Clinical and microbiological implications of invasive pneumococcal disease in hospitalized patients (1998-2013)

Abstract Introduction Infections caused by Streptococcus pneumoniae (pneumococcus) still represent a challenge for health systems around the world. Objective The objective of this study was to assess microbiological and clinical aspects in hospitalized patients with invasive pneumococcus disease between 1998 and 2013. Materials and methods This was a retrospective study that analyzed the results of pneumococcus identification, serotyping, and susceptibility testing found in the Adolfo Lutz Institute databank. Personal variables, medical history and clinical outcome of patients admitted with invasive pneumococcal disease were analyzed. These were obtained from records of a public teaching hospital – Hospital das Clínicas Faculdade de Medicina Ribeirão Preto. Results The sample comprised 332 patients. Patient age ranged from less than one month to 89 years old (mean 20.3 years) and the sample was predominately male. Pneumonia (67.8%) was the most common disease, accounting for 18.2% of deaths. Serotypes 14, 1, 3, 9V, 6B, 6A, 23F, 19A, 18C, 19F, 12F, and 4 were the most common (75.3%). Most patients, or 67.5%, were cured without any complication (success), 6.9% had some type of sequela (failure), and 25.6% died (failure). In the case of deaths due to meningitis, strains of fully penicillin resistant pneumococcus were isolated. Furthermore, 68.2% of patients who died presented some type of comorbidity. The 60 and older age group presented the most significant association (Odds Ratio = 4.2), with outcome failure regardless of the presence of comorbidity. Serotype 18C was the most significant risk factor both in raw analysis (Odds Ratio = 3.8) and when adjusted for comorbidity (Odds Ratio = 5.0) or age (Odds Ratio = 5.4). The same occurred with serotype 12F (respectively, Odds Ratio = 5.1, Odds Ratio = 5.0, and Odds Ratio = 4.7) Conclusion The present findings highlight the importance of IPD among young adults and older adults. In the era of conjugate vaccines, monitoring serotypes in different age groups is essential to assess the impact and adequacy of immunization.

Phenotypic and genotypic characterization of Rhodococcus equi isolated from sputum

INTRODUCTION: Rhodococcus equi is an opportunistic pathogen, causing rhodococcosis, a condition that can be confused with tuberculosis. Often, without identifying M. tuberculosis, physicians initiate empiric treatment for tuberculosis. R. equi and M. tuberculosis have different susceptibility to drugs. Identification of R. equi is based on a variety of phenotypic, chromatographic, and genotypic characteristics. OBJECTIVE: This study aimed to characterize bacterial isolates from sputum samples suggestive of R. equi. METHODS: The phenotypic identification included biochemical assays; thin-layer chromatography (TLC) and polymerase chain reaction (PCR) were used for genotypic identification. RESULTS: Among 78 Gram-positive and partially acid-fast bacilli isolated from the sputum of tuberculosis-suspected patients, 51 were phenotypically and genotypically characterized as R. equi based on literature data. Mycolic acid analysis showed that all suspected R. equi had compounds with a retention factor (Rf) between 0.4-0.5. Genotypic characterization indicated the presence of the choE gene 959 bp fragments in 51 isolates CAMP test positive. Twenty-two CAMP test negative isolates were negative for the choE gene. Five isolates presumptively identified as R. equi, CAMP test positive, were choE gene negative, and probably belonged to other bacterial species. CONCLUSIONS: The phenotypic and molecular techniques used constitute a good methodological tool to identify R. equi.

