Meningitis neonatal precoz causada por transmisión vertical de Escherichia coli productora de beta-lactamasa de espectro extendido en parto prematuro con rotura prematura de membranas / Early neonatal meningitis caused by vertical transmission of extended-spectrum beta-lactamase-producing Escherichia coli in premature labor with premature rupture of membranes

Se comunica el caso de un recién nacido producto de un parto prematuro con rotura prematura de membranas, que desarrolló precozmente meningitis neonatal por Escherichia coli productora de beta-lactamasa de espectro extendido. Los cultivos en líquido céfalo raquídeo y sangre neonatal fueron tempranamente positivos para esta bacteria. No obstante no aislarse este microorganismo en la madre, los hallazgos de la biopsia placentaria y la precocidad de la infección neonatal son determinantes en señalar que se trató de infección intraamniótica con transmisión vertical al neonato. La meningitis neonatal fue tratada con meropenem y el niño se dio de alta en buenas condiciones después de 41 días de hospitalización. Las guías perinatales actuales, preconizan el tamizaje de muestras vaginales para la prevención del parto prematuro y de los resultados adversos asociados a infección bacteriana ascendente durante el embarazo.

We report the case of a newborn resultant of premature delivery with premature rupture of membranes, which developed early-onset neonatal meningitis caused by transmission of Escherichia coli producer of betalactamasa of spectrum extended. Cultures in cerebrospinal fluid and neonatal blood were early positive for this bacterium. Although this microorganism is not isolated in the mother, the findings of the placenta biopsy and the precocity of the neonatal infection are determinant in indicating that it was an intraamniotic infection with vertical transmission to the neonate. Neonatal meningitis was treated with meropenem and the child was discharged in good condition after 41 days of hospitalization. The current perinatal guidelines support the screening of vaginal samples for the prevention of preterm birth and the adverse outcomes associated with ascending bacterial infection during pregnancy.

Diarrheagenic Escherichia coli

ABSTRACT Most Escherichia coli strains live harmlessly in the intestines and rarely cause disease in healthy individuals. Nonetheless, a number of pathogenic strains can cause diarrhea or extraintestinal diseases both in healthy and immunocompromised individuals. Diarrheal illnesses are a severe public health problem and a major cause of morbidity and mortality in infants and young children, especially in developing countries. E. coli strains that cause diarrhea have evolved by acquiring, through horizontal gene transfer, a particular set of characteristics that have successfully persisted in the host. According to the group of virulence determinants acquired, specific combinations were formed determining the currently known E. coli pathotypes, which are collectively known as diarrheagenic E. coli. In this review, we have gathered information on current definitions, serotypes, lineages, virulence mechanisms, epidemiology, and diagnosis of the major diarrheagenic E. coli pathotypes.

Resistencia bacteriana en infecciones del tracto urinario de origen comunitario / Bacterial resistance in urinary tract infections of community origin

Antecedentes: Las infecciones del tracto urinario (ITU) representan una de las principales causas de morbilidad. Recientemente ha surgido preocupación por la creciente tasa de resistencia en los patógenos causantes, y el origen comunitario de la infección ya no garantiza susceptibilidad antibiótica. Objetivo: Determinar la tasa de los diferentes patrones de resistencia en infecciones de vías urinarias comunitarias, junto a los principales factores de riesgo asociados. Metodología: Estudio descriptivo prospectivo donde se incluyó a todos los pacientes que consultaron a la emergencia de Medicina Interna con síndrome clínico de ITU y en quienes se demostró la etiología infecciosa mediante urocultivo. Se documentaron las comorbilidades y el consumo previo de antibióti-cos y se buscó la significancia estadística de esto sobre el desarrollo de resistencia.Resultados: Se incluyeron 100 sujetos a estudio, 90% de las infecciones se debieron a E coli y K pneu-moniae, se documentó resistencia en 68% de los casos, 41% resistentes a quinolonas, 27% ESBL(+) y 17% a cefalosporinas de 3ra generación. Se encontró que la DM era la comorbilidad más común (46%) y representó un factor de riesgo para el desarrollo de resistencia a cefalosporinas (p=0.031) y cepas ESBL(+) (p=0.045). El consumo previo de aminopenicilinas, cefalosporinas y quinolonas condicionó para el desarrollo de diferentes resistencias.Conclusiones: Se encontró relación significativa entre la DM y el desarrollo de resistencia bacteriana, al igual que el uso previo de quinolonas, cefalosporinas y aminopenicilinas. El 68% de las cepas mos-tró alguna resistencia. Hay elevada tasa de resistencia a quinolonas, cefalosporinas y cepas ESBL(+). (AU)

