofloxacin resistance of the P. aeruginosa isolates. Ala-88 → Pro alteration in parC was generally found in high level ciprofloxacin resistant isolates, which were suggested to be responsible for fluoroquinolone resistance. These findings showed that in P. aeruginosa, gyrA was the primary target for fluoroquinolone and additional mutation in parC led to highly resistant isolates.


Subject(s)
Humans , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , Pseudomonas Infections/microbiology , Pseudomonas Infections/epidemiology , Fluoroquinolones/pharmacology , DNA Gyrase/genetics , DNA Topoisomerase IV/genetics , Drug Resistance, Bacterial , Mutation , Pseudomonas aeruginosa/isolation & purification , Microbial Sensitivity Tests , Sequence Analysis, DNA , Iran/epidemiology , Anti-Bacterial Agents/pharmacology
15.
An. bras. dermatol ; 91(6): 815-816, Nov.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-837971

ABSTRACT

Abstract Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Furthermore, because of its similar clinical presentation, cutaneous anthrax must be ruled out.


Subject(s)
Humans , Female , Child, Preschool , Pseudomonas Infections/microbiology , Skin Ulcer/microbiology , Ecthyma/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Pseudomonas aeruginosa , Pseudomonas Infections/pathology , Skin Ulcer/pathology , Ecthyma/pathology
16.
Mem. Inst. Oswaldo Cruz ; 111(9): 551-558, Sept. 2016. tab, graf
Article in English | LILACS | ID: lil-794722

ABSTRACT

Carbapenem-resistance mechanisms are a challenge in the treatment of Pseudomonas aeruginosa infections. We investigated changes in P. aeruginosa carbapenem-resistance determinants over a time period of eight years after the emergence of São Paulo metallo-β-lactamase in a university hospital in Rio de Janeiro, Brazil. Patients admitted to the intensive care unit (ICU) were screened for P. aeruginosa colonisation and followed for the occurrence of infections from April 2007 to April 2008. The ICU environment was also sampled. Isolates were typed using random amplified polymorphic DNA, pulsed-field gel electrophoresis and multilocus sequence typing. Antimicrobial susceptibility was determined by disk diffusion and E-test, production of carbapenemases by a modified-CarbaNP test and presence of carbapenemase-encoding genes by polymerase chain reaction. Non-carbapenemase resistance mechanisms studied included efflux and AmpC overexpression by PAβN and cloxacillin susceptibility enhancement, respectively, as well as oprD mutations. From 472 P. aeruginosa clinical isolates (93 patients) and 17 isolates from the ICU environment, high genotypic diversity and several international clones were observed; one environment isolate belonged to the blaSPM-1 P. aeruginosa epidemic genotype. Among isolates from infections, 10 (29%) were carbapenem resistant: none produced carbapenemases, three exhibited all non-carbapenemase mechanisms studied, six presented a combination of two mechanisms, and one exclusively displayed oprD mutations. Carbapenem-resistant P. aeruginosa displayed a polyclonal profile after the SPM-1 epidemic genotype declined. This phenomenon is connected with blaSPM-1 P. aeruginosa replaced by other carbapenem-resistant pathogens.


Subject(s)
Humans , beta-Lactam Resistance/genetics , beta-Lactamases/biosynthesis , Carbapenems/pharmacology , Pseudomonas aeruginosa/enzymology , Pseudomonas Infections/microbiology , Anti-Bacterial Agents/pharmacology , beta-Lactam Resistance/drug effects , Disk Diffusion Antimicrobial Tests , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Genotype , Hospitals, University , Intensive Care Units , Multilocus Sequence Typing , Polymerase Chain Reaction , Prospective Studies , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics
17.
Rev. Soc. Bras. Med. Trop ; 49(3): 305-311, tab, graf
Article in English | LILACS | ID: lil-785790

