ABSTRACT
INTRODUCTION: The dramatic increase in the prevalence and clinical impact of infections caused by Carbapenemase-Producing Bacteria in the nosocomial setting in Latin America represents an emerging challenge to public health. The present study detected carbapenemase-producing Gram-negative bacteria in patients from a Hospital from Venezuela, by phenotypic and genotypic methods. METHODOLOGY: The bacterial identification was carried out using conventional methods. The resistance to carbapenems was performed by Kirby-Baüer disk diffusion method, according to CLSI recommendations. The modified Hodge Test, double-disk with phenylboronic acid, double-disk with EDTA and Blue Carba Test were performed to detect phenotypic carbapenemase producers. The carbapenemase-encoding genes blaKPC, blaVIM, blaIMP, blaOXA-2, blaOXA-3, blaOXA-15 and blaOXA-21 were determined. RESULTS: The bacterial species identified were Klebsiella pneumoniae complex (181), Pseudomonas aeruginosa (51), and Acinetobacter baumannii-calcoaceticus complex (119). KPC-type was detected in 40.17% of isolates and VIM-type in 14.53%. KPC-type gene was only identified in K. pneumoniae isolates (77.9%). VIM-type gene was identified in P. aeruginosa (86.27%) and K. pneumoniae isolates (3.87%). There was not detection of IMP-type and OXA-type genes. CONCLUSIONS: We found a predominance of K. pneumoniae KPC producers and a high rate of VIM-producing P. aeruginosa. The epidemiology of CPB in Venezuela is rapidly evolving, and enhanced surveillance and reporting are needed across the healthcare continuum.
Subject(s)
Ambulatory Care Facilities/statistics & numerical data , Bacterial Proteins/genetics , Enterobacteriaceae/classification , Enterobacteriaceae/genetics , Public Health , beta-Lactamases/genetics , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/biosynthesis , Carbapenems/pharmacology , Disk Diffusion Antimicrobial Tests , Enterobacteriaceae/drug effects , Enterobacteriaceae/enzymology , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae Infections/microbiology , Genotype , Humans , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Phenotype , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/enzymology , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/isolation & purification , Venezuela/epidemiology , beta-Lactamases/biosynthesisABSTRACT
Carbapenem-resistant Gram-negative bacteria isolated in Venezuela have been poorly characterized. The present study characterized a total of 34 isolates obtained from 27 patients; five of these patients were multi-infected. The bacterial species identified were Klebsiella pneumoniae (17), Pseudomonas aeruginosa (9), and Acinetobacter baumannii (8). From these isolates, 85% were identified as carbapenemase-producing bacteria, and the identified carbapenemase genes were blaKPC-2 (10/29 [34.4%]), blaVIM-type (7/29 [24.1%]), blaOXA-23 (7/29 [24.1%]), blaNDM-1 (8/29 [27.5%]), and the coexistence of blaOXA-23/blaNDM-1 (2/29 [6.8%]). Patient 1 was multi-infected by K. pneumoniae ST11 and ST2413 isolates harbouring the blaNDM-1 and blaKPC-2 genes, respectively. The other patients were multi-infected by two or three different bacterial species such as ESBL-producing K. pneumoniae isolates, P. aeruginosa harbouring the blaVIM-type gene, K. pneumoniae ST147 harbouring the blaKPC-2 gene and by A. baumannii harbouring the blaOXA-23 gene. The blaNDM-1 gene in A. baumannii is flanked by an uncommon genetic structure, whereas blaNDM-1 gene in K. pneumoniae revealed a common structure described in different plasmids from Enterobacteriaceae isolates. This study provides new information about the epidemiology of carbapenemase-producing bacteria in clinical setting in Venezuela.
