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1.
PLoS One ; 19(1): e0297161, 2024.
Article in English | MEDLINE | ID: mdl-38277372

ABSTRACT

Bacterial bloodstream infections (BSI) are a common threat among patients with haematological malignancies (HM) and hematopoietic stem cell transplant recipients (HSCT). The purpose of this research was to describe clinical and microbiological aspects of BSI caused by carbapenem-resistant Klebsiella pneumoniae (CRKp) and assess risk factors associated with 30-day mortality in a 10-year cohort of haematological patients. A total of 65 CRKp-BSI episodes occurring in HM patients and HSCT recipients and CRKp-BSI between January 2010 and December 2019 were retrospectively studied. Acute leukemias were the most frequently observed underlying disease (87.7%) and 18 patients (27.7%) received HSCT. Mucosal barrier injury in the gastrointestinal tract was the primary cause of bacteremia (86.1%). Also, 14 individuals (21.6%) had an Invasive Fungal Disease (IFD) throughout the episode. Regarding treatment, in 31 patients (47.7%) empirical therapy was deemed appropriate, whereas 33 (50.8%) patients received a combination therapy. Microbiological data revealed that the majority of isolates (53-58%) had the Polymyxin B co-resistance phenotype, while amikacin resistance was less common (16 samples, or 24.7%). The mortality rates at 14 and 30 days were 32.3% and 36.9%, respectively. In a multivariate Cox regression analysis, prompt appropriate antibiotic administration within three days was associated with a better outcome (Adjusted Hazard Ratio [aHR]: 0.33; 95% Confidence Interval [CI]: 0.14-0.76; p = 0.01), whereas hypotension at presentation (aHR: 3.88; 95% CI: 1.40-10.74; p = 0.01) and concurrent IFD (aHR: 2.97; 95% CI: 1.20-7.37; p = 0.02) were independently associated with death within 30 days. Additionally, a favorable correlation between combination therapy and overall survival was found (aHR: 0.18; 95%CI: 0.06-0.56; p = 0.002). In conclusion, 30-day mortality CRKp-BSI was elevated and most of the isolates were polymyxin B resistant. Early appropriate antimicrobial treatment and the use of combination therapy were linked to a better outcome.


Subject(s)
Bacteremia , Carbapenem-Resistant Enterobacteriaceae , Hematologic Neoplasms , Hematopoietic Stem Cell Transplantation , Klebsiella Infections , Humans , Klebsiella pneumoniae , Retrospective Studies , Polymyxin B/therapeutic use , Brazil/epidemiology , Klebsiella Infections/microbiology , Anti-Bacterial Agents/therapeutic use , Bacteremia/microbiology , Hematologic Neoplasms/therapy , Hematologic Neoplasms/drug therapy , Carbapenems/therapeutic use , Hematopoietic Stem Cell Transplantation/adverse effects , Risk Factors
2.
Article in English | MEDLINE | ID: mdl-29158274

ABSTRACT

This study aimed to characterize multidrug-resistant Proteus mirabilis clones carrying a novel class 1 integron-borne blaIMP-1 In1359 was inserted into a large conjugative plasmid that also carried blaCTX-M-2 The production of carbapenemases in Enterobacteriaceae that are intrinsically resistant to polymyxins and tigecycline is very worrisome, representing a serious challenge to clinicians and infection control teams.


Subject(s)
Gene Expression Regulation, Bacterial , Integrons , Plasmids/chemistry , Proteus mirabilis/genetics , beta-Lactamases/genetics , Anti-Bacterial Agents/pharmacology , Brazil/epidemiology , Carbapenems/pharmacology , Clone Cells , Drug Resistance, Multiple, Bacterial/genetics , Humans , Microbial Sensitivity Tests , Plasmids/metabolism , Polymyxins/pharmacology , Proteus Infections/drug therapy , Proteus Infections/epidemiology , Proteus Infections/microbiology , Proteus Infections/transmission , Proteus mirabilis/drug effects , Proteus mirabilis/enzymology , Proteus mirabilis/isolation & purification , Tertiary Care Centers , Tigecycline/pharmacology , beta-Lactamases/metabolism
3.
J Microbiol Methods ; 142: 1-3, 2017 11.
Article in English | MEDLINE | ID: mdl-28844719

ABSTRACT

The rapid detection of KPC-producing Enterobacteriaceae by microbiology laboratories has been required for infectious control programs. Herein we evaluated the performance of a novel immunochromatographic test for detecting KPC-2-, KPC-3-, KPC-4-, KPC-6-, KPC-7-, KPC-8-, and KPC-11-producing isolates and the influence of different growth media on the test performance.


