Presencia de infección de sitio quirúrgico en procedimientos gineco-obstétricos en un hospital de II nivel de atención, Honduras 2017-2018 / Presence of surgical site infection in obstetric-gynecological procedures in a level II care hospital, Honduras 2017-2018

OBJETIVO: Identificar la presencia de infección de sitio quirúrgico y factores de riesgo en pacientes sometidas a cirugías Gineco-Obstétricas de forma programada o de urgencia en un hospital de II nivel de atención en Honduras. METODOLOGÍA: Estudio observacional, descriptivo, retrospectivo; recopilando 226 fichas del registro de infección de sitio quirúrgico recuperadas de los expedientes clínicos brindados por el servicio de estadística del Hospital Mario Catarino Rivas. Captando pacientes sometidas a cirugías Gineco-Obstétricas, durante el 2017 y 2018. RESULTADOS: 99 fichas cumplieron los criterios de inclusión, reportando una edad de 24 años [RIQ, 19,0 - 30,0], peso 82,0 kg [RIQ, 51,7 - 98,25], talla 154 cm [150,0 - 158,0] y el IMC de 25,8 ± 3,6 kg/m2. Un 9,1% presento antecedentes de inmunosupresión. 5,1% presento ISQ. El 55.6% de las cirugías se realizó el mismo día de ingreso del paciente. El tiempo entre la profilaxis antibiótica y el comienzo de la intervención quirúrgica es de 60 minutos [RIQ, 40,0 - 160,0]. La duración de los procedimientos quirúrgicos son de 45 minutos [RIQ, 35,0 - 55,0]. Los microrganismos aislados en los cultivos fueron Cocos gram positivos (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSIÓN: La presencia de ISQ en cirugías Gineco-Obstétricas del HMCR es del 5.1%, identificando los siguientes factores de riesgo: edad extrema, obesidad, diabetes mellitus, estado inmunitario (VIH), profilaxis antibiótica (temprana); por último, la técnica y el tiempo quirúrgico.

OBJECTIVE: To identify the presence of surgical site infection and risk factors in patients undergoing Gynecological-Obstetric surgeries on a scheduled or emergency basis in a 2nd level of care hospital in Honduras. METHODOLOGY: Observational, descriptive, retrospective study, compiling 226 data sheets of the surgical site infection record recovered from the clinical records provided by the statistics service of the "Hospital Mario Catarino Rivas". Recruiting patients undergoing Gynecological-Obstetric surgeries, during 2017 and 2018. RESULTS: 99 tabs met the inclusion criteria, reporting an age of 24 [RIQ, 19.0 - 30.0], weight 82.0 kg [RIQ, 51.7 - 98.25], size 154 cm [150.0 - 158.0] and BMI of 25.8 ± 3.6 kg/m2. 9.1% have a history of immunosuppression. 5.1% present ISQ. 55.6% of surgeries were performed on the same day as the patient's admission. The time between antibiotic prophylaxis and the onset of surgery 60 minutes [RIQ, 40.0 - 160.0]. Duration of surgical procedures 45 minutes [RIQ, 35.0 - 55.0]. Isolated micro-morphisms in crops were Cocos gram positives (2/5), Enterococcus faecalis (1/5), Klebsiella pneumoniae (2/5). CONCLUSION: The presence of ISQ in HMCR Gynecological-Obstetric surgeries is 5.1%, identifying the following risk factors: extreme age, obesity, diabetes mellitus, immune status (HIV), early antibiotic prophylaxis; finally, technique and surgical time.

Identifying gram-positive cocci in dermatoscopes and smartphone adapters using MALDI-TOF MS: a cross-sectional study

Abstract Background: The increasingly frequent use of dermoscopy makes us think about the possibility of transfer of microorganisms, through the dermatoscope, between doctor and patients. Objectives: To identify the most frequent gram-positive cocci in dermatoscopes and smartphone adapters, as well as the resistance profile, and to evaluate the factors associated with a higher risk of bacterial contamination of the dermatoscopes. Methods: A cross-sectional study was carried out with 118 dermatologists from Porto Alegre/Brazil between September 2017 and July 2018. Gram-positive cocci were identified by MALDI-TOF MS and habits of use of the dermatoscope were evaluated through an anonymous questionnaire. Results: Of the dermatoscopes analysed, 46.6% had growth of gram-positive cocci on the lens and 37.3% on the on/off button. The microorganisms most frequently found were S. epidermidis, S. hominis and S. warneri. Attending a hospital, using the dermatoscope at the hospital, with inpatients and in the intensive care unit were significantly associated with colonisation by gram-positive cocci. The highest resistance rates were observed for penicillin, erythromycin and sulfamethoxazole-trimethoprim. Study limitations: The non-search of gram-negative bacilli, fungi and viruses. Moreover, the small number of adapters did not make it possible to better define if the frequency differences were statistically significant. Conclusion: Coagulase-negative staphylococci were frequently identified. S. aureus was detected only on the lens.

