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1.
Femina ; 49(6): 373-378, 20210630. graf
Article in Portuguese | LILACS | ID: biblio-1290582

ABSTRACT

Objetivo: O presente estudo tem como objetivo avaliar o perfil de sensibilidade antimicrobiana do patógeno mais comum causador da infecção do trato urinário (ITU) de gestantes que foram internadas em um hospital de ensino do município de São Paulo em determinado período. Métodos: Estudo retrospectivo, transversal, quantitativo, realizado avaliando as uroculturas positivas e o perfil de sensibilidade antimicrobiana dos agentes mais comuns encontrados em ITUs das gestantes de hospital e maternidade-escola do município de São Paulo de janeiro de 2019 até janeiro de 2020. Resultados: A partir da análise de uroculturas positivas e antibiograma de 149 gestantes admitidas com quadro de infecção urinária no referido hospital no intervalo de tempo analisado, constatou-se que 83,89% dos casos apresentaram como patógeno a bactéria Escherichia coli. No âmbito da resistência bacteriana, percebeu-se que o maior índice foi encontrado no que tange a cefalotina (65%), ampicilina (58%) e ampicilina/sulbactam (45%). Ademais, a partir das análises individuais, 20 pacientes, ou seja, aproximadamente 13,42% apresentaram cepas sensíveis a todas as medicações apontadas, e as demais apresentaram resistência a, pelo menos, uma delas. Conclusão: A partir da premissa de eficácia desempenhada pelo protocolo de medicação empírica estabelecido pela instituição no tocante ao tratamento de infecção do trato urinário em gestantes, a cefalotina certamente não deveria compor o rol de drogas ofertadas às pacientes. Isso se dá, pois a sensibilidade apresentada pela Escherichia coli, patógeno que mais comumente está associado aos quadros de ITU do serviço, a essa droga é muito baixa. Já a nitrofurantoína apresentou um satisfatório espectro de cobertura, sendo a resistência à droga inferior a 10%. Com isso, conclui-se que ela deve permanecer como droga inicial para as ITUs das gestantes que chegam a essa instituição.(AU)


Objective: The present study aims to evaluate the antimicrobial sensitivity profile of the most common pathogen that causes urinary tract infection (ITU) in pregnant women who were admitted to a Teaching Hospital in the city of São Paulo in a specific period. Methods: Retrospective, cross-sectional, quantitative study carried out evaluating positive urine cultures and the antimicrobial sensitivity profile of the most common agents found in ITU of pregnant women at Teaching Maternity hospital in the city of São Paulo from January 2019 to January 2020. Results: From the of positive urine culture and antibiogram of 149 pregnant women admitted with a urinary tract infection in the referred hospital in the analyzed period of time, it was found that 83.89% of the cases presented the bacterium Escherichia coli as a pathogen. In the scope of bacterial resistance, it was noticed that the highest index was found with respect to Cephalothin (65%), ampicillin (58%) and ampicillin/sulbactam (45%). Furthermore, from the individual analyzes, 20 patients, that is, approximately 13.42% had strains sensitive to all the medications indicated, with the others showing resistance to at least one of them. Conclusion: Based on the premise of efficacy performed by the empirical medication protocol established by the institution regarding the treatment of urinary tract infection in pregnant women, Cephalothin should certainly not be included in the list of drugs offered to patients. This happens because the sensitivity presented by Escherichia coli, the most commonly pathogen associated with the UTI pathogen of the service, to this drug is very low. Nitrofurantoin, on the other hand, presented a satisfactory coverage spectrum, with drug resistance below 10%. Thus, it is concluded that this should remain as an initial drug for ITUs of pregnant women who arrive at this institution.(AU)


Subject(s)
Humans , Female , Pregnancy , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiology , Urinary Tract Infections/drug therapy , Drug Resistance, Microbial/drug effects , Pregnancy Complications/microbiology , Brazil/epidemiology , Cross-Sectional Studies
2.
Einstein (Säo Paulo) ; 18: eRC5063, 2020. graf
Article in English | LILACS | ID: biblio-1039731

ABSTRACT

ABSTRACT A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.


RESUMO Homem de 65 anos com história de trauma do sistema urinário, sendo necessário cistotomia e sondagem vesical crônica, apresentando alterações crônicas e não investigadas da cor do sistema coletor de urina, sem alteração da cor da urina, e urocultura positiva para Proteus mirabilis . Tais características remetem à síndrome do saco coletor de urina roxo, uma entidade pouco conhecida, de curso benigno na maioria da vezes, associada à infecção urinária em paciente com cateterismo vesical de demora. Embora seja caracterizada por alterações marcantes, é subdiagnosticada pelos profissionais de saúde.


