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Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais.
Objective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.
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Humanos , Masculino , Feminino , Microbiota , Transplantados , Anti-Infecciosos , Pacientes , RimRESUMO
Objective:To establish a rapid and accurate method for the detection of Klebsiella pneumoniae carbapenemase (KPC) carbapenemase gene based on recombinase aided amplification (RAA)-CRISPR-Cas13a (CRISPR-Cas13a) technology. Methods:Twenty-five clinical isolates of carbapenem-resistant Klebsiella pneumoniae (CRKP) and five carbapenem-sensitive Klebsiella pneumoniae (CSKP) strains preserved in 2020-2021 in Beijing Chuiyangliu Hospital were randomly collected, and the total DNA samples of the strains was extracted. RAA primers specific for KPC DNA and CRISPR RNA (crRNA) were designed to establish a rapid and accurate method for the detection of KPC carbapenemase gene based on RAA-CRISPR-Cas13a technology. The method was evaluated by plasmids and clinical sample strains, and the detection was also performed by Quantitative real-time PCR (qPCR) method to compare the detection rate and consistency of the two methods. Results:The RAA-CRISPR-Cas13a method can detect KPC plasmids and samples with a sensitivity of 1 copy/μl, which is higher than that of qPCR (10 1 copies/μl). Among the 30 clinical strains (including 25 CRKP strains and 5 CSKP strains), 23 strains were detected to carry KPC gene by both RAA-CRISPR-Cas13a method and qPCR method, and 7 strains were not detected with KPC gene. The detection rate of KPC gene in the 25 CRKP strains was 92% (23/25). The positive coincidence rate of the two methods was 100% (23/23). Conclusions:This study combined RAA amplification technology with CRISPR-Cas13a technology to establish a rapid and accurate method for detecting KPC carbapenemase gene. The method is useful for accurate screening of KPC carbapenemase-producing strains. It has a wide application prospect in drug resistance monitoring and infection control.
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ABSTRACT This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher's exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria.
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Introducción: Staphylococcus aureus (SA) puede ocasionar cuadros infecciosos severos y muerte. La emergencia de cepas resistentes a meticilina constituye un desafío terapéutico. Objetivos: determinar el perfil de resistencia antimicrobiana de: Staphylococcus aureus adquirido en la comunidad (SA-CA), obtenidos de muestras biológicas de niños, entre 2015 a 2020. Material y Método: estudio descriptivo, observacional y retrospectivo. Las muestras para cultivos se extrajeron al ingreso hospitalario del paciente. Para determinación de resistencia y sensibilidad se utilizó normas de CSLI. Resultados: 244 aislamientos de SA-CA. Masculinos 99 (59%), menores de un año: 42 (25%), de 2 a 5 años: 34 (20%), de 6 a 11 años: 50 (30%) y entre 12 a 15 años: 42 (25%). De los aislados, 72% fueron SAMR (121/168) y 28% SAMS (47/168). Se observó un incremento de tasas anuales de aislamientos SAMR en infecciones de la comunidad desde el 2015 al 2020. Los aislamientos se originaron en piel y partes blandas 53,2 %; sangre 37,4%, orina 3,5%, LCR 2,4%, liquido articular 1,7%, abscesos profundos 1,2% y liquido pleural 0,6%. La prevalencia de SAMR-CA fue de 60,5 en el 2015, 59,6 %, 61,5%, 72,2 %, 67,3% y 75,5 % en los años sucesivos. No se aisló ninguna cepa resistente a la vancomicina. El 10,1% de las cepas estudiadas presentó resistencia inducida a la clindamicina. Conclusión: El SAMR se ha establecido como patógeno de la comunidad. La resistencia inducida por clindamicina fue del 10,1%. Un tercio de las infecciones fueron causadas por SAMS. Las prevalencias de SAMS muestran tendencia a la disminución.
Introduction: Staphylococcus aureus (SA) can cause severe infectious conditions and death. The emergence of methicillin-resistant strains constitutes a therapeutic challenge. Objectives: to determine the antimicrobial resistance profile of: Staphylococcus aureus acquired in the community (SA-CA), obtained from biological samples of children, between 2015 and 2020. Material and Method: descriptive, observational and retrospective study. The samples for cultures were extracted upon hospital admission of the patient. To determine resistance and sensitivity, CSLI standards were used. Results: 244 isolates of SA-CA. Males 99 (59%), under one-year-old: 42 (25%), from 2 to 5 years old: 34 (20%), from 6 to 11 years old: 50 (30%) and between 12 and 15 years old: 42 (25%). Of the isolates, 72% were SAMR (121/168) and 28% SAMS (47/168). An increase in annual rates of MRSA isolates in community infections was observed from 2015 to 2020. The isolates originated in skin and soft parts 53.2 %; blood 37.4%, urine 3.5%, CSF 2.4%, joint fluid 1.7%, deep abscesses 1.2% and pleural fluid 0.6%. The prevalence of MRSA-CA was 60.5 in 2015, 59.6%, 61.5%, 72.2%, 67.3%, and 75.5% in subsequent years. No vancomycin resistant strain was isolated. 10.1% of the strains studied presented induced resistance to clindamycin. Conclusion: MRSA has been established as a community pathogen. The resistance induced by clindamycin was 10.1%. One third of the infections was caused by SAMS. The prevalence of SAMS shows a downward trend.