Isolamento, caracterização e resistência a antimicrobianos de bactérias Gram-negativas aeróbias e anaeróbias facultativas de amostras de solo / Isolation, characterization, and antimicrobial resistance of Gram-negative aerobic and facultative anaerobic bacteria from soil samples

Cerca de 7% da população bacteriana do solo está representado por bactérias Gram-negativas aeróbias/anaeróbias facultativas. Muitas espécies são patogênicas e estão envolvidas em casos de infecções hospitalares. O potencial de patogenicidade dessas bactérias pode ser avaliado através da investigação da sua resistência a antimicrobianos. Além deste propósito, o objetivo do trabalho foi também identificar bacilos gram-negativos (BGN) isolados do solo. Para isso, 18 amostras de solo foram semeadas em caldo de Hajna. A obtenção de colônias isoladas seguiu-se em Mc Conkey ágar e Mueller Hinton ágar com 5% de sangue de carneiro. Foram repicadas 283 colônias com diferentes características morfológicas, em meio de IAL. Na triagem, obteve-se BGN fermentadores e não fermentadores, cuja identificação se fez pela metodologia convencional. Identificou-se 94,35% de enterobactérias e 5,65% BGN não fermentadores. A resistência bacteriana foi mais expressiva aos antibióticos ampicilina, cefalotina, cefoxitina, amoxicilina com ácido clavulânico e tetraciclina, variando entre 49,82% a 87,28%. Todos os isolados bacterianos foram resistentes a pelo menos um antibiótico, o que demonstra considerável potencial patogênico por constituírem um reservatório de resistência. A associação entre solo e resistência antimicrobiana precisa ser mais estudada. Observações e experimentos adicionais possibilitarão conhecer melhor essa relação e os processos que possam contribuir para a emergência de bactérias resistentes.

Etiology of acute diarrhea among children in Ribeiräo Preto-SP, Brazil

To study the main enteropathogens causing diarrhea in the region of Ribeiräo Preto regarding serogroups and serotypes, the feces of 1836 children under 10 years old, from both sexes, attack of acute gastroenteritis, were analysed during a period of 4 years in Adolfo Lutz Institute - Ribeiräo Preto, SP. The pathogens identified by standard methods were the following: Escherichia coli, Salmonella spp., Shigella spp., Campylobacter spp., Yersinia spp., and Cryptosporidium spp. Positive samples were 22.8 percent (419) with 1.7 percent association of pathogens. Larger isolates were mainly from children 0 to 11 months old. Enteropathogenic E. coli (EPEC) was most frequent (8.7 percent) with predominance of serogroup O119 (40.2 percent), followed by Shigella (6.2 percent), 63.6 percent of which S. sonnei

Avaliaçäo do diagnóstico laboratorial da doença meningogócica pelos laboratórios reginais do Instituto Adolfo Lutz / Laboratorial diagnosis evaluation of meningococcal disease by the regional laboratories of Instituto Adolfo Lutz

31.833 amostras de líquido céfalo-raquidiano foram processadas nos Laboratórios Regionais de Campinas, Presidente Prudente, Ribeiräo Preto, Santo André, Santos, Säo José do Rio Preto e Sorocaba, no período de 1989 a 1995. A metodologia utilizada para transporte, semeadura e identificaçäo do agente etiológico foi a recomendada pelo Centro Nacional de Referência para meningite, Instituto Adolfo Lutz, Ministério da Saúde. Foram diagnosticados um total de 1.748 casos de meningite meningocócica. Destes, 91(5,20 por cento) casos foram definidos somente pela bacterioscopia e 24 (1,54 por cento) cepas de Neisseria meningitidis näo puderam ser sorogrupadas. Das 1630 cepas de Neisseria meningitidis sorogrupadas, o sorogrupo mais frequente foi o B com 848 (52,02 por cento), seguido de 743 (45,58 por cento) C,30 (1,84 por cento) W135,3 (0,18 por cento) Y e 1(0,06 por cento) X. É digno de nota a ocorrência de 5 casos de meningococo A, exclusivamente diagnosticados pela reaçäo de imunoeletroforese cruzada. A maior positividade foi encontrada na cultura (87,4 por cento), seguida pela bacterioscopia (75,3 por cento) e imunoeletroforese cruzada (54,8 por cento). A variaçäo sazonal dos casos foi como esperado, com alta inicidência no inverno. A melhoria do diagnostico etiológico e das ações de vigilância da doença meningocócica foi demonstrada pelo aumento progressivo no número de casos diagnosticados pelos laboratórios desde 1989