Subject(s)
Humans , Male , Aged , Urinary Tract Infections/microbiology , Urinary Reservoirs, Continent/adverse effects , Catheter-Related Infections/microbiology , Proteus mirabilis/isolation & purification , Syndrome , Urinary Tract Infections/pathology , Urine/microbiology , Risk Factors , Catheter-Related Infections/pathology
3.
Rev. Soc. Bras. Med. Trop ; 53: e20190429, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057306

ABSTRACT

Abstract INTRODUCTION: Nosocomial and community acquired urinary tract infections (UTIs) are one of the most encountered infections in the world. METHODS: This study aimed to determine the antibiotic susceptibility, phylogeny, and virulence genes of 153 Escherichia coli strains isolated from UTIs. Antimicrobial susceptibility of the isolates to different classes of antimicrobials was determined by the VITEK-2 automated system. Presence of virulence genes and phylogenetic groups were investigated by PCR. RESULTS: Regarding susceptibility to antimicrobials, ampicillin resistance was most abundant (67.3%), followed by amoxicillin-clavulanic acid (50.9%); least abundant was resistance to amikacin (1.3%) and nitrofurantoin (1.3%). Multi drug resistance (MDR) was observed in 34.6% of the isolates, and all isolates were found to be susceptible to imipenem, meropenem and fosfomycine. The majority of the isolates belonged to the phylogenetic group B23 (35.9%), followed by A1 (20.9%), D1 (18.9%), D2 (12.4%), A0 (%5.9), B1 (3.9%) and B2 (1.9%). Among E. coli strains examined, 49% had iucD, 32.7% papE-F, 26.1% papC, 15% cnf2, 11.1% sfa, 7.8% cnf1, 1.3% afaE, 1.3% afaD, 1.3% hlyA, 0.7% f17a-A, 0.7% clpG and 0.7% eaeA genes. CONCLUSIONS Our research demonstrated that virulence factors were distributed among different phylogroup/subgroups, which play a role in UTIs pathogenesis in humans. For this reason, complex and detailed studies are required to determine the relationship between virulence factors and specific E. coli strains that cause UTIs in humans.


Subject(s)
Humans , Urinary Tract Infections/microbiology , Virulence Factors/genetics , Escherichia coli/drug effects , Escherichia coli/genetics , Escherichia coli Infections/microbiology , Anti-Bacterial Agents/pharmacology , Phylogeny , RNA, Ribosomal, 16S , Microbial Sensitivity Tests , Polymerase Chain Reaction , Escherichia coli/isolation & purification , Genotype
4.
Rev. Inst. Nac. Hig ; 50(1-2): 4-13, Diciembre 2019. Tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1118292

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Urinary Tract Infections/microbiology , Urinary Tract Infections/drug therapy , Drug Resistance, Bacterial , Escherichia coli/isolation & purification , Anti-Bacterial Agents/therapeutic use , Phenotype , Cross-Sectional Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Escherichia coli/drug effects , Escherichia coli/genetics , Anti-Bacterial Agents/pharmacology
5.
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
6.
Rev. Soc. Bras. Med. Trop ; 52: e20180499, 2019. tab
Article in English | LILACS | ID: biblio-1013306

ABSTRACT

Abstract INTRODUCTION : Escherichia coli ranks among the most common sources of urinary tract infections (UTI). METHODS: Between November 2015 and August 2016, 90 isolates of E. coli were isolated from patients at Rize Education and Research Hospital in Turkey. Antibiotic susceptibility was determined for all isolates using the Kirby-Bauer disk diffusion method. These E. coli isolates were also screened for virulence genes, β-lactamase coding genes, quinolone resistance genes, and class 1 integrons by PCR. RESULTS: With respect to the antibiotic resistance profile, imipenem and meropenem were effective against 98% and 90% of isolates, respectively. A high percentage of the isolates showed resistance against β lactam/β lactamase inhibitor combinations, quinolones, and cephalosporins. PCR results revealed that 63% (57/90) of the strains carried class 1 integrons. In addition, a high predominance of extended-spectrum β-lactamases (ESBLs) was observed. The qnrA, qnrB, and qnrS genes were found in 24 (26.6%), 6 (6.6%), and 3 (3.3%), isolates, respectively. The most common virulence gene was fim (82.2%).The afa, hly, and cnf1 genes were detected in 16.6%, 16.6%, and 3.3% of isolates, respectively. Moreover, we observed eleven different virulence patterns in the 90 E. coli isolates. The most prevalent pattern was fım, while hly-fım, afa-aer-cnf-fım, aer-cnf, afa-aer, and afa-cnf-fım patterns were less common. CONCLUSIONS: Most of the E. coli virulence genes investigated in this study were observed in E. coli isolates from UTI patients. Virulence genes are very important for the establishment and maintenance of infection.