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SUMMARY OBJECTIVE: The aim of this study was to evaluate the demographic data, molecular epidemiology, and in vitro antifungal susceptibility results of patients with Aspergillus isolated from various clinical specimens. METHODS: A total of 44 Aspergillus strains were studied. The definition of invasive aspergillosis in patients was made according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Strains were phenotypically and molecularly identified. Demographic characteristics of patients and genotypes of strains were evaluated. Phylogenetic analysis was done by the The Unweighted Pair-Group Method with Arithmetic Mean (UPGMA). Antifungal susceptibility of strains was determined according to The Clinical and Laboratory Standards Institute (CLSI)-M61-Ed2 and The European Committee on Antimicrobial Susceptibility Testing (EUCAST). RESULTS: A total of 11 patients were classified as proven and 33 as probable invasive aspergillosis. There was a statistically significant difference in age groups, subdisease, neutropenic, and receiving chemotherapy between groups. A total of 23 strains were identified as Aspergillus fumigatus, 12 as Aspergillus niger, 6 as Aspergillus flavus, and 3 as Aspergillus terreus. Phylogenetic analysis revealed five different genotypes. No statistical difference was found in the comparisons between patients groups and genotype groups. There was a statistically significant difference between genotype groups and voriconazole, posaconazole, and itraconazole Minimum Inhibition Concentration (MIC). CONCLUSION: Accurate identification of strains and antifungal susceptibility studies should be performed due to azole and amphotericin B resistance. Genotyping studies are important in infection control due to identifying sources of infection and transmission routes.
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Objective:To assess the susceptibility of gonococcal clinical isolates to gentamicin in Guangxi region, China, and to analyze the correlation between the minimum inhibitory concentration (MIC) of gentamicin and MICs of 7 other antibiotics.Methods:From December 2020 to December 2021, 584 gonococcal clinical isolates were collected from 37 medical institutions in 14 prefecture-level cities in Guangxi region. The susceptibility of gonococcal clinical isolates to ceftriaxone, cefixime, azithromycin, spectinomycin, penicillin, tetracycline, ciprofloxacin and gentamicin was determined by using an agar dilution method. The MIC values of antibiotics were logarithmically transformed with base 2, and Spearman correlation analysis was carried out to evaluate the correlation between the MIC of gentamicin and MICs of the other 7 antibiotics.Results:The MIC of gentamicin ranged from 1 to 16 mg/L, and the MIC50 and MIC90 values were 4 and 8 mg/L, respectively; 361 strains (61.8%) were fully sensitive to gentamicin with the MIC ≤ 4 mg/L, 223 strains (38.2%) moderately sensitive with the MIC ranging from 8 to 16 mg/L, and no gentamicin-resistant strains were found. The number of strains resistant to azithromycin, penicillin, tetracycline and ciprofloxacin was 136 (23.3%), 415 (71.1%), 339 (58.0%) and 574 (98.3%) respectively, the number of lowly sensitive strains to ceftriaxone and cefixime was 17 (2.9%) and 6 (1.0%) respectively, and no spectinomycin-resistant strains were found. Spearman correlation analysis showed that the MIC of gentamicin was weakly correlated with the MICs of azithromycin, spectinomycin, penicillin, tetracycline, and ciprofloxacin (all P < 0.05), but was uncorrelated with the MICs of ceftriaxone and cefixime (both P > 0.05) . Conclusion:All gonococcal clinical isolates tested in this study showed a certain degree of susceptibility to gentamicin, and cross-resistance between gentamicin and other antibiotics was less likely to occur.
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Objective:Based on the principle that the aggregation-induced emission (AIE) fluorescent probe 6PD-DPAN could bind and aggregate with bacteria, and the fluorescence intensity could reflect the quantity of bacteria, a new method for rapid, convenient, and accurate bacterial drug sensitivity testing was established, which provided a basis for rapid and accurate clinical drug use.Methods:This was a methodological evaluation study. A total of 107 clinical isolates were collected from Houjie Hospital of Dongguan City from January to December 2022, among which 46 isolates were used for the establishment of the new method, and 61 isolates were used for methodological validation. The minimum inhibitory concentration (MIC) determined by broth microdilution method was used as the gold standard, and three antibacterial drugs, gentamicin, levofloxacin, and cefotaxime, were used as experimental drugs. The AIE plate was incubated for 4 hours, and the fluorescence intensity was measured every half an hour to draw a fluorescence change curve. The MIC results were compared with the CLSI breakpoints to determine the bacteria as sensitive, intermediate, or resistant. To simplify the detection process, the ratio of fluorescence intensity at 4 hours(R) was calculated, and the ROC curve was used to analyze the efficacy of R in determining bacterial growth and establish its cutoff value. The new method was used to determine the MIC of 61 clinical isolates, with broth microdilution method as the gold standard. The basic consistency, categorical consistency, very major errors, and major errors of the new method were analyzed, and the consistency between the two methods was determined by the Kappa test.Results:ROC curve analysis of the R after 4 hours of culture: The cut-off value was 3.0, with both sensitivity and specificity for determining bacterial growth being 100%. The median (interquartile) R for bacterial growth inhibition was 11.1 (8.6, 14.4); the median R-value for bacterial growth was 1.1 (1.0, 1.2). Compared to the gold standard, the newly established method showed 100% (61/61) essential agreement in detecting MICs of 61 clinical isolates, with a categorical agreement of 96.7% (59/61). There were no very major or major errors, and the Kappa value was 0.94, indicating good consistency between the newly established method and the microbroth dilution method.Conclusions:This study successfully established a new method for bacterial drug sensitivity testing based on AIE technology, which could obtain satisfactory results within 5 hours, providing a basis for early precision drug treatment in clinical practice.
