ABSTRACT
Se presentan 2 casos de bacteriemia por Helicobacter cinaedi. El primero se diagnosticó en un varón de 76 años y resultó secundario a la colocación de un acceso vascular; el segundo correspondió a un lactante febril de 37 días de vida, asociado a un cuadro de gastroen-terocolitis aguda. H. cinaedi es un microorganismo que presenta dificultad para desarrollarse en diferentes medios de cultivo y lograr su identificación a nivel de especie. En ambos casos fue fundamental la observación microscópica en fresco de las botellas de hemocultivo, la utilización de la espectrometría de masas y la posterior secuenciación del gen hsp60 para llegar a esa instancia. En los últimos anos se han informado infecciones por H. cinaedi con frecuencia creciente en otras partes del mundo. En este trabajo presentamos los primeros casos de bacteriemia por H. cinaedi documentados en Argentina.
Two cases of bacteremia caused by Helicobacter cinaedi are presented. The first case was diagnosed in a 76-year-old male patient, and was secondary to a vascular access device placement; the second case corresponded to a febrile infant of 37 days of life, and was associated with acute gastroenteritis. H. cinaedi is a microorganism difficult to grow in different culture media and also to identify to species level. In both cases, the microscopic observation of blood culture bottles, the use of mass spectrometry and the subsequent sequencing of the hsp60 gene were essential. In the recent literature, H. cinaedi infections are being reported more frequently. In this report we present the first documented cases of bacteremia caused by H. cinaedi in Argentina.
Subject(s)
Humans , Male , Infant , Aged , Helicobacter Infections/diagnosis , Bacteremia/diagnosis , Argentina/epidemiology , Mass Spectrometry/methods , Blood Culture/methodsABSTRACT
Two cases of bacteremia caused by Helicobacter cinaedi are presented. The first case was diagnosed in a 76-year-old male patient, and was secondary to a vascular access device placement; the second case corresponded to a febrile infant of 37 days of life, and was associated with acute gastroenteritis. H. cinaedi is a microorganism difficult to grow in different culture media and also to identify to species level. In both cases, the microscopic observation of blood culture bottles, the use of mass spectrometry and the subsequent sequencing of the hsp60 gene were essential. In the recent literature, H. cinaedi infections are being reported more frequently. In this report we present the first documented cases of bacteremia caused by H. cinaedi in Argentina.
Subject(s)
Bacteremia/microbiology , Helicobacter Infections/complications , Helicobacter , Aged , Argentina , Bacteremia/diagnosis , Helicobacter Infections/diagnosis , Humans , Infant , MaleABSTRACT
OBJECTIVE: To assess a LED-fluorescence microscopy (LED-FM) capacitation program for the training of laboratory technicians without previous experience in FM. METHODS: We evaluated a teaching program that consists of a three-day course followed by an "in situ" two-month phase in which technicians acquired skills without the help of a FM expert; in order to gain confidence to recognize auramine-stained bacillus, during this phase, technicians examined duplicate slides stained by Ziehl Neelsen (ZN) and FM in a unblinded way. Technicians with acceptable performance, continued with a blinded-training period. Testing panels and rechecking process were used to evaluate proficiency after different length of experience. RESULTS: Post-course panel results showed that 70% of trainees made Low False Positive errors (LFPs). Analysis of two other panels showed that LFPs significantly decreased (Chi-squared test, p<0.05) as the "in situ" training phase progressed. Processing at least three slides/day was associated with acceptable performance. During the blinded-training period, results of the rechecking process showed that sensitivity (96.8%) and specificity (99.8%) levels were satisfactory. CONCLUSION: Moderate training (a three-day course) is not enough to make technicians proficient in LED-FM; however, great ability can be reached after a short "in situ" training phase even without the presence of experienced staff available in field to review doubtful results. Training was more effective in services with a minimum workload of 750 slides/year.