Subject(s)
Humans , Male , Female , Urinary Tract Infections/drug therapy , Drug Resistance, Multiple, Bacterial , Virulence Factors/genetics , Escherichia coli/genetics , Escherichia coli/pathogenicity , Escherichia coli Infections/genetics , Escherichia coli Infections/drug therapy , Anti-Bacterial Agents/pharmacology , Turkey , Urinary Tract Infections/microbiology , beta-Lactamases , Microbial Sensitivity Tests , Quinolones , Escherichia coli/isolation & purification
7.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 16(3): 44-50, dic. 2018. ilus, tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1007742

ABSTRACT

Las infecciones del tracto urinario (ITU) en niños con vejiga neurogénica, pueden producir alteraciones tanto morfológicas como funcionales, y desencadenan una respuesta inmune que no siempre es evidente. Las ITU son una de las principales causas de morbilidad y mortalidad. Resulta de suma importancia un correcto diagnóstico de las mismas, para un buen tratamiento y así evitar las complicaciones y secuelas que puedan ocasionar. El objeto del trabajo fue analizar la prevalencia y la etiología de las ITU en pacientes con vejiga neurogénica, y su patrón de resistencia. En un estudio descriptivo, retrospectivo se incluyeron 46 muestras de orina para cultivo de niños de 1 a 18 años, de ambos sexos, con vejiga neurogénica, que fueron procesadas en un laboratorio de microbiología. De 46 urocultivos, 19 correspondieron a varones (19/46) 41% y 27 a niñas (27/46) 59%, los niños tenían una edad promedio de 11(2. De estos 21 resultaron positivos (21/46) 46%, aislando en mayor proporción E. coli. La frecuencia de ITU en niños con vejiga neurogénica fue de 21/46, 46%, siendo el porcentaje en este tipo de pacientes mucho más elevado que en niños que no presentan dicha anomalía. Los uropatógenos aislados con mayor frecuencia fueron E coli y K pneumoniae. El uso de sondas y pañales, así como la mala higiene predisponen a estas infecciones. En este estudio se vio buena sensibilidad a la nitrofurantoina y cefixima(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Urinary Tract Infections/microbiology , Urinary Bladder, Neurogenic/microbiology , Drug Resistance, Bacterial , Enterobacteriaceae/drug effects , Anti-Bacterial Agents/therapeutic use , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology , Urinary Bladder, Neurogenic/drug therapy , Microbial Sensitivity Tests , Prevalence , Retrospective Studies , Risk Factors , Disabled Children
8.
Acta bioquím. clín. latinoam ; 52(4): 423-428, dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-1001066

ABSTRACT

Distintos autores difieren en la mayor o menor prevalencia de las infecciones urinarias (IU) por Streptococcus agalactiae y Staphylococcus saprophyticus en mujeres embarazadas (ME) y no embarazadas (NE). Se realizó un estudio retrospectivo, comparativo, de cohortes con el objetivo de evaluar la frecuencia de IU por S. agalactiae y S. saprophyticus en ME asintomáticas pertenecientes a centros de atención primaria de la salud del Municipio de La Plata (CAPS) entre 2008 y 2016 y se la comparó con la de NE sintomáticas en edad fértil, no internadas, que asistieron al Hospital "San Roque" (HSR) entre 2014 y 2017. Se procesaron 2.378 orinas de ME que concurrieron a las CAPS. De ese total, 201 fueron positivas (8,5%), el 10,4% de las mismas (n: 21) correspondieron a S. agalactiae y el 10,0% a S. saprophyticus (n: 20). En el 54% se aisló Escherichia coli. El total de urocultivos en la población de NE fue de 2.281 y 526 fueron positivos (23,1%): 7 correspondieron a S. agalactiae (1,3%), 18 a S. saprophyticus (3,4%) y el 78% a E. coli. En conclusión, la frecuencia de aislamiento de S. agalactiae y S. saprophyticus fue significativamente mayor en la población de ME pertenecientes a las CAPS respecto de las NE estudiadas en el HSR.