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OBJECTIVE@#Agar dilution method (ADM) was used as the golden standard to evaluate the consistency of Epsilometer test (E-test) in detecting the sensitivity of Helicobacter pylori (H. pylori) to metronidazole.@*METHODS@#From August 2018 to July 2020, patients with H. pylori infection treated for the first time in Peking University Third Hospital for gastroscopy due to dyspepsia were included in this study. Gastric mucosas were taken from the patients with H. pylori infection. H. pylori culture was performed. Both the ADM and E-test were applied to the antibiotic susceptibility of H. pylori to metro-nidazole, and the consistency and correlation between the two methods were validated.@*RESULTS@#In the study, 105 clinical isolates of H. pylori were successfully cultured, and the minimum inhibitory concentration ≥ 8 mg/L was defined as drug resistance. Both ADM and the E-test showed high resistance rates to metronidazole, 64.8% and 62.9%, respectively. Among them, 66 drug-resistant strains were detected by ADM and E-test, and 37 were sensitive strains, so the consistency rate was 98.1%. Two strains were evaluated as drug resistance by ADM, but sensitive by the E-test, with a very major error rate of 1.9%. There was zero strain sensitive according to ADM but assessed as resistant by the E-test, so the major error rate was 0%. Taking ADM as the gold standard, the sensitivity of E-test in the detection of metronidazole susceptibility was 97.1% (95%CI: 0.888-0.995), and the specificity was 100% (95%CI: 0.883-1.000). Cohen's kappa analysis showed substantial agreement, and kappa coefficient was 0.959 (95%CI: 0.902-1.016, P < 0.001). Spearmans correlation analysis confirmed this correlation was significant (r=0.807, P < 0.001). The consistency evaluation of Bland-Altman method indicated that it was good, and there was no measured value outside the consistency interval. In this study, cost analysis, including materials and labor, showed a 32.2% higher cost per analyte for ADM as compared with the E-test (356.6 yuan vs. 269.8 yuan).@*CONCLUSION@#The susceptibility test of H. pylori to metronidazole by E-test presents better agreement with ADM. Because it is less expensive, less labor intensive, and more rapid, it is an easy and reliable method for H. pylori susceptibility testing.
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Humanos , Metronidazol/uso terapêutico , Helicobacter pylori , Ágar/uso terapêutico , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Testes de Sensibilidade Microbiana , Infecções por Helicobacter/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
Objective:To investigate the clinical manifestations and related risk factors of patients with Pseudomonas aeruginosa (PAE) bloodstream infection, and to provide references for clinical diagnosis and treatment of PAE bloodstream infection after combining with bacterial resistance condition. Methods:The clinical data and biological data of all patients with PAE bloodstream infection who received treatment in the Third Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2020 were analyzed retrospectively. The independent influential factors of PAE bloodstream infection were analyzed using binary logistic regression. Results:Eighty-three patients had PAE bloodstream infection. Among them, 71 patients were included in the final analysis. Among the 71 patients, 36 patients (50.70%) had carbapenem-resistant Pseudomonas aeruginosa ( CRPA). Univariate analysis showed that the history of hospitalization within 90 days ( χ2 = 3.90, P = 0.048), indwelling catheterization ( χ2 = 5.08, P = 0.024), septic shock ( χ2 = 4.00, P = 0.046), mechanical ventilation ( χ2= 12.35, P < 0.001), deep venous catheter ( χ2 = 4.08, P = 0.043), acute physiology and chronic health evaluation score II ≥ 10 points ( χ2 = 4.06, P = 0.044), and multi-drug resistance ( χ2 = 11.75, P = 0.001) were the suspicious influential factors of CRPA bloodstream infection. Multivariate logistic regression analysis showed that mechanical ventilation was an independent risk factor for CRPA bloodstream infection ( OR = 7.43, 95% CI 1.182-46.674, P = 0.032). Multi-drug resistance was an independent risk factor for CRPA bloodstream infection ( OR = 5.842, 95% CI 1.520-22.450, P = 0.010). Conclusion:Mechanical ventilation and multi-drug resistance are the independent influential factors of CRPA bloodstream infection. Invasive operations such as mechanical ventilation should be avoided in the clinic.
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Objective:To study the distribution and drug resistance of pathogenic bacteria of biliary tract infection in patients with hepatobiliary surgery.Methods:A total of 103 patients with biliary tract infection who received treatment in the Department of Hepatobiliary Surgery, Lanxi People's Hospital from May 2020 to October 2022 were included in this study. Their bile was cultured to analyze the distribution and drug resistance of pathogenic bacteria. The data were processed using the WHONET5.5 software system.Results:Fifty-eight pathogenic bacteria-positive samples were cultured from the bile of 103 patients with biliary tract infection, with a pathogenic bacteria-positive rate of 56.31%. Among 58 strains of pathogenic bacteria, 38 strains (65.52%) were gram-negative bacteria, mainly Escherichia coli and Klebsiella pneumonia, and 5 strains (8.62%) were fungal strains. Escherichia coli and Klebsiella pneumoniae were highly resistant to sulfamethoxazole-trimethoprim, ciprofloxacin, and other antibacterial drugs, and were completely sensitive to imipenem and meropenem. Enterococcus faecalis was mainly resistant to ampicillin and penicillin G,and it was completely sensitive to vancomycin and teicoplanin. Staphylococcus aureus was resistant to vancomycin, ciprofloxacin, cefotaxime, and other drugs. A total of 13 strains of ultrabroad-spectrum beta-lactamase bacteria were isolated from 25 strains of Escherichia coli and 7 strains of Klebsiella pneumonia, with the positive detection rate of 40.63%. Conclusion:The main pathogenic bacteria of biliary tract infection are Gram-negative bacteria, which are widely distributed and have serious drug resistance. In clinical practice, antimicrobial drugs should be reasonably selected according to the results of bile drug sensitivity tests.
