Antibacterial activity of Kemloko fruit ethanol extract (Phyllanthus emblica L.) against Staphylococcus aureus and MRSA bacteria

Background: Indonesia is a tropical country, so the prevalence of infectious diseases caused by bacteria remains high. On the other hand, the high use of antibacterial ingredients in Indonesia causes bacterial resistance to existing antibacterial drugs. One of the herbal plants that some people widely use is Kemloko fruit. This study aimed to determine the activity of Kemloko fruit (Phyllanthus emblica L.) ethanol extract against the growth of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Methods: Simplicia of Kemloko fruit were tested for secondary metabolites and characterization test of the simplicia. The antibacterial activity test was carried out using the diffusion method, where the disc paper was immersed in the test solution with the ratio of the test concentration. Results: The results of phytochemical screening showed that the secondary metabolite compounds of Kemloko fruit are alkaloids, flavonoids, steroids, tannins, saponins, and glycosides. Antibacterial activity of ethanol extract of Kemloko fruit with agar diffusion method effectively inhibits S. aureus bacteria, namely at a concentration of 80 mg/ml, the inhibition zone is 14.1 mm, and at a concentration of 100 mg/ml, MRSA bacteria obtained an inhibition zone of 14.3 mm. Conclusions: The ethanol extract inhibits the growth of S. aureus and MRSA.

Desafío Diagnóstico

Niña 6 años, originaria de Darién, sin antecedentes personales de interés. Inicia cuadro de dolor y cojera de miembro inferior izquierdo con edema en región posterior de tobillo izquierdo. Los familiares lo relacionan con haber estado de excursión en un río de Darién días previos. Consultan en varias ocasiones en centros de salud de la zona, donde pautan tratamiento ambulatorio y colocación de férula. (provisto por Infomedic International)

6-year-old girl, originally from Darien, with no personal history of interest. She begins with pain and lameness of the left lower limb with edema in the posterior region of the left ankle. Family members relate it to having been hiking in a river in Darien the previous days. They consulted several times in health centers in the area, where they prescribed outpatient treatment and splinting. (provided by Infomedic International)

Skin care for toxic shock syndrome: case report / Cuidados com a pele na síndrome do choque tóxico: relato de caso / Cuidado de la piel en el síndrome de shock tóxico: reporte de caso

Objetivo: A síndrome do choque tóxico (SCT) é uma condição multissistêmica grave, causada por Staphylococcus aureus ou Streptococcus pyogenes,e o manejo inicial e contínuo das lesões de pele é essencial para o controle da infecção. Este relato teve o objetivo de descrever os cuidados com a pele nessa síndrome. Relato do caso: Paciente do sexo masculino com abscesso no quadril que evoluiu com febre e hipotensão e consequente transferência para a Unidade de Terapia Intensiva (UTI). Foi diagnosticado com choque séptico de provável foco no quadril, imediatamente abordado cirurgicamente para tratamento local da infecção. Apresentou insuficiência renal, além de disfunção multissistêmica (hepática e cardíaca), instabilidade hemodinâmnica e lesões disseminadas de pele. Com o isolamento do Staphylococcus aureus, iniciou-se clindamicina e o diagnóstico foi de SCT, uma vez que apresentou lesões epidermolíticas desde o início do quadro. Foram iniciadas medidas de recuperação cutânea com a sulfadiazina de prata e, posteriormente, com hidrofibra com prata com restauração do epitélio em 8 dias. Após 10 dias da pele restaurada, o paciente recebeu alta da UTI para enfermaria com manutenção do tratamento proposto. Conclusão: Neste caso, o uso da hidrofibra obteve uma performancesatisfatória, contudo ainda há necessidade de estudos robustos que comprovem tal eficácia. (AU)

Objective: Toxic shock syndrome (TSS) is a severe multisystemic condition caused by Staphylococcus aureus or Streptococcus pyogenes, and initial management of skin lesions is essential for infection control. This article aimed to describe skin care for TSS. Case report: We report a man with a hip abscess who developed fever and hypotension and was subsequently transferred to an intensive care unit (ICU). He was diagnosed with septic shock, probably of hip origin, and was immediately treated surgically for local infection control. He presented with renal failure besides multiple organ dysfunction (hepatic and cardiac), hemodynamic instability, and disseminated skin lesions. With the isolation of Staphylococcus aureus, clindamycin was initiated, and the diagnosis was TSS due to epidermolytic lesions since the onset of the condition. Cutaneous recovery measures were initiated with silver sulfadiazine, followed by silver hydrofiber with skin recovery in 8 days. After 10 days of skin recovery, the patient was discharged from the ICU to the ward with maintenance of the proposed treatment. Conclusion: In this case, the use of hydrofiber showed satisfactory performance; however, robust studies are needed to confirm such efficacy. (AU)

