ABSTRACT
BACKGROUND: Studies have investigated risk factors for infections by specific species of carbapenem-resistant Gram-negative bacilli (CR-GNB), but few considered the group of GNB species and most of them were performed in the setting of bacteremia or hospital infection. This study was implemented to identify risk factors for sepsis by CR- and carbapenem-susceptible (CS) GNB in intensive care unit (ICU) patients to improve management strategies for CR-GNB sepsis. METHODS: We developed a case-case-control study from a prospective cohort of patients with systemic inflammatory response syndrome (SIRS), sepsis-2 or sepsis-3 criteria in which blood and other sample cultures were collected and antimicrobial therapy was instituted, in an adult clinical-surgical ICU, at tertiary public hospital in Rio de Janeiro, from August 2015 through March 2017. RESULTS: Among the total of 629 ICU admissions followed by 7797 patient-days, after applying inclusion and exclusion criteria we identified 184 patients who developed recurrent or single hospital-acquired sepsis. More than 90% of all evaluable cases of sepsis and 87% of control group fulfilled the modified sepsis-3 definition. Non-fermenting bacilli and ventilator-associated pneumonia predominated as etiology and source of CR-GNB sepsis. While Enterobacteriaceae and intra-abdominal surgical site plus urinary-tract infections prevailed in CS-GNB than CR-GNB sepsis. Carbapenemase production was estimated in 76% of CR-GNB isolates. Multivariate logistic regression analysis revealed previous infection (mostly hospital-acquired bacterial infection or sepsis) (OR = 4.28; 95% CI 1.77-10.35), mechanical ventilation (OR = 4.21; 95% CI 1.17-15.18), carbapenem use (OR = 3.42; 95% CI 1.37-8.52) and length of hospital stay (OR = 1.03; 95% CI 1.01-1.05) as independent risk factors for sepsis by CR-GNB. While ICU readmission (OR = 6.92; 95% CI 1.72-27.78) and nosocomial diarrhea (OR = 5.32; 95% CI 1.07-26.45) were factors associated with CS-GNB sepsis. CONCLUSIONS: The investigation of recurrent and not only bacteremic episodes of sepsis was the differential of this study. The results are in agreement with the basic information in the literature. This may help improve management strategies and future studies on sepsis by CR-GNB.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Carbapenems/therapeutic use , Gram-Negative Bacteria/drug effects , Gram-Negative Bacterial Infections/blood , Intensive Care Units/statistics & numerical data , Sepsis/microbiology , Adult , Aged , Aged, 80 and over , Brazil , Case-Control Studies , Critical Illness , Cross Infection/drug therapy , Cross Infection/microbiology , Female , Gram-Negative Bacteria/pathogenicity , Gram-Negative Bacterial Infections/drug therapy , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Risk Factors , Sepsis/drug therapy , Tertiary Care Centers/statistics & numerical data , Young AdultABSTRACT
Recent studies point atypical enteropathogenic Escherichia coli (aEPEC) to be an important agent in childhood diarrhoea in Brazil. aEPEC are commonly found in various animal species, including dogs. Although the true zoonotic risk remains unknown, some strains recovered from dogs present the same serotypes and carry the same virulence genes implicated in human disease. In this study, we compared the virulence and genetic relationship among a set of aEPEC strains previously isolated from diarrheic faeces from companion dogs and humans. A total of 17 strains, 12 from puppies and five from children, were studied. The strains were assessed for: (i) presence of virulence-associated genes (a total of 31 genes) using PCR assays; (ii) genetic relationship by Random Amplified Polymorphic DNA (RAPD), Multilocus Sequence Typing (MLST) and Pulsed-field Gel Electrophoresis (PFGE); and (iii) adherence pattern in intestinal Caco-2 cells. The occurrence of virulence genes was similar between the canine and human isolates presenting the same serotype. The fimbrial genes ecpA and fimH were the most frequently detected, followed by hcpA, tccP, tccP2, lpfA1, lpfA2, astA and toxB genes. Several nle genes were also detected, with one canine strain (O156:H- / ST327) showing all PAI O-122 genes investigated (efa-1, nleB, nleE and ent/espL2). Canine and human strains of the same serotype were grouped into a single cluster by RAPD and PFGE, in which the ST10 and ST206 were identified. Additionally, most of the strains exhibited a localized adherence-like phenotype when interacting with Caco-2 cells. The results showed that some canine aEPEC strains share virulence genes commonly found in human pathogenic strains. Moreover, strains of the same serotype, isolated from dogs and children, share virulence genes and are phylogenetically close, suggesting a potential zoonotic risk.