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Objective:To analyze types of mucosal candidiasis and drug resistance of relevant pathogens in a dermatology outpatient clinic in Taiyuan.Methods:Clinical data were collected from 172 patients with mucosal candidiasis, who had positive fungal culture results, in the dermatology outpatient clinic of Shanxi Bethune Hospital from 2019 to 2020. Pathogens were identified by a molecular biological approach, and in vitro drug sensitivity test was performed. Results:Among the 172 patients with mucosal candidiasis, 142 (82.6%) had vulvovaginal candidiasis, 24 (14.0%) had candidal balanoposthitis, and 6 (3.5%) had oral candidiasis; 3 patients were aged ≤ 18 years, 155 were aged 19 - 59 years, and 14 were aged ≥ 60 years, and the proportion of patients with vulvovaginal candidiasis significantly differed among the above 3 age groups (2/3, 134/155[86.45%], 6/14, respectively; χ2 = 14.29, P < 0.05) . Molecular biological identification showed that all the 172 isolated strains belonged to the genus Candida, including 165 strains of Candida albicans (95.9%) , 5 strains of Candida glabrata (2.9%) , and 2 strains of Candida parapsilosis (1.2%) ; the sensitivity to common antifungal agents including flucytosine, amphotericin B, fluconazole, itraconazole and voriconazole was 95.9%, 100.0%, 62.2%, 47.1% and 56.4%, respectively. Conclusion:In the dermatology outpatient clinic of Shanxi Bethune Hospital, vulvovaginal candidiasis was the most common type of mucosal candidiasis, and the main pathogen was Candida albicans; the Candida isolates showed high sensitivity to flucytosine and amphotericin B.
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Objective:To evaluate the clinical performance of direct antimicrobial susceptibility test in blood culture-positive broth, and to provide a basis for optimizing the antibiotic use strategy in clinical bloodstream infection.Methods:A retrospective analysis was conducted on 780 blood culture-positive samples collected in Peking University People′s Hospital from May 2017 to December 2021. The direct antimicrobial susceptibility test was performed by disk diffusion method on blood culture-positive broth. The antimicrobial susceptibility breakpoints were in accordance with Clinical and Laboratory Standards Institute (CLSI) M100 S32 edition document.Results:In this study, a total of 331 strains of Gram-negative bacteria (139 strains of Escherichia coli, 79 strains of Klebsiella pneumoniae, 35 strains of Pseudomonas aeruginosa, 21 strains of Acinetobacter baumannii) and 396 strains of Gram-positive cocci (25 strains of Staphylococcus aureus, 316 strains of coagulase-negative staphylococci, 47 strains of Enterococcussp.) were collected, after excluding 53 cases with two or more isolates. Compared with the routine antimicrobial susceptibility test (AST), the rates of category agreement (CA), major error (ME), and very major error (VME) of Gram-negative bacteria were 86.0% (1368/1 591), 8.7% (139/1 591), and 0.5% (8/1 591), respectively. On the other hand, the CA%, ME%, and VME% of Gram-positive cocci were 89.2% (960/1 076), 7.5% (81/1 076), and 1% (11/1 076), respectively. Regarding the individual antimicrobial agents, the CA% of Escherichia coli was 16/17 for imipenem, 90.1% (109/121) for meropenem, and 70.8% (85/120) for cefepime. For Klebsiella pneumoniae, the CA% of was 10/13 for imipenem, 80.9% (55/68) for meropenem, and 80.3% (53/66) for cefepime. The CA% of meropenem in Pseudomonas aeruginosa and Acinetobacter baumannii were 96.0% (24/25) and 16/16. The CA% of linezolid and cefoxitin in Staphylococcus aureus were 100% (25/25) and 100% (24/24), respectively. The CA% of linezolid, cefoxitin and gentamicin in coagulase-negative staphylococci were 98.9% (269/272), 94.5% (277/293) and 71.6% (194/271) respectively. Finally, for Enterococcus sp., the CA% of vancomycin and ampicillin were 91.5% (43/47) and 94.7% (36/38), respectively. Conclusion:Compared with the conventional AST, the blood culture-positive broth direct AST exhibited high category agreement and low error rates for both Gram-negative bacteria and Gram-positive cocci, which can serve a rapid alternative for AST in cases of clinical bloodstream infection.
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Objective:The aim of this study was to evaluate the in vitro activity of lysosin-Ⅰ against Methicillin-resistant Staphylococcus aureus (MRSA) and its synergistic effect with eight common antibacterial drugs against MRSA. Methods:This study was conducted following the design principles of a randomized controlled trials. Ten MRSA isolates, clinically isolated from the Second Xiangya Hospital of Central South University between September and November 2021, were determined the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and bactericidal kinetic test of lycosin-Ⅰ in vitro anti-MRSA by micro-broth dilution method. Additionally, the micro-broth chessboard dilution method was utilized to evaluate the in vitro efficacy of lycosin-Ⅰ in combination with eight common antimicrobial agants, including penicillin, erythromycin, levofloxacin, gentamicin, rifampicin, minocycline, vancomycin, and linezolid. Results:The MIC range of lycosin-Ⅰ against MRSA was found to be between 4-8 mg/L with the MIC 50 and MIC 90 were 4 mg/L and 8 mg/L, respectively. The range of MBC was also between 4-8 mg/L, and the ratio of MBC/MIC was 1-2. The bactericidal kinetics test revealed that the number of surviving MRSA clinical isolates and standard strains initially decreased rapidly but then showed a resurgence when the concentration of lycosin-Ⅰ was 1/2 MIC or MIC. While, the bacterial load gradually reduced until complete elimination when the concentration was at 2 MIC or 4 MIC. The combination of lycosin-Ⅰ and gentamicin exhibited mainly synergistic effects, while the combination with other antibiotics showed mainly additive effects. Moreover, the combination of lycosin-Ⅰ and antibacterial drugs can significantly reduce the MIC 50 and MIC 90 of antibiotics. Conclusion:lycosin-Ⅰ has great antibacterial and bactericidal activity against MRSA in vitro with rapid and thorough sterilization effect and it can play a synergistic or additive role when combined with other antibacterial drugs against MRSA in vitro.