Several authors differ in the greater or lesser prevalence of urinary tract infections (UTI) due to Streptococcus agalactiae and Staphylococcus saprophyticus in pregnant women (PW) and non-pregnant women (NPW). A retrospective, comparative, cohort study was carried out with the objective of evaluating the frequency of UTI by S. agalactiae and S. saprophyticus in asymptomatic PW from primary care centers of the Municipality of La Plata (PCC) between 2008 and 2016 and comparing it with symptomatic NPW in a fertile age, not hospitalized women, who attended the "San Roque" Hospital (HSR) between 2014 and 2017. A total of 2,378 urine samples from PW assisted at the PCC were processed. Two hundred and one were positive (8.5%); 10.4% of them (n: 21) corresponded to S. agalactiae and 10.0% to S. saprophyticus (n: 20). Escherichia coli was isolated in 54%. The total of urine cultures in the population of NPW of the HSR was 2,281 and 526 were positive (23.1%): 7 corresponded to S. agalactiae (1.3%), 18 to S.saprophyticus (3.4%) and 78% to E. coli. In conclusion, the frequency of isolation of S. agalactiae and S. saprophyticus was significantly higher in the population of PW belonging to the PCC than in the NPW studied in the HSR.


Diferentes autores diferem na maior ou menor prevalência das infecções do trato urinário (ITU) devido a Streptococcus agalactiae e Staphylococcus saprophyticus em mulheres grávidas (MG) e mulheres não grávidas (NG). Realizou-se um estudo retrospectivo e comparativo de coortes com o objetivo de avaliar a frequência de ITU por S.agalactiae e S.saprophyticus em MGs assintomáticas pertencentes a salas de atendimento primário do município de La Plata (CAPS) entre 2008 e 2016 e compará-lo com NG sintomáticas em idade fértil, não hospitalizadas, que frequentaram o Hospital "San Roque" (HSR) entre 2014 e 2017. Foram processadas 2.378 amostras de urina de MG atendidas nas CAPS. Desse total, 201 foram positivos (8,5%), 10,4% das mesmas (n: 21) corresponderam a S. agalactiae e 10,0% a S. saprophyticus (n: 20). Escherichia coli foi isolada em 54%. As culturas de urina total na população de NG foram de 2.281 e 526 foram positivas (23.1%): 7 correspondem a S.agalactiae (1.3%), 18 a S.saprophyticus (3.4%) e 78% para E. coli. Em conclusão, a frequência de isolamento de S. agalactiae e S. saprophyticus foi significativamente maior na população de MG pertencente às CAPS do que as NG estudadas no HSR.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Pregnancy Complications, Infectious/microbiology , Staphylococcal Infections/diagnosis , Streptococcal Infections/diagnosis , Streptococcus agalactiae , Urinary Tract Infections/microbiology , Staphylococcus saprophyticus , Prevalence , Retrospective Studies
10.
Braz. j. microbiol ; 49(1): 152-161, Jan.-Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-889202

ABSTRACT

ABSTRACT The present investigation was designed to study the effect of an active compound isolated from Justicia wynaadensis against multi drug resistant organisms (MDRO's) associated with diabetic patients. The drug resistant pathogens implicated in wound and urinary tract infection of diabetic patients were isolated and identified by molecular sequencing. Solvent-solvent fractionation of crude methanol extract produced hexane, chloroform, ethyl acetate and methanol-water fraction, among which chloroform fraction was found to be potent when compared with other three fractions. Further, chloroform fraction was subjected to preparatory HPLC (High-Performance Liquid Chromatography), that produced four sub-fractions; chloroform HPLC fraction 1 (CHF1) through CHF4. Among the sub-fractions, CHF1 inhibited the pathogens effectively in comparison to other three sub-fractions. The purity of CHF1 was found to be >95%. Therefore, CHF1 was further characterized by NMR and FTIR analysis and based on the structure elucidated, the compound was found to be 3,3',4'-Trihydroxyflavone. The effective dose of this bioactive compound ranged from 32 µg/mL to 1.2 mg/mL. Thus, the present study shows that 3,3',4'-Trihydroxyflavone isolated from J. wynaadensis is an interesting biopharmaceutical agent and could be considered as a source of antimicrobial agent for the treatment of various infections and used as a template molecule for future drug development.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Bacteria/drug effects , Diabetes Complications/microbiology , Flavonols/pharmacology , Justicia/chemistry , Plant Extracts/pharmacology , Urinary Tract Infections/microbiology , Wounds and Injuries/microbiology , Anti-Bacterial Agents/chemistry , Anti-Bacterial Agents/isolation & purification , Bacterial Physiological Phenomena , Bacteria/genetics , Bacteria/isolation & purification , Flavonols/chemistry , Flavonols/isolation & purification , Microbial Sensitivity Tests , Plant Extracts/chemistry , Plant Extracts/isolation & purification , Plant Leaves/chemistry
11.
Rev. Assoc. Med. Bras. (1992) ; 64(3): 253-263, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-896448

