Identificación y sensibilidad antibiótica directas desde el hemocultivo positivo para bacilos gram negativos. Rendimiento comparativo de los sistemas Vitek 2C y Phoenix / Direct identification and susceptibility testing from positive blood cultures. A head-to-head performance comparison between Vitek 2C and Phoenix systems / Identificação e sensibilidade antibiótica diretas a partir da hemocultura positiva para bacilos gram negativos. Desempenho comparativo dos sistemas Vitek 2C e Phoenix

Resumen El objetivo de este estudio fue comparar los resultados de las pruebas de identificación y sensibilidad antimicrobiana obtenidos por los sistemas Vitek 2C (bioMérieux, Francia) y Phoenix (Becton Dickinson, EE.UU.) directamente a partir de hemocultivos positivos. Se realizó un estudio observacional prospectivo en el Hospital Naval Pedro Mallo de Buenos Aires, Argentina, que incluyó 70 bacteriemias monomicrobianas por gram negativos. Se obtuvo una identificación correcta por Vitek® 2C y por Phoenix del 100% y 97% respectivamente [p: no significativa (NS)]. La concordancia categórica para todos los antimicrobianos fue 97,1% y 98,1% (p: NS) con Vitek 2C y con Phoenix respectivamente. El tiempo medio para obtener un resultado fue de 10,19 h y 13,8 h (p: NS), respectivamente. Vitek 2C y Phoenix son herramientas importantes, rápidas y confiables para la identificación y las pruebas de sensibilidad realizadas directamente a partir de hemocultivos positivos.

Abstract The aim of this study was to compare the results of identification and antimicrobial susceptibility tests obtained by the Vitek 2C (bioMérieux, France) and Phoenix (Becton Dickinson, USA) systems directly from positive blood cultures. A prospective observational study was performed at the Pedro Mallo Navy Hospital in Buenos Aires, Argentina, which included 70 monomicrobial bacteremias by gram negative rods. Correct identification by Vitek® 2C and Phoenix was 100% and 97%, respectively [p: not significant (NS)]. Categorical agreement for all antimicrobials was 97.1% and 98.1% (p: NS) with Vitek 2C and Phoenix, respectively. The mean time to result was 10.19 h and 13.8 h (p: NS), respectively. Vitek 2C and Phoenix are important, rapid and reliable tools for identification and susceptibility testing when performed directly from positive blood cultures.

Resumo O objetivo deste estudo foi comparar os resultados dos testes de identificação e de suscetibilidade antimicrobiana obtidos pelos sistemas Vitek 2C (bioMérieux, França) e Phoenix (Becton Dickinson, EUA) diretamente a partir de culturas de sangue positivas. Foi realizado um estudo observacional prospectivo no Hospital Naval Pedro Mallo em Buenos Aires, Argentina, incluindo 70 bacteriemias monomicrobianas devido a gram negativos. A identificação correcta por Vitek® 2C e Phoenix obtida foi de 100% e 97% respectivamente [p: não significativo (NS)]. O acordo categórico para todos os antimicrobianos foi de 97,1% e 98,1% (p: NS) com Vitek 2C e Phoenix respectivamente. O tempo médio para obter o resultado foi de 10,19 h e 13,8 h (p: NS), respectivamente. Vitek 2C e Phoenix são ferramentas importantes, rápidas e fiáveis para a identificação e testes de sensibilidade realizados diretamente a partir de hemoculturas positivas.

Impacto de un programa de vigilancia activa y medidas de control de infecciones sobre la incidencia de bacilos gram negativos resistentes a carbapenems en una unidad de cuidados intensivos

Resumen Las infecciones hospitalarias causadas por bacilos gram negativos resistentes a carbapenems (BGNCR) están asociadas al aumento de morbimortalidad y gasto sanitario. La identificación mediante cultivos de vigilancia y las medidas de control de infecciones permiten reducir su diseminación. El objetivo del estudio fue evaluar el impacto de un programa de vigilancia integrado a protocolos de control de infecciones sobre la incidencia de BGNCR y conocer su epidemiología molecular en una unidad de cuidados intensivos. Se realizaron auditorías seguidas de un programa de cultivo de vigilancia activa y caracterización molecular de BGNCR, antes y después de la implementación de programas de prevención y control de infecciones. El screening microbiológico se realizó en medios cromogénicos; la caracterización molecular de p-lactamasas (blaKPC, bla0XA-48-like, blaVIM, blaiMP, blaNDM, blaSHV y blaCTx-M) por PCR y la tipificación molecular por PFGE y MLST para Klebsiella pneumoniae. El protocolo desarrollado permitió reducir la colonización global de 16,92% al 9,67%. La diseminación de K. pneumoniae fue a expensas de diversos clones portadores de KPC-2 asociada a BLEE SHV-2 y CTX-M-15, y distribuidos en varios secuenciotipos (ST17, ST13, ST2256, ST353); no se observó persistencia de un clon particular y ningún aislamiento presentó factores de virulencia asociados a hipervi-rulencia. Los aislamientos de Acinetobacter baumannii fueron mayoritariamente productores de IMP-1. El análisis PFGE individualizó 3 clusters, asumiendo que la diseminación fue clonal.

Abstract Hospital-acquired infections caused by carbapenem-resistant Gram-negative bacteria (CRGNB) have been increasingly reported worldwide and are associated with high rates of mortality especially in intensive care units(ICUs). Early identification through rectal surveillance cultures and implementation of infection control measures(ICM) including contact precautions, staff education on cleaning and hand hygiene may reduce the spread of these microorganisms. The aim of this work was to assess the impact of enhanced ICM on CRGNB colonization and to describe the molecular epidemiology of these bacteria in a polyvalent ICU in a tertiary level hospital. A prospective study including audits and active surveillance culture program, with molecular characterization, was conducted before and after the implementation of prevention programs and infection control measures. Microbiological screening was performed in chromogenic media; PCR targeting p-lactamases genes (ó/qkpc, óíQndm, blaviM and blaoxA-48, blasHv and ó/qctx-m), molecular typing by PFGE; and MLST in K. pneumoniae were performed. CRGNB colonization was reduced from 16.92% to 9.67% upon implementing the infection control measures. In K. pneumoniae the most frequent carbapenemase type was KPC-2 associated with SHV-2 and CTX-M-15, and was disseminated in various STs (ST17, ST13, ST2256, ST353); there was no persistence of particular clones and virulence factors showed no association with hypervirulence. IMP-1 carbapenemase predominated in A. baumannii and the PFGE analysis individualized 3 clusters, assuming that the dissemination in the ICU was clonal. The early detection of patients colo-nized with CRBGN by using epidemiological surveillance cultures and the implementation of prophylactic measures are key to reducing the incidence of these microorganisms.

Resistencia a antibióticos ß-lactámicos y eritromicina en bacterias de la cavidad oral / Resistance to ß-lactam Antibiotics and Erythromycin in Bacteria of the Oral Cavity

Resumen Introducción. La microbiota humana como fuente de bacterias y genes de resistencia constituyen un problema de salud pública. En este estudio se investigó la prevalencia de bacilos entéricos Gram negativos resistentes a β-lactámicos y de los Streptococcus del grupo viridans (EGV) con resistencia a eritromicina en la cavidad oral. Métodos. Se realizó un estudio descriptivo de corte transversal con 193 aislamientos de la cavidad oral sana de 178 adultos que asistieron a una Clínica Odontológica de la ciudad de Cali durante el 2018. La evaluación de la sensibilidad antimicrobiana se realizó en 59 bacilos entéricos y 134 EGV y se identificó por PCR los genes que confieren resistencia a β-lactámicos y eritromicina. El análisis estadístico se realizó mediante el empleo del paquete SPSS vs 23. Resultados. El 84,7% de los bacilos entéricos fueron multirresistentes y presentaron genes bla, siendo blaTEM-1 (49,2%) y blaVIM-2 (30,5%,) los más prevalentes. Los EGV fueron resistentes a eritromicina (38,8%) y clindamicina (28,4%). El 18,7% presentaron el fenotipo cMLSβ, 4,5% el iMLSβ y el 14,9% fueron M. El gen ermB se detectó en los cMLSβ, (13,4%) y el gen mef en los M (9,7%). Conclusión. En este estudio se demostró la presencia de EGV y bacilos entéricos resistentes a los antibióticos y portadores de genes de resistencia a eritromicina y genes bla en la cavidad oral sana. La presencia de estas bacterias representa un riesgo para la salud de los individuos portadores y contribuyen a la creciente epidemia de resistencia bacteriana.