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ABSTRACT Objective. To describe antimicrobial resistance profiles of Escherichia coli and Salmonella spp. isolated from chicken carcasses and the antimicrobials commonly used in animals in Ecuador and provide information on antimicrobial resistance patterns for implementing evidence-based corrective measures. Methods. Meat samples were collected from chicken carcasses in 199 slaughterhouses across Ecuador as part of a national pilot study for monitoring antimicrobial resistance in agricultural sources in 2019. Samples were tested for E. coli and Salmonella spp. Sensitivity to 10 critically important and three highly important antimicrobials (from a human health perspective) was assessed. The country report submitted to the World Organization for Animal Health was accessed to extract the quantity of antimicrobials produced or imported for use in animals. Results. Of 383 samples, E. coli was isolated from 148 (39%) and Salmonella spp. from 20 (5%) samples. Ninety percent of the isolates were resistant to at least one critically important antimicrobial. Resistance was highest to erythromycin (E. coli 76%; Salmonella spp. 85%) and tetracycline (E. coli 71%; Salmonella spp. 90%). Critically or highly important antimicrobials (colistin, tetracycline, trimethoprim/sulfamethoxazole) formed the bulk (87%) of antimicrobials used in animals as per the World Organization for Animal Health report. Conclusions. High prevalence of antimicrobial resistance in poultry in Ecuador calls for the development of guidelines and regulations on the use of antimicrobials and for engagement with livestock producers. The existing surveillance system needs to be strengthened to improve the monitoring of antimicrobial use and evolving resistance patterns.
RESUMEN Objetivo. Describir los perfiles de resistencia antimicrobiana de las bacterias Escherichia coli y Salmonella spp. aisladas en carne de pollo y los antimicrobianos comúnmente empleados en animales en Ecuador, así como proporcionar información sobre los patrones de resistencia a los antimicrobianos para poner en marcha medidas correctivas basadas en la evidencia. Métodos. Se recogieron muestras de carne de pollo en 199 mataderos de todo Ecuador en el marco de un estudio piloto nacional para monitorear la resistencia a los antimicrobianos en fuentes agrícolas en el 2019. Se analizaron las muestras en busca de E. coli y Salmonella spp. Se evaluó la sensibilidad a diez antimicrobianos de importancia crítica y tres muy importantes (para la salud humana). Se accedió al informe de país presentado ante la Organización Mundial de Sanidad Animal para obtener la cantidad de antimicrobianos producidos o importados para su uso en animales. Resultados. De 383 muestras, se aisló E. coli en 148 (39%) y Salmonella spp. en 20 (5%). En total, 90% de las cepas aisladas fueron resistentes a al menos un antimicrobiano de importancia crítica. Hubo una mayor resistencia a la eritromicina (E. coli: 76%; Salmonella spp.: 85%) y a la tetraciclina (E. coli: 71%; Salmonella spp.: 90%). Los antimicrobianos de importancia crítica o muy importantes (colistina, tetraciclina, trimetoprima/sulfametoxazol) constituyeron la mayor parte (87%) de los antimicrobianos empleados en animales según el informe de la Organización Mundial de Sanidad Animal. Conclusiones. Debido a la alta prevalencia de la resistencia a los antimicrobianos en las aves de corral en Ecuador, son imprescindibles la elaboración de directrices y regulaciones sobre el uso de antimicrobianos y el compromiso con los productores pecuarios. Es necesario fortalecer el sistema de vigilancia existente para mejorar el seguimiento del uso de antimicrobianos y de la evolución de los patrones de resistencia.
RESUMO Objetivo. Descrever perfis de resistência aos antimicrobianos em Escherichia coli e Salmonella spp. isoladas de carcaças de frango e os antimicrobianos comumente usados em animais no Equador e fornecer informações sobre padrões de resistência aos antimicrobianos para implementar medidas corretivas baseadas em evidências. Métodos. Foram coletadas amostras de carne de carcaças de frango em 199 abatedouros em todo o Equador como parte de um estudo piloto nacional para monitorar a resistência aos antimicrobianos de origem agrícola em 2019. Foram testadas amostras de E. coli e Salmonella spp. Foi avaliada a sensibilidade a 10 agentes antimicrobianos de importância crítica e três agentes antimicrobianos muito importantes (do ponto de vista da saúde humana). O relatório do país apresentado à Organização Mundial de Saúde Animal foi acessado para extrair a quantidade de antimicrobianos produzidos ou importados para uso em animais. Resultados. De 383 amostras, E. coli foi isolada em 148 (39%) e Salmonella spp. em 20 (5%). Noventa por cento dos isolados foram resistentes a pelo menos um antimicrobiano de importância crítica. A resistência foi maior à eritromicina (E. coli, 76%; Salmonella spp., 85%) e à tetraciclina (E. coli, 71%; Salmonella spp., 90%). Antimicrobianos de importância crítica ou muito importantes (colistina, tetraciclina, trimetoprim/sulfametoxazol) responderam pela maior parte (87%) dos antimicrobianos utilizados em animais, conforme o relatório da Organização Mundial de Saúde Animal. Conclusões. A alta prevalência de resistência aos antimicrobianos na avicultura no Equador exige o desenvolvimento de diretrizes e regulamentos sobre o uso de antimicrobianos e o envolvimento com os produtores de gado e avícolas. O sistema de vigilância existente precisa ser reforçado para melhorar o monitoramento do uso de antimicrobianos e a evolução dos padrões de resistência.