Urinary tract infections (UTI's) represent one of the leading causes of disease worldwide. In recent years, great concern has emerged regarding the growing resistance rate among the different bacteria responsible for these infections, and community acquired infections no longer guarantee antibiotic susceptibility. Objective: To determine the rate of antibiotic resistance patterns in community acquired UTI's, and to identify the associated risk factors.Methods: This was a prospective study performed in the Emergency Room of a Reference Hospital in Guatemala City. Every patient that consulted with urinary symptoms and whose diagnosis was con-firmed by urinary culture was included. The patients were questioned about past medical history and previous antibiotic use. The statistical analysis was done using the IBM SPSS ™ software.Results: One-hundred patients were included. 90% were caused by E coli and K pneumoniae. Any resistance was detected in 68% of the cases, 41% were resistant to fluoroquinolones, 27% had ESBL enzymes, and 17% were found to be resistant to 3rd generation cephalosporines. Diabetes was pre-sent in 46% of the patients and prooved to be an important risk factor for the development of cepha-losporines (p=0.031) and ESBL(+) (p=0.045) resistance. Previous use of fluoroquinolones, cephalos-porines and aminopenicillins determined the development of certain resistance patterns.Conclusion: A statistical significant relationship was found between diabetes and ATB resistance as well as with previos ATB consumption and the latter. 68% showed any resistance. A high resistance pattern to quinolones, cephalosporins ESBL+ was documented.(AU)

Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant Escherichia coli

BACKGROUND/AIMS: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. METHODS: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. RESULTS: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p =0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). CONCLUSIONS: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.

Amikacin therapy for urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli

BACKGROUND/AIMS: The number of urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) is increasing. In an outpatient setting, there are limited therapeutic options to treat ESBL-producing pathogens. We evaluated the outcomes of amikacin outpatient parenteral antibiotic therapy (OPAT) for UTIs caused by ESBL-EC in patients not pre-treated with carbapenem. METHODS: We retrospectively evaluated the outcomes of amikacin OPAT for UTIs caused by ESBL-EC. RESULTS: From November 2011 to October 2012, eight females, who could not be hospitalized for carbapenem treatment, were treated with amikacin OPAT for nine episodes of non-bacteremic ESBL-EC UTIs. Seven of the eight patients had one or more comorbidities. Of the nine UTI cases, three had symptomatic lower UTIs and six had non-bacteremic upper UTIs. In all of the cases, symptomatic and laboratory improvements were observed following amikacin OPAT. One patient showed a delayed relapse with bilateral microabscesses 3 weeks after treatment cessation; however, a clinical and microbiological cure was eventually reached. All of the patients were able to tolerate amikacin OPAT without any significant nephrotoxicity or ototoxicity. CONCLUSIONS: Amikacin OPAT represents a feasible therapeutic option for non-bacteremic UTIs caused by ESBL-EC in settings with limited resources.

Development of bilateral gluteal pyomyositis during treatment of acute pyelonephritis in a patient with diabetes

No abstract available.

Intrathoracic kidney with left-sided Bochdalek hernia in a woman with bacteremic acute pyelonephritis due to Escherichia coli

No abstract available.

Purple urine bag syndrome in a patient with a urethral balloon catheter and a history of ileal conduit urinary diversion

No abstract available.