Abstract Introduction. The human microbiota as a source of bacteria and resistance genes is a public health problem. This study researched the prevalence of Gram-negative enteric bacilli resistant to β-lactams and erythromycin resistance in the oral cavity. Methods. A descriptive cross-sectional study was carried out with 193 isolates obtained from the oral cavity of 178 healthy adults who were treated at a Dental Clinic in the city of Cali during 2018. The evaluation of antimicrobial sensitivity was performed in 59 enteric bacilli and 134 EGV and the genes that confer resistance to β-lactam and erythromycin were identified by PCR. Statistical analysis was performed using the SPSS statistical package vs. 25.0. Results. 84.7% of the enteric bacilli presented the MDR phenotype and all presented the bla genes, blaTEM-1 (49.2%) and blaVIM-2 (30.5%) being the most prevalent. EGVs were resistant to erythromycin (38.8%) and clindamycin (28.4%). 18.7% presented the cMLSβ phenotype, 4.5% the iMLSβ and 14.9% were M. The ermB gene was detected more frequently in the cMLSβ, (13.4%) and the mef gene in the M (9.7%). Conclusion. This study demonstrated the presence of antibiotics and Gram-negative enteric bacilli resistant to antibiotics and carriers of erythromycin resistance genes and bla genes, respectively in the healthy oral cavity. The presence of these bacteria represents a risk to the health of carrier individuals and contributes to the growing epidemic of bacterial resistance.

Estudio de la Inhibición de formación de biopelículas en cepas de Pseudomonas aeruginosa en presencia de própolis / Inhibition study of biofilms production of Pseudomonas aeruginosa strains in the presence of propolis

Uno de los principales fracasos de los tratamientos antibióticos de las infecciones por P. aeruginosa, es debido a la producción de biopelículas. El objetivo de este trabajo fue estudiar la inhibición de formación de biopelículas en cepas de Pseudomonas aeruginosa en presencia de própolis. A todas las cepas se les determinó el perfil de susceptibilidad y se hicieron pruebas de sinergismo. Se detectó el nivel de producción de biopelículas sobre membranas de nitrocelulosa y por microscopía electrónica de transmisión. Se estudió la inhibición de las biopelículas por própolis por dilución en placas. En el hospital de Cumaná, "Dr. Julio Rodríguez", se aislaron cepas de P. aeruginosa, de diferentes procesos infecciosos, principalmente, pie diabético. Todas las cepas produjeron biopelículas a diferentes niveles (leve 60%, moderado 24% e intenso 16%). Sesenta por ciento de las cepas son productoras de MBL y 49% de AmpC. El antibiotipo predominante fue la resistencia a aminoglucósidos y fluoroquinolonas (XII). Siete cepas fueron resistentes a colistin. Las biopelículas tratadas con própolis (10 µg/ml), fueron inhibidas con éxito en su casi totalidad. En conclusión, el própolis logró erradicar la formación de biopelículas in vitro, rompiendo las barreras de los diferentes mecanismos de resistencia a los antibióticos expresados por las cepas de P. aeruginosa estudiadas en este trabajo

One of the main failures of antibiotics treatments of P. aeruginosa infections is due to the production of biofilms. The objective of this work was to study the inhibition of biofilm production in Pseudomonas aeruginosa strains in the presence of propolis. Susceptibility testing and synergism were performed in all strains. Biofilm production level was determined onto nitrocellulose membranes and transmission electronic microscopy. Biofilm inhibition propolis was did on plate dilution. "Dr. Julio Rodríguez" hospital, in Cumaná, P. aeruginosa strains were isolated from different infectious processes, mainly diabetic foot. All the strains produced biofilm at different levels (60% mild, 24% moderate and 16% high). Sixty percent of the strains are producers of MBL, and 49% of AmpC. The predominant antibiotype was resistance to aminoglycosides and fluoroquinolones (XII). Seven strains were resistant's to colistin. Biofilms treated with propolis (10 µg/ml) were almost completely inhibited. In conclusion, the propolis achieved to eradicate the in vitro biofilm production, breaking the barriers of the different mechanisms of resistance to the antibiotics expressed by the P. aeruginosa strains studied in this work

Presencia de Bacilos Gram-negativos y Candida albicans en provisionales de polimetilmetacrilato (PMM)en pacientes de Clínica Integrada de la Universidad Autónoma de Asunción / Presence of Gram-negative bacilli and Candida albicans in provisional polymethylmethacrylate in patients of the Integrated Clinic of the Autonomous University of Asunción

Las resinas a base de polimetilmetacrilato (PMM) son una solución para la reposición de estructuras dentarias. Este material ha sido muy utilizado debido a su buena estética, pero las rugosidades, grietas y defectos de este material son propicios para la proliferación de microrganismos que podrían constituir un riesgo para la salud de los pacientes. Estudio observacional descriptivo de corte transversal, donde se tomaron muestras de provisorios de PMM de 20 pacientes de la cátedra de Clínica Integrada de Odontología de la Universidad Autónoma de Asunción. Los datos sobre el crecimiento de los microorganismos fueron anotados en planillas Excel para análisis estadísticos. De los 20 pacientes que participaron en esta investigación, 50% fueron de sexo femenino y 50% masculino, el promedio de edad fue de 32,35 años (DE±11,94). Se analizaron un total de 7 pónticos (6 pónticos de 3 piezas y 1 de 6 piezas) y 19 coronas unitarias, el tiempo de permanencia en boca fue de entre 4 a 20 semanas con una media de 8,6 semanas. El 65% de las muestras dio positivo al cultivo microbiológico. En algunas muestras se aislaron más de un género de microorganismos. Se aislaron 5 especies de bacterias Gram-negativas, la más frecuente fue K. pneumoniae con un 40%. Se aisló C. albicans en un 10% de las muestras. En el proceso de elección de los materiales para rehabilitación es fundamental considerar la situación global de cada paciente, pues exponerlos a un material con grandes capacidades retentivas de microrganismos conlleva un peligro

Polymethylmethacrylate (PMM) based resins are a solution for the replacement of dental structures. This material has been widely used due to its good aesthetics, but the roughness, cracks and defects of this material are propitious for the proliferation of microorganisms that could constitute a risk to the health of patients. This was a descriptive cross-sectional observational study, where samples of PMM provisionals were taken from 20 patients of the Department of Integrated Dental Clinic of the Autonomous University of Asunción. Data on the growth of microorganisms were recorded in Excel spreadsheets for statistical analysis. Of the 20 patients who participated in this research, 50% was female and 50% male, and the average age was 32.35 years (SD±11.94). Seven pontics (6 pontics of 3 pieces and 1 of 6 pieces) and 19 unit crowns were analyzed, the time spent in the mouth was between 4 to 20 weeks with an average of 8.6 weeks. Sixty-five percent of the samples tested positive in the microbiological culture. In some samples, more than one genus of microorganisms was isolated. Five species of Gram-negative bacteria were isolated, the most frequent was Klebsiella pneumoniae with 40%. Candida albicans was isolated in 10% of the samples. In the process of choosing materials for rehabilitation, it is essential to consider the overall situation of each patient, since exposing them to a material with high retention capacities of microorganisms carries a danger