Survey of canine tick-borne diseases in Lábrea, Brazilian Amazon: ‘accidental’ findings of Dirofilaria immitis infection / Pesquisa de agentes transmitidos por carrapatos em cães de Lábrea, Amazonas: achados “acidentais” de Dirofilaria immitis

Blood samples were collected from 99 domestic dogs from the urban and rural areas of the Lábrea municipality, state of Amazonas, Brazil. Canine serum samples were tested by immunofluorescence assay against Rickettsia spp., which revealed that only 3.0% (1/33) and 7.6% (5/66) of the dogs from urban and rural areas, respectively, reacted positively to at least one Rickettsia species. DNA was extracted from canine blood and tested by a battery of PCR assays targeting protozoa of the genera Babesia and Hepatozoon, and bacteria of the genera Rickettsia and Ehrlichia and family Anaplasmataceae. All samples were negative in the PCR assays targeting the genera Babesia, Hepatozoon, Ehrlichia and Rickettsia. For Anaplasmataceae, 3% (1/33) and 39.4% (26/66) of the urban and rural dogs, respectively, yielded amplicons that generated DNA sequences 100% identical to the corresponding sequence of Wolbachia endosymbiont of Dirofilaria immitis. Because of these results, all canine DNA samples were further tested in a PCR assay targeting filarial nematodes, which was positive for 18.2% (6/33) and 57.6% (38/66) urban and rural dogs, respectively. Filarial-PCR products generated DNA sequences 100% identical to D. immitis. While tick-borne infections were rare in Lábrea, D. immitis infection rates were among the highest reported in South America.

Amostras de sangue foram coletadas de 99 cães domésticos de áreas urbana e rural do município de Lábrea, estado do Amazonas. Soros caninos foram testados pela técnica de imunofluorescência indireta contra Rickettsia spp., resultando em apenas 3,0% (1/33) e 7,6% (5/66) de cães soropositivos nas áreas urbana e rural, respectivamente. DNA foi extraído do sangue canino e testado por diferentes protocolos da PCR para detecção de protozoários dos gêneros Babesia e Hepatozoon, e bactérias dos gêneros Rickettsia e Ehrlichia e da família Anaplasmataceae. Todas as amostras foram negativas nos protocolos de PCR para os gêneros Babesia, Hepatozoon, Ehrlichia e Rickettsia. Para Anaplasmataceae, 3% (1/33) e 39,4% (26/66) dos cães de áreas urbana e rural, respectivamente, geraram sequências de DNA 100% idênticas ao endosimbionte Wolbachia de Dirofilaria immitis. Posteriormente, as amostras foram testadas pela PCR para nematódeos filarídeos, resultando em 18,2% (6/33) e 57,6% (38/66) de amostras positivas nas áreas urbana e rural, respectivamente. Os produtos geraram sequências de DNA 100% idênticas a D. immitis. Em contraste com várias outras regiões do Brasil, infecções transmitidas por carrapatos foram raras em Lábrea. Por outro lado, as frequências de infecção por D. immitis estiveram entre as mais altas relatadas na América do Sul.

Endocarditis infecciosa activa: 152 casos / Active infective endocarditis: 152 cases