Objetivo: El síndrome de shock tóxico (SST) es una afección multisistémica grave causada por Staphylococcus aureuso Streptococcus pyogenes, y el tratamiento inicial y continuo de las lesiones cutáneas es esencial para controlar la infección. Este informe tuvo como objetivo describir los cuidado de la piel en este síndrome. Reporte del caso:Paciente masculino con absceso en la cadera que desarrolló fiebre e hipotensión y fue tranferido a la Unidad de Cuidados Intensivos (UCI). Se diagnosticó shock séptico, probablemente focalizado en la cadera, por lo que fue inmediatamente abordado quirúrgicamente para tratamiento local de la infección. Presentó insuficiencia renal además de disfunción multisistémica (hepática y cardiaca), inestabilidad hemodinámica y lesiones cutáneas diseminadas. Con el aislamiento de Staphylococcus aureus, se inició clindamicina y el diagnóstico fue SST, ya que presentaba lesiones epidermolíticas desde el inicio del cuadro. Se iniciaron medidas de recuperación cutánea con sulfadiazina de plata y, posteriormente, se optó por hidrofibra con plata, con restauración del epitelio en 8 días. Después de 10 días de piel restaurada, el paciente fue dado de alta de la UCI a planta con mantenimiento del tratamiento propuesto. Conclusión: Alcen este caso, el uso de hidrofibra obtuvo un desempeño satisfactorio, sin embargo, aún se necesitan estudios robustos para probar tal eficacia. (AU)

Endocarditis Infecciosa: una mirada desde la semiología, a propósito de un caso / Infectious Endocarditis: a View from Semiology, case report

Infective endocarditis (IE) is an infection of the inner lining of the heart, especially the heart valves, and carries high morbidity and mortality. It can manifest itself acutely or subacutely, the latter being more insidious. Diagnosis is challenging, especially in early stages, requiring high clinical suspicion using modified Duke criteria. Treatment involves antimicrobials and in certain cases cardiac surgery is essential. The clinical case presents a patient with a history of aortic valve replacement, who develops acute symptoms. Although the diagnosis of endocarditis is achieved, a por physical examination delays starting optimal treatment. Early diagnosis is crucial to avoid adverse outcomes. Post-hospital discharge follow-up is essential to identify possible long-term complications.

La endocarditis infecciosa es una infección del revestimiento interno del corazón, especialmente de las válvulas cardíacas, con alta morbimortalidad. Se manifiesta como aguda o subaguda, siendo esta última más insidiosa. El diagnóstico es desafiante, especialmente en etapas tempranas, requiriendo sospecha clínica en pacientes con fiebre, factores de riesgo cardiacos o no cardiacos y el uso de los criterios de Duke- International Society of Cardiovascular Infectious Diseases. El tratamiento implica antimicrobianos y en ciertos casos es imprescindible la cirugía cardiaca. Se presenta un caso clínico de un paciente con antecedentes de reemplazo valvular aórtico, que desarrolla síntomas agudos. Aunque se logra el diagnóstico de endocarditis, un examen físico poco exhaustivo causa retraso en el inicio del tratamiento óptimo. Un diagnóstico temprano es crucial para evitar resultados adversos. Es esencial la vigilancia estrecha post alta hospitalaria debido a complicaciones a largo plazo.

Antibacterial effectiveness test and characterization of ethanol extract of bandotan herba against Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa

Background: The bandotan plant has been officially recognized by the world health organization (WHO) as a traditional medicinal medicine. The Chinese government has officially recognized the bandotan plant as having health-promoting and longevity-enhancing properties. The content of several secondary metabolites of this bandotan plant, such as alkaloids, tannins, flavonoids, glycosides, and saponins, makes this plant have significant potential as an alternative to traditional therapy. This research aims to evaluate the bactericidal efficacy of the ethanol extract derived from the bandotan herb against Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa bacteria. Methods: The test was conducted using agar diffusion and streaking methods, with the test sample concentration being taken into account. The test results demonstrated that the ethanol extract of herba bandotan, at a dosage of 300 mg/mL, possesses inhibitory effects on the development of Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa bacteria. Results: The concentration required to kill Staphylococcus aureus bacteria by 50 mg/mL is achieved with a percent reduction of 98.27%. Similarly, a concentration of 75 mg/mL is needed to kill Pseudomonas aeruginosa bacteria with a percent reduction of 96.36%. Lastly, a concentration of 100 mg/mL can effectively eliminate Staphylococcus aureus bacteria with a percent reduction of 99.24%. Conclusions: The study's findings indicate that the ethanol extract derived from the bandotan plant had bactericidal and bacteriostatic properties against Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa bacteria.

Síndrome de piel escaldada asociado a estafilococcemia en un neonato: reporte de un caso / Scalded skin syndrome associated with staphylococcemia in a neonate: a case report

RESUMEN El síndrome de piel escaldada estafilocócica es una patología poco frecuente que principalmente afecta a población pediátrica. Si bien en la mayoría de los casos tiene un desenlace favorable, un buen diagnóstico diferencial y manejo antibiótico oportuno son cruciales para un buen pronóstico. Objetivo: Describir un caso de síndrome de piel escaldada con aislamiento en hemocultivos de S. Aureus meticilino resistente en un neonato. Caso clínico: Femenina de 25 días de vida, nacida a término y sin antecedentes perinatales relevantes que cursa con fiebre, dermatosis eritemato-descamativa generalizada, edema palpebral y de miembros inferiores. Se hospitalizó con diagnóstico de sepsis neonatal tardía y sindrome de piel escaldada. Reporte de hemocultivos con crecimiento de S. Aureus meticilino resistente, manejada con vancomicina durante 14 días. Control de hemocultivos negativos, evolución satisfactoria y de alta hospitalaria sin complicaciones. Conclusiones: A pesar de la baja incidencia del síndrome de piel escaldada, es importante incluir dentro del diagnóstico diferencial de la fiebre y las dermatosis tardías del neonato la infecciones por toxinas del S. Aureus, ya que su identificación y tratamiento oportuno son de gran importancia en el pronóstico del menor.