Primer reporte de bacterias y dinoflagelados marinos luminiscentes del Parque Nacional Isla del Coco, Costa Rica

Introducción: La bioluminiscencia es la capacidad de ciertos organismos para transformar la energía química en energía lumínica mediante varios procesos bioquímicos. Objetivo: El aislamiento e identificación por primera vez de bacterias luminiscentes en agua marina superficial y la identificación de dinoflagelados luminiscentes marinos del Parque Nacional Isla del Coco, Costa Rica. Metodología: Se colectaron muestras de agua marina obtenida por buceo a 20 m y a nivel superficial de 13 sitios en la Isla del Coco, Costa Rica. Por otra parte, se analizaron muestras de fitoplancton colectadas desde la superficie hasta los 30 m de profundudad en los alrededores de 8 sitios de la Isla del Coco, y se determinaron varias especies luminiscentes pertenecientes a los géneros Ornithocercus y Ceratocorys. Resultados: Se logró obtener 7 aislados bacterianos luminiscentes, se identificaron y caracterizaron bioquímicamente mediante una plataforma automatizada (Vitek) con altos niveles de confianza, se ubicaron taxonómicamente dentro del género Vibrio,2 especies: V. alginolyticus y V. parahaemolyticus, además, algunos aislados presentaron resistencia al antibiótico ampicilina y 100% capacidad hemolítica. Esta investigación muestra evidencia de la presencia de especies microscópicas marinas en Isla del Coco, Costa Rica, capaces de presentar el fenómeno de la luminiscencia, por lo que profundizar en su estudio sería relevante en cuanto a la importancia de estos microorganismos en la producción de metabolitos secundarios y como indicadores de floraciones algales nocivas, por lo que se hace necesario realizar más investigación científica para determinar su potencial biotecnológico. Conclusiones: De la misma forma, los resultados obtenidos en esta investigación sugieren expandir las localidades de colecta y aislamientos de microorganismos luminiscentes, acompañado de una caracterización bioquímica y molecular, con el fin de explorar la diversidad microbiana asociada a eventos de luminiscencia y determinar los ambientes en el que estas especies se desarrollan.

Introduction: Bioluminescence is the ability of certain organisms to transform chemical energy into light energy through various biochemical processes. Objective: Isolation and identification for the first time of luminescent bacteria of superficial marine water, and the identification of marine luminescent dinoflagellates of Isla del Coco National Park, Costa Rica. Methods: Samples of seawater obtained by diving at 20 m and at a surface level of 13 sites were collected. On the other hand, phytoplankton samples collected from the surface up to 30 m deep were analyzed in the surroundings of 8 sites of Cocos Island, and several luminescent species belonging to the genera Ornithocercus and Ceratocorys were determined. Results: Seven luminescent bacterial isolates were obtained, they were identified and characterized biochemically by means of an automated platform (Vitek) with high levels of confidence, they were taxonomically located within the genus Vibrio, 2 species: V. alginolyticus and V. parahaemolyticus, in addition, some isolates presented resistance to the antibiotic ampicillin and 100% hemolytic capacity. This research shows evidence of the presence of marine microscopic species in Cocos Island, Costa Rica, capable of presenting the phenomenon of luminescence, so that further study would be relevant in terms of the importance of these microorganisms in the production of metabolites secondary and as indicators of harmful algal blooms, so it is necessary to conduct more scientific research to determine their biotechnological potential. Conclusions: In the same way, the results obtained in this investigation suggest expanding the collection and isolation of luminescent microorganisms, accompanied by a biochemical and molecular characterization, in order to explore the microbial diversity associated with luminescence events and determine the environments in which that these species develop.

Colonization and risk of infection by multidrug-resistant bacteria in hemodialysis patients: a topic of concern / Colonización e infección por bacterias multirresistentes en pacientes en hemodiálisis: un tema de preocupación

Antimicrobial resistance worsens the prognosis in patients with chronic diseases. Patients on hemodialysis have infection rates that exceed those reported in other types of patients. Colonization has been suggested as a risk factor for the development of infections. However, the majority of the studies that have evaluated this association have methodological limitations that have called into question the validity of the results; such as the lack of use of molecular methods to confirm that the colonizing species are the same as that which causes infection, the measurement of exposure only at the beginning of the study, the absence of follow-up, the evaluation of bacteremia as the only important outcome and the focus only on Staphylococcus aureus, without including other resistant bacteria of clinical importance such as multidrug-resistant Gram-negative bacteria. This lead to the need to use molecular epidemiology methods for refine the association between colonization and infection in endemic countries like Colombia, where the high rates of antimicrobial resistance demand accurate prevention strategies in susceptible patients.

La resistencia antimicrobiana empeora el pronóstico en pacientes con enfermedades crónicas. Los pacientes en hemodiálisis son un grupo particularmente afectado con porcentajes de infección bacteriana que exceden las reportadas en otro tipo de pacientes. La colonización ha sido sugerida como un factor de riesgo para el desarrollo de infecciones. Sin embargo, los estudios que han evaluado esta asociación presentan limitaciones metodológicas que han cuestionado la validez de los resultados; como la falta de utilización de métodos moleculares que confirmen que la especie que coloniza es la misma que causa infección, la medición de la exposición solo al inicio del estudio, la ausencia de seguimiento y la evaluación de bacteriemia como el único desenlace de importancia. Así mismo, la mayoría de los estudios se han enfocado solo en Staphylococcus aureus sin incluir otras bacterias resistentes de importancia clínica como son los bacilos Gram negativos multirresistentes. Lo anterior lleva a la necesidad de utilizar métodos de epidemiología molecular que permitan refinar el análisis de la asociación entre colonización e infección, más aún en países endémicos como Colombia, en el que los altos porcentajes de resistencia demandan estrategias de prevención más certeras en pacientes susceptibles.

Endocarditis infecciosa por bacilos gram negativos no HACEK. Experiencia en un centro de alta complejidad de la República Argentina (1998-2016) / Infective endocarditis due to non-HACEK gram-negative bacilli in a Level III cardiovascular center in Argentina (1998-2016)

Los bacilos gram negativos (BGN) que no pertenecen al grupo HACEK son una causa infrecuente de endocarditis infecciosa. Los aspectos epidemiológicos, diagnósticos y pronósticos de esta entidad son poco conocidos y la experiencia aún es limitada. Nuestros objetivos fueron analizar las características clínicas y microbiológicas de las endocarditis infecciosas (EI) por BGN no HACEK diagnosticadas en un centro de alta complejidad de Argentina en el período 1998-2016 y conocer su evolución hospitalaria, a fin de compararlas con las EI debidas a otros microorganismos.

Non-HACEK Gram-negative bacilli are a rare cause of infective endocarditis. Epidemiological, diagnostic and prognostic aspects of this entity are little known, and there is limited experience. The aim of this study was to analyze the clinical, microbiological and in-hospital outcomes of non-HACEK Gram negative bacilli endocarditis and to compare them with those due to other microorganisms.