ABSTRACT

Summary Objective: The aim of this study was to assess the efficacy and safety of ceftazidime-avibactam in the treatment of complicated intra-abdominal infections (CIAIs) and complicated urinary tract infections (CUTIs) with meta-analysis method. Method: We included six randomized clinical trials identified from Medline, Embase, Cochrane Library, "ISRCTN Register" and "ClinicalTrials.gov" which compared ceftazidime-avibactam with comparison group. The meta-analysis was performed using Review Manager software version 5.3. Results: Ceftazidime-avibactam versus active comparisons demonstrated a statistically significant higher rate of microbiological response success on microbiological evaluable populations at the test-of-cure visit (95CI 1.10-2.38, p=0.02) and late-follow-up visit (95CI 1.09-2.23, p=0.02) for the treatment of CUTIs. Ceftazidime-avibactam versus active comparisons demonstrated a statistically significant higher rate of microbiological response success on EME populations at the test-of-cure visit (95CI 1.08-4.27, p=0.03) and late-follow-up visit (OR=1.75, 95CI 1.33-2.29, p<0.0001) for the treatment of CUTIs. Similar results were obtained at the late-follow-up visit (OR = 1.58, 95CI 1.26-1.97, p<0.0001) on microbiologically modified intent-to-treat (mMITT) populations for the treatment of CUTIs. We can find better eradication rates for E. coli and Klebsiella pneumoniae based on mMITT populations. In terms of AEs, SAEs and mortality, ceftazidime-avibactam had a safety and tolerability profile broadly similar to the comparison group. Conclusion: This meta-analysis provides evidence of the efficacy of ceftazidime-avibactam as a potential alternative for the treatment of patients with CUTIs, and CIAIs.


Subject(s)
Humans , Urinary Tract Infections/drug therapy , Ceftazidime/therapeutic use , Azabicyclo Compounds/therapeutic use , Intraabdominal Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Safety , Urinary Tract Infections/microbiology , Randomized Controlled Trials as Topic , Treatment Outcome , Drug Combinations , Intraabdominal Infections/microbiology
12.
Rev. Soc. Bras. Med. Trop ; 51(1): 44-51, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-897051

ABSTRACT

Abstract INTRODUCTION: Multidrug-resistant (MDR) Escherichia coli, a species that is a leading cause of urinary tract infections (UTIs) and is a major global public health concern. This study was designed to detect the differences in antibiotic resistance patterns, the production and type of extended spectrum β-lactamases (ESBLs), and the clonal relationships among E. coli isolates from UTIs and fecal samples. METHODS: Antibacterial resistance was determined by the disk diffusion method. ESBL, carbapenemase, and AmpC-producing isolates were detected phenotypically. Then, the ESBL genes were sequenced to detect the type. Enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) was performed on the ESBL-positive isolates. RESULTS: The most common effective antibacterial agents were colistin, imipenem, and amikacin. Among the isolates, 204 (56.6%) were MDR. Of the 163 ESBL-positive isolates, 11 (6.7%) produced AmpC, and the frequencies of beta-lactamase-positive genes were as follows: bla CTX-Mgroup1, 76%; bla TEM1, 74.8%; bla SHV12, 1.2%; and bla OXA1, 12.88%. ERIC PCR showed a diverse pattern, suggesting that clonal spread of E. coli in this area is uncommon, and that most of the infecting strains are endogenous. CONCLUSIONS: The high rates of antibacterial-resistant and MDR isolates are quite important since these strains can act as source of resistant bacteria that can be spread in the community. Controlling antibiotic use, against inappropriate use and abuse, in the community and continuous surveillance of emerging resistance traits are critical to controlling the spread of resistance.


Subject(s)
Humans , Urinary Tract Infections/microbiology , beta-Lactamases/genetics , Escherichia coli/drug effects , Feces/microbiology , Anti-Bacterial Agents/pharmacology , beta-Lactamases/drug effects , Polymerase Chain Reaction , Drug Resistance, Multiple, Bacterial , Escherichia coli/isolation & purification , Escherichia coli/enzymology , Disk Diffusion Antimicrobial Tests , Iran
13.
Clin. biomed. res ; 38(1): 87-92, 2018.
Article in English | LILACS | ID: biblio-1022449