Subject(s)
Bacterial Proteins/genetics , Carbapenem-Resistant Enterobacteriaceae/genetics , Chromatography, Affinity/methods , Klebsiella pneumoniae/genetics , beta-Lactamases/genetics , Carbapenem-Resistant Enterobacteriaceae/enzymology , Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Humans , Klebsiella pneumoniae/enzymology , Microbial Sensitivity Tests
4.
J Clin Microbiol ; 47(4): 1074-81, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19225102

ABSTRACT

The reevaluation of the genus Trichosporon has led to the replacement of the old taxon Trichosporon beigelii by six new species. Sequencing of the ribosomal DNA (rDNA) intergenic spacer 1 (IGS1) is currently mandatory for accurate Trichosporon identification, but it is not usually performed in routine laboratories. Here we describe Trichosporon species distribution and prevalence of Trichosporon asahii genotypes based on rDNA IGS1 sequencing as well as antifungal susceptibility profiles of 22 isolates recovered from blood cultures. The clinical isolates were identified as follows: 15 T. asahii isolates, five Trichosporon asteroides isolates, one Trichosporon coremiiforme isolate, and one Trichosporon dermatis isolate. We found a great diversity of different species causing trichosporonemia, including a high frequency of isolation of T. asteroides from blood cultures that is lower than that of T. asahii only. Regarding T. asahii genotyping, we found that the majority of our isolates belonged to genotype 1 (86.7%). We report the first T. asahii isolate belonging to genotype 4 in South America. Almost 50% of all T. asahii isolates exhibited amphotericin B MICs of >or=2 microg/ml. Caspofungin MICs obtained for all the Trichosporon sp. isolates tested were consistently high (MICs >or= 2 microg/ml). Most isolates (87%) had high MICs for 5-flucytosine, but all of them were susceptible to triazoles, markedly to voriconazole (all MICs

Subject(s)
Antifungal Agents/pharmacology , DNA, Fungal/genetics , DNA, Ribosomal Spacer/genetics , Fungemia/epidemiology , Mycoses/epidemiology , Trichosporon/classification , Trichosporon/drug effects , Adolescent , Adult , Aged , Child , Child, Preschool , DNA, Fungal/chemistry , DNA, Ribosomal Spacer/chemistry , Female , Genotype , Humans , Infant , Infant, Newborn , Male , Microbial Sensitivity Tests , Middle Aged , Molecular Sequence Data , Phylogeny , Prevalence , Sequence Analysis, DNA , South America/epidemiology , Trichosporon/genetics , Trichosporon/isolation & purification
5.
Mycopathologia ; 166(3): 121-32, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18568419

ABSTRACT

Trichosporon spp. are widely distributed in nature and can occasionally belong to the human microbiota. For many years, the unique species of the genus, Trichosporon beigelli, was only known as an environmental and saprophytic fungus occasionally found as the etiological agent of white piedra. However, case reports of invasive trichosporonosis have been frequently published and the genus is currently considered the second most common agent of yeasts disseminated infections. Based on molecular analysis, the taxon T. beigelli was replaced by several species and the taxonomy of the genus was progressively modified. Despite the reported increase of Trichosporon infections refractory to conventional antifungal drugs, there are only a few studies investigating in vitro susceptibility of Trichosporon spp. to new compounds. Difficulties on different species identification as well as the lack of standardized sensitivity tests in vitro, contribute to the limited information available on epidemiology, diagnosis and therapeutics of trichosporonosis.


Subject(s)
Trichosporon/classification , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/drug therapy , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/microbiology , Humans , Microbial Sensitivity Tests , Mycological Typing Techniques , Mycoses/diagnosis , Mycoses/drug therapy , Mycoses/epidemiology , Mycoses/microbiology , Species Specificity , Trichosporon/drug effects , Trichosporon/genetics
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