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Introduction. Malassezia is a lipophilic and lipid-dependent yeast genus belonging to the skin microbiota of humans and other animals. However, due to dysbiosis processes or other factors in the host, this yeast can cause different pathologies, ranging from skin diseases, such as seborrheic dermatitis, to fungemia. Isolation of Malassezia furfur has been reported in HIV-positive patients with or without skin lesions. Due to its opportunistic nature and its variable resistance to antifungal compounds, it is relevant to know the Malassezia sensitivity profiles. Objective. To determine the sensitivity to different antifungal agents, of clinical isolates of M. furfur obtained from HIV-positive or negative patients, with or without seborrheic dermatitis. Materials and methods. Assessment of isolates sensitivity to itraconazole, voriconazole, fluconazole, and amphotericin B was performed by two techniques: (1) Broth microdilution using Clinical and Laboratory Standards Institute (CLSI) protocol M27-A3 with modifications; and (2) agar tests using Etest®. Results. Isolates obtained from HIV patients showed an increase in the minimum inhibitory concentration of fluconazole, voriconazole, and amphotericin B, compared with those of non-HIV patients. Itraconazole was the antifungal with the lowest minimum inhibitory concentration (MIC) in most isolates. Conclusion. We observed differences in the sensitivity profiles of M. furfur isolates according to the context of the patient. High MIC of antifungals like fluconazole, commonly used for treating pathologies caused by Malassezia, were identified.
Introducción. Malassezia es un género de levaduras lipofílicas que dependen de los lípidos y hacen parte de la microbiota de la piel de humanos y otros animales. No obstante, debido a procesos de disbiosis u otros factores en el huésped, esta levadura puede llegar a causar diferentes enfermedades: desde cutáneas (como dermatitis seborreica) hasta fungemias. Se han reportado aislamientos de Malassezia furfur en pacientes positivos para HIV, con lesiones cutáneas o sin ellas. Por su carácter oportunista y sensibilidad variable a los compuestos antifúngicos, es relevante conocer los perfiles de sensibilidad. Objetivo. Determinar la sensibilidad a diferentes antifúngicos de aislamientos clínicos de M. furfur obtenidos de pacientes positivos o negativos para HIV, con dermatitis seborreica o sin ella. Materiales y métodos. La sensibilidad de los aislamientos a itraconazol, voriconazol, fluconazol y anfotericina B, se determinó mediante dos técnicas: microdilución en caldo según el protocolo M27-A3 del Clinical & Laboratory Standards Institute (CLSI), con modificaciones, y pruebas en agar mediante Etest®. Resultados. Los aislamientos obtenidos de pacientes con HIV mostraron aumento de la concentración inhibitoria mínima a fluconazol, voriconazol y anfotericina B, en comparación con los de pacientes sin HIV. Por otro lado, al evaluar la mayoría de los aislamientos, el itraconazol fue el antifúngico con la menor concentración inhibitoria mínima. Conclusión. Se evidencian diferencias en los perfiles de sensibilidad de los aislamientos de M. furfur, según el contexto del paciente, y elevadas concentraciones inhibitorias mínimas de antifúngicos como el fluconazol, usados comúnmente para el tratamiento de las enfermedades causadas por Malassezia spp.
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Testes de Sensibilidade Microbiana , Farmacorresistência Fúngica , HIV , Dermatite Seborreica , Malassezia , AntifúngicosRESUMO
Objetivo : Determinar la susceptibilidad antimicrobiana de cepas de Streptococcus agalactiae (EGB) aisladas entre 2015-2020 en un hospital materno-infantil. Material y métodos : Estudio descriptivo realizado entre 2015 y 2020. La identificación y susceptibilidad antimicrobiana se determinaron por el sistema automatizado Vitek® 2. La base de datos obtenida fue transferida al programa WHONET versión 5.6. Se incluyeron 506 aislamientos de EGB. Resultados : 500 (98,8%) fueron en mujeres. La edad media fue de 31,9 ± 11,8 años. Todos fueron sensibles a penicilina, ampicilina y vancomicina, la resistencia a eritromicina, clindamicina y levofloxacino fue de 38,5%, 37,4% y 28%, respectivamente, mostrando un pico de resistencia en 2018. Conclusión : Se observó un incremento en la resistencia de EGB a los antimicrobianos, especialmente el año 2018.
SUMMARY Objective : To determine the antimicrobial susceptibility of S. agalactiae (SA) strains isolated from 2015-2020 in a maternal-infant hospital in Lima, Peru. Methods : A descriptive study was carried-out from 2015 to 2020. Identification and susceptibility were performed using Vitek®2. Data base was transferred to the WHONET version 5.6 program; 506 isolates were analyzed. Results: 500 (98.8%) were females; mean age was 31.9 ± 11.8 years. All strains were susceptible to penicillin, ampicillin and vancomycin. Resistance to erythromycin, clindamycin and levofloxacin were 38.5%, 37.4% and 28%, respectively, showing the highest value in 2018. Conclusions : An increase in resistance of SA to antimicrobials was observed, especially in 2018.