Subject(s)
Bacterial Proteins/biosynthesis , Gram-Negative Bacteria/genetics , beta-Lactam Resistance/genetics , beta-Lactamases/biosynthesis , Acinetobacter baumannii , Adult , Female , Genes, Bacterial/genetics , Gram-Negative Bacteria/enzymology , Humans , Klebsiella pneumoniae , Male , Middle Aged , Pseudomonas aeruginosa , VenezuelaABSTRACT
Intestinal pathogens infection represents a global public health problem, and are associated with morbidity and mortality high rates, particularly in children; we determined the relative frequency of intestinal parasites and diarrheagenic bacteria in 22 children of the Basic State School "Comandante Remigio Negron", Maracaibo, Venezuela. Most of the children showed elevated parasites (72.73%) and polyparasitism (22.73%). The highest frequency corresponded to the protozoa and chromist (95.65%), finding a high frequency of Blastocystis sp. (52.17%); while Giardia intestinalis was detected only in 8.70%, in contrast to global data that indicate it is the most frequent protozoan species in children. In addition, the complex E. histolytica/E. dispar / E. moshkovskii (13.04%) was detected and also Hymenolepis nana (4.35%). Non-typhoidal Salmonella (4.54%) was also detected, the most common bacterial pathogen causing foodborne infection globally and the main stool-isolated bacteria in pediatric patients of the region. These results demonstrate the high relative frequency of intestinal parasites in the studied children, with predominance of protozoa and chromist, as well as the presence of Salmonella sp.; highlighting the need to promote the hygiene and environmental sanitation, to reduce the relative frequency of intestinal pathogens and their consequences to health and school performance.
Las infecciones por patógenos intestinales representan un problema de salud pública mundial y se encuentran asociadas con elevadas tasas de morbilidad y mortalidad, especialmente en niños; por lo cual se determinó la frecuencia relativa de parásitos intestinales y bacterias enteropatógenas entre 22 niños de la Escuela Básica Estadal "Comandante Remigio Negrón", Maracaibo, Venezuela. La mayoría de los niños presentaron parásitos (72,73%) y poliparasitismo elevado (22,73%). La frecuencia más alta correspondió a los protozoarios y cromistas (95,65%), encontrando una elevada frecuencia de Blastocystis sp. (52,17%); mientras que G. intestinalis fue detectada sólo en 8,70%, a diferencia de datos mundiales que indican es la especie de protozoario más frecuente en niños. Asimismo, se detectó el Complejo E. histolytica/E. dispar/E. moshkovskii (13,04%) e Hymenolepis nana (4,35%). Se detectó Salmonella no tifoidea (4,54%), que constituye el principal patógeno bacteriano que ocasiona infecciones transmitidas por alimentos a nivel mundial y la principal bacteria aislada de heces en pacientes pediátricos de la región. Estos resultados demuestran la elevada frecuencia relativa de parásitos intestinales en la población infantil estudiada, con predominio de protozoos y cromistas, así como la presencia de Salmonella sp.; señalando la necesidad de fomentar los hábitos higiénicos y el saneamiento ambiental, para disminuir la frecuencia relativa de patógenos intestinales y sus secuelas en el estado de salud y rendimiento escolar.
ABSTRACT
La alta incidencia de las enfermedades infecciosas y el aumento de la resistencia a los antibióticos se han convertido en la actualidad en un problema de salud pública, siendo las enterobacterias productoras de Betalactamasas de Espectro Extendido (BLEE) un ejemplo de este fenómeno. En el presente estudio se determinó la producción de BLEE en aislados clínicos de la familia Enterobacteriaceae procedentes de una institución de salud de la ciudad de Maracaibo, durante el periodo septiembre de 2014 a febrero de 2015. Para la detección de BLEE se utilizó como método preliminar el de Kirby-Baüer, siguiendo los lineamientos del CLSI; adicionalmente se utilizó como prueba confirmatoria fenotípica el método de sinergia del doble disco y como prueba confirmatoria genotípica la detección de los genes blaCTX-M, blaTEM y blaSHV mediante PCR. Se analizaron 55 enterobacterias productoras de BLEE, distribuidas de la siguiente manera: Escherichia coli 56,36%, Klebsiella pneumoniae 21,82%, Enterobacter cloacae 7,27%, Proteus mirabilis y Serratia marcescens 5,45% para cada especie, por último, Salmonella spp. y Morganella morganii 1,82% respectivamente. En cuanto al tipo de BLEE detectado mediante PCR, se observó que el 83,63% de los aislados presentó el tipo TEM, seguido de CTX-M (23,63%) y SHV (21,81%), mientras que el 27,27% de los aislados produjo dos o tres BLEE de manera simultánea. Los resultados de este estudio confirman la alta diseminación de este mecanismo de resistencia entre las enterobacterias productoras de infecciones en nuestras instituciones públicas de salud, por lo que deben aplicarse medidas de control que permitan controlar y disminuir su incidencia.