ABSTRACT Staphylococcal scalded skin syndrome is a rare pathology, which mainly affects pediatric population. Although in most cases it has a favorable outcome, making a good differential diagnosis and early antibiotic management are crucial for a good prognosis. Objective: To describe a case of scalded skin syndrome with methicillin-resistant S. aureus bloodstream infection in a newborn. Clinical case: A 25-day-old female, born at term and with no relevant perinatal history, presented with fever, generalized scaly erythematous dermatosis, eyelid and lower limb edema. She is hospitalized with a diagnosis of late neonatal sepsis and scalded skin syndrome. Report of blood cultures with growth of methicillin-resistant S. Aureus, managed with vancomycin for 14 days. Control cultures were negative, satisfactory evolution and hospital discharge without complications. Conclusions: Despite the low incidence of scalded skin syndrome, it is important to include S. aureus toxin infections in the differential diagnosis of fever and late-onset dermatoses in the newborn. The identification and early treatment are of great importance in the prognosis of the child.

Prevalencia de Staphylococcus aureusy su sensibilidad antibiótica en aislamientos en infecciones de piel y partes blandas en pacientes ambulatorios / Staphylococcus aureus prevalence and antimicrobial susceptibility in isolates from skin and soft tissue infections in outpatients

ntroducción: Las infecciones de piel y partes blandas (IPPB) constituyen la tercera causa de consulta en nuestro centro. S.aureus es el agente etiológico más frecuente en este tipo de infecciones y la meticilino resistencia es clínicamente el mecanismo de resistencia más importante. El objetivo de este trabajo fue analizar la prevalencia de los distintos agentes etiológicos en IPPB en pacientes ambulatorios, así como también estudiar su sensibilidad a los antibióticos y resistencias acompañantes más frecuentes. Materiales y métodos: Estudio descriptivo y retrospectivo que incluyó todas las muestras provenientes de IPPB de pacientes ambulatorios desde octubre de 2017 a abril de 2022. Resultados: Se obtuvieron 180 cultivos positivos de muestras provenientes de IPPB durante el periodo estudiado, 12 fueron infecciones polimicrobianas. En total se obtuvieron 307 aislamientos: el microorganismo aislado con mayor frecuencia fue S.aureus (111; 36,2%). Se hallaron 71 SAMR (64%) y 40 SAMS (36%). De los SAMR, 67 (95%) fueron comunitarios (SAMRC) por criterios microbiológicos, y 4 SAMR hospitalarios (5%). De las cepas SAMRC, 44 (66%) no presentaron resistencias acompañantes, 15 (22% ) fueron resistentes a eritromicina, 12 (18%) a gentamicina y 7 (10%) a clindamicina. Conclusiones: El microorganismo más frecuentemente aislado en IPPB en pacientes ambulatorios fue el S.aureus y 67 aislamientos fueron categorizados como SAMRC por lo cual es necesario considerar al SAMRC como un patógeno frecuente. Debido a la baja resistencia hallada para CLI y TMS ambos podrían ser de elección en el tratamiento empírico en las IPPB en pacientes ambulatorios

Background:S. aureus is the main cause of skin and soft tissues infections (SSTIs) in immunocompetent patients. This type of infection is the third cause of medical consultation in our center. Our objective was to evaluate the prevalence of S. aureus, as well as its sensitivity to antimicrobials, isolated from skin and soft tissue samples from outpatients at an interzonal general acute care hospital located in Buenos Aires, Argentina.Methods: Descriptive and retrospective study that included all outpatient SSTIs samples from October 2017 to April 2022.Results: We obtained 215 positive cultures of samples from SSTIs during the study period. Of a total of 276 isolates: the most frequently isolated microorganism wasS. aureus (111; 40.22%). The prevalence of S. aureuswas 51.63%. We found 71 MRSA (63.96%). Of the SAMR strains, 60.56% did not present accompanying resistance, and only 8 isolates (11.27%) showed resistance to clindamycin. All SAMRs remained sensitive to minocycline and trimethoprim-sulfamethoxazole.Conclusions: The most frequently isolated microorganism in SSTIs was S. aureus and 71 isolates were categorized as SAMR, therefore it is necessary to consider SAMR as a frequent pathogen. Due to the low resistance found for CLI and TMS, they should be considered for empirical treatment in SSTIs in outpatients

Escarlatina estafilocócica como complicación de quemadura por contacto

El Staphylococcus aureus causa una variedad de infecciones localizadas e invasivas supurativas y 3 síndromes mediados por toxinas: Síndrome de choque tóxico estafilocócico (STSS, por sus siglas en ingles), síndrome de piel escaldada estafilocócica (SSSS) e intoxicación alimentaria1. La escarlatina estafilocócica está relacionada con las toxinas del STSS y SSSS. De hecho, se pudieron describir dos síndromes diferentes cada uno relacionado a un tipo de toxina que eran formas atenuadas de estas entidades. El curso de esta patología generalmente es autolimitado, pero puede evolucionar rápidamente a enfermedad severa que ponga en peligro la vida. Un entendimiento de este conjunto de patologías nos permite abordar al paciente de una manera oportuna, manteniendo la vigilancia y en caso de ser necesario intervenir para evitar el advenimiento del STSS que puede desembocar en falla orgánica múltiple e incluso la muerte. Esta revisión se trata de un caso atendido en la unidad de quemados del Hospital del Niño Dr. José Renán Esquivel (HDNJRE) en el mes de mayo del 2023 con quemadura por contacto complicada con escarlatina estafilocócica. (provisto por Infomedic International)