Costos médicos directos de las infecciones del tracto urinario por bacilos Gram negativos resistentes a betalactámicos en un hospital de alta complejidad de Medellín, Colombia / Direct medical costs of urinary tract infections by Gram-negative bacilli resistant to beta-lactams in a tertiary care hospital in Medellín, Colombia

Resumen Introducción. Las infecciones del tracto urinario son muy frecuentes en el ámbito hospitalario. Debido a la aparición de la resistencia antimicrobiana, la complejidad de los procesos de atención ha aumentado y, con ello, la demanda de recursos. Objetivo. Describir y comparar el exceso de los costos médicos directos de las infecciones del tracto urinario por Klebsiella pneumoniae, Enterobacter cloacae y Pseudomonas aeruginosa resistentes a betalactámicos. Materiales y métodos. Se llevó a cabo un estudio de cohorte en una institución de tercer nivel de Medellín, Colombia, entre octubre del 2014 y septiembre del 2015. Se incluyeron los pacientes con infección urinaria, unos por bacterias sensibles a los antibióticos betalactámicos, y otros por bacterias resistentes a las cefalosporinas de tercera y cuarta generación y a los antibióticos carbapenémicos. Los costos se analizaron desde la perspectiva del sistema de salud. La información clínico-epidemiológica se obtuvo de las historias clínicas y los costos se calcularon utilizando los manuales tarifarios estándar. El exceso de costos se estimó mediante análisis multivariados. Resultados. Se incluyeron 141 pacientes con infección urinaria: 55 (39 %) por bacterias sensibles a los betalactámicos, 54 (38,3 %) por bacterias resistentes a las cefalosporinas y 32 (22,7 %) por bacterias resistentes a los carbapenémicos. El exceso de costos totales ajustado de los 86 pacientes con infecciones del tracto urinario por bacterias resistentes a las cefalosporinas y a los carbapenémicos, fue de USD$ 193 (IC95% -347 a 734) y USD$ 633 (IC95% -50 a 1.316), respectivamente comparados con el grupo de 55 pacientes por bacterias sensibles a los betalactámicos. Las diferencias se presentaron principalmente en el uso de antibióticos de amplio espectro, como el meropenem, la colistina y la fosfomicina. Conclusión. Los resultados evidenciaron un incremento sustancial de los costos médicos directos de los pacientes con infecciones del tracto urinario por bacterias resistentes a las cefalosporinas o a los carbapenémicos. Esta situación genera especial preocupación en los países endémicos como Colombia, donde la alta frecuencia de infecciones del tracto urinario y de resistencia a los betalactámicos puede causar un mayor impacto económico en el sector de la salud.

Abstract Introduction: Urinary tract infections are very frequent in the hospital environment and given the emergence of antimicrobial resistance, they have made care processes more complex and have placed additional pressure on available healthcare resources. Objective: To describe and compare excess direct medical costs of urinary tract infections due to Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa resistant to beta-lactams. Materials and methods: A cohort study was conducted in a third level hospital in Medellín, Colombia, from October, 2014, to September, 2015. It included patients with urinary tract infections caused by beta-lactam-susceptible bacteria, third and fourth generation cephalosporin-resistant, as well as carbapenem-resistant. Costs were analyzed from the perspective of the health system. Clinical-epidemiological information was obtained from medical records and the costs were calculated using standard tariff manuals. Excess costs were estimated with multivariate analyses. Results: We included 141 patients: 55 (39%) were sensitive to beta-lactams, 54 (38.3%) were resistant to cephalosporins and 32 (22.7%) to carbapenems. The excess total adjusted costs of patients with urinary tract infections due to cephalosporin- and carbapenem-resistant bacteria were US$ 193 (95% confidence interval (CI): US$ -347-734) and US$ 633 (95% CI: US$ -50-1316), respectively, compared to the group of patients with beta-lactam sensitive urinary tract infections. The differences were mainly found in the use of broad-spectrum antibiotics such as meropenem, colistin, and fosfomycin. Conclusion: Our results show a substantial increase in the direct medical costs of patients with urinary tract infections caused by beta-lactam-resistant Gram-negative bacilli (cephalosporins and carbapenems). This situation is of particular concern in endemic countries such as Colombia, where the high frequencies of urinary tract infections and the resistance to beta-lactam antibiotics can generate a greater economic impact on the health sector.

Avaliação da multirresistência a antibióticos e produção de ESBL e carbapenemases em bacilos gram-negativos de efluente hospitalar e urbano / Evaluation of antibiotic multi-resistance and production of ESBL and carbapenemases in gram-negative bacilli of hospital and urban effluent

A multirresistência aos antibióticos observada em bacilos gram-negativos é um grave problema de saúde pública devido a alta morbidade e mortalidade apresentada, especialmente em instituições assistenciais de saúde. Como consequência do intenso uso de antibióticos, a multirresistência a esses fármacos é principalmente mediada por enzimas hidrolisantes, onde destaca-se as enzimas ?-lactamases, principal mecanismo de resistência aos ?-lactâmicos verificado em bacilos gram-negativos. Os esgotos de origem hospitalar e de estações de tratamento de esgoto (ETE) são considerados como reservatórios de bactérias multirresistentes pela presença de antibióticos que as selecionam e por favorecem a transmissão de determinantes de resistência. Nesse sentido, o presente estudo objetivou avaliar a multirresistência a antibióticos e a produção de enzimas ?-lactamases em bacilos gram-negativos isolados de efluente hospitalar e da estação de tratamento de esgoto, na cidade de Ribeirão Preto, SP. No hospital terciário, amostras de esgotos foram coletadas dos ambulatórios, das enfermarias e da junção do esgoto hospitalar. Na ETE, amostras foram coletadas na caixa de entrada do esgoto bruto e após ao tratamento. Dez microlitros foram semeados em ágar MacConkey, SalmonellaShigella, Cetrimide e TCBS e a identificação dos bacilos gram-negativos foi realizada pelo kit Bactray®. O teste de susceptibilidade aos antibióticos foi realizado pelo método de discodifusão em ágar. A detecção fenotípica de bacilos produtores de ESBL foi realizada pelos testes de sinergia de disco-duplo e disco combinado com ácido clavulânico, e para detecção de isolados produtores de carbapenemases foi utilizado os testes de disco combinado com ácido fenilborônico e EDTA e o teste Blue Carba. A PCR foi utilizada para amplificação dos genes codificadores de ESBL e carbapenemases. No total, 45 bacilos gram-negativos foram isolados, sendo as espécies Klebsiella pneumoniae e Pseudomonas aeruginosa as de maiores prevalências. Ampla resistência foi verificada aos antibióticos ?-lactâmicos, sendo a resistência ao aztreonam, a cefepime e a cefotaxima mais expressiva nos isolados do esgoto hospitalar, com diferenças estatisticamente significante (p<0,05). O fenótipo multidroga resistente foi atribuído a 33,3%, nos isolados exclusivamente do esgoto hospitalar, com diferença estatisticamente significante (p = 0,0025) em relação aos isolados do esgoto da ETE. Genes de ?-lactamases foram encontrados em 35,6% das bactérias, sendo o blaKPC e blaTEM os de maiores ocorrências, ambos em 17,8% dos isolados, e os genes blaSHV e blaCTX-M em 13,3% e 8,9%. Somente em um isolado de Enterobacter cloacae no esgoto tratado da ETE foi identificado o gene blaSHV, os demais isolados portadores dos genes de ?-lactamases foram encontrados no esgoto hospitalar. Os dados obtidos neste estudo são importantes levando em consideração que no Brasil o esgoto hospitalar pode ser lançado in natura na rede coletora municipal, no entanto, acredita-se que tal permissão favorece a disseminação da multirresistência bacteriana, posto que, os resultados demonstram alta frequência de bactérias portadoras de genes de resistência a antibióticos no esgoto hospitalar estudado. Assim, a implementação do tratamento de efluentes hospitalares, especialmente os de hospitais terciários, e adicionalmente ao tratamento da ETE evitaria a propagação dessas bactérias no ambiente e de impactar negativamente os recursos hídricos

