ABSTRACT
A real-time TaqMan multiplex polymerase chain reaction (PCR) assay was developed to detect genes encoding five types of serine carbapenemases (GES, IMI/NMC, KPC, OXA-48 and SME). The assay was validated using control strains known to produce each of these types of enzyme and was then further assessed by 'blindly' testing 59 previously characterised clinical isolates, including 19 with serine (KPC or OXA-48) carbapenemases, 22 with metallo- (IMP, VIM or NDM) carbapenemases, and 18 with carbapenem resistance contingent upon extended-spectrum ß-lactamase (ESBL) or AmpC production combined with porin loss. The assay detected and correctly assigned the serine carbapenemases in all five positive control strains and in 19 clinical isolates. No false-positive results were seen for isolates with metallo-enzymes or for those that lacked a carbapenemase. The five serine carbapenemase genotypes could also be distinguished by melt-curve analysis or the molecular size of the amplicons.
Subject(s)
Bacterial Proteins/genetics , Enterobacteriaceae/enzymology , Enterobacteriaceae/genetics , Polymerase Chain Reaction/methods , beta-Lactam Resistance/genetics , beta-Lactamases/genetics , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Chromatography, Gel , DNA Primers , Enterobacteriaceae/drug effects , Enterobacteriaceae/isolation & purification , Enterobacteriaceae Infections/microbiology , Humans , Microbial Sensitivity Tests , Taq Polymerase , Time Factors , Transition Temperature , beta-Lactams/pharmacologySubject(s)
Hand/microbiology , Health Personnel , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/microbiology , Staphylococcal Infections/transmission , Bacterial Typing Techniques , Bacteriophage Typing , DNA Fingerprinting , Electrophoresis, Gel, Pulsed-Field , Hospitals, Teaching , Humans , Methicillin-Resistant Staphylococcus aureus/classification , Molecular Epidemiology , United KingdomABSTRACT
Se realice el estudio de un brote de EDA causado por Salmonella enteritidis en un Centro Educativo (CE) de una población urbano marginal (José Gálvez-JG-, Unidad Territorial de Salud de Villa María del Triunfo-UTES VMT, Dirección Sub Regional de Salud II Lima Sur-DISURSII-LS-), en noviembre de 1992. Se buscó precisar la sintomatología y evolución; posteriormente se investigó la prevalencia de portadores asintomáticos. Se estudiaron 52 casos que presentaron los siguientes signos y síntomas: diarreas acuosas (100%), dolor abdominal (90.69%), vómitos (83.72%), y fiebre (79.06%). La sintomatología cedió en un tiempo máximo de 7 días, resolviéndose la mayoría de los casos entre el 3er y 5to día (60.46%). El uso de antibióticos prolongó la evolución clínica, con respecto a los que no los recibieron; la sintomatología del 90% de éstos últimos cedió en los primeros 4 días. A las 8 semanas se evaluaron 36 pacientes; el 50% de las muestras tomadas para coprocultivo fueron positivas a Salmonella enteritis, sin relación aparente con el tratamiento antibiótico. Se concluye que el probable consumo de productos derivados de huevos crudos contaminados fue la causa del presente brote. Se plantea que el tratamiento antibiótico prolongó la evolución del cuadro clínico. Cabe destacar el hallazgo de una alta prevalencia de portadores asintomáticos en relación a lo descrito en la literatura, lo que se podría estar condicionando por la deficiencia dele estado inmune, la meno acidez gástrica de los niños y la automedicación indiscriminada con antibióticos de amplio espectro.
An acute diarrhoeal outbreak caused caused by Salmonella enteridis in an urban-marginal schooll (Jose Galvez-JG-, Unidad Territorial de Salud de Villa Maria del Triunfo-UTES VMT, Direccion Sub Regional de Salud II Lima Sur-DISURSII-LS-) in November 1992 was studied. The symptoms, evolution and further asymptomatic carriers prevalence were reached. 52 cases were studied; they presented the following signs and symptoms: diarrhea (100%), abdominal pain (90.69%), vomiting (83.72%), and fever (79.06%). The symptomatology lasted up to 7 days and most cases were solved by the 3rd and 5th days (60.46%). The use of antibiotics prolonged the clinical evolution, compared to those who didn´t received them; the clinical evolution, compared to those who didnÆt received them; the lattersÆ symptoms disappeared during the first 4 days. By the 8th week, 36 patients were evaluated; 50% the culture were positive to Salmonella enteridis, apparently not related to antibiotics. The conclusion was that possibly contaminated raw egg products caused this outbreak. The study suggests that antibiotic therapy prolonged the clinical evolution. Is remarkable the high prevalence of the asymptomatic carriers in relation to literature reports and it could be conditioned by immune-deficiency, infantsÆ low gastric acidity and uncontrolled self-prescription with broad-spectrum antibiotics.
Subject(s)
Humans , Male , Female , Anti-Bacterial Agents/therapeutic use , Disease Outbreaks , Salmonella Infections , Suburban Population , Urban Population , Salmonella enteritidisABSTRACT
Twenty episodes of shunt-associated ventriculitis caused by staphylococci or streptococci were treated with intraventricular vancomycin together with removal of the shunt and insertion of an external drain. Systemic antibiotics given concurrently included intravenous vancomycin or flucloxacillin. All the patients responded to therapy although five had re-infections and one had a relapse. Four patients were treated solely with intrathecal vancomycin. We now use intraventricular vancomycin alone for 'blind' treatment of uncomplicated shunt-associated infections when Gram-positive cocci are seen in the ventricular CSF.