Staphylococcus aureus causes a variety of localized and invasive suppurative infections and 3 toxin-mediated syndromes: staphylococcal toxic shock syndrome (STSS), staphylococcal scalded skin syndrome (SSSS) and food poisoning1 . Staphylococcal scarlet fever is related to STSS and SSSS toxins. In fact, two different syndromes each related to a type of toxin could be described which were attenuated forms of these entities. The course of this pathology is usually self-limiting, but can rapidly progress to severe life-threatening disease. An understanding of this set of pathologies allows us to approach the patient in a timely manner, maintaining vigilance and if necessary intervening to prevent the advent of STSS that can lead to multiple organ failure and even death. This review is about a case treated at the burn unit of the Hospital del Niño Dr. José Renán Esquivel (HDNJRE) in May 2023 with contact burn complicated by staphylococcal scarlet fever. (provided by Infomedic International)

Antibacterial activity of tekelan leaf ethanol extract (Chromolaena odorata (L.) R. M. King and H. Rob) against of Staphylococcus aureus bacteria

Background: Indonesia is a tropical country, so the prevalence of infectious diseases caused by bacteria still remains high. On the other hand, the intense use of antibacterial agent in Indonesia causes a tendency for bacterial resistance to existing antibacterial drugs. One of the herbal plants that is widely used by some people is tekelan leaves. The purpose of this study was to determine the activity of an ethanol extract of tekelan leaves on the growth of Staphylococcus aureus bacteria. Methods: Simplisia of tekelan leaves was tested for secondary metabolites and simplisa characterization testing. Antibacterial activity testing is carried out by the disc paper method, where the disc paper is immersed in the test solution with a comparison of the test concentration. Results: The results of phytochemical screening show that the secondary metabolites of tekelan leaves are alkaloids, flavonoids, steroids/triterpenoids, tannins, and glycosides. The results of the characterization of simplisia moisture content are 7.99%, water-soluble juice content is 13.29%, ethanol-soluble juice content is 12.18%, total ash content is 7.45%, and insoluble acid ash content is 0.92%. The observation of the antibacterial activity of the ethanol extract of tekelan leaves was carried out by the disc diffusion method. The test results showed that the ethanol extract of tekelan leaves was categorized as moderate at concentrations of 1% and 2% and as strong at concentrations of 4%, 5%, 10%, 20%, 40%, 60%, 80%, and 100%. The conclusion of this study is that ethanol extract had activity to inhibit the growth of Staphylococcus aureus and the MIC value obtained 0.7%. Conclusions: The conclusion of this study is that ethanol extract had activity to inhibit the growth of Staphylococcus aureus.

Application of multi-disciplinary team mode in prevention and control of multidrug resistant organism infection in lung transplant recipients / 器官移植

<b>Objective</b> To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. <b>Methods</b> Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. <b>Results</b> The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (<i>P</i><0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (<i>P</i><0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (<i>P</i><0.001). <b>Conclusions</b> MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application.

Study on the detection rate,epidemiology and resistance mechanism of MRSA in a hospital in recent 5 years / 国际检验医学杂志

Objective To investigate the detection rate,epidemiology and resistance mechanism of methicil-lin-resistant Staphylococcus aureus(MRSA)in a hospital in recent 5 years.Methods A total of 762 strains of non repetitive Staphylococcus aureus detected from 2016 to 2020 in a hospital were collected retrospectively.Methicillin-sensitive Staphylococcus aureus(MSSA)was 392 strains(MSSA group)and 370 strains caused by MRSA(MRSA group),and 95 strains of MRSA isolated in 2020 were further used for resistance mechanism.Staphylococcus aureus was identified and tested for drug sensitivity by Vitek 2 automatic microbial system.Molecular epidemiological typing was determined by multilocus sequence typing.The biofilm formation was performed by crystal violet staining.PCR amplification was used to detect drug resistance genes,virulence genes and biofilm related genes,and logistic regression analysis was used to investigate the independent risk factors of its occurrence.Results The detection rate of MRSA in past five years was 48.56％,mainly was from pus samples and secretion samples(38.38％,33.51％respectively).MRSA was found in the general sur-gery(18.65％)and otorhinolaryngology(12.70％).ST88 was the most common multilocus sequence typing(37.89％),and followed by ST951(24.21％).Moderate biofilm formation was the most common,accounting for 74.73％.Multivariate regression analysis showed that compared with MSSA group,hypoproteinemia,en-docrine system diseases,wound infection and history of antibiotic use within six months were the independent risk factors for infection in MRSA group.Compared with the control group,hospital transfer,wound infection and tumor were independent risk factors for infection in MRSA group(P＜0.05).Conclusion The detection rate of MRSA in a hospital is high,and the carrying rate of various drug-resistant genes is high.The hospital should pay attention to the prevalence of MRSA and related risk factors,so as to prevent it early.