ABSTRACT

Introduction: The intestinal microbiota may undergo changes after solid organ transplantation. The purpose of this systematic review was to characterize the intestinal microbiota of patients undergoing solid organ transplantation. Methods: MEDLINE, EMBASE and Cochrane Library databases were searched from inception to July 21, 2017. Studies of patients undergoing solid organ transplantation that evaluated changes in intestinal microbiota composition and one of the following outcomes were included: post-transplant weight, new-onset diabetes after transplantation, delayed graft function, acute rejection, graft and patient survival, and post-transplant infections. Results: Out of 765 studies found in this search, two studies (86 patients) fulfilled inclusion criteria. Both studies assessed kidney transplantation recipients, and a reduction in bacterial species diversity after transplantation was observed. Changes in intestinal microbiota were associated with acute rejection in both studies. One study reported diarrhea and urinary infections, while the other one reported urinary and respiratory infections. None of them reported other outcomes of interest. Conclusion: Changes in intestinal microbiota were observed after kidney transplantation, and they were associated with higher incidence of acute rejection and infections in transplant recipients. However, data are still scarce and more studies are needed to evaluate if microbiota changes have an impact on post-transplant outcomes. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Kidney Transplantation/adverse effects , Transplants/microbiology , Gastrointestinal Microbiome , Respiratory Tract Infections/microbiology , Urinary Tract Infections/microbiology , Treatment Outcome , Diarrhea/microbiology , Graft Rejection
15.
Rev. chil. infectol ; 35(1): 29-35, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-899774

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Middle Aged , Urinary Tract Infections/microbiology , beta-Lactamases/drug effects , beta-Lactamases/genetics , Escherichia coli/drug effects , Escherichia coli/genetics , Anti-Bacterial Agents/pharmacology , beta-Lactamases/isolation & purification , Microbial Sensitivity Tests , Community-Acquired Infections/microbiology , beta-Lactam Resistance , Electrophoresis , Escherichia coli/isolation & purification , Escherichia coli/enzymology , Escherichia coli Infections/microbiology , Genotype , Mexico
16.
Afr. j. lab. med. (Online) ; 7(1): 1-3, 2018. tab
Article in English | AIM, AIM | ID: biblio-1257319

ABSTRACT

Between June 2015 and October 2015, 159 mid-stream urine samples from diabetic patients were cultured. The prevalence of urinary tract infection was high at 22% and women were more affected compared with men (P = 0.017). Factors associated with urinary tract infection in these patients were age, sex and high blood glucose levels. Diabetic patients should be screened periodically for urinary tract infection


Subject(s)
Diabetes Mellitus , Prevalence , Uganda , Urinary Tract Infections/microbiology
17.
Rev. chil. infectol ; 35(3): 246-252, 2018. tab
Article in Spanish | LILACS | ID: biblio-959438

ABSTRACT

Resumen Introducción: Las infecciones urinarias asociadas a la atención de la salud (ITU-AAS) representan un importante problema sanitario, siendo poco conocidas sus características cuando no están asociadas a cateterización urinaria u ocurren fuera de unidades de cuidados intensivos (UCI). Objetivos: Determinar las características de los pacientes con ITU-AAS, etiología y susceptibilidad antimicrobiana de las mismas, tanto asociadas a catéter (ITU-C) como no asociadas a catéter (ITU-noC), en UCI y en sala general. Materiales y Métodos: Se realizó un estudio analítico retrospectivo de corte transversal entre 2009 y 2013 en un hospital universitario de tercer nivel. Se identificaron todos los episodios de ITU-AAS, diferenciándolas en ITU-C e ITU-noC. Resultados: Se incluyeron 253 episodios de ITU-AAS, siendo más frecuentes las ITU-C (60,9%) respecto a ITU-noC. Un 37,4% de ITU-noC y 59,7% de ITU-C ocurrieron en UCI. Los microorganismos aislados más frecuentemente fueron Escherichia coli, Klebsiella pneumoniae y Enterococcus sp. El 19% de los bacilos gramnegativos fueron productores de β-lactamasa de espectro extendido, siendo su frecuencia similar en ambos grupos. Conclusión: Las co-morbilidades de los pacientes con ITU-AAS, los agentes etiológicos responsables y sus correspondientes espectros de sensibilidad, fueron similares en los grupos de ITU-C e ITU-noC, tanto en sala general como en UCI.