Primer aislamiento de Escherichia coli enteroagregativo 0104: H4 de un caso de diarrea en Argentina / First isolation of enteroaggregative Escherichia coli 0104:H4 from a diarrhea case in Argentina

Se describe el primer aislamiento de una cepa de Escherichia coli enteroagregativo (EAEC) O104:H4 de un caso de diarrea aguda en Argentina. Se realizaron dos PCR múltiples como tamizaje: mPCR1 para los genes eae, lt y st, y mPCR2 para los genes IpaH, aggR, stx1y stx2. Se incluyó una mPCR para detectar los genes rfbO104, fliCH4 y terD, además de PCR simples para los genes del plásmido pCVD432, aaiC y lpfO113. Se realizaron ensayos bioquímicos, de sensibilidad a los antimicrobianos y de serotipificación. La cepa de E. coli identificada fue sensible a todos los antimicrobianos ensayados y presentó los genes aggR, aaiC, plásmido pCVD432, lpfO113, rfbO104, fliCH4 y terD. Si bien EAEC O104:H4 es un serotipo poco común, se han comunicado casos esporádicos, pero la preocupación global aumentó después del brote masivo ocurrido en Europa en 2011. El hallazgo de EAEC O104:H4 refuerza la necesidad de mejorar las metodologías para la detección de todos los patotipos de E. coli en Argentina

We describe the first isolation of an enteroaggregative Escherichia coli (EAEC) O104:H4 strain associated with an acute diarrhea case in Argentina. Two multiplex PCRs (mPCR) were performed as screening of genes mPCR1 (eae, lt, and st) and mPCR2 (IpaH, aggR, stx1 and stx2). A mPCR to detect the rfbO104, fliCH4 and terD genes, and PCR assays for the detection of pCVD432 plasmid, aaiC and lpfO113 genes were included. Biochemical and antimicrobial susceptibility assays as well as serotyping were performed. The identified E. coli strain was susceptible to all antimicrobials tested and harbored the aggR, aaiC, pCVD432 plasmid, lpfO113, rfbO104, fliCH4 and terD genes. Although serotype EAEC O104:H4 rarely spreads and sporadic cases have been reported, global concern increased after the large-scale outbreak in Europe in 2011. The finding of EAEC O104:H4 reinforces the need for improved methodologies for the detection of all E. coli pathotypes

Escherichia coli O157:H7: local epidemiology and disease spectrum in Brazil

Escherichia coli O157: H7 is one of the most important foodborne pathogens nowadays, since it has been responsible for severe outbreaks worldwide. Event hough this food pathogen has been isolated in many countries, Brazilian foods were considered E. coli O157:H7-free until recently. However, the presence of E. coli O157:H7 has been reported in diverse foods produced in Brazil and an increasing number of isolation from cattle feces has been observed, demonstrating that this pathogen is present in different parts of Brazil, and severe foodborne outbreaks mayoccur in the near future if adequate control measures are not implemented

Acute pyelonephritis in a horseshoe kidney

No abstract available.

Etiología bacteriana de la infección urinaria en niños / Bacterial etiology of the urinary tract infection in children

Objetivos: describir el comportamiento etiológico de los principales microorganismos causantes de infección urinaria y la susceptibilidad antimicrobiana del principal agente causal. Métodos: estudio observacional, descriptivo, retrospectivo, en el laboratorio de microbiología del Hospital Pediátrico Juan Manuel Márquez en el período comprendido entre 1 de enero y 31 de diciembre de 2010. Se revisó el registro de urocultivos del citado laboratorio y se tomaron los 579 urocultivos positivos, procedentes de niños con diagnóstico presuntivo de infección del tracto urinario y que conformaron el universo de estudio. Resultados: los microorganismos uropatógenos más frecuentes encontrados fueron: Escherichia coli con franco predominio en ambos sexos, seguido por Klebsiella spp., también en ambos sexos, Proteus spp., en varones y Serratia spp., en hembras. El principal agente causal, Escherichia coli, tuvo una susceptibilidad por encima del 80 porciento a meropenem, cloranfenicol, nitrofurantoína, amikacina, gentamicina, cefuroxima, ceftriaxona y amoxicilina/clavulánico; la susceptibilidad a cotrimoxazol y ampicilina fue de 62 y 33 porciento respectivamente. Conclusiones: la Escherichia coli es el principal causante de infección en el tracto urinario en niños, de ahí que el conocimiento de su comportamiento ante diferentes antibióticos, permite al médico orientarse en su práctica diaria al iniciar el tratamiento empírico, sin confirmación bacteriológica de la enfermedad