Clinical characteristics of patients with Staphylococcus aureus bloodstream infection and analysis of risk factors and predictive indicators for the development of septic shock / 国际检验医学杂志

Objective To investigate the clinical features of of patients with Staphylococcus aureus blood-stream infection and risk factors for septic shock.Methods A total of 51 patients diagnosed with Staphylococ-cus aureus bloodstream infection in the hospital from January 2018 to March 2023 were enrolled in the study.According to whether the patients developed septic shock,they were divided into septic shock group and non-septic shock group.The clinical data of the patients were collected,and the clinical laboratory indicators were detected on the day of blood culture samples were collected.Bacteria isolated from blood culture specimens of patients were identified and tested for drug sensitivity.The clinical data and clinical laboratory test indicators of the two groups were compared.Multivariate Logistic regression was used to analyze the independent risk factors of septic shock in patients with Staphylococcus aureus bloodstream infection.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of clinical laboratory test indicators for septic shock in patients with Staphylococcus aureus bloodstream infection.Results Septic shock occurred in 12 of 51 patients,with an incidence of 23.5％.The proportion of patients with diabetes,gouty arthritis,the proportion of patients with long-term glucocorticoid use,the proportion of patients with respiratory tract in-fection,the proportion of patients who died,and the hospitalization cost in the septic shock group were higher than those in the non-septic shock group,and the differences were statistically significant(P＜0.05).Long-term glucocorticoid use was an independent risk factor for septic shock in Staphylococcus aureus bloodstream infection(P＜0.05).The combination of C-reactive protein(CRP),albumin(Alb),neutrophil/lymphocyte ratio(NLR)and procalcitonin(PCT)had high value in predicting septic shock in patients with Staphylococ-cus aureus bloodstream infection,and the area under the ROC curve was 0.983.Conclusion Long-term use of glucocorticoids can lead to an increased risk of septic shock in patients with Staphylococcus aureus blood-stream infection.The combined detection of CRP,Alb,NLR and PCT has a higher predictive value than single detection for septic shock in patients with Staphylococcus aureus bloodstream infection.

Advances in Xpert MRSA/SA technology for colonisation and decolonisation of methicillin-anti staphylococcus aureus / 中国综合临床

Methicillin-anti staphylococcus aureus(MRSA) is one of the common pathogenic bacteria in hospital infection. Many asymptomatic MRSA carriers have been found in clinical practice, which can not only transmit the strain to others, but also cause secondary infection due to their own reasons. Decolonization measures can reduce the number of MRSA colonizers, thereby reducing the risk of endogenous infection and secondary transmission. Early identification is the first step to prevent transmission and secondary infection, which requires high accuracy and sensitivity of detection methods. Xpert MRSA/SA assay (Cepheid, Sunnyvale, CA, USA) may be a better choice, which can shorten the time of traditional methods, and has high specificity and sensitivity. Unlike other rapid detection methods, the Xpert MRSA/SA assay may be more suitable for MRSA colonisation detection.

Bactericidal Effect of Selenium Nanoparticles Combined with Povidone-iodine on Pathogenic Bacteria in Surgical Site Infection / 中山大学学报(医学科学版)

ObjectiveTo investigate the bactericidal effect of loaded multifunctional povidoneiodine-nanometer selenium （PVP-I@Se） disinfectant on Staphylococcus aureus （SA） and methicillin-resistant Staphylococcus aureus （MRSA）， and to provide an experimental basis for the reduction of surgical site infection （SSI）. MethodsThe control group was the povidone iodine （PVP-I） group with different concentrations of iodine （50， 75， 100， 200 and 400 μg/mL）. The PVP-I@Se group （experimental group） was the PVP-I group further supplemented with 2 μg/mL Selenium nanoparticles （SeNPs）. Then we compared the bactericidal effect of the two groups of disinfectant solutions on SA and MRSA by examining the minimum inhibitory concentration （MIC）， minimum bactericidal concentration （MBC）， the shortest sterilization time at a concentration of 50 μg/mL iodine and the inhibition zone diameters at concentrations of 200 μg/mL and 400 μg/mL iodine. ResultsMIC values of PVP-I against SA and MRSA were both 79.17 μg/mL， and those of PVP-I@Se were 54.17 and 70.83 μg/mL， respectively. MBC values of PVP-I against SA and MRSA were 129.17 and 150.00 μg/mL， respectively， and those of PVP-I@Se were 70.83 and 87.50 μg/mL， respectively. At a concentration of 50 μg/mL iodine， the shortest sterilization time of PVP-I for SA and MRSA was 130 s and 140 s， respectively， and that of PVP-I@Se was 65 s and 75 s， respectively. At a concentration of 200 μg/ml iodine， the inhibition zone diameters of PVP-I for SA and MRSA were 7.67 mm and 8.33 mm， and those of PVP-I@Se were both 9.50 mm. At a concentration of 400 μg/mL iodine， the inhibition zone diameters of PVP-I for SA and MRSA were 9.00 mm and 9.33 mm， and those of PVP-I@Se were 11.67 mm and 12.00 mm， respectively. ConclusionsPVP-I with different concentrations of 50， 75， 100， 200 and 400 μg/mL iodine supplemented with 2 μg/mL SeNPs have better and faster bactericidal effect on SA and MRSA. When combined with SeNPs， PVP-I can enhance the bactericidal activity against SA and MRSA， but with better sensitizing effect on SA than MRSA and higher demand of iodine concentration （400 μg/mL） for sensitizing effect on MRSA. This study provides a theoretical basis for selecting optimal concentration and action time of the disinfectant， thus reducing SSI.