Subject(s)
Dog Diseases/transmission , Enteropathogenic Escherichia coli/isolation & purification , Escherichia coli Infections/veterinary , Zoonoses/transmission , Age Factors , Animals , Child , Diarrhea/epidemiology , Diarrhea/microbiology , Dog Diseases/diagnosis , Dog Diseases/epidemiology , Dog Diseases/microbiology , Dogs , Enteropathogenic Escherichia coli/genetics , Enteropathogenic Escherichia coli/pathogenicity , Escherichia coli Infections/epidemiology , Escherichia coli Infections/transmission , Feces/microbiology , Humans , Multilocus Sequence Typing , Phylogeny , Random Amplified Polymorphic DNA Technique , Serogroup , Virulence , Zoonoses/epidemiology , Zoonoses/microbiologySubject(s)
Escherichia coli Proteins/genetics , Escherichia coli/genetics , beta-Lactamases/genetics , Aged , Brazil , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Escherichia coli Infections/drug therapy , Escherichia coli Infections/microbiology , Female , Humans , Male , Microbial Sensitivity Tests , PlasmidsABSTRACT
The aim of this study was to investigate the genetic relatedness of 57 KPC-2-producing Klebsiella pneumoniae isolates from 5 states in Brazil, during 2006-2009. Pulse-field gel electrophoresis analysis identified 10 pulsotypes. The pulsotype designated as Kp-RJ (Klebsiella pneumoniae-Rio de Janeiro) was the dominant clone found in the states of Rio de Janeiro and Espírito Santo. Multilocus sequence typing of Kp-RJ assigned it to ST 437. Sequence types ST11, ST16, ST25, ST70, ST101, ST105, ST423, ST442, and ST443 were also identified. These results indicate the dissemination of a successful KPC-producing clone (ST437) in Brazil, which is a single locus variant of ST258.
Subject(s)
Klebsiella Infections/epidemiology , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/enzymology , Molecular Typing , beta-Lactamases/biosynthesis , Brazil/epidemiology , Electrophoresis, Gel, Pulsed-Field , Genotype , Humans , Klebsiella Infections/microbiology , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Molecular Epidemiology , Multilocus Sequence TypingSubject(s)
Anti-Bacterial Agents/therapeutic use , Pseudomonas Infections/microbiology , Pseudomonas putida/metabolism , Pseudomonas stutzeri/metabolism , beta-Lactamases/metabolism , Child , Drug Resistance, Multiple, Bacterial , Female , Gene Expression Regulation, Bacterial , Gene Expression Regulation, Enzymologic , Humans , Infant , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/microbiology , Pseudomonas putida/genetics , Pseudomonas stutzeri/genetics , beta-Lactamases/geneticsABSTRACT
OBJECTIVES: The aim of this study was to characterize the KPC-type carbapenem-hydrolysing beta-lactamase, extended-spectrum beta-lactamases (ESBLs) and class 1 integrons among nosocomial Klebsiella pneumoniae isolated in Rio de Janeiro, Brazil. METHODS: MICs were determined and isolates were screened for ESBLs, metallo-beta-lactamases (MBLs) and class A carbapenemase-producing phenotypes. The main beta-lactamases resistance genes (bla(TEM), bla(SHV), bla(CTX-M), bla(KPC), bla(IMP) and bla(VIM)) and class 1 integrons were detected by PCR followed by DNA sequencing. The genetic relatedness of isolates was determined by PFGE. RESULTS: All K. pneumoniae isolates were positive for ESBL and class A carbapenemase production and negative for MBL production. All isolates were resistant to all beta-lactam antibiotics, ciprofloxacin and gentamicin, being susceptible only to tigecycline and polymyxin B. The bla(KPC-2), bla(CTX-M-1), bla(CTX-M-2), bla(CTX-M-8) and bla(SHV-11) genes were detected. PFGE analysis revealed two clonal types among KPC-producing isolates, both identified in the same hospital. CONCLUSIONS: Our findings should alert medical authorities to implement stringent methods for the detection and spread control of emerging KPC-2 carbapenemases in the hospital setting in Brazil.