La endocarditis infecciosa es una enfermedad de baja incidencia que en las últimas décadas mostró modificaciones respecto de su presentación, posibilidad diagnóstica y tratamiento. A pesar de estos avances, la mortalidad hospitalaria sigue siendo muy elevada. Nuestro objetivo fue analizar las características de los pacientes con endocarditis infecciosa activa y su relación con la mortalidad hospitalaria a lo largo de 16 años. Se realizó un registro prospectivo entre 1994 y 2010 de pacientes ingresados con endocarditis. Se analizaron características clínicas, evolución y tratamiento y se registraron los eventos intrahospitalarios. Ingresaron 152 pacientes, 64.5% varones, edad 45 ± 16 años, las causas más frecuentes de cardiopatía de base fueron: congénita 32 (21%) y reumática 20 (13.2%). Los motivos de internación fueron síndrome febril 116 (76.3%) e insuficiencia cardíaca 61 (40.1%). Se identificó el agente infeccioso en 106 (69.7%) de los casos, el más frecuente fue Streptococcus viridans. El ecocardiograma mostró vegetaciones en 123 (80.9%) de los pacientes y 88 (57.8%) presentaron complicaciones durante su internación, siendo la más frecuente la insuficiencia cardíaca. Se indicó tratamiento quirúrgico en 96 (63.1%) de los casos, fundamentalmente por insuficiencia cardíaca en 66. La mortalidad hospitalaria global fue 46 (30.2%). El desarrollo de complicaciones en la internación, la indicación de cirugía y la presencia de insuficiencia cardíaca refractaria al tratamiento fueron predictores independientes de mortalidad hospitalaria, mientras que la presencia de vegetaciones resultó un predictor independiente de mejor supervivencia. La identificación temprana de estos predictores descriptos podría ayudar a mejorar los resultados.

Active infective endocarditis (IE) is a disease of low incidence that has showed changes in presentation, diagnosis and treatment options during the past decades. Despite these advances, mortality remains very high. Our goal was to analyze the characteristics of patients with active IE and their relationship with in-hospital mortality over 16 years. Between 1994 and 2010 we performed a prospective registry of 152 consecutive patients (64.5% male, age 45 ± 16 years) admitted with IE. Clinical characteristics, treatment and inpatient outcomes were analyzed. The most common causes of underlying heart disease were: congenital (21%) and rheumatic fever (13.2%). The reasons for hospitalization were fever (76.3%) and heart failure (40.1%). The infectious agent was identified in 69.7% of cases, and the most frequent was Streptococcus viridans. The echocardiogram showed vegetations in 80.9% of patients and 57.8% of them presented complications (the most frequent was heart failure) during hospitalization. Surgical treatment was indicated in 63.2% of cases, mainly due to heart failure. The overall hospital mortality was 30.2%. The presence of complications, requirement of surgical treatment and refractory heart failure were independent predictors of mortality whereas the single presence of vegetation showed better survival rate. The identification of these predictors could help to improve the outcomes in IE.

Urinary bacterial pathogens and their antimicrobial susceptibility profile for the years 2005-2007 in St Kitts / Patógenos bacterianos urinarios y su perfil de susceptibilidad antimicrobiana durante los años 2003-2007 en Saint Kitts

OBJECTIVE: The purpose of this study is to review bacterial isolates from cases of urinary tract infection (UTI) and their antimicrobial susceptibility pattern for the years 2005-2007 in St Kitts. It is hoped that the study will be of use in the treatment of cases of UTI in St Kitts. METHODS: The laboratory records at St Francis Hospital, Basseterre, St Kitts, for bacterial isolates from cases of urinary tract infection and their susceptibility profiles for three years, 2005-2007, were retrospectively reviewed and compared. RESULTS: A total of 595 isolates of 13 species of pathogenic bacteria were recovered from cases of UTI. Escherichia coli was the predominant species recovered each year. Among the other species frequently recovered were Citrobacter spp, Enterobacter spp, Klebsiella pneumoniae and Pseudomonas aeruginosa. CONCLUSION: This study, the first of its kind from St Kitts serves to emphasize that treatment of UTI should be instituted generally on the basis of antimicrobial susceptibility tests.

OBJETIVO: El propósito de este estudio es examinar los aislados bacterianos de casos de infección del tracto urinario (ITU) y su modelo de susceptibilidad antimicrobiana durante los años 2005-2007 en Saint Kitts. Se espera que el estudio sea de utilidad en el tratamiento de casos de ITU en Saint Kitts. MÉTODOS: Los archivos de laboratorio del Hospital Saint Francis, Basseterre, Saint Kitts, sobre los aislados bacterianos de los casos de infección del tracto urinario y sus perfiles de susceptibilidad durante tres años, 2005-2007, fueron examinados y comparados retrospectivamente. RESULTADOS: Un total de 595 aislados de 13 especies de bacterias patógenas fueron recuperadas de casos de ITU. Escherichia coli fue la especie predominante recuperada cada año. Entre las otras especies frecuentemente recuperadas se hallan: Citrobacter spp, Enterobacter spp, Klebsiella pneumoniae y Pseudomonas aeruginosa. CONCLUSIÓN: Este estudio - el primero de su tipo en Saint Kitts - sirve para enfatizar que el tratamiento de la ITU generalmente debe establecerse sobre la base de pruebas de susceptibilidad antimicrobiana.