ABSTRACT

Abstract: INTRODUCTION: The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. Given the lack of information regarding the dynamics of multidrug resistance in northern Brazil, we analyzed the clinical and microbiological features of nosocomial infections caused by P. aeruginosa. METHODS Between January 2010 and March 2012, we conducted a retrospective cohort study of P. aeruginosa isolates from 54 patients who were hospitalized in intensive care units. The clinical and epidemiologic variables were analyzed, including the patients' demographic data and comorbidities, and the lengths of the intensive care unit stays, the classification of the infections as nosocomial, the use of invasive procedures, antimicrobial therapy, and the patients' outcomes. We undertook susceptibility tests, molecular detection of the metallo-β-lactamase genes, and genotypic analyses of the isolates using the repetitive element-polymerase chain reaction. RESULTS: Multidrug resistance occurred most frequently among isolates from adults who had been hospitalized for an average of 87.1 days. The use of mechanical ventilation and urinary catheters were risk factors for infection. The four isolates that harbored the blaSPM-1-like gene showed >95% genetic similarity. CONCLUSIONS This study's findings show that P. aeruginosa has a high death rate, and that inadequate treatment and invasive procedures are risk factors for infection. This is the first report describing the detection of the blaSPM-1-like gene in northern Brazil. These results highlight the need for better monitoring and a greater understanding of nosocomial infections and their public health impacts.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Pseudomonas aeruginosa/enzymology , Pseudomonas Infections/microbiology , beta-Lactamases/genetics , Cross Infection/microbiology , Anti-Bacterial Agents/pharmacology , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , Brazil , Microbial Sensitivity Tests , Polymerase Chain Reaction , Retrospective Studies , Cohort Studies , Drug Resistance, Multiple , Genotype , Intensive Care Units , Middle Aged
18.
Acta cir. bras ; 31(3): 206-211, Mar. 2016. tab, graf
Article in English | LILACS | ID: lil-777090

ABSTRACT

ABSTRACT PURPOSE: To determine the genetic diversity of MDR P. aeruginosa strains isolated from burn and wound infections in Ahvaz, Iran, by ERIC-PCR. METHODS: From total 99 strains of P. aeruginosa defined as MDR by using drug susceptibility testing, 66 were subjected to ERIC-PCR analysis, comprises 53 strains isolated from burn infection, and 13 randomly selected strains from wound infection with higher resistance to combinations of more numbers of drugs. RESULTS: Eight clusters (I to VIII), and 50 single clones were generated for tested MDR isolates analyzed by ERIC-PCR. The high heterogeneity was observed among the isolates from burn infections including 16 isolates which were categorized in eight clusters and 37 single clones. The isolates in clusters II, III, VI, VIII showed 100% similarity. CONCLUSIONS: The high level of genotypic heterogeneity in P. aeruginosa strains demonstrated no genetic correlation between them. Extremely high drug resistance in isolates from burn, suggests that efficient control measures and proper antibiotic policy should be observed.


Subject(s)
Humans , Pseudomonas aeruginosa/genetics , Pseudomonas Infections/microbiology , Wound Infection/microbiology , Burns/microbiology , DNA, Bacterial/genetics , Drug Resistance, Multiple, Bacterial/genetics , Pseudomonas aeruginosa/isolation & purification , Repetitive Sequences, Nucleic Acid/genetics , Polymerase Chain Reaction , Genotype
20.
J. pediatr. (Rio J.) ; 91(5): 435-441, Sept.-Oct. 2015. tab
Article in English | LILACS | ID: lil-766176