Subject(s)
Anti-Bacterial Agents/antagonists & inhibitors , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/isolation & purification , beta-Lactamases/genetics , beta-Lactamases/metabolism , beta-Lactams/antagonists & inhibitors , Anti-Bacterial Agents/metabolism , Bacterial Typing Techniques , Brazil , Cross Infection/microbiology , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Genotype , Humans , Integrons , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/genetics , Microbial Sensitivity Tests , Polymerase Chain Reaction , Sequence Analysis, DNA , beta-Lactam Resistance , beta-Lactams/metabolismABSTRACT
The bacterial community associated with the midgut of three Brazilian Lutzomyia longipalpis (Lutz & Neiva) populations, two from endemic areas for visceral leishmaniasis (Jacobina, Bahia State and São Luís, Maranhão State) and one from a non-endemic area (Lapinha Cave, Minas Gerais State), was identified. Five groups, 35 females each, from each population were separated; a total of 175 females per collecting area were analyzed. The species identification was based on molecular and traditional bacteriological methods. All bacteria were either affiliated to non-Enterobacteriaceae, such as Acinetobacter, Burkholderia, Flavimonas, Pseudomonas and Stenotrophomonas, or and to Enterobacteriaceae, such as Citrobacter, Enterobacter, Escherichia, Klebsiella, Serratia, Pantoea, Morganella and Weeksella. Stenotrophomonas was found to be associated with all three populations studied. In addition, Serratia spp., which are well documented as laboratory contaminant of insects, were detected only in the Jacobina population. We also discuss the impact of the colonization of insect gut by bacteria on the development and transmission of pathogens.
Subject(s)
Psychodidae/microbiology , Animals , BrazilABSTRACT
A flora bacteriana encontrada no intestino de populações brasileiras de Lutzomyia longipalpis (Lutz & Neiva) provenientes de duas áreas endêmicas para leishmaniose visceral (Jacobina, BA e São Luís, MA) e de uma área não endêmica (Gruta da Lapinha, MG) é descrita. Cinco grupos de 35 fêmeas de cada população foram separados, no total de 175 fêmeas analisadas por área de coleta. A identificação das espécies foi baseada em métodos moleculares e em métodos bacteriológicos tradicionais. As bactérias encontradas foram classificadas como pertencentes ao grupo das não-Enterobacteriaceae, como Acinetobacter, Burkholderia, Flavimonas, Pseudomonas, ou ao grupo das Enterobacteriaceae, como Stenotrophomonas, Citrobacter, Enterobacter, Escherichia, Klebsiella, Serratia, Pantoea, Morganella e Weeksella. Stenotrophomonas esteve presente nas três populações analisadas. Além disso, Serratia spp., grupo bem documentado como contaminante laboratorial de insetos, foi detectado apenas na população de Jacobina. O impacto da colonização do intestino de insetos por bactérias no desenvolvimento e transmissão de patógenos é discutido.
The bacterial community associated with the midgut of three Brazilian Lutzomyia longipalpis (Lutz & Neiva) populations, two from endemic areas for visceral leishmaniasis (Jacobina, Bahia State and São Luís, Maranhão State) and one from a non-endemic area (Lapinha Cave, Minas Gerais State), was identified. Five groups, 35 females each, from each population were separated; a total of 175 females per collecting area were analyzed. The species identification was based on molecular and traditional bacteriological methods. All bacteria were either affiliated to non-Enterobacteriaceae, such as Acinetobacter, Burkholderia, Flavimonas, Pseudomonas and Stenotrophomonas, or and to Enterobacteriaceae, such as Citrobacter, Enterobacter, Escherichia, Klebsiella, Serratia, Pantoea, Morganella and Weeksella. Stenotrophomonas was found to be associated with all three populations studied. In addition, Serratia spp., which are well documented as laboratory contaminant of insects, were detected only in the Jacobina population. We also discuss the impact of the colonization of insect gut by bacteria on the development and transmission of pathogens.