Diversidad bacteriana en un biorreactor de lecho fluidificado durante el tratamiento de agua contaminada con nafta / Bacterial diversity in a fluidized bed bioreactor (FBR) treating gasoline-contaminated groundwater

El objetivo principal de esta investigación fue determinar la diversidad bacteriana del proceso de biorremediación de agua contaminada con nafta en un biorreactor de lecho fluidificado en el Recinto Universitario de Mayagüez, de la Universidad de Puerto Rico. El aislamiento y la caracterización de las colonias bacterianas del sistema de biorremediación fueron realizados en medio R2A. Las pruebas morfológicas incluyeron la determinación de la morfología celular y de las colonias, y la reacción frente a la coloración de Gram. Las propiedades fisiológicas se determinaron usando el sistema Biolog® y sobre la base de la habilidad para desarrollar en medio mínimo con nafta como única fuente de carbono. La caracterización molecular se llevó a cabo por BOX-PCR y por análisis de secuencia del ADNr 16S mediante la técnica de ARDRA (amplified ribosomal DNA restriction analysis). De los 162 morfotipos de colonias aislados, 75% fueron bacilos gram-negativos, 19% bacilos gram-positivos, 5% cocos gram-negativos y 1% cocos gram-positivos. Según el análisis ARDRA, estos morfotipos se distribuyeron en 90 grupos genéticos, de los cuales 53% incluyeron cepas con crecimiento en nafta. Las 86 cepas que crecieron en nafta presentaron 52 patrones de amplificación, los que a través de BOX-PCR se agruparon en 50 grupos metabólicamente no relacionados. El alto nivel de diversidad microbiana observado en el reactor permitió la remoción del contaminante y, al parecer, fue importante para la operación estable y eficiente del sistema.

The main objective of this research project was to determine the bacterial diversity during the process of bioremediation of water contaminated with gasoline in a fluidized bed reactor at Mayagüez, PR. Isolation and characterization of bacterial populations from the bioremediation system was performed on R2A medium. Morphological tests included cellular and colonial shape and reaction to Gram coloration. Physiological properties were determined by using carbon utilization profiles (Biolog®) and by the ability of axenic cultures to use gasoline as the sole carbon source. Molecular characterization was performed by BOX-PCR and 16S rDNA sequence analysis (ARDRA). From a total of 162 distinctive isolates, 75% were gram-negative bacilli, 19% gram-positive bacilli, 5% gram-negative cocci and 1% gram-positive cocci. The 162 axenic cultures corresponded to 90 different genetic groups; 53% of which included strains with growth in gasoline as sole carbon source. The 86 strains capable of growing in gasoline corresponded to 52 different amplification patterns in BOX-PCR; which were not metabolically related (Biolog® system). The high degree of microbial diversity in the FBR allowed efficient and stable hydrocarbon removal throughout the operation of the system.

Antibiotic resistance and trend of urinary pathogens in general outpatients from a major urban city

OBJECTIVE: We assessed the antimicrobial resistance patterns of pathogens responsible for urinary tract infections (UTI) in outpatients in São Paulo, Brazil, as well as the Escherichia coli antimicrobial resistance trend. MATERIALS AND METHODS: Outpatients urine cultures were collected from January 2000 to December 2003. Statistical analysis considered positive results for one bacterial species with colony count > 100,000 CFU/mL. Stratification was done on age group and gender. Statistical tests used included chi-square and the chi-square test for trend to evaluate differences between susceptibility rates among age groups and ordering in the E. coli resistance rates per year, respectively. RESULTS: There were 37,261 positive results with Enterobacteriaceae isolated in 32,530 (87.3 percent) and Gram-positive cocci in 2,570 (6.9 percent) cultures. E. coli had the highest prevalence (71.6 percent). Susceptibility tests were performed in 31,716 cultures. E. coli had elevated resistance rates (> 30 percent) to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. Significant differences between age groups and ordering among years were observed. CONCLUSIONS: The use of trimethoprim-sulfamethoxazole is precluded in the population studied due to elevated resistance rates (> 30 percent) among most prevalent pathogens. Significant resistance rate differences among age groups and years were observed, particularly for fluoroquinolones. Fluoroquinolones should be used with caution. Nitrofurantoin should be used as empirical therapy for primary, non-complicated urinary tract infections.