Antibiotic multi-resistance observed in Gram-negative bacilli is a serious public health problem due to high morbidity and mortality, especially in health care institutions. As a consequence of the intense use of antibiotics, multi-resistance to these drugs is mainly mediated by hydrolyzing enzymes, in which ?-lactamases, the main ?-lactam resistance mechanism observed in Gramnegative bacilli, are prominent. Hospital sewage and wastewater treatment plants (WWTP) are considered reservoirs of multiresistant bacteria by the presence of antibiotics that select these bacteria and favor the transmission of resistance determinants. In this sense, the present study aimed to evaluate the antibiotics multi-resistance and the production of ?-lactamase enzymes in Gram-negative bacilli isolated from hospital effluent and the wastewater treatment plants in Ribeirão Preto city, SP. In the tertiary hospital, sewage samples from the outpatient clinics, rooms patients and the hospital sewage junction were collected. In the WWTP, raw and treated sewage were collected. Ten microliters were seeded on MacConkey, Salmonella-Shigella, Cetrimide and TCBS agar and the identification of Gram-negative bacilli was performed by the Bactray® kit. Antibiotic susceptibility test was performed by agar-diffusion method. Phenotypic detection of ESBL-producing bacilli was performed by double-disc and discsynergy tests combined with clavulanic acid, and for the detection of carbapenemase-producing isolates the combined disk tests with phenylboronic acid and EDTA and Blue Carba test were used. PCR amplification of ESBL and carbapenemases-encoding genes was used. In total, 45 Gram-negative bacilli were isolated, and Klebsiella pneumoniae and Pseudomonas aeruginosa being the most prevalent. Extensive resistance was verified to ?-lactam antibiotics and resistance to aztreonam, cefepime and cefotaxime was more pronounced in hospital sewage isolates, with statistically significant differences (p<0.05). Multidrug-resistant phenotype was attributed to 33.3% in isolates exclusively from hospital sewage, with a statistically significant difference (p = 0.0025) in relation to the sewage isolates from the WWTP. ?-lactamase genes were found in 35.6% of the bacteria, with blaKPC and blaTEM having the highest occurrences, both in 17.8% of the isolates, and the blaSHV and blaCTX-M genes in 13.3% and 8, 9%. Only in an isolate of Enterobacter cloacae in the treated sewage from WWTP was the blaSHV gene identified, the other isolates carrying the ?-lactamases genes were found in hospital sewage. The data obtained in this study are important considering that in Brazil the hospital sewage can be released in nature in municipal collection network, however, it is believed that such permission favors the dissemination of bacterial multi-resistance, since, the results show high frequency of bacteria carrying antibiotic resistance genes in the hospital sewer studied. Thus, the implementation of treatment of hospital effluents, especially those in tertiary hospitals, and in addition to the treatment of WWTP would prevent the spread of these bacteria in the environment and negatively impact water resources

Bacterial resistance in bats from the Phyllostomidae family and its relationship with unique health / Resistência bacteriana em morcegos da família Phyllostomidae e sua relação com a saúde única

The Phyllostomidae family is important among the bats found in Brazil, with several species and diverse eating habits, and is the only one to have frugivorous representatives. These bats can be found in urban and in wild life environments in search for the best reproductive and feeding conditions. The versatility of environments can be associated with the incidence and/or distribution of some diseases through pathogenic agents. The present paper has the purpose to identify the oral and perianal microbiota and to detect the bacterial resistance of frugivorous bats captured near communities inhabited by humans in the northwestern region of the state of Paraná. A total of 68 bats were captured, belonging to four species of the Phyllostomidae family, namely Artibeus lituratus, Artibeus planirostris, Carollia perspicillata and Sturnira lillium, originated from forest fragments in the micro region of Umuarama, state of Paraná. A total of 64 isolates from oral bacteria and 39 from perianal region were submitted to identification. They were later submitted to a susceptibility test to 22 human and veterinary antimicrobials. The most prevalent bacteria were Escherichia coli 33.3% in the oral region, and 35.90% in the perianal region, Enterobacter aerogenes 12.7% and 5.13%, Enterobacter agglomerans 7.9% and 10.25%, and Serratia liquefaciens 9.5% and 5.13% in the oral and perianal region respectively. All bat species studied had resistant strains, with a few of them presenting multi-resistance to antimicrobials. The species with the highest multi-resistance index to antimicrobials was Carollia perspicillata, with three strains of the oral region resistant to 15 antimicrobials; it also presented two strains in the perianal region, which were resistant to 13 and 10 antimicrobials respectively. Based on the results found, it is possible to conclude that the oral and perianal microbiota of bats is composed of several enterobacterial species resistant to one or several antimicrobials used in human and veterinarian medicine. This is an issue and a future warning for unique health, since high percentages of resistance were found against antimicrobials broadly used, such as ampicillin, amoxicillin and amoxicillin+clavulonate.(AU)

A família Phyllostomidae se destaca entre as famílias de morcegos encontrados no Brasil, com diversificadas espécies e hábitos alimentares, sendo a única a apresentar representantes frugívoros, podendo ser encontrada tanto em meio urbano, como de vida livre, em busca de melhores condições reprodutivas e alimentares. Essa versatilidade de ambientes pode estar associada à incidência e/ou distribuição de determinadas doenças por agentes patogênicos. O presente trabalho objetivou identificar a microbiota oral e perianal e detectar a resistência bacteriana em morcegos frugívoros capturados próximos às comunidades habitadas pelo homem na região noroeste do estado do Paraná. Foram capturados 68 morcegos, de quatro espécies da família Phyllostomidae, são eles Artibeus lituratus, Artibeus planirostris, Carollia perspicillata e Sturnira lillium, oriundos de fragmentos de Mata da microrregião de Umuarama, estado do Paraná. Um total de 64 isolados de bactérias da região oral e 39 da região perianal foram submetidos, identificação e posteriormente teste de susceptibilidade a 22 antimicrobianos de uso humano e veterinário. As bactérias mais prevalentes foram Escherichia coli 33,3% na região da boca e 35,90% na região perianal, Enterobacter aerogenes 12,7% e 5,13%, Enterobacter agglomerans 7,9% e 10,25% e Serratia liquefaciens 9,5% e 5,13% na região da boca e perianal, respectivamente. Todas as espécies de morcegos estudadas apresentaram cepas que foram resistentes, e algumas multirresistência aos antimicrobianos. A espécie que apresentou maior índice de multirresistência aos antimicrobianos foi Carollia perspicillata, com três cepas na região oral resistente a 15 antimicrobianos, e duas na perianal, com resistência a 13 e 10 antimicrobianos respectivamente. Baseados nos resultados encontrados, é possível concluir que a microbiota oral e perianal de morcegos, é composta por diversas espécies de enterobactérias, resistentes a um, ou vários antimicrobianos utilizados na medicina humana e veterinária, tornando-se um problema, e um alerta futuro para a saúde única, uma vez que foram encontrados elevados percentuais de resistência contra antimicrobianos utilizados em larga escala tais como ampicilina, amoxicilina e amoxicilina+clavulonato.(AU)

Características clínicas y microbiológicas de pacientes con periodontitis agresiva generalizada / Clinical and microbiological characteristics of a patients with generalized aggressive periodontitis

RESUMEN: Objetivo: el objetivo de este estudio es describir las características clínicas y microbiológicas de una muestra de pacientes diagnosticados con periodontitis agresiva generalizada (PAgG). Materiales y métodos: En este estudio de corte transversal, 20 sujetos menores de 30 años con PAgG atendidos en las clínicas odontológicas de la Universidad de Antioquia en Medellín Colombia, fueron invitados a participar entre diciembre del 2015 y marzo del 2017, las muestras microbiológicas fueron analizadas usando técnicas de cultivo y tomadas en los seis sitios más profundos de cada paciente (≥ 5mm). Resultados: Prevotella ssp y F. nucleatum fueron detectados en altos porcentajes, Porphyromonas gingivalis (P.g) fue positivo para la mitad de los sujetos estudiados; además de los microorganismos comúnmente estudiados, el 10% de los pacientes fueron positivos para bacilos entéricos gram-negativos. Conclusiones: se observaron grandes proporciones de microorganismos que incluyeron Prevotella spss y F. nucleatum; el 10% de los pacientes fueron positivos para bacilos entéricos gram-negativos.