The high incidence of the infectious diseases and the antimicrobial resistance arise represent a public health threat today. The extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae are an example of this phenomenon. We determined the ESBL-production in Enterobacteriaceae isolates from a Healthcare Center in Maracaibo, during September 2014 to February 2015. The Kirby-Baüer method was perform to preliminary phenotypic detection of ESBL, according to CLSI guidelines. ESBL-production was confirmed by a double-disk synergy test according to the CLSI standards. To genotypic confirmation, the genes blaCTX-M, blaTEM and blaSHV were amplified by PCR. Fifty-five (n=55) strains were analyzed distributed in Escherichia coli (56.36 %), Klebsiella pneumoniae (21.82 %), Enterobacter cloacae (7.27 %), Proteus mirabilis and Serratia marcescens (5.45 % each one), Salmonella spp. and Morganella morganii (1.82 % each one). The major encoded ESBL was the blaTEM gene (83.63 %); followed by 23.63% of the blaCTX-M gene, and 21.81 % encoded the blaSHV gene. 27.27 % of the isolates produced two or three ESBL simultaneously. These results confirmed the high spread of this resistant mechanism among Enterobacteriaceae-producing infections in our public health institutions, therefore control measures should applied to control and reduce its incidence.
ABSTRACT
Staphylococcus aureus resistente a oxacilina (SAOR) continúa siendo una causa importante de infecciones nosocomiales en todo el mundo. Se determinó la resistencia a los antibióticos de cepas intrahospitalarias, clasificándolas en multidrogo-resistentes, extensamente drogo-resistentes o pandrogo-resistentes. Las muestras biológicas fueron recolectadas entre septiembre 2013-febrero 2014 y procesadas de acuerdo a técnicas de bacteriología convencional. La resistencia a los antibióticos se determinó mediante el método de difusión con discos en agar y el gen mecA se detectó mediante reacción en cadena de la polimerasa. Se observó baja prevalencia de SAOR intrahospitalario (13,86%). La mayor resistencia fue a eritromicina (66,07%), mientras que la resistencia frente a aminoglucósidos, fluoroquinolonas, clindamicina y tetraciclina fue inferior al 25%; la resistencia frente a trimetoprim/sulfametoxazol fue muy baja y el 100% de las cepas mostraron sensibilidad a rifampicina, linezolid, vancomicina y teicoplanina. El fenotipo de resistencia a MLSB más frecuente fue el de resistencia a eritromicina y susceptibilidad a clindamicina (33,93%, fenotipo MSB). Las cepas SAOR aisladas presentaron 25 antibiotipos diferentes, siendo la mayoría de los aislamientos multidrogo-resistentes (55,36%). No se observó resistencia extensa a los antibióticos ni pandrogo-resistencia y la presencia del gen mecA se demostró en todos los aislamientos resistentes a oxacilina.
Oxacillin-resistant Staphylococcus aureus (ORSA) has remained a major cause of nosocomial infections worldwide. The antibiotic resistance of isolations was determined and we classify them in multidrug-resistant, extensively drug-resistant or pandrug-resistant. The biological samples of patients from a Maracaibos Hospital, during September 2013 to February 2014, were processed according to conventional techniques of bacteriology. Antibiotic resistance was determined by disk diffusion method in agar and the mecA gene was detected by polymerase chain reaction. It was observed a low prevalence of nosocomial ORSA (13.86%). The higher antibiotic resistance was observed against erythromycin (66.07%) and a resistance lower than 25% to aminoglycosides, fluoroquinolones, tetracycline and clindamycin. The isolates showed a very low resistance to trimethoprim/sulfamethoxazole and all isolates were susceptible to rifampicin, linezolid, vancomycin and teicoplanin.The majority of isolates had a MSB phenotype (33.93%), with erythromycin resistance and susceptibility to clindamycin. The ORSA isolates in this study had 25 different antibiotypes and the majority of them were multidrug-resistant (55.36%). There was not both extensively drug-resistant and pandrug-resistant isolates and the presence of the mecA gene was demonstrated in all isolates of ORSA.