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RESUMEN: Porphyromonas gingivalis (P. gingivalis) es un microorganismo frecuentemente aislado en pacientes con periodontitis, en los que también se incluye los de la población chilena. El modelo de "Keystone bacteria" demostró que P. gingivalis induce la disbiosis del biofilm subgingival y permite el desarrollo de algunas especies sobre otras, modulando la patogenicidad de la comunidad microbiológica completa. El tratamiento de la periodontitis es principalmente mecánico, pero en condiciones específicas es necesario el complemento con antibioterapia. Los estudios globales de antibióticos evaluados en ensayos clínicos y estudios in vitro han mostrado resultados mixtos en cuanto a eficacia y susceptibilidad. Este estudio descriptivo tuvo como objetivo evaluar el perfil de susceptibilidad antimicrobiana in vitro a metronidazol, clindamicina, amoxicilina más ácido clavulánico, moxifloxacino y azitromicina de P. gingivalis aisladas de pacientes periodontales chilenos. Se obtuvieron muestras microbiológicas de pacientes con diagnóstico de periodontitis estadíos III y IV generalizada, las que se sometieron a procesos de identificación mediante un espectrómetro de masas (MALDI-TOF MS). Posteriormente, a cada muestra positiva a P. gingivalis se aplicó el protocolo gold standard de susceptibilidad para los cinco antimicrobianos evaluados (Dilución en Agar Sangre Brucella- McFarland 0.5). Se seleccionaron 50 pacientes (25 mujeres, 25 hombres) entre 34-69 años. Finalmente, se recuperaron 25 cepas de P. gingivalis (50 %) para el análisis de susceptibilidad y todas ellas fueron sensibles a todos los antibióticos evaluados (100 % susceptibilidad). Las cepas de P. gingivalis fueron altamente sensibles a los cinco antibióticos evaluados en esta población, lo que podría implicar contar con diferentes alternativas de tratamiento farmacológico antimicrobi ano como complemento al tratamiento mecánico convencional en pacientes específicos.
ABSTRACT: Porphyromonas gingivalis (P. gingivalis) is a microorganism frequently isolated in patients with periodontitis, which also include those of Chilean population. The "Keystone bacteria" model demonstrated that P. gingivalis induces dysbiosis of the subgingival biofilm and allows the development of some species over others, modulating the pathogenicity of the entire microbiological community. The treatment of periodontitis is mainly mechanical; nevertheless, under specific conditions the complement with antibiotherapy is needed. Global studies of antibiotics evaluated in clinical trials and in vitro studies have shown mixed results in terms of efficacy and susceptibility. This descriptive study aimed to evaluate antimicrobial susceptibility profile in vitro to metronidazole, clindamycin, amoxicillin plus clavulanic acid, moxifloxacin and azithromycin of P. gingivalis isolated from Chilean periodontal patients. Microbiological samples were obtained from patients with a diagnosis of generalized periodontitis stages III and IV, which were exposed to identification processes by a mass spectrometer (MALDI-TOF MS). Subsequently, the gold standard susceptibility protocol for the five antimicrobials evaluated was applied to each P. gingivalis- positive sample (Dilution in Brucella-McFarland Blood Agar 0.5). 50 patients (25 women, 25 men) between 34-69 years old were selected. Finally, 25 P. gingivalis strains (50 %) were recovered for susceptibility testing and all of them were susceptible to all antibiotics tested (100 % susceptibility). P. gingivalis strains were highly susceptible to the five antibiotics evaluated in this population, which could implies counting different antimicrobial pharmacological treatment alternatives as a complement to conventional mechanical treatment in specific patients.
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RESUMEN Objetivo: Determinar el comportamiento clínico epidemiológico de apoyo al diagnóstico terapéutico y susceptibilidad antimicrobiana de infección del tracto urinario (ITU) en hospitalización del servicio de Pediatría del Hospital Regional de Moquegua durante los años 2014-2020. Materiales y métodos: Estudio observacional, descriptivo y retrospectivo. Para el propósito del estudio se tomó en cuenta una población de 248 pacientes, de 1 mes de edad a 14 años con 11 meses y 30 días, con diagnóstico de ITU, a quienes se les realizó un urocultivo. Se utilizó una ficha de recolección de datos y se procesaron los resultados en el programa SPSS versión 23. Resultados: La infección se presentó con más frecuencia en pacientes de sexo femenino (82,26 %) y la fiebre (83,87 %) fue la manifestación clínica predominante. El tratamiento médico que más se utilizó fue la amikacina (49,19 %). El germen que se aisló con mayor frecuencia fue E. coli (70,57 %). Los gérmenes aislados mostraron mayor frecuencia de sensibilidad frente a los antibióticos nitrofurantoina (70,16 %), ceftazidima (51,20 %), gentamicina (43,14 %) y amikacina (28,62 %). Por otro lado, presentaron resistencia frente al sulfametoxazol-trimetropim (74,59 %). Dentro de los hallazgos más comunes sobre estudios de imágenes se encontró la pielectasia unilateral (43,14 %). Conclusiones: La ITU se presenta con mayor frecuencia en mujeres. Es fundamental realizar la anamnesis y el examen clínico y, además, contar con el examen completo de orina y de imágenes. El diagnóstico definitivo se obtendrá vía urocultivo; iniciar el tratamiento de manera empírica dependerá del historial de sensibilidad y resistencia en base a los urocultivos realizados.