Introduction: Nosocomially acquired urinary tract infections (NAUTI) represent an important public health issue, but its characteristics when they are not catheter associated (CA-UTI) or when they take place outside intensive care units (ICU) are poorly understood. Objectives: To determine the patients' characteristics, etiology and antimicrobial susceptibility of NAUTI, both CA-UTI and no CA-UTI, in general ward and ICU. Methods: We conducted a retrospective analytic cross-sectional study, between 2009 and 2013, in a third level universitary hospital. All NAUTI episodes were identified, classifying them as CA-UTI and no CA-UTI. Results: We included 253 episodes of NAUTI, being CA-UTI (60,9%) more frequent than no CA-UTI. A 37,4% of no CA-UTI and 59,7% of CA-UTI were identified in ICU. The most frequently isolated microorganisms were Escherichia coli, Klebsiella pneumoniae and Enterococcus sp. A 19% of extended spectrum betalactamase producing gram negative bacilli were found, without differences between groups. Conclusion: Patients's comorbidities, microorganisms associated to NAUTI and its antimicrobial susceptibility were similar in CA-UTI and no CA-UTI, as in general ward and ICU.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Urinary Tract Infections/etiology , Urinary Catheterization/adverse effects , Cross Infection/etiology , Catheter-Related Infections/complications , Urinary Tract Infections/microbiology , Microbial Sensitivity Tests , Cross Infection/microbiology , Cross-Sectional Studies , Retrospective Studies , Gram-Negative Aerobic Bacteria/isolation & purification , Gram-Negative Aerobic Bacteria/drug effects , Gram-Positive Bacteria/isolation & purification , Gram-Positive Bacteria/drug effects , Hospitals, University , Intensive Care Units , Anti-Bacterial Agents/pharmacology
18.
Rev. chil. infectol ; 35(3): 329-331, 2018. tab
Article in Spanish | LILACS | ID: biblio-1042647

ABSTRACT

Resumen Actualmente se recomienda el uso de cefazolina para determinar la susceptibilidad a cefalosporinas orales de primera generación en cepas de enterobacterias en ITU no complicada. Nuestro objetivo fue establecer la susceptibilidad a cefalosporinas orales en cepas urinarias según puntos de corte para cefalotina o cefazolina y la correlación de susceptibilidad entre cefazolina y cefadroxilo. Se estudió la concordancia entre cefalotina y cefazolina en 52 cepas por método de Kirby-Bauer y Vitek XL. En Escherichia coli fue de 0% para VitekXL y 50% para Kirby-Bauer. La concordancia entre cefazolina y cefadroxilo fue 95,6%. En el laboratorio debiera usarse cefazolina para determinar susceptibilidad a cefalosporinas orales de primera generación. La concordancia entre cefazolina y cefadroxilo sugiere que cefazolina podría predecir susceptibilidad para cefadroxilo.


Currently, the use of cefazolin is recommended to determine the susceptibility to first-generation oral cephalosporins in strains of enterobacteria in uncomplicated UTI. We determined susceptibility differences to oral cephalosporins in urinary strains according to cefazolin or cefalotin breakpoints and the correlation of susceptibility between cefazolin and cefadroxil. We studied 52 strains with cefalotin and cefazolin by disk-diffusion and MIC (Kirby-Bauer and Vitek XL) and a subgroup by disk-diffusion for cefadroxil. Agreement among different methods was 100% for K. pneumoniae and Proteus spp. In Escherichia coli, agreement for Vitek and disk-diffusion were 0 and 50% respectively. Susceptibility to first generation cephalosporins in E. coli should be determined with cefazolin. Agreement between cefazolin and cefadroxil suggests that cefazolin could also predict the susceptibility of cefadroxil.


Subject(s)
Humans , Cephalosporins/pharmacology , Enterobacteriaceae/drug effects , Anti-Bacterial Agents/pharmacology , Proteus/drug effects , Urinary Tract Infections/microbiology , Microbial Sensitivity Tests/methods , Cefadroxil/pharmacology , Cefazolin/pharmacology , Cephalosporins/classification , Cephalothin/pharmacology , Enterobacteriaceae/classification , Enterobacteriaceae Infections/microbiology , Escherichia coli/drug effects , Klebsiella pneumoniae/drug effects
19.
Arch. argent. pediatr ; 115(6): 454-457, dic. 2017.
Article in Spanish | LILACS, BINACIS | ID: biblio-887413

ABSTRACT

El incremento del amonio en sangre, hiperamoniemia, es pasible de provocar compromiso neurológico al atravesar la barrera hematoencefálica. La causa más frecuente y conocida de hiperamoniemia es la alteración en la función hepática. Sin embargo, se deben considerar otras patologías, de menor frecuencia y poco conocidas. La infección del tracto urinario por gérmenes productores de ureasa debe ser contemplada a pesar de ser infrecuente en pediatría. Se reporta el caso de un niño con encefalopatía aguda grave, con niveles elevados de amonio en sangre, en quien, luego de descartar otros diagnósticos diferenciales, se asumió el cuadro como hiperamoniemia secundaria a infección del tracto urinario por Corynebacterium riegelii, un germen productor de ureasa. Se implementaron medidas generales de tratamiento para la encefalopatía hiperamoniémica y tratamiento antibiótico específico, con buena evolución el paciente.