Effects of the various herbs and different proportions of the herbs in Huidu Yinhua powder on methicillin-resistant Staphylococcus aureus / 中国比较医学杂志

Objective To study the inhibitory effect of Huidu Yinhua powder from the Orthodox Manual of External Medicine on methicillin-resistant Staphylococcus aureus(MRSA),virulence factor α-hemolysin(Hla)activity,and biofilm formation,and to explore the optimal ratios of Huidu Yinhua powder and provide experimental support for its use.Methods The inhibitory effects of Huidu Yinhua powder and the herbs in the formula on USA300 were analyzed by the minimum inhibitory concentration(MIC),minimum bactericidal concentration(MBC),and disk diffusion assay(K-B method).Hemolysis,neutralization,oligomerization,and Western blot assays were used to verify in which form the drug inhibits the activity of virulence factor α-hemolysin(Hla).A biofilm assay was performed to evaluate the inhibitory effect of Huidu Yinhua powder on biofilm.Orthogonal experiments were performed to explore the optimal ratio of Huidu Yinhua powder.Results Huidu Yinhua powder inhibited the MRSA strain with a MIC90 of 64 mg/mL and an MBC of 256 mg/mL with antibacterial circle diameter of(7.50±0.50)mm.Huidu Yinhua powder inhibited Hla activity by inhibiting Hla secretion.The minimum effective concentration(MEC)was 16 mg/mL,and the MEC of biofilm was 8 mg/mL.In Huidu Yinhua powder,honeysuckle and astragalus only affected the hemolytic activity of MRSA and biofilm formation without inhibiting bacterial growth.The hemolytic activity and biofilm of MEC were both 32 mg/mL.Glycyrrhiza had a strong bacterial inhibitory capacity with a MIC90 of 8 mg/mL and biofilm MEC of 1 mg/mL without showing inhibitory hemolytic activity at subinhibitory concentrations.The orthogonal experiment showed that,at a ratio of honeysuckle,astragalus,and glycyrrhiza in Huidu Yinhua powder of 1∶2∶4,the MIC90 was 16 mg/mL,MEC of hemolytic activity was 8 mg/mL and that of biofilm was 4 mg/mL,both of which were the lowest among the nine groups.Conclusions Huidu Yinhua powder affects the hemolytic activity and biofilm formation of MRSA at subinhibitory concentrations with the optimal ratio of honeysuckle,astragalus,and glycyrrhiza being 1∶2∶4.

Distribution of virulence genes in clinical isolates of hospital-associated and community-associated methicillin-susceptible Staphylococcus aureus from Terengganu, Malaysia

@#Staphylococcus aureus is a common bacterial pathogen known to cause various kinds of infections due to its repertoire of virulence factors. This study aimed to investigate the distribution of 19 types of virulence genes among clinical isolates of methicillin-susceptible S. aureus (MSSA) using the polymerase chain reaction. A total of 109 MSSA isolates, i.e., 63 hospital-associated (HA) and 46 community-associated (CA) were collected from Hospital Sultanah Nur Zahirah, the main tertiary hospital in Terengganu, Malaysia, from July 2016 to June 2017. The most frequent virulence genes detected were hla (78.9%, n=86) and hld (78.0%, n=85) encoding hemolysins, lukED (56.9%, n=62) encoding leukotoxin ED, followed by seb (26.6%, n=29) and sea (24.8%, n=27) encoding enterotoxins. Among 34 (31.2%) isolates carrying six or more virulence genes, only five were multidrug resistant (MDR) while the remaining isolates were susceptible. Significant associations were discovered between the hld gene with CA-MSSA (p=0.016) and the seo gene with HA-MSSA (p=0.023). However, there is no significant association between virulence genes among the different types of infection. The clinical MSSA isolates in Terengganu showed high prevalence and high diversity of virulence gene carriage.

Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance

Abstract Objective: The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil. Methods: This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022. Results: Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus. Conclusion: Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.

El desarrollo y los complejos mecanismos de resistencia de S. aureus: una amenaza persistente en la era de los antibióticos