Subject(s)
Animals , Psychodidae/microbiology , BrazilABSTRACT
Introdução: a melhor prevenção para sífilis congênita possivelmente seja a realização dos testes de triagem durante o pré-natal, principalmente nas mulheres consideradas de comportamento de risco para a infecção pelo HIV e demais DST. Para o obstetra, a importância dessa doença transcende seus aspectos clínicos, principalmente pela transmissão vertical de seu agente etiológico. Desta forma, o diagnóstico laboratorial precoce e correto é uma poderosa ferramenta na profilaxia da sífilis congênita. Objetivo: estabelecer o significado dos baixos títulos para o teste de VDRL frente aos testes treponêmicos em gestantes. Métodos: foram analisadas 215 amostras de soro de gestantes de duas maternidades da cidade do Rio de Janeiro, RJ. Utilizou-se o teste VDRL e testes treponêmicos (TPHA, ELISA e Western-blotting). Os títulos de VDRL foram confrontados com testes não-reagentes, tendo como variável independente os testes treponêmicos. Resultados: houve associação estatisticamente significativa (?<0,05) entre os diversos títulos de VDRL (baixos títulos:1/1, 1/2 e 1/4 e altos títulos: ?1/8) quando confrontados com os testes treponêmicos. Por meio da análise comparativa de sensibilidade e especificidade obteve-se a curva ROC (Receiver Operator Characteristic). Títulos de VDRL acima de 1/1 associaram-se, de modo significativo, com os testes treponêmicos. Conclusão: os resultados mostraram que os baixos títulos de VDRL devem ser valorizados e que o teste considerado como screening pode também ser útil quando utilizado como teste diagnóstico para asífilis em gestantes.
Subject(s)
Humans , Female , Pregnancy , Clinical Laboratory Techniques , Enzyme-Linked Immunosorbent Assay , Pregnant Women , Sexually Transmitted Diseases , Syphilis , Treponema Immobilization Test , Case Reports , Women's HealthABSTRACT
Neisseria gonorrhoeae isoladas de forma consecutiva foram testadas para penicilina, tetraciclina, azitromicina, ciprofloxacin, ceftriaxona e cloranfenicol, utilizando o método E-test para determinação da concentração mínima inibitória
Subject(s)
Humans , Male , Female , Neisseria gonorrhoeae , Sexually Transmitted DiseasesABSTRACT
The aims of this study were to determine the frequency and antimicrobial resistance patterns of microorganisms associated with sepsis cases in a public maternity hospital, and to analyze the main demographic data relating to these infected neonates over a two year period. We analyzed 255 positive blood cultures and the medical records of newborns admitted to the neonatal intensive care unit of the Hospital Maternidade Alexander Fleming II, Rio de Janeiro city, Brazil, from July 1997 to July 1999. Identification and antibiograms of the isolated strains were performed according to routine laboratory procedures. Demographics and microbiological data were analyzed using the Epi-Info program. The mean age of the newborns was 13.1 days, with an average of 1.2 strains isolated per patient. Antibiotics were administered to 207 83.1(per cent) patients before positive blood culture presentation. A total of 90.8 (per cent) patients were premature; 83.9 (per cent) had a gestational age of less than 36 weeks; 52.6 (per cent) presented very low birth weight; 39.8 (per cent) had asphyxia and 33.3 (per cent) presented hyaline membrane disease. A total of 301 microorganisms were isolated with a predominance of Klebsiella pneumoniae 22.9 (per cent), coagulase-negative Staphylococci 17.3 (per cent), Serratia marcescens 15.9 (per cent) and Pseudomonas aeruginosa 10.6 (per cent). Gram-negative strains showed high resistance levels to cephalosporins and aminoglycosides. A total of 93.3 (per cent) Staphylococcus aureus strains were methicillin-resistant. The newborns examined in this study presented several risk factors for acquiring hospital infection and the isolated microorganisms showed high levels of resistance to the majority of the antibiotics routinely used in the hospital.
Subject(s)
Humans , Infant, Newborn , Frequency of Garbage Collection , Epidemiology and Biostatistics , In Vitro Techniques , Infant, Newborn , Cross Infection/diagnosis , Cross Infection/microbiology , Drug Resistance, Microbial , Sepsis , Hematologic Tests/methods , Culture Media , Serologic Tests/methodsABSTRACT
A sífilis é comum em pacientes HIV, entretando, pouco se sabe sobre a forma como a infecçäo pelo HIV poderia afetar as manifestaçöes da doença. Em infectados pelo HIV, a sífilis pode ter um curso acelerado e a resposta sorológica à infecçäo pode estar bloqueada ou alterada. Objetiva a estimar a prevalência da sífilis em infectados pelo HIV e analisar características epidemiológicas associadas