Elevated level of ammonia in the blood, defined as hyperammonemia, is feasible to cause neurological symptoms when crossing the blood-brain barrier. The most frequent and studied cause of hyperammonemia is liver failure. Nevertheless, other less frequent and known etiologies must be considered. Urinary tract infection caused by urea-splitting bacteria, despite being unusual in pediatric patients, must be taken into account. We report a pediatric patient with severe acute encephalopathy and high levels of ammonia in blood. After ruling out other causes of hyperammonemia, it was assumed secondary to urinary tract infection by Corynebacterium riegelii, a ureasplitting bacteria. General treatment for hyperammonemic encephalopathy was established, as well as specific treatment with antibiotics. The patient evolved favorably.


Subject(s)
Humans , Male , Child, Preschool , Urea/metabolism , Urinary Tract Infections/complications , Brain Diseases, Metabolic/etiology , Corynebacterium Infections/complications , Hyperammonemia/etiology , Urinary Tract Infections/microbiology , Corynebacterium Infections/metabolism
20.
Medicina (B.Aires) ; 77(4): 304-308, ago. 2017. tab
Article in Spanish | LILACS | ID: biblio-894483

ABSTRACT

La infección urinaria no complicada en mujeres es un motivo frecuente de consulta e indicación de antimicrobianos. El objetivo de este estudio fue definir etiología y resistencia a antimicrobianos en episodios de infección urinaria no complicada. Este estudio prospectivo incluyó mujeres premenopáusicas no embarazadas, con infección urinaria no complicada, que consultaron en un hospital público y tres centros privados de las ciudades de Buenos Aires y La Plata (2011-2013). La edad media de 138 pacientes con infección confirmada por urocultivo fue 28 años. El diagnóstico fue cistitis en 97 (70%) y pielonefritis en 41 (30%). Las frecuencias de los microorganismos aislados fueron: Escherichia coli 97 (70%), Staphylococcus saprophyticus 24 (17%), Proteus spp. 10 (7%), Klebsiella spp. 5 (4%), Enterococcus spp. 1 (0.7%) y Pseudomonas aeruginosa 1 (0.7%). Las frecuencias de resistencia a antimicrobianos fueron: ampicilina-sulbactam 51 (37%), cefalexina 39 (28%), trimetoprima/sulfametoxazol 31 (22%), nitrofurantoína 17 (12%), gentamicina 10 (7%) y ciprofloxacina 7 (5%). La frecuencia de resistencia a ampicilina-sulbactam, trimetoprima/sulfametoxazol y cefalexina es mayor que las previamente publicadas en Argentina, lo que limita su recomendación para el tratamiento empírico. Una mejor comprensión de la etiología y la susceptibilidad antimicrobiana local permite el diseño de pautas más adecuadas para el tratamiento empírico.


Uncomplicated urinary tract infections rank among the most frequent bacterial infections in women in the outpatient setting and represent a major cause of antimicrobial prescription. The aims of this study were to assess frequencies and antimicrobial resistance of current uropathogens causing uncomplicated urinary tract infection. In a prospective multicenter study, patients were recruited in ambulatory settings of four participating hospitals between June 2011 and December 2013. We analyzed 138 patients that met clinical and bacteriological diagnostic criteria. The mean age was 28 years. Cystitis was defined in 70% (n: 97) and pyelonephritis in 30% (n: 41). Frequencies of isolated microorganisms were: Escherichia coli 70% (n: 97), Staphylococcus saprophyticus 17% (n: 24), Proteus spp. 7% (n: 10), Klebsiella spp. 4% (n: 5), Enterococcus spp. and Pseudomonas aeruginosa 1 (0.7%) each. The antimicrobial resistance was: ampicillin-sulbactam 37% (n: 51) cephalexin 28% (n: 39), trimethoprim/sulfamethoxazole 22% (n: 31), nitrofurantoin 12% (n: 17), gentamicin 7% (n: 10) and ciprofloxacin 5% (n: 7). The levels of resistance found for ampicillin-sulbactam, trimethoprim/sulfamethoxazole and cephalexin were higher than those previously reported in Argentina. A better knowledge of the etiology and local antimicrobial susceptibility allows the design of more adequate guidelines for empirical treatment.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Young Adult , Urinary Tract Infections/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Anti-Bacterial Agents/pharmacology , Argentina , Urinary Tract Infections/drug therapy , Drug Resistance, Microbial , Microbial Sensitivity Tests , Prospective Studies , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects
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