ABSTRACT Objective: To determine the clinical and epidemiological characteristics of urinary tract infections (UTIs) supported by the diagnosis, therapy and antimicrobial susceptibility of inpatients of the Pediatric Unit of the Hospital Regional de Moquegua from 2014 to 2020. Materials and methods: An observational, descriptive and retrospective study. The research included a population of 248 patients aged between 1 month and 14 years 11 months 30 days with a diagnosis of UTI who underwent a urine culture. A data collection sheet was used and the results were processed using the IBM SPSS Statistics statistical software 23.0. Results: The infection occurred more often in female patients (82.26 %), with fever being the most prevalent clinical manifestation (83.87 %). The most widely used medical treatment was amikacin (49.19 %). E. coli was the most frequently isolated germ (70.57 %). The isolated germs showed sensitivity to antibiotics such as nitrofurantoin (70.16 %), ceftazidime (51.20 %), gentamicin (43.14 %) and amikacin (28.62 %). In contrast, they were resistant to sulfamethoxazole-trimethoprim (74.59 %). One of the most common findings in the imaging tests was unilateral pyelectasis (43.14 %). Conclusions: UTIs occur more frequently in women. The anamnesis and clinical examination, together with a complete urinalysis and imaging tests, are essential for the diagnosis and treatment of these patients. The definitive diagnosis must be established by a urine culture. The choice of an empirical therapy will depend on the patient's history of sensitivity and resistance to antibiotics based on the urine cultures performed.
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Objective:To investigate the microbiota distribution and drug resistance in gravidas with suspected infection to provide a reference for the treatment of maternal infectious diseases.Methods:This retrospective study analyzed the distribution and in vitro antimicrobial susceptibility of microorganisms isolated from obstetric patients in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University (Beijing Maternal and Child Health Care Hospital) from January 1, 2016. to December 31, 2019. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used to identify pathogenic microorganisms. The susceptibility of isolated pathogenic bacteria to common antimicrobial agents was detected using bioMerieux VITEK-2 (France). Descriptive statistical methods was used. Results:A total of 4 086 strains were isolated from 3 781 samples of 3 225 gravidas and 44.17% (1 670) of the strains were from secretion specimens, including 767 cervical, 423 vulvovaginal, 318 perineum wound and 117 uterine secretion specimens. The most common bacterium was Escherichia coli (1 728, 42.29%), followed by Saccharomyces (901, 22.05%), Streptococcus (429, 10.50%), Enterococcus (377, 9.23%), and Staphylococcus (300, 7.34%). The proportion of Enterococcus among all the positive bacteria increased during the study period with its ranking rising from the 5th in 2016 to the 3rd in 2019, while the ranking of the proportion of Staphylococcus fell from the 4th in 2016 to the 5th in 2019. More than 90% of Escherichia coli were sensitive to carbapenems, piperacillin/tazobactam, amikacin, nitrofurantoin and ceftazidime, but only 35% or less to ampicillin and cefazolin. More than 98% of Candida strains were sensitive to amphotericin, but less than 56% to itraconazole. From 2016 to 2019, the sensitivity of Escherichia coli to cefuroxime sodium and ceftriaxone remained around 65%. The sensitive rate of Candida albicans to voriconazole and fluconazole gradually decreased from about 90% to 56%. The most common Enterococcus was Enterococcus faecalis and its susceptibility to vancomycin, ampicillin, penicillin, linezolid, nitrofurantoin and levofloxacin were all over 90%. Conclusions:Escherichia coli is the most common pathogenic microorganism in gravidas with suspected clinical infection and its susceptibility to cefuroxime sodium and ceftriaxone is stable. Candida albicans shows a gradually decreased susceptibility to voriconazole and fluconazole, which needs close attention. The proportion of Enterococcus in all pathogenic bacteria increases significantly over time, while that of Staphylococcus decreases.
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Objective:To investigate the distribution of respiratory pathogens and risk factors of death in patients with pulmonary infection in neurosurgical intensive care unit (NICU).Methods:A total of 87 patients with pulmonary infection in the NICU of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from January 2018 to December 2019 were collected, and the pathogens of their respiratory tract were analyzed to understand the types and distribution of bacteria in the lung infection. Univariate statistical analysis was used to analyze the relationship between the patient′s clinical outcome with age, diabetes, hypertension, renal insufficiency, hypoproteinemia, anemia, chronic respiratory disease, surgery, tracheotomy, and bacterial multi-resistance. Binary logistic regression analysis was used to analyze the influencing factors of death in NICU patients with pulmonary infection.Results:A total of 112 pathogenic bacteria were isolated in this research group, including 83 Gram-negative bacteria (74.11%), 22 Gram-positive bacteria (19.64%), and 7 Fungi (5.25%). Imipenem was highly sensitive to Gram-negative bacteria, vancomycin was highly sensitive to Gram-positive bacteria, and other drugs were highly resistant. 41 patients died (47.13%). Age≥60 ( OR=3.501, 95% CI: 1.152-10.638), renal insufficiency ( OR=3.872, 95% CI: 1.336-11.224), tracheotomy ( OR=0.317, 95% CI: 0.114-0.882), bacteria multi-drug resistance ( OR=3.480, 95% CI: 1.162-10.422) were independent risk factors for death in NICU patients with pulmonary infection. Conclusions:Patients with severe neurological diseases are in critical condition, and there are many patients with pulmonary infection, with poor prognosis and high mortality. Gram-negative bacteria are the most common respiratory pathogens. Carbapenems account for the highest proportion of antibiotics in clinic. Advanced age, renal insufficiency and bacterial multidrug resistance increase the mortality of patients, while early tracheotomy can reduce the mortality of patients.