Introducción: S. aureus ha emergido como una amenaza persistente, demostrando una notable habilidad para desarrollar resistencia a lo largo de la evolución de los antibióticos. Desde los primeros enfrentamientos con la penicilina hasta los desafíos actuales con cepas resistentes a la vancomicina y la daptomicina, el estudio de los mecanismos de resistencia de este patógeno ha adquirido una importancia crítica. Objetivos: documentar los cambios en los patrones de resistencia de S. aureus a lo largo del tiempo, además de identificar las etapas críticas en el desarrollo de la resistencia a diferentes antibióticos. Materiales y métodos: el proceso de selección de artículos revisados se llevó a cabo identificando artículos publicados entre 2010 y 2023. Se utilizaron varias bases de datos relevantes, incluyendo PubMed, Scopus, Embase, Cochrane Library y Scielo. Se incluyeron estudios observacionales, artículos de revisión y guías clínicas. Se desarrollaron estrategias de búsqueda específicas para cada base de datos utilizando palabras clave y términos de búsqueda relacionados con S. aureus y su resistencia antimicrobiana, así como los tipos de estudios de interés. Se extrajeron datos relevantes de los estudios seleccionados, incluyendo información sobre los patrones de resistencia, mecanismos de resistencia, impacto clínico y estrategias terapéuticas. Los datos recopilados se analizaron y sintetizaron para documentar los cambios en los patrones de resistencia de S. aureus a lo largo del tiempo y para identificar las etapas críticas en el desarrollo de la resistencia a diferentes antibióticos. Resultados: se incluyeron 100 artículos donde se evidencia una evolución temporal de la resistencia, desde las primeras cepas resistentes a la penicilina hasta las actuales cepas resistentes a la vancomicina y la daptomicina. Estos estudios proporcionaron un análisis detallado de los mecanismos moleculares clave que impulsan la resistencia antimicrobiana, tales como la producción de beta-lactamasas, las alteraciones en las proteínas de unión a penicilina y las modificaciones en la membrana celular. Los hallazgos destacan una evolución significativa en la capacidad de S. aureus para adaptarse a diferentes antibióticos a lo largo del tiempo, subrayando la complejidad y la diversidad de los mecanismos de resistencia desarrollados por esta bacteria. Conclusiones: la evolución de la resistencia de S. aureus ha seguido un patrón marcado por etapas críticas, desde la aparición de cepas productoras de penicilinasa tras la introducción de la penicilina, hasta el surgimiento de MRSA con la meticilina y de VISA y VRSA con la vancomicina. Estos cambios destacan la capacidad de adaptación de S. aureus a nuevas presiones antibióticas. La revisión subraya la necesidad urgente de desarrollar estrategias antimicrobianas innovadoras y sostenibles para controlar esta creciente amenaza. Comprender los mecanismos de resistencia es crucial para desarrollar enfoques más efectivos y personalizados en el tratamiento de las infecciones por este germen.

Introduction: S. aureus has emerged as a persistent threat, demonstrating a remarkable ability to develop resistance throughout the evolution of antibiotics. From the first confrontations with penicillin to the current challenges with strains resistant to vancomycin and daptomycin, the study of the resistance mechanisms of this pathogen has acquired critical importance. Objectives: To document changes in S. aureus resistance patterns over time and identify critical stages in the development of resistance to different antibiotics. Materials and methods: The reviewed articles were selected by identifying articles published between 2010 and 2023. Several relevant databases were used, including PubMed, Scopus, Embase, Cochrane Library, and SciELO. Observational studies, review articles, and clinical guidelines were included. Specific search strategies were developed for each database using keywords and search terms related to S. aureus and its antimicrobial resistance as well as the types of studies of interest. Relevant data were extracted from the selected studies, including information on resistance patterns, resistance mechanisms, clinical impact, and therapeutic strategies. The collected data were analyzed and synthesized to document changes in S. aureus resistance patterns over time and identify critical stages in the development of resistance to different antibiotics. Results: One hundred articles were included where a temporal evolution of resistance is evident, from the first strains resistant to penicillin to the current strains resistant to vancomycin and daptomycin. These studies provided a detailed analysis of the key molecular mechanisms driving antimicrobial resistance, such as beta-lactamase production, alterations in penicillin-binding proteins, and cell membrane modifications. The findings highlight a significant evolution in the ability of S. aureus to adapt to different antibiotics over time, underscoring the complexity and diversity of resistance mechanisms developed by this bacterium. Conclusions: The evolution of S. aureus resistance has followed a pattern marked by critical stages, from the appearance of penicillinase-producing strains after the introduction of penicillin to the emergence of MRSA with methicillin and of VISA and VRSA with vancomycin. These changes highlight the ability of S. aureus to adapt to new antibiotic pressures. The review highlights the urgent need to develop innovative and sustainable antimicrobial strategies to control this growing threat. Understanding resistance mechanisms is crucial to developing more effective and personalized approaches for the treatment of infections caused by this germ.

Piomiositis multifocal por Staphylococcus aureus: a propósito de un caso pediátrico / Multifocal pyomyositis due to Staphylococcus aureus: a clinical case study / Piomiosite multifocal por Staphylococcus aureus: relato de caso

Introducción: la piomiositis (PMS) es una infección bacteriana aguda o subaguda del músculo esquelético. Entidad rara en pediatría, suele acompañarse de la formación de abscesos. Se presenta más frecuentemente en preescolares de sexo masculino, afectando mayoritariamente a extremidades y región pélvica. La manifestación multifocal es frecuente. El principal agente etiológico es Staphylococcus aureus. Caso clínico: 3 años, sexo masculino, sano. Consulta por fiebre continua de hasta 39 ºC de seis días de evolución, dolor de ambos miembros inferiores a predominio izquierdo, cojera y repercusión general. Examen físico: tumoración en muslo izquierdo de límites difusos de 13 x 5 cm, lisa, firme, impresiona adherida a planos musculares, dolorosa. Sin elementos fluxivos en la piel. Ecografía de partes blandas: aumento de tejidos blandos de la extremidad. Resonancia magnética (RM): abscesos que comprometen logia de los aductores del miembro izquierdo, el vasto externo del muslo derecho, musculatura paravertebral lumbar izquierda y cérvico-torácica izquierda. Tratamiento: drenaje, requiere de múltiples limpiezas quirúrgicas y antibioticoterapia prolongada. Cultivo de la lesión: Staphylococcus aureus meticilino resistente (SAMR). Buena evolución clínica e imagenológica. Discusión: la PMS ha presentado una incidencia creciente con la aparición del SAMR. La ecografía es un método adecuado para realizar diagnóstico local. La experiencia en la interpretación de la RM permite pesquisar el compromiso multifocal, identificando focos sin traducción clínica. La antibioticoterapia y el drenaje quirúrgico son los pilares del tratamiento. El pronóstico es bueno en la mayoría de los casos.