Comparação entre a azitromicina e a amoxicilina no tratamento da exacerbação infecciosa da doença pulmonar obstrutiva crônica / Comparison between azithromycin and amoxicillin in the treatment of infectious exacerbation of chronic obstructive pulmonary disease

OBJETIVO: Comparar a eficácia, segurança e tolerabilidade da azitromicina e da amoxicilina no tratamento de pacientes com quadro clínico de exacerbação infecciosa da doença pulmonar obstrutiva crônica. MÉTODOS: Seis centros brasileiros incluíram 109 pacientes com idades entre 33 e 82 anos. Desses pacientes, 102 foram randomizados para receber azitromicina (500 mg por dia por três dias, n = 49) ou amoxicilina (500 mg a cada oito horas por dez dias, n = 53). Os pacientes foram avaliados no início do estudo, após dez dias e depois de um mês. A avaliação clínica, de acordo com os sinais e sintomas presentes após dez dias e após um mês, consistiu na classificação dos casos nas categorias cura, melhora ou falha terapêutica. A avaliação microbiológica foi feita pela cultura de amostras de escarro consideradas adequadas após contagem de leucócitos e coloração de Gram. Avaliações secundárias de eficácia foram feitas com relação aos sintomas (tosse, dispnéia e expectoração) e à função pulmonar. RESULTADOS: Não houve diferenças entre as proporções de casos classificados como cura ou melhora entre os grupos tratados com a azitromicina ou a amoxicilina. Essas proporções foram, respectivamente, de 85 por cento vs. 78 por cento (p = 0,368) após dez dias, e de 83 por cento vs. 78 por cento (p = 0,571) após um mês. Também não foram encontradas diferenças significativas entre os dois grupos quando comparadas as variáveis secundárias de eficácia e a incidência de eventos adversos. CONCLUSÃO: A azitromicina tem eficácia e tolerabilidade semelhantes às da amoxicilina para o tratamento da exacerbação aguda da Doença pulmonar obstrutiva crônica.

OBJECTIVE: To compare the efficacy, safety, and tolerability of azithromycin and amoxicillin in the treatment of patients with infectious exacerbation of chronic obstructive pulmonary disease. METHODS: This study was conducted at six medical centers across Brazil and included 109 patients from 33 to 82 years of age. Of those, 102 were randomized to receive either azithromycin (500 mg/day for three days, n = 49) or amoxicillin (500 mg every eight hours for ten days, n = 53). The patients were evaluated at the study outset, on day ten, and at one month. Based on the clinical evaluation of the signs and symptoms present on day ten and at one month, the outcomes were classified as cure, improvement, or treatment failure. The microbiological evaluation was made through the culture of sputum samples that were considered appropriate samples only after leukocyte counts and Gram staining. Secondary efficacy evaluations were made in order to analyze symptoms (cough, dyspnea, and expectoration) and pulmonary function. RESULTS: There were no differences between the groups treated with azithromycin or amoxicillin in terms of the percentages of cases in which the outcomes were classified as cure or improvement: 85 percent vs. 78 percent (p = 0.368) on day ten; and 83 percent vs. 78 percent (p = 0.571) at one month. Similarly, there were no significant differences between the two groups in the secondary efficacy variables or the incidence of adverse effects. CONCLUSION: Azithromycin and amoxicillin present similar efficacy and tolerability in the treatment of acute exacerbation of chronic obstructive pulmonary disease.

Bacterial, fungal and yeast contamination in six brands of irreversible hydrocolloid impression materials

This study assessed the level of contamination of six commercially available irreversible hydrocolloids (two containing chlorhexidine) and identified the contamination present in the materials. Petri dishes containing selective and enriched culture media were inoculated with alginate powder (0.06 g), in triplicate. After incubation (37°C/7 days), the colony-forming units (CFU) were counted and Gram stained. Biochemical identification of the different morphotypes was also performed. The contamination levels for the materials were: Jeltrate - 389 CFU/g; Jeltrate Plus - 516 CFU/g; Jeltrate Chromatic - 135 CFU/g; Hydrogum - 1,455 CFU/g; Kromopan - 840 CFU/g; and Greengel - 59 CFU/g. Gram staining revealed the presence of Gram-positive bacillus and Gram-positive cocci. The bacteria Staphylococcus epidermidis, Bacillus subtilis, Bacillus sp., Bacillus coagulans, Bacillus licheniformis, Bacillus cereus, Micrococcus luteus, and Nocardia sp.; the filamentous fungi Aspergillus niger, Aspergillus flavus, Rhizopus sp., Neurospora sp.; and the yeast Candida sp. were isolated. The contamination detected in the impression materials points out the need for adopting measures to improve the microbiological quality of these materials. The use of contaminated materials in the oral cavity goes against the basic principles for controlling cross-contamination and may represent a risk for debilitated or immunocompromised patients.