ABSTRACT
Los antibióticos carbapenemes representan generalmente los últimos recursos para el tratamiento de infecciones asociadas a los servicios de salud producidas por bacterias Gram negativas multiresistentes. Es preocupante que esta situación esté siendo amenazada en todo el mundo por la aparición de cepas con resistencia a estos antibióticos debido a la producción de Carbapenemasas. Observando este panorama, se caracterizaron tanto fenotípica como genotípicamente las cepas de Enterobacteriaceae productoras de Carbapenemasas tipo KPC aisladas en un Hospital de la región Zuliana, durante 2009 a 2013. Fueron detectadas 423 cepas de Enterobacteriaceae resistentes a los carbapenemes debido a la producción de estas enzimas (36,29%). Los pacientes más afectados fueron adultos de sexo masculino procedentes de la Unidad de Terapia Intensiva. El sitio de colonización más frecuente fue el tracto respiratorio, mientras que el estado de portador rectal fue poco frecuente. Las KPC fueron detectadas principalmente en K. pneumoniae, K. oxytoca, E. coli y E. cloacae, siendo multidrogo-resistentes y extensamente drogo-resistentes. La mayoría de los métodos fenotípicos utilizados permitieron confirmar la presencia de Carbapenemasas y la detección del gen blaKPC confirmó que las carbapenemasas que circulan en cepas de Enterobacteriaceae de nuestra región son del tipo KPC.
Carbapenems have generally been considered the pharmacotherapy of last resort for managing infections associated with health services caused by multidrug-resistant gram-negative bacteria. However, it is worrisome that this situation is being threatened worldwide with the appearance of bacterial strains that resist these antibiotics due to the production of novel b-lactamases with direct carbapenem-hydrolyzing activity (carbapenemases). This study was performed to characterize KPC carbapenemase-producing Enterobacteriaceae isolated from a hospital in the Zulia region during 2009-2013 in terms of their geno- and phenotypes. KPC carbapenemase production was detected in 423 strains of carbapenem-resistant Enterobacteriaceae (36.29%). The most affected patients were male adults from the intensive care unit. The most common site of colonization was the respiratory tract, while rectal carrier status was rare. These KPC carbapenemases were detected mainly in K. pneumoniae, K. oxytoca, E.coli and E. cloacae. Most isolates showed multidrug-resistance and an extensively drug-resistant phenotype. The majority of the phenotypic methods were effective for the detection of KPC producers in Enterobacteriaceae isolates and the presence of blaKPC gene confirmed that the Carbapenemase circulating in Enterobacteriaceae strains in this region are the KPC type.
ABSTRACT
La evaluación de la calidad sanitaria de los camarones procesados y destinados a la exportación requiere determinaciones permanentes que garanticen la inocuidad del producto. No obstante, la información sobre la diversidad y ocurrencia de Salmonella en camarones es muy escasa en Venezuela. Se determinó la prevalencia y diversidad de cepas de Salmonella en 1.022 muestras de camarones crudos congelados procedentes de cultivo para exportación y procesados en una planta del estado Zulia. La recolección, manejo y transporte de las muestras para los análisis bacteriológicos se realizaron de acuerdo al manual de Administración de Drogas y Alimentos norteamericana y la norma venezolana COVENIN. La serotipificación de Salmonella se realizó según la fórmula antigénica descrita por la Organización Mundial de la Salud. Salmonella enterica subsp. enterica estuvo presente en 20 muestras, obteniendo una prevalencia de 2%. Adicionalmente, se observó una amplia diversidad de serotipos de Salmonella, siendo los más frecuentes Tennessee (20%), Typhimurium (15%), Caracas (10%) y Kentucky (10%). La presencia y amplia diversidad de serotipos de Salmonella pudieran estar relacionadas con las condiciones de producción del camarón. En cambio, la baja prevalencia pudiera deberse a las condiciones higiénicas de la planta procesadora y al efecto de las bajas temperaturas.
The evaluation of the sanitary quality of processed shrimps destined for exportation requires permanent determinations which guarantee the safety of the product. Nevertheless, the information regarding Salmonella diversity and occurrence in shrimps is very scarce in Venezuela. The prevalence and diversity of Salmonella strains was determined in 1,022 samples of raw frozen shrimps destined for exportation and processed in a facility located at Zulia State. The collection, management and transportation of samples for the bacteriological analyses were done according to a manual published by the North American Food and Drug Administration and the Venezuelan regulations COVENIN. Salmonella serotyping was done according to the antigenic formula described by the World Health Organization. Salmonella enterica subsp. enterica was found in 20 samples, establishing a 2 % prevalence. Additionally, a wide variety of Salmonella serotypes was found, the most frequent being Tennessee (20%), Typhimurium (15%), Caracas (10%), and Kentucky (10%). The presence and wide variety of Salmonella serotypes could be related to the production conditions of shrimps. On the other hand, the low prevalence could be due to the hygienic conditions of the processing plants and the effect of low temperatures.
ABSTRACT
Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.