Objectives: To contribute to the knolewdge about the etiologic behavior of the most frequent microorganisms causing urinary tract infection and the antimicrobial susceptibility to the antibiotics of the main causative agent. Methods: retrospective, observational, and descriptive study conducted in the microbiology laboratory of Juan Manuel Márquez pediatric hospital in the period of January 1st through December 31st, 2010. The register of urine cultures of the mentioned laboratory was revised, from which the 579 positive cultures from presumptively diagnosed children with urinary tract infection were taken. They made up the universe of study. Results: the most frequent microorganisms found were Escherichia coli followed by Klebsiella spp., with clear predominance in both sexes; Proteus spp. in males and Serratia spp. in females. The main causal agent, Escherichia coli, showed over 80 percent susceptibility to meropenem, chloramphenicol, nitrofurantoin, amykacin, gentamycin, cefuroxime, ceftriaxone and amoxycillin/clavulanic acid, whereas susceptibility to cotrimoxazole and to ampicillin was 62 percent and 33 percent respectively. Conclusions: Escherichia coli is the main causative agent of urinary tract infection at Juan Manuel Márquez hospital, so the knowledge of its susceptibility to various antibiotics can guide the doctor in its daily practice at the time of beginning the empiric treatment, prior to the bacteriological confirmation of the illness

Detection of diarrheagenic Escherichia coli by multiplex PCR.

Background: Diarrheagenic E.coli (DEC) are an important cause of childhood diarrhea.Identification of DEC strains needs to detect factors that determine the virulence of these organisms. There is not much data regarding the importance of DEC as a cause of diarrhea in children in India.The prevalence of DEC in children belowfive years with and without diarrhea was studied using two multiplex PCR assays. Materials and Methods: Two multiplex polymerase chain reaction assays were used to detect genes of five types of DEC.The targets selected for each category were eae and bfpA (bundle-forming pilus) forEnteropathogenic E.coli (EPEC), hlyA for Enterohemorrhagic E.coli (EHEC), elt and stla for Enterotoxigenic E.coli (ETEC), CVD432 for Enteroaggregative E.coli (EAEC) and ial for Enteroinvasive E.coli (EIEC). Results: In 200 children with diarrhea 52 (26%) DEC infections were found. Among 100 controls 8 (8%) DEC infections were found. EAEC was the most common DEC by multiplex PCR both in cases (26, 13%)and controls (5,5%), followed byEPEC seen in 16% cases and 3% controls. ETEC and EIEC were found in 7 (3.5%) and 3 (1.5%) of the diarrheal cases. EIEC and ETEC were not detected in the control cases. EHEC was not isolated from either the diarrheal or control cases. Conclusion: DEC strains are a significant cause of diarrhea in children. The two Multiplex PCR assays can be used for the detection of DEC in routine diagnostic laboratories. These assays are specific and sensitive for the rapid detection of DEC. EAEC was the most frequent pathotype in the population under study.

Escherichia coli shigatoxigénica en animales relacionados con casos de diarreas sanguinolentas o síndrome urémico hemolítico y prevalencia en roedores de la Ciudad de Buenos Aires / Shiga toxin-producing escherichia coli in animals related to cases of bloody diarrhea