Introduction: pyomyositis (PMS) is an acute or subacute bacterial infection of the skeletal muscle. It is a rare infection in pediatrics, and it is usually accompanied by abscess formation. It occurs more frequently in male preschoolers, mostly affecting the extremities and pelvic region. The multifocal manifestation is frequent. The main etiological agent is Staphylococcus aureus. Clinical case: 3 year-old, male, healthy patient. He consulted for continuous fever of up to 39ºC of 6 days of evolution, pain in both lower limbs predominantly on the left, lameness and general repercussions. Physical examination: a 13 x 5 cm tumor in the left thigh with diffuse limits, smooth, firm, adhered to muscle layers, painful. Without fluxive elements on the skin. Soft tissue ultrasound: enlargement of the soft tissues of the extremity. Magnetic resonance imaging (MRI): abscesses involving the adductor lodge of the left limb, the vastus lateralis of the right thigh, left lumbar paravertebral musculature and left cervical-thoracic musculature. Treatment: drainage, requires multiple surgical cleanings and prolonged antibiotic therapy. Culture of the lesion: methicillin-resistant Staphylococcus Aureus (MRSA). Good clinical and imaging evolution. Discussion: PMS has had an increasing incidence with the appearance of MRSA. Ultrasound is a suitable method for local diagnosis. Experience in the interpretation of MRI has enabled us to research multifocal involvement, identifying unobserved foci during clinical check-up. Antibiotic therapy and surgical drainage are the main treatments. The prognosis is good in most cases.

Introdução: Ia Piomiosite (TPM) é uma infecção bacteriana aguda ou subaguda do músculo esquelético. É uma entidade rara em pediatria, costuma vir acompanhada de formação de abscessos. Ocorre com maior frequência em pré-escolares do sexo masculino, afetando principalmente as extremidades e a região pélvica. A manifestação multifocal é comum. O principal agente etiológico é o Staphylococcus aureus. Caso clínico: paciente 3 anos, sexo masculino, hígido. Consulta por febre contínua de até 39ºC há 6 dias, dor em ambos os membros inferiores predominantemente esquerdo, claudicação e repercussão geral. Exame físico: tumor na coxa esquerda com limites difusos de 13 x 5 cm, liso, firme, aparentemente aderido aos planos musculares, doloroso. Sem elementos fluidos na pele. Ultrassonografia de tecidos moles: aumento dos tecidos moles da extremidade. Ressonância magnética (RM): abscessos envolvendo o alojamento adutor do membro esquerdo, vasto lateral da coxa direita, músculos paravertebrais lombares esquerdos e cérvico-torácicos esquerdos. Tratamento: drenagem, requer múltiplas limpezas cirúrgicas e antibioticoterapia prolongada. Cultura da lesão: Staphylococcus aureus resistente à meticilina (MRSA). Boa evolução clínica e imagiológica. Discussão: a TPM tem tido uma incidência crescente com o aparecimento do MRSA. A ultrassonografia é um método adequado para diagnóstico local. A experiência na interpretação de ressonância magnética permite-nos investigar o envolvimento multifocal, identificando focos sem tradução clínica. A antibioticoterapia e a drenagem cirúrgica são os pilares do tratamento. O prognóstico é bom na maioria dos casos.

Thymidine-dependent Staphylococcus aureus and lung function in patients with cystic fibrosis: a 10-year retrospective case-control study

ABSTRACT Objective: Thymidine-dependent small-colony variants (TD-SCVs) of Staphylococcus aureus are being isolated with increasing frequency from patients with cystic fibrosis (CF). The aim of this study was to evaluate the relationship between TD-SCV isolation and pulmonary function in patients with CF, as well as to determine whether the emergence of TD-SCVs was associated with trimethoprim-sulfamethoxazole (TMP-SMX) use and with coinfection with other microorganisms. Methods: This was a retrospective case-control study including patients with CF who visited the Clinical Hospital Complex of the Federal University of Paraná, in Curitiba, Brazil, between 2013 and 2022. Demographic, clinical, and spirometric data, as well as information on TD-SCVs and other isolated microorganisms, were collected from the medical records of patients with CF and TD-SCVs (TD-SCV group; n = 32) and compared with those of a matched group of patients with CF without TD-SCVs (control group; n = 64). Results: Isolation of TD-SCVs was positively associated with TMP-SMX use (p = 0.009), hospitalization (p < 0.001), and impaired pulmonary function (p = 0.04). Conclusions: The use of TMP-SMX seems to contribute to the emergence of TD-SCVs, the isolation of which was directly associated with worse pulmonary function in our sample.