Subject(s)
Hepacivirus/isolation & purification , Hepatitis C Antibodies/blood , Hepatitis C/epidemiology , Renal Dialysis , Adolescent , Adult , Aged , Enzyme-Linked Immunosorbent Assay , Hepacivirus/immunology , Hepatitis C/prevention & control , Humans , Immunoblotting , Incidence , Middle Aged , Risk Factors , Venezuela/epidemiologyABSTRACT
Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95 percent confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.
Durante período de 2 anos, estudamos a incidência da infecção pelo vírus da hepatite C (VHC) em 29 pacientes em tratamento de diálise, com idades entre 15 e 75 anos (c ± DS; 45 ± 39,5 anos), procedentes da unidade de hemodiálise do Hospital Universitário de Maracaibo, Estado Zulia, Venezuela. Para a detecção dos anticorpos contra o VHC (anti-VHC) utilizamos a técnica de imunoensaio enzimático (ELISA, Innotest HCV Ab IV) e em amostras reativas por ELISA, utilizamos o método de immunoblot recombinante de terceira geração (Inno-LIA HCV Ab III), ambos da casa comercial Innogenetics N.V., Bélgica. Os resultados demonstram ausência de soroconversão ao VHC nos pacientes hemodializados durante o período estudado, o que foi confirmado pelo método de imunoblot recombinante. Os fatores de risco ao VHC foram 0,327 (95 por cento CI: 0,01323 - 8,080) nos pacientes submetidos ao tratamento de diálise. Nossos resultados sugerem ausência de fontes de infecção neste centro de hemodiálise e que as medidas universais de controle de infecção são cumpridas.
Subject(s)
Adolescent , Adult , Aged , Humans , Middle Aged , Hepacivirus/isolation & purification , Hepatitis C Antibodies/blood , Hepatitis C/epidemiology , Renal Dialysis , Enzyme-Linked Immunosorbent Assay , Hepacivirus/immunology , Hepatitis C/prevention & control , Immunoblotting , Incidence , Risk Factors , Venezuela/epidemiologyABSTRACT
The hepatitis C virus (HCV) infection constitutes an important, worldwide public health problem. Studies about the prevalence of HCV antibodies among surgical patients are few, and the involvement of surgery in the iatrogenic transmission of HCV remains a matter of controversy. Blood transfusions and other medical acts, have contributed to the spreading of HCV among the population. However, some HCV patients do not have antecedents of transfusions which suggest other mechanisms of transmission such as surgical acts, that continue facilitating the viral transmission. Some studies find an association between previous hospitalizations and the HCV infection, others report that such association does not exist. Several investigations suggest that the HCV infection risk does not reside in the surgery, but in the use of multidose containers, anesthetic products, saline solution, etc., administered during surgery. In Venezuela, the HCV overall prevalence is 1%. However, in poli-transfused, hemodialized or surgical patients is 10-22%. The studies carried out in surgery units, support the idea that surgical acts are not involved in the HCV spreading, although they can be responsible for this transmission in specific occasions. The HCV transmission due to surgical acts can happen in particular contexts of the sanitary environment and the study of this relationship is essential to adopt preventive measures that can help to eradicate or decrease this problem.
Subject(s)
Hepatitis C/transmission , Cross Infection , Humans , Iatrogenic DiseaseABSTRACT
The hepatitis C virus (HCV) infection constitutes an important, worldwide public health problem. Studies about the prevalence of HCV antibodies among surgical patients are few, and the involvement of surgery in the iatrogenic transmission of HCV remains a matter of controversy, Blood transfusión and other medical acts, have contributed to the spreading of HCV among the population. However, some HCV patients do not have antecedent of transfusions which suggest other mechanisms of transmission such as surgical acts, that continue facilitating the viral transmission. Some studies find an association between previous hospitalizations and the HCV infection, others report that such association does not exist. Several investigations suggest that the HCV infection risk does not reside in the surgery, but in the use of multidose containers, anesthetic products, saline solution, etc., administered during surgery. In Venezuela, the HCV overall prevalence is 1 per ceent. However, in poli-transfused, hemodialized or surgical patients is 10-22 per cent. The studies carried out in surgery units, support the idea that surgical acts are not involved in the HCV spreading, although they can be responsible for this transmission in specific occasions. The HCV transmission due to surgical acts can happen in particular contexts of the sanitary enviroment and the study of this relationship is essential to adopt preventive measures that can help to eradicate or decrease, this problem