Escherichia coli shigatoxigénica (STEC) es un patógeno endémico en Argentina, responsable de diarrea aguda sanguinolenta (DAS) y/o síndrome urémico hemolítico (SUH). La correlación entre SUH y alimentos contaminados ha sido documentada, aunque no siempre se estableció la fuente de infección. La ruta de contagio persona-persona es relevante. Dados los registros previos de prevalencia de STEC en animales de compañía y los hábitos de convivencia humano-animal en centros urbanos, es necesario evaluar la ruta mascota-persona. A su vez, los roedores podrían tener un papel epidemiológico en la endemia. OBJETIVO: Estudiar posibles reservorios animales relacionados con casos de SUH/DAS en la Ciudad Autónoma de Buenos Aires y estimar la prevalencia de STEC en roedores. MÉ-TODOS: Se intervino en 28 casos de SUH y 49 de DAS. Se realizó rastrillaje de cepas STEC por PCR a partir de hisopados rectales de los animales vinculados a cada caso. La prevalencia en roedores se estimó por PCR de sus hisopados rectales. RESULTADOS: Se aislaron cepas STEC en 1/10 caninos y 1/3 felinos con vivientes con casos de SUH, y 1/9 felinos contacto con casos de DAS. Rattus rattus fue hospedero de cepas STEC en 33% de los animales capturados en focos de SUH. En roedores, la prevalencia fue de 3,1%. CONCLUSIONES: Las cepas STEC circulan en los animales que conviven o tienen al menos un hábitat compartido con la población en riesgo, quienes podrían participar en la transmisión del agente. Es necesario reevaluar las intervenciones sanitarias en focos y en programas de control de SUH/DAS

Shigatoxigenic Escherichia coli(STEC) is an endemic pathogen in Argentina, which causes bloody diarrhea (BD) and/or hemolytic uremic syndrome (HUS).The co-relation between HUS and contaminated food has been documented, although the source of infection was not always established. Person-to-person route of infection is relevant. Taking into account previous STEC prevalence data in companion animals and the habits of human-animal coexistence in urban centers, it is necessary to evaluate pet-to-person transmission. On the other hand, rodents may also play an epidemiologic role in the endemic transmission. OBJECTIVE: To study potential animal reservoirs related to HUS and BD cases in the City of Buenos Aires and to estimate the prevalence of STEC in rodents. METHODS: An intervention was conducted in 28 cases of HUS and 49 of BD. Screening for STEC was performed by PCR from rectal swabs of linked animals to each case. The prevalence in rodents was estimated by PCR from rectal swabs. RESULTS: STEC strains were isolated in 1/10 dogs and 1/3 cats cohabiting with HUS cases, and in 1/9 cats in contact with DAS cases. Rattus rattus was host of STEC strains in 33% of the animals captured in HUS areas. In rodents, the prevalence was 3.1%. CONCLUSIONS: STEC strains circulate in animals that live withor share at least the same habitat with the population at risk, and could participate in the transmission of the agent. It is necessary to re-evaluate health interventions both in outbreaks and in control programs of HUS/BD

Bilateral Emphysematous Pyelonephritis

No abstract available.

Importancia de las imágenes y el diagnóstico etiológico en el paciente inmunocomprometido con afección del sistema nervioso central: Segunda parte / Importance of images and etiological diagnosis in the immunocompromised patient with central nervous system envolvement: Part II

We present the case of a 12-year-old boy with acute lymphocytic leukemia who developed pneumonia and multiple brain infarcts compatible with acute necrotic encephalitis. The infectious disease screening tests revealed influenza A H1N1 virus, Staphylococcus aureus in broncho alveolar lavage, E. coli and galactomannan antigen in blood. CNS influenza associated complications are reviewed. This case highlights the importance of magnetic resonance imaging as a diagnostic tool in the assessment of immunocompromised patients with CNS compromise and the value of brain biopsy in the final identification of an infectious disease etiology.

Escolar de 12 años de edad, con Leucemia Linfocítica Aguda en tratamiento que desarrolla una bronconeumonía bilateral, infartos cerebrales compatibles con encefalitis necrosante aguda. El estudio infectológico demostró más de una causas infecciosa que pudiera explicar su evolución destacando influenza A H1N1, Staphylococcus aureus meticilina sensible en lavado bronco alveolar, E. coli y galactomanano en sangre. Se revisa el compromiso del SNC por influenza A H1N1. Se destaca la importancia del uso de resonancia magnética nuclear al evaluar pacientes inmunocomprometidos con complicaciones neurológicas y el aporte de una biopsia cerebral en aclarar la etiología de este compromiso.