Este estudo avaliou o nível de contaminação de seis marcas comerciais de alginato (duas contendo clorexidina) e identificou a contaminação presente nesses materiais. Alíquotas de alginato (0,06 g) foram semeadas em meios de cultura seletivos e enriquecidos, em triplicata. Após incubação (37°C/7 dias), as unidades formadoras de colônia (UFC) foram contadas e foram realizadas as identificações morfotintorial (Gram) e bioquímica. Os níveis de contaminação dos materiais foram: Jeltrate - 389 UFC/g; Jeltrate Plus - 516 UFC/g; Jeltrate Chromatic - 135 UFC/g; Hydrogum - 1.455 UFC/g; Kromopan - 840 UFC/g; e Greengel - 59 UFC/g. A coloração de Gram revelou a presença de bacilos Gram-positivos e cocos Gram-positivos. As bactérias Staphylococcus epidermidis, Bacillus subtilis, Bacillus sp., Bacillus coagulans, Bacillus licheniformis, Bacillus cereus, Micrococcus luteus e Nocardia sp.; os fungos filamentosos Aspergillus niger, Aspergillus flavus, Rhizopus sp., Neurospora sp.; e a levedura Candida sp. foram isolados. A contaminação detectada nos materiais aponta a necessidade de adoção de medidas para melhorar seu controle de qualidade microbiológica. O uso de materiais contaminados na boca contradiz os princípios básicos de controle de infecção-cruzada e pode representar um risco para pacientes debilitados ou imunocomprometidos.

[ prevalence and molecular characterization of vancomycin resistant gram positive cocci isolated from patients in Tehran]

Gram positive bacteria, particularly, Staphylococcus aureus, coagulase negative staphylococci and enterococci are of particular concern in hospitals. But there has been increasing concern about the development of vancomycin resistant enterococci and MRSA strains with reduced susceptibility to vancomycin over the last decade. Therefore, the present study was carried out to confirm the identification of vancomycin resistant gram positive cocci, to determine antibiotic resistance pattern and to study vancomycin resistance genes. The isolates from clinical samples were collected from hospitalized patients and outpatients in Tehran. Gram positive cocci species identification was performed by using conventional tests and PCR using specific primers. VRE isolates were subjected to antibiotic susceptibility testing, MICs of vancomycin were determined by the E-test method. Determination of vancomycin resistance genes, vanA and vanB were performed with PCR. Confirmation of transposons was performed with specific primers for vanS. Out of 1030 gram positive isolates, none of the staphylococci or streptococci isolates were resistant to vancomycin. Most of vancomycin resistant isolates in this study were VRE. faecium [96%] and harbored vanA. All of the isolates were positive for vanS the conserved fragment of transposon and carried the identical digestion pattern like type strain. According to the results of this study, all of the vancomycin resistant isolates were enterococcus spp. Vancomycin resistant enterococci itself is now a major and largely untreatable infection, and can pass the vancomycin resistance genes to the other highly virulent gram positive cocci

Profile of antimicrobial resistance of bacteria isolated from cockroaches (Periplaneta americana) in a Brazilian health care institution

Cockroaches carry microorganisms to sterilized materials, equipment and non-contaminated food in hospitals and in homes. Hence, they are regarded as major microbial vectors. We isolated and identified microorganisms from living cockroaches captured from a Brazilian health care institution and we determined the antimicrobial susceptibility profile of the isolates. Following collection, cockroaches were immobilized at 4°C for 10 to 20 minutes, immersed in 0.8 percent saline solution and then homogenized. Next, the suspension was seeded in culture media: brain and heart agar infusion, MacConkey agar, Naito agar, and they were incubated for up to 48 hours at 37°C. Sabouraud agar cultures were incubated at ambient temperature. The microbial colonies were analyzed with a stereomicroscope to count and phenotypically identify the colony-forming units (cfu). The discdiffusion method was used to determine the profile of susceptibility to antimicrobials. Among the 103 cockroaches analyzed, fungi were found in 97 percent, enterobacteria in 74.6 percent and coagulase-negative staphylococci (CNS) in 25.40 percent. Among the enterobacteria, 96 percent were resistant to gentamicin, 84 percent to ampicillin, 75.3 percent to caphalothin, 66.7 percent to ampicillin-sulbactam, 50 percent to aztreonam and 30 percent to chloramphenicol. Among the CNS, 61 percent were resistant to oxacillin. We concluded that cockroaches carry organisms associated with nosocomial infections and that are resistant to antimicrobials. This fact contributes to the epidemiological chain, complicating therapeutics, and consequently, medical costs are increased.