ABSTRACT: Aim: The aim of this study is to describe the clinical and microbiological characteristics of a sample of patients diagnosed with generalized aggressive periodontitis (PAgG). Materials and methods: In this cross-sectional study, 20 subjects under 30 years of age with PAgG treated at the dental clinics of the University of Antioquia in Medellín, Colombia were invited to participate between December 2015 and March 2017, the microbiological samples analyzed using culture techniques were taken at the six deepest sites of each patient (≥ 5mm). Results: Prevotella ssp and F. nucleatum were detected in high percentages, Porphyromonas gingivalis (P.g) was positive for half of the studied subjects; In addition to the microorganisms commonly studied, 10% of the patients were positive for gram-negative enteric bacilli. Conclusions: large proportions of microorganisms were observed, including Prevotella spss and F. nucleatum; 10% of the patients were positive for gram-negative enteric bacilli.

Mortalidad por meningitis por Pasteurella canis: Oportunidades de aprendizaje / Mortality meningitis Pasteurella canis: Learning opportunities

La meningitis bacteriana es una enfermedad importante de distribución mundial, causa mayor y sustancial de mortalidad y morbilidad en países en desarrollo. La Organización Mundial de la Salud (OMS) sostiene que la meningitis es una de las diez afecciones principales del ser humano y debe ser considerada como una emergencia infectológica; por eso es fundamental reconocer que esta enfermedad es causa de muerte en niños de todo el mundo, sin distinción de raza, nivel económico o sociocultural. Se realizó una investigación de caso en menor de 53 días de nacido, que cumplía con los criterios clínicos y de laboratorio compatible con meningitis bacteriana, con el propósito de analizar y fortalecer la toma de decisiones en salud pública por parte de la secretaría local de salud del municipio de Valledupar (Colombia). Entre los hallazgos se encontró antecedentes infecciosos en el menor, coloración de Gram y cultivo de LCR, en el que se identificó cocobacilos Gram negativos, que fueron aislados como agente causal Pasteurella canis. Este estudio pretende sensibilizar a los prestadores de salud para que cuenten con personal altamente capacitado para brindar tratamientos adecuados y prevenir complicaciones en la meningitis bacteriana en niños, y así disminuir la posibilidad de secuelas o muerte, tanto en pacientes con compromiso inmunológico o sin este.

Bacterial meningitis is an important substantial worldwide disease, and a major cause of mortality and morbidity in developing countries. The World Health Organization (WHO) says that meningitis is one of the top ten diseases that affect humans and should be considered as an infectious diseases specialist emergency, it is essential to recognize that this disease causes death in children worldwide regardless of race, economic status or social and cultural. An investigation of the case in less than 53 days old, who met the clinical criteria and compatible laboratory with bacterial meningitis, in order to analyze and strengthen decision making in public health by the local health department came forward the municipality of Valledupar (Colombia). Among the findings infectious history was found in the lower, Gram stain and culture of CSF where Gram negative coccobacillary identified, isolated as a causative agent Pasteurella canis. This study aims to sensitize health care providers to have highly trained staff to provide adequate treatment and prevent complications of bacterial meningitis in children and lessen the possibility of sequelae or death, both in patients with and without immune compromise.

Impacto da salmonelose na suinocultura e suas implicações em saúde pública / Impact of salmonelosis on pork meat industry and its implications on public health

O objetivo deste trabalho foi mostrar a presença da Salmonella na cadeia de produção de suínos e o risco em potencial para a saúde pública. As bactérias do gênero Salmonella são importantes agentes causadores de doenças transmitidas por alimentos (DTAs) em humanos. Estima-se que cerca de 10% do total de casos de salmonelose sejam veiculados por produtos de origem suína. A transmissão ao homem pode ocorrer pelo contato direto com animais, tanto nas granjas quanto nos frigoríficos, mas principalmente devido à ingestão de alimentos contaminados. A infecção de lotes suínos pode ocorrer em qualquer fase zootécnica e o principal ciclo de infecção é fecal-oral, podendo a bactéria se alojar nos linfonodos e ser excretada quando o animal for submetido a um fator estressante, como o transporte e/ou o reagrupamento. O uso inadequado de antimicrobianos também gera cepas multirresistentes. Os equipamentos e utensílios, de uma forma geral, estão relacionados à contaminação cruzada, agindo como veículos de propagação do micro-organismo dentro da indústria. Para garantir a segurança alimentar do consumidor, conclui-se que cuidados como limpeza, desinfecção e biossegurança devem se iniciar na granja de criação, com a utilização correta de antibióticos, passando pelo transporte evitando a superlotação e com medidas higiênico-sanitárias rigorosas durante o abate desses animais.(AU)

The objective of this study was to show the presence of Salmonella in the swine production chain, and its impact on public health. Bacteria of the Salmonella genus are an important cause of food transmitted diseases in Brazil. Around 10% of clinical salmonellosis cases are attributed to swine products. Humans can become infected through direct contact with the animals, both living and in slaughter houses; however, the most common cause of infection is the ingestion of contaminated food. Infection of swine herds can occur in any of the rearing stages, mainly through a fecal-oral cycle, where the bacteria will shelter in the lymph nodes and be excreted when the host is submitted to a stress factor, such as transport and/or regrouping. Equipment and utensils are also associated with cross contamination among animals, acting as vehicles in the propagation of the microorganism inside the industry or rearing facility. Furthermore, inadequate use of antimicrobial agents will contribute to the rise of resistant bacteria. This study shows that, in order to safeguard consumer health, awareness must begin in the rearing facilities, with special care to hygiene, biosafety, and the proper use of antibiotics. Further care must be considered during transportation, and especially rigorous measures should be set during slaughter.(AU)

Bacteriemias por bacilos Gram negativos multirresistentes en neutropénicos febriles con enfermedades hematológicas / Bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematological diseases

Las infecciones por bacilos Gram negativos multiresistentes (BGN-MR) son frecuentes en nuestro hospital. Presentan limitadas opciones terapéuticas e importante impacto en la morbimortalidad y costos. Objetivo: analizar los factoes de riesgo y evolución de las bacteriemias por BGN-MR en pacientes neutropénicos febriles con patologías hematológicas. Materiales y métodos: estudio prospectivo, descriptivo y observacional de los factores de riesgo para BGN-MR en la población descripta. Se realizó análisis univariado y multivariado de variables clínicas, epidemiológicas, microbiológicas y evolutivas. Resultados: El 27 % de los episodios de neutropenia y fiebre cursaron con bacteriemias por BGN, 42 % de ellos fueron producidos por BGN-MR. En el análisis univariado, dichas bacteriemias se asociaron al uso previo de antibióticos; a las bacteriemias de brecha y neutropenias mayores a 7 días. En el análisis multivariado la bacteriemia de brecha mantuvo su significancia estadística (P<0,001; OR: 5,17; IC 95 % 2,1-12,7). Acinetobacter spp fue el BGN-MR más frecuentemente aislado incluso en los pacientes fallecidos. No se detectó el foco en el 45,9 % de los episodios. Los tratamientos inadecuados fueron significativamente más frecuentes en los pacientes con BGN-MR y la mortalidad tanto global como atribuible también se asoció significativamente al tratamiento inadecuado de las bacteriemias por BGN-MR (P<0,04;RR: 2,46;IC 95 % 1,03-5,9 y P< 0,014; RR: 3,02; IC 95 % 1,22-0,45 respectivamente). Conclusiones: Las bacteriemias por BGN-MR son frecuentes en la población estudiada en especial los que han recibido ATB previo y en las que surgen intratratamiento ATB. Recibieron con mayor frecuencia tratamiento empírico inadecuado, lo que se asoció a mayor mortalidad...

