RESUMO
La bacteriemia sigue siendo una de las causas más importantes de morbilidad y mortalidad en pacientes adultos, a pesar de los numerosos antimicrobianos hoy disponibles y del aumento de las medidas de soporte. El objetivo del presente estudio fue analizar los episodios de bacteriemia por enterobacterias adquiridas en la comunidad y durante la hospitalización registrados durante un período de cinco años, estableciendo la prevalencia de especies, los factores de riesgo y los focos, así como la sensibilidad a los antimicrobianos de los microorganismos involucrados. Entre enero de 2000 y diciembre de 2004 se registraron en el Hospital Nacional de Clínicas de Córdoba 129 episodios de bacteriemias por enterobacterias: 45 correspondientes a pacientes ambulatorios (35%) y 84 a hospitalizados (65%). Los factores de riesgo más frecuentes fueron neoplasia (33,3%) y diabetes (12,4%); y los focos más habituales el urinario (29,5%) y el abdominal (13,9%). La enterobacteria aislada con mayor frecuencia en ambas poblaciones fue E. coli, con una incidencia media del 53,5%, seguida de Klebsiella spp. (21,7%) y Enterobacter spp. (12,4%). Las bacteriemias por Klebsiella spp. fueron más comunes en UTI. Esta especie junto con Enterobacter spp. fueron las bacterias más resistentes a los antimicrobianos ensayados.
Bacteremia continues to be one of the main causes of morbidity and mortality in adult patients despite the existence of numerous antimicrobial agents and an increase in support measures. The aim of this study was to analyze the cases of community and hospital-acquired bacteremia, by evaluating the prevalence of species, risk factors, source of infection and antimicrobial susceptibility of the microorganisms involved. From January 2000 to December 2004, 129 cases of bacteremia due to enterobacteria were detected in 45 outpatients (35%) and 84 inpatients (65%). The most common risk factors were neoplasia (33.3%) and diabetes (12.4%); being urinary (29.5%) and abdominal (13.9%) the most frequently found sources of infection. E. coli was the most common enterobacteria isolated in both populations, followed by Klebsiella spp. (21.7%), and Enterobacter spp. (12.4%). Klebsiella spp. bacteremia was most common in ICU patients and, together with Enterobacter spp., constituted the most antibiotic-resistant microorganisms.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bacteriemia/microbiologia , Enterobacteriaceae/isolamento & purificação , Enterobacteriaceae/efeitos dos fármacos , Hospitais Universitários , Testes de Sensibilidade Microbiana , Fatores de TempoRESUMO
Between April 1, 1999 and June 30, 2000, 144 isolates of enterococci (one per patient) from cultures of several anatomic sites were collected. One hundred and nineteen (82.6
) E. faecium and 14 (9.7
) of other species (5 E. raffinosus, 4 E. avium, 3 E. casseliflavus, 1 E. pseudoavium, and 1 E. dispar) were associated with clinical infections. The most common sites of isolation were: the urinary tract 54.9
. High-level resistance to gentamicin or streptomycin or both was detected in 48.6
of the isolates. E. faecium and E. raffinosus were significantly more resistant than E. faecalis to ampicilin and imipenem. None of the strains exhibited beta-lactamase activity. One strain of E. faecium (0.7
) was resistant to vancomicin and teicoplanin (Van A phenotype) and two strains of E. casseliflavus (1.4
) showed low level of resistance to vancomicin (Van C phenotype). Because of these diverse antimicrobial resistance mechanisms, successful treatment and control of enterococcal infections with current antimicrobial agents are becoming increasingly difficult.
RESUMO
BACKGROUND: The technique of Fluorescence In-Situ Hybridization (FISH), a hybrid of cytogenetics and molecular biology has increased the resolution and application of cytogenetics in various neoplastic processes. In various types of leukemias, primary investigation by conventional cytogenetic [CC] technique followed by FISH has increased our understanding of the abnormal clonal formation involving different gene region. AIMS: Present study is aimed to use different kinds of in-house FISH probes in various hematological malignancies and its correlation with conventional cytogenetic finding. MATERIAL AND METHODS: Cytogenetic study was carried out in 360 patients either from peripheral blood or from bone marrow cells suspected for various types of leukemias. Four of 360 cases were further selected for FISH study by using different types of in-house probes, such as BAC [Bacterial Artificial Chromosome], PAC [Phague Artificial Chromosome], alphoid, PCP [Partial Chromosome Paint] and WCP [Whole Chromosome paint]. RESULTS: The results confirmed breakpoints of inversion 16 and del 16 in case 2 and 3 respectively. Whereas, case 1 did not confirm the cytogenetic findings of t(15;17) by PML/RARa fusion signals as multiple cell lines were involved in the patients. PCP and WCP were helpful in the identification of the marker chromosome in case 1. Telomeric and centromeric probes confirmed the cytogenetic findings of t(5;7) in case 4. CONCLUSION: We observe from this study that, in addition to the conventional cytogenetic study, FISH study provide further confirmation of chromosomal rearrangements. This facilitates our understanding of the neoplastic process more precisely for the better prognostication of the patient.