A comparison of the antimicrobial resistance patterns of gram-positive cocci isolated from community-private and university-affiliated hospitals from Puerto Rico

The antimicrobial resistance patterns of 2,462 selected Gram-positive cocci obtained from three Community-Private Hospitals (CPH) and three University-Affiliated Hospitals (UAH) were evaluated utilizing the institutions' antimicrobial susceptibility reports for the year 2000. The objectives of this study were: 1) to evaluate the in vitro resistance to selected standard antibiotics of Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium and Streptococcus pneumoniae clinical isolates, and 2) to compare the antimicrobial resistance patterns between community-private (CPH) and university-affiliated hospitals (UAH). Staphylococcus aureus was the most common Gram-positive isolated organism in CPH (63.3 per cent) followed by E. faecalis (31.0 per cent). In UAH, the most prevalent cocci were E. faecalis (51.7 per cent) followed by S. aureus (43.9 per cent). Enterococcus faecium represented 2.3 per cent and 4.4 per cent of CPH and UAH isolates, respectively. Streptococcus pneumoniae represented 3.4 per cent of the total Gram-positive isolates from CPH, no S. pneumoniae was reported in UAH. The antimicrobial susceptibility results showed that for Staphylococcus aureus there was a statistically significant higher resistance to methicillin and thrimethoprim sulfamethoxazole in UAH, while resistance to erythromycin was significantly higher in CPH. There was no difference in the resistance of S. aureus to other antimicrobial agents between hospitals groups. A statistically significant resistant to vancomycin was found between enterococcal isolates from UAH (43 per cent) and CPH (12.7 per cent). High-level aminoglycoside resistance (HLAR) was observed among UAH enterococcal isolates with E. faecium showing a higher resistance than E. faecalis, no data for HLAR in CPH could be obtained. For pneumococci 46 per cent of CPH isolates were resistant to penicillin. In summary, there are important differences in the prevalence and antimicrobial resistance between the Gram-positive bacteria isolated from community and teaching hospitals.

Prospective study using standardized methodology for antimicrobial susceptibility of gram-positive cocci isolated from the Puerto Rico Medical Center

The Gram-positive cocci (GPC), Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium, have become important causes of community and nosocomial-acquired infections. The prevalence of multiple resistant isolates to standard antimicrobial drugs has significantly increased over the past decades. Few prospective studies have been performed in Puerto Rico (PR) concerning the GPC antimicrobial susceptibilities pattern. The purpose of this study was to evaluate the in vitro susceptibility of GPC clinical isolates from PR to selected standard antibiotics and to the new antimicrobial agents, linezolid (LZ), quinupristin/dalfopristin (Q/D) and gemifloxacin (GM). The in vitro susceptibility utilizing disk diffusion and Etest methods to selected antibiotics was determined for a total of 429 isolates obtained during a period of 5 months from the Puerto Rico Medical Center Bacteriology Laboratory. The distribution of GPC collected was as follows: 213 S. aureus isolates, 162 E. faecalis, 16 E. faecium and 38 S. pneumoniae. The results of the susceptibility test demonstrated: 1) that in S. aureus, 100 per cent of the isolates were susceptible to vancomycin (VAN), LZ and Q/D; 93 per cent to GM; and 61 per cent to methicillin/oxacillin; 2) in S. pneumoniae, 100 per cent were susceptible to LN and GM; 87 per cent to Q/D; and 53 per cent to penicillin; 3) in E. faecalis, 99 per cent were susceptible to ampicillin; 93 per cent to LZ; 79 per cent to GM; 78.6 per cent to VAN; and 0 per cent to Q/D. Sixty eight and 66 per cent of the E. faecalis isolates were susceptible to gentamicin and streptomycin respectively; and 4) in E. faecium, 100 per cent were susceptible to LZ; 94 per cent to Q/D; 69 per cent to GM; 37.5 per cent to VAN and 20 per cent to ampicillin. In E. faecium isolates, 50 per cent and 31 per cent were susceptible to gentamicin and streptomycin, respectively. Of the vancomycin resistant enterococci, 88.9 per cent and 21 per cent of E. faecium and faecalis showed VanA phenotypic resistance, respectively...

Bacteraemia in high-risk patients.