Bacterial infections by multiresistant Gram-negative bacilli (BGN-MR) are an increasing problem in our hospital with a major impact on morbidity, mortality and costs. Objective: to analize risk factors and outcome in bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematologic diseases. Material and Methods: We conducted a prospective, descriptive and observational study to describe the risk factors and outcome of BGN-MR bacteremia in these patients. Results: Twenty seven percent of neutropenia and fever episodes had Gram-negative bacilli bacteremia and 42 % of them were caused by BGN-MR. Previous use of antibioteics, breakthrough bacteremia and prolonged neutropenia (<7 days) were significant in univariate analysis. In multivariate analysis only breakthrough bacteremia was significant (P< 0.001; OR 5,17;IC 95 % 2.1-12.7). Acinetobactersppp was the most common BGN-MR isolated in blood-stream infections and in patients who died. The source of infections was unknown in 45,9 % of the episodes. Inadequate empirical therapy was most common in BGN-MR bacteremia and it was associated with increased overall and attributable mortality (P<0.04; RR: 2.46; IC 95 % 1.03-5.9 y P<0.014; RR: 3.02; IC 95 % 1.22-7.45). Conclusions: BGN-MR was frequent in neutropenic patients with hematological diseases specially in those exposed to antibiotics and in breakthroug bacteremia. Inappropiate antimicrobial therapy was common and is associated with adverse outcome...

Presence and antimicrobial profile of Gram-negative facultative anaerobe rods in patients with chronic periodontitis and gingivitis

La periodontitis crónica es una enfermedad infecciosa multifactorial hacen parte de la microflora subgingival. En los últimos años se han realizado estudios para valorar la presencia de bacilos Gramnegativos anaerobios facultativos (enterobacterias) y suimportancia en el desarrollo y rogresión de la periodontitis crónica. El objetivo de este estudio fue determinar la presencia de enterobacterias en pacientes con periodontitis crónica y gingivitis y conocer la susceptibilidad antimicrobiana de los aislamientosclínicos. Se realizó un estudio observacional y descriptivo en elque se incluyeron 64 pacientes con periodontitis crónica y 22 pacientes con gingivitis. Las muestras tomadas en el surco gingival con conos de papel se depositaron en caldo tioglicolato, seincubaron durante 4 horas a 37 oC y se resembraron finalmente en Agar MacConkey. En la identificación de las bacterias se utilizó el sistema API-20E (Biomerieux, France) y la susceptibilidadantimicrobiana se realizó por el método de difusión en disco. En los dos grupos se identificaron 29 especies enterobacterianas, 7 en el grupo con gingivitis y 22 en el grupo con periodontitis crónica. En el grupo de periodontitis crónica las especies masfrecuentes fueron: K. oxytoca n=5, S. liquefaciens n=4 y K.pneumoniaey E. coli con n=3. En el grupo con gingivitis, Erwiniasp tuvo la mayor frecuencia (n=2). Los aislamientos clínicos presentaron níveles muy bajos de sensibilidad a los B-lactamicosampicilina y amoxicilina/ ac.clavulanico, 17.2 y 27.6 por ciento, y la mayor sensibilidad a ciprofloxacina. En conclusión, la alta frecuencia de enterobacterias en pacientes con periodontitis debe conducir a la prevención y a desarrollar terapias mecánicas y antimicrobianas en las cuales se tengan en cuenta, como parte del tratamiento periodontal, los perfiles antimicrobianos reportados.

Estudo bacteriológico do lavado broncoalveolar na gestão de antibióticos na pneumonia associada à ventilação mecânica de pacientes em unidades de terapia intensiva cirúrgica / Bacteriological study of bronchoalveolar lavage in the antibiotic management of suspected ventilator-associated pneumonia of patients in surgical intensive care units

OBJETIVO: determinar a correlação da coloração de Gram com o resultado final das culturas de LBA em pacientes cirúrgicos sob ventilação mecânica com PAV clínica. MÉTODOS: Estudo retrospectivo de 252 amostras de lavado broncoalveolar em pacientes com clínica de pneumonia associada à ventilação mecânica com trauma ou cuidados de pós-operatório. As amostras de coloração de Gram foram classificadas como cocos Gram-positivos e bacilos Gram-negativos, todos os outros resultados foram excluídos. Culturas de lavado broncoalveolar foram comparadas aos resultados da coloração de Gram. RESULTADOS: A correlação entre a coloração de Gram e a cultura do lavado broncoalveolar apresentou índice kappa de 0,27. A sensibilidade da coloração de Gram foi 53,9% e a especificidade de 80,6%. Considerando a identificação de cocos Gram-positivos comparada com os outros resultados (negativos e bacilos Gram-negativos), o valor preditivo negativo foi 94,8%. Na avaliação de bacilos Gram-negativos comparada com os outros resultados (negativos e cocos Gram-positivos), a sensibilidade foi 27,1% e a especificidade foi 95,4%. CONCLUSÃO: O valor preditivo negativo para cocos Gram-positivos parece ser aceitável, mas a sensibilidade da coloração de Gram na etiologia de pneumonia associada à ventilação mecânica não permite prever qual é o micro-organismo antes da cultura.

OBJECTIVE: To determine the correlation of Gram staining with the culture of bronchoalveolar lavage in patients with clinical features of ventilator-associated pneumonia from two adult trauma and surgical intensive care units. METHODS: We conducted a retrospective study of 252 samples of bronchoalveolar lavage from patients with clinical ventilator-associated pneumonia in trauma or surgical postoperative care. Gram staining samples were classified as Gram-positive cocci and Gram-negative bacilli, all other results being excluded. Cultures from bronchoalveolar lavage were compared with Gram staining results. RESULTS: The correlation between Gram staining and culture from the bronchoalveolar lavage showed a kappa index of 0.27. The sensitivity of Gram staining was 53.9% and the specificity, 80.6%. Considering the identification of Gram-positive cocci against other results (negative and Gram-negative bacilli), the negative predictive value was 94.8%. The evaluation of Gram-negative bacilli against other results (negative and Gram-positive cocci) rendered a sensitivity of 27.1% and a specificity of 95.4%. CONCLUSION: It appears that the negative predictive value for Gram-positive cocci is acceptable, but the sensitivity of Gram staining in the etiology of ventilator-associated pneumonia was not able to identify the microorganism before culture.

Multirresistência microbiana e opções terapêuticas disponíveis / Microbial multi-resistance and available therapeutic options

JUSTIFICATIVA E OBJETIVOS: Devido ao uso irracional de antimicrobianos e a administração empírica, vários problemas de resistência microbiana surgiram como um novo desafio para a terapêutica, causando elevados índices de mortalidade. Dentre os grupos de micro-organismos relacionados a infecções resistentes destacam-se: Staphylococcus aureus resistente à meticilina e Staphylococcus aureus resistente à vancomicina, Enterococcus sp resistentes a diferentes classes de antimicrobianos, Streptococcus pneumoniae resistente à penicilina, Klebsiella pneumoniae carbapenemase, Pseudomonas aeruginosa e Acinetobacter baumanii resistentes aos carbapenêmicos e ainda as enterobactérias produtoras beta-lactamases de espectro ampliado (ESBL). O objetivo deste estudo foi rever na literatura científica a abordagem do surgimento de micro-organismos multirresistentes e as opções terapêuticas disponíveis no Brasil. CONTEÚDO: Novos antimicrobianos são lançados no mercado com o intuito de alcançar tratamento efetivo para infecções causadas por micro-organismos resistentes. Para abordar os mecanismos de resistência mais comuns, das novas opções terapêuticas disponíveis no Brasil e das novas diretrizes de uso desses fármacos. CONCLUSÃO: Enquanto o uso dos medicamentos antimicrobianos continuarem sendo de modo irresponsável e não for cumpridaa legislação para seu uso, os novos fármacos serão eficazes apenas temporariamente, fazendo constante o problema da multirresistência microbiana.