ABSTRACT

ABSTRACT OBJECTIVE: This study aimed at evaluating the predictors and outcomes associated with multidrug-resistant gram-negative bacterial (MDR-GNB) infections in an oncology pediatric intensive care unit (PICU). METHODS: Data were collected relating to all episodes of GNB infection that occurred in a PICU between January of 2009 and December of 2012. GNB infections were divided into two groups for comparison: (1) infections attributed to MDR-GNB and (2) infections attributed to non-MDR-GNB. Variables of interest included age, gender, presence of solid tumor or hematologic disease, cancer status, central venous catheter use, previous Pseudomonas aeruginosa infection, healthcare-associated infection, neutropenia in the preceding 7 days, duration of neutropenia, length of hospital stay before ICU admission, length of ICU stay, and the use of any of the following in the previous 30 days: antimicrobial agents, corticosteroids, chemotherapy, or radiation therapy. Other variables included initial appropriate antimicrobial treatment, definitive inadequate antimicrobial treatment, duration of appropriate antibiotic use, time to initiate adequate antibiotic therapy, and the 7- and 30-day mortality. RESULTS: Multivariate logistic regression analyses showed significant relationships between MDR-GNB and hematologic diseases (odds ratio [OR] 5.262; 95% confidence interval [95% CI] 1.282-21.594; p = 0.021) and healthcare-associated infection (OR 18.360; 95% CI 1.778-189.560; p = 0.015). There were significant differences between MDR-GNB and non-MDR-GNB patients for the following variables: inadequate initial empirical antibiotic therapy, time to initiate adequate antibiotic treatment, and inappropriate antibiotic therapy. CONCLUSIONS: Hematologic malignancy and healthcare-associated infection were significantly associated with MDR-GNB infection in this sample of pediatric oncology patients.


RESUMO OBJETIVO: Este estudo visou a avaliar os preditores e resultados associados às infecções por bactérias gram-negativas multirresistentes (BGN-MR) em uma unidade de terapia intensiva pediátrica oncológica (UTIP). MÉTODOS: Foram coletados dados com relação a todos os episódios de infecção por BGN que ocorreram em uma UTIP entre janeiro de 2009 e dezembro de 2012. As infecções por BGN foram divididas em dois grupos para comparação: 1) infecções atribuídas a BGN-MR e 2) infecções atribuídas a BGN não multirresistente. As variáveis de interesse incluíram idade, sexo, presença de tumor sólido ou malignidade hematológica, câncer, uso de cateter venoso central, infecção anterior por Pseudomonas aeruginosa, infecção hospitalar, neutropenia nos sete dias anteriores, duração da neutropenia, tempo de internação antes da UTI, duração da internação na UTI e uso de quaisquer dos seguintes nos 30 dias anteriores: agentes antimicrobianos, corticosteroides, quimioterapia ou radioterapia. Outras variáveis incluíram: tratamento antimicrobiano inicial adequado, tratamento antimicrobiano definitivo inadequado, duração do uso de antibióticos adequados, tempo de início da terapia antibiótica adequada, mortalidade em sete dias e mortalidade em 30 dias. RESULTADOS: As análises de regressão logística multivariada mostraram relações significativas entre as BGN-MR e as doenças hematológicas (razão de chance (RC) 5,262; intervalo de confiança de 95% (IC de 95%) 1,282-21,594; p = 0,021) e infecções hospitalares (RC 18,360; IC de 95% 1,778-189,560; p = 0,015). Houve diferenças significativas entre os pacientes com BGN-MR e BGN não MR com relação às seguintes variáveis: recebimento de terapia antibiótica empírica inicial inadequada, tempo para início do tratamento antibiótico adequado e recebimento de terapia antibiótica inadequada. CONCLUSÕES: A malignidade hematológica e a infecção hospitalar foram significativamente associadas à infecção por BGN-MR nessa amostra de pacientes pediátricos oncológicos.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/drug effects , Gram-Negative Bacterial Infections/microbiology , Hematologic Neoplasms/microbiology , Pseudomonas Infections/microbiology , Acinetobacter Infections/microbiology , Acinetobacter baumannii/isolation & purification , Anti-Bacterial Agents/therapeutic use , Case-Control Studies , Cross Infection/drug therapy , Cross Infection/mortality , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/mortality , Hematologic Neoplasms/drug therapy , Hematologic Neoplasms/mortality , Intensive Care Units, Pediatric/statistics & numerical data , Length of Stay/statistics & numerical data , Pseudomonas aeruginosa/isolation & purification , Risk Factors , Treatment Outcome
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