In this study, we noticed a high incidence of bacteraemia in high-risk patients especially due to nonfermenter gram negative bacilli (NFGNB) and coagulase negative staphylococci (CoNS). Bacteraemia caused by some rare bacteria such as Moraxella spp., Aeromonas spp., Flavobacterium meningosepticum was also noted during the study. Antibiotic resistance pattern showed that many isolates were Multi Drug Resistant (MDR). This can be attributed to nosocomial-infection, which may occur due to more and more invasive procedures for diagnosis and therapy during long stay of patients in the hospital. Also, the MDR strains and the wide spread oxacillin resistant CoNS (OR-CoNS) and slowly emerging vancomycin resistant CoNS (VR-CoNS) associated with nosocomial infections pose a great threat to the clinicians. We recommend the usage of commonly used antibiotics along with cephalosporins for the patients admitted to these high-risk units, before the antibiotic susceptibility test findings.

Immunoglobulin-M estimation and C-reactive protein detection in neonatal septicemia.

Immunoglobulin-M estimation, and C-Reactive Protein test and blood culture were performed on 57 neonates, clinically suspected to have septicemia. IgM level of > or = 20 mg/dl was found in 58.62% cases and CRP test was positive in 68.98% of culture proven sepsis. Blood culture was positive in 29 cases, with the predominant organism being Klebsiella. Of the 2 tests, CRP had a higher sensitivity (68.97%) while IgM estimation had a higher specificity (82.14%). When the 2 tests were considered together the sensitivity and specificity further increased. Death rate among neonates with IgM levels < 20 mg/dl was 5 times higher than those with elevated IgM levels.

Cinco años de experiencia con sepsis neonatal en un centro pediátrico / Five years experience of neonatal sepsis in a pediatric center

Objetivo. Describir la etiología, manifestaciones clínicas y cambios hematológicos asociados a sepsis en la unidad de cuidados intensivos neonatales del Hospital Infantil de México Federico Gómez y determinar la frecuencia de citología hemática (CH) normal al diagnóstico de sepsis. Métodos. Análisis de expedientes clínicos de los pacientes sépticos hospitalizados entre enero de 1992 a diciembre de 1996. Resultados. Ingresaron 945 recién nacidos (RN). Se detectaron 147 bacteriemias en 103 pacientes. Los cocos grampositivos fueron los gérmenes más comunes (55 por ciento). El cuadro clínico de sepsis fue inespecífico y en los RN pretérmino (RNPT) la apnea y la ictericia fueron más frecuentes que en los RN de término (RNT) (p< 0.05). Al diagnóstico de sepsis, la CH fue normal en 19 por ciento y 8 por ciento de los RNPT y RNT respectivamente; la leucopenia fue un dato del mal pronóstico pues 7 de 35 fallecimientos tuvieron leucopenia vs uno de 68 sobrevivientes (p< 0.05) La mortalidad global fue de 34 por ciento pero la atribuible a sepsis fue de 13 por ciento. Conclusiones. La incidencia de sepsis en esta población fue alta predominando los cocos grampositivos. Las manifestaciones clínicas de sepsis fueron inespecíficas. La CH fue normal al diagnóstico en una proporción considerable de los RNPT séptico y la leucopenia fue un dato de mal pronóstico. La mortalidad asociada a sepsis fue alta

Screening and isolation of anti-Fusarium moniliforme compounds producing microorganisms from soil and corn

Fusarium moniliforme, fitopatógeno cosmopolita de milho, é responsável pela produçäo de micotoxina recentemente descoberta, denominada fumonisima. Com a finalidade de avaliar a inibiçäo de F. moniliforme, 34 antagonistas isolados de 60 amostras de solo e de 20 amostras de milho foram testados contra F. moniliforme 113F, produtor de fumonisina. O extrato bruto foi preparado com a cultura de microrganismos selecionados em caldo infuso de cérebro e coraçäo (BHI) e concentrados, adicionando-se etanol na proporçäo 1:1. A presença de organismos inibidores de F.moniliforme ocorreu em 29 amostras de solo, obtendo-se 36 microrganismos antagonistas. Referente ao milho, 15 amostras apresentaram microrganismos inibidores, permitindo o isolamento de 15 antagonistas. A caracterizaçäo destes 51 isolados demonstrou que 5 consistiram de leveduras, 3 cocos Gram-positivos , 3 cocos Gram-negativos e 40 bacilos Gram positivos, destacando-se a predominância do último grupo. Todos os 51 isolados