BACKGROUND AND OBJECTIVES: Due to antibiotics irrational use and the empiric administration, many microbial resistance problems become a new therapeutic challenge, causing elevated mortality rates. Among the microorganisms groups related with resistant infections are: methicillin-resistant and vancomycin-resistant Staphylococcus aureus, multi-resistant Enterococcussp, penicillin-resistant Streptococcus pneumoniae, Klebsiella pneumoniae carbapenemase, carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumanii and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL). The aim of this work was carry out a review of scientific literature in order to discuss the emergence of multidrug-resistant microorganism sand the therapeutic options available in Brazil. CONTENTS: New antimicrobials are launched in order to achieve effective treatment for resistant microorganisms infections. To discuss the most common resistance mechanisms, new therapeutic options available in Brazil and new guidelines for the use of these drugs. CONCLUSION: While the use of antimicrobial drugs to keep so irresponsible and the law for its use not met, the new drugs will be effective only temporarily, keeping constant the microbial multi-resistance problem.

Administración sistémica adjunta de moxifloxacina versus ciprofloxacina másmetronidazol en el tratamiento de periodontitis crónica con presencia de bacilos entéricos Gram negativos: I. efectos clínicos y microbiológicos / Adjunctive systemic administration of moxifloxacin versus ciprofloxacin plus metronidazole in the treatment of chronic periodontitis harboring gram-negative enteric rods: I microbiological and clinical effects

Introducción: los hallazgos clínicos preliminares indican que las lesiones periodontales asociadas a bacilos entéricos Gram negativos no responden al tratamiento convencional. Los objetivos del presente estudio fueron evaluar y comparar los efectos clínicos ymicrobiológicos del raspaje y alisado radicular (RAR) combinado con la administración sistémica de moxifloxacina (MOX) o ciprofloxacinamas metronidazol (CIPRO + MET), en el tratamiento de sujetos con periodontitis crónica. Métodos: en este ensayo clínico participaron 76 pacientes, divididos en dos grupos. Los sujetos se trataron con RAR más MOX (Grupo MOX; n = 38) o RAR más CIPRO + MET (GrupoCIPRO + MET; n = 38). Los datos clínicos y microbiológicos se registraron a nivel base, y a los 3 y 6 meses después del tratamiento. Loscambios significativos en los parámetros clínicos y microbiológicos, intra e inter grupos, se midieron utilizando las pruebas de Mann-Whitney y Wilcoxon, respectivamente. Resultados: después de seis meses, los dos grupos de tratamiento presentaron una reducción significativa en la profundidad de sondaje y en el sangrado al sondaje, además de una ganancia en la inserción clínica (P < 0,05). Se observó disminución estadísticamente significativa de la proporción de sitios > 6 mm. No se identificaron entéricos ni Aggregatibacter actinomycetemcomitansen ninguno de los grupos, después de la terapia. Conclusiones: este estudio proporciona evidencia del beneficio adjunto de MOX o CIPROMET al RAR, en pacientes con periodontitis crónica que presentan entéricos. Sin embargo, MOX puede ser el antibiótico de elección envista de los pocos efectos adversos ocasionados y debido a su dosificación solo una vez al día.

Introduction: preliminary clinical findings indicate that periodontal lesions associated with Gram-negative enteric rods do not respond to conventional treatment modalities. The aim of the present study was to evaluate and compare the clinical and microbiologicaleffects of scaling and root planing (SRP) combined with systemic administration of moxifloxacin (MOX) or ciprofloxacin plus metronidazole (CIPRO + MET) in the treatment of chronic periodontitis. Methods: seventy-six patients participated in this randomized clinical trial, and they were divided into two groups. Subjects were treated with SRP plus adjunctive MOX (MOX group; n = 38) or SRP plus adjunctive CIPRO + MET (CIPRO + MET GROUP; n = 38). Clinical and microbiological data were recorded at baseline and at 3 and 6 months after treatment. The significant changes in clinical and microbiological parameters between and within the groups were measured using theMann-Whitney test and Wilcoxon’s rank test respectively. Results: after six months, both treatment groups showed a significant reduction in probing depth and bleeding on probing (P < 0.05) and better clinical attachment. A statistically significant reduction of the proportionof sites > 6 mm was also observed. Gram-negative enteric rods and Aggregatibacter actinomycetemcomitans were not identified in either group six months after baseline. Conclusions: this study provides evidence of the benefit of using MOX or CIPRO+MET as adjunct to SRP in patients with chronic periodontitis harboring Gram-negative enteric rods. However, MOX may be the antibiotic of choice in view of itsfew adverse effects and single dose treatment per day.

Prevalência de bacilos Gram-negativos não fermentadores de pacientes internados em Porto Alegre-RS / Prevalence of non-fermenting Gram-negative bacilli among inpatients from Porto Alegre-RS

INTRODUÇÃO: Os bacilos Gram-negativos não fermentadores (BGNNF) são frequentemente associados às infecções hospitalares. Além da alta incidência, esses microrganismos possuem resistência a diversos antimicrobianos. OBJETIVO: Analisar a prevalência e o perfil de resistência de BGNNF. MÉTODOS: Foram analisados 14.971 laudos de pacientes em um hospital privado de Porto Alegre-RS, no período de maio de 2006 a março de 2008, sem distinção de sexo e idade. RESULTADOS E CONCLUSÃO: Foram isoladas 326 amostras de BGNNF. As espécies mais prevalentes foram: Pseudomonas aeruginosa (65,03 por cento), Acinetobacter baumannii (16,56 por cento) e Stenotrophomonas maltophilia (9,5 por cento). Outras espécies apresentaram índices inferiores a 5 por cento. Os microrganismos foram isolados de diversos sítios infecciosos. Os materiais biológicos que apresentaram maior positividade para esses microrganismos foram o aspirado traqueal (38,34 por cento), o escarro (18,71 por cento) e a urina (15,95 por cento). A resistência bacteriana mostrou-se mais expressiva a tetraciclinas (89,57 por cento) e sulfametoxazol/trimetoprima (79,75 por cento). Os antimicrobianos mais ativos foram polimixina B, com 100 por cento de sensibilidade, e piperaciclina/tazobactam, com 75,2 por cento de sensibilidade.

INTRODUCTION: The non-fermenting Gram-negative bacilli (NFGNB) have been widely associated with nosocomial infections. Not only are these microorganisms highly prevalent but they are also highly resistant to NFGNB. OBJECTIVE: To assess the prevalence and resistance profile of non-fermenting Gram-negative bacilli. METHODS: 14.971 patient reports from a private hospital in Porto Alegre, Rio Grande do Sul, from May/2006 to March/2008 were analyzed. RESULTS AND CONCLUSION: Three hundred twenty-six samples of non-fermenting Gram-negative bacilli were isolated. The most prevalent species were Pseudomonas aeruginosa (65.03 percent), Acinetobacter baumannii (16.56 percent), and Stenotrophomonas maltophilia (9.5 percent). Other species showed rates lower than 5 percent. The microorganisms were isolated from several infectious sites and the biological materials that showed higher positivity were the following: tracheal aspirate (38.34 percent), spittle (18.71 percent) and urine (15.95 percent). Bacterial resistance was higher with tetracyclines (89.57 percent) and sulfamethoxazole/trimethoprim (79.75 percent). The most active antimicrobials were polymyxin B and piperacillin/tazobactam with 100 percent and 75.2 percent sensibility, respectively.