Subject(s)
Medical Laboratory Personnel/education , Microscopy, Fluorescence , Mycobacterium tuberculosis/isolation & purification , Tuberculosis/diagnosis , Argentina , Capacity Building , Clinical Competence , Feasibility Studies , Female , Humans , Male , Microscopy, Fluorescence/methods , Quality ControlABSTRACT
ABSTRACT Objective To assess a LED-fluorescence microscopy (LED-FM) capacitation program for the training of laboratory technicians without previous experience in FM. Methods We evaluated a teaching program that consists of a three-day course followed by an "in situ" two-month phase in which technicians acquired skills without the help of a FM expert; in order to gain confidence to recognize auramine-stained bacillus, during this phase, technicians examined duplicate slides stained by Ziehl Neelsen (ZN) and FM in a unblinded way. Technicians with acceptable performance, continued with a blinded-training period. Testing panels and rechecking process were used to evaluate proficiency after different length of experience. Results Post-course panel results showed that 70% of trainees made Low False Positive errors (LFPs). Analysis of two other panels showed that LFPs significantly decreased (Chi-squared test, p<0.05) as the "in situ" training phase progressed. Processing at least three slides/day was associated with acceptable performance. During the blinded-training period, results of the rechecking process showed that sensitivity (96.8%) and specificity (99.8%) levels were satisfactory. Conclusion Moderate training (a three-day course) is not enough to make technicians proficient in LED-FM; however, great ability can be reached after a short "in situ" training phase even without the presence of experienced staff available in field to review doubtful results. Training was more effective in services with a minimum workload of 750 slides/year.(AU)
RESUMEN Objetivo Evaluar un programa de capacitación en microscopía de fluorescencia LED (MF-LED) para el entrenamiento de técnicos de laboratorio sin experiencia en MF. Métodos Se evaluó un programa de capacitación que consiste en un curso de tres días seguido de dos meses de entrenamiento «in situ¼, en donde los técnicos adquirieron habilidades sin presencia de un experto en la práctica diaria; para alcanzar confianza en el reconocimiento del bacilo, los técnicos, durante estos meses, examinaron en forma «no cegada¼ extendidos duplicados teñidos por Ziehl Neelsen (ZN) y MF. Aquellos laboratoristas que lograron rendimiento aceptable continuaron su entrenamiento «a ciegas¼. Su desempeño fue evaluado en distintos períodos del entrenamiento mediante paneles de láminas y relectura de extendidos. Resultados Los resultados de un panel posterior al curso mostraron que 70% de los participantes cometieron errores falsos positivos bajos (FPB). Dos paneles posteriores evidenciaron que los FPB disminuían significativamente (prueba de Chi cuadrado, p<0.05) a medida que el entrenamiento avanzaba. El procesamiento de al menos tres extendidos/ día se asoció con desempeño aceptable. Durante el período a ciegas, la relectura de láminas evidenció que la sensibilidad (96,8%) y especificidad (99,8%) fueron satisfactorias. Conclusiones Una capacitación moderada (curso de tres días) no es suficiente para adquirir competencia en MF-LED; sin embargo, se puede alcanzar habilidad después de una corta capacitación «in situ¼, incluso si no hay personal con experiencia disponible en el servicio para revisar los resultados dudosos diariamente. El entrenamiento fue más efectivo en servicios con carga de trabajo mínima de 750 extendidos/año.(AU)
Subject(s)
Humans , Training Courses , Laboratory Personnel/education , Argentina , Multicenter Study , Analysis of Situation , Microscopy, FluorescenceABSTRACT
Se realizó una revisión retrospectiva durante 12 años de las infecciones por Staphylococcus aureus en pacientes adultos (PA) y pediátricos (PP) asistidos en el Hospital Interzonal General de Agudos Evita de Lanús, para conocer la incidencia, los focos y el origen de la infección, y analizar el perfil de resistencia antimicrobiana. Se documentaron 2125 casos de infección en PA y 361 en PP. La incidencia de casos en PA descendió significativamente en el último trienio (χ²; p < 0,05); en los PP aumentó significativamente durante los últimos 5 años (χ²; p < 0,0001). En ambas poblaciones se detectó un aumento significativo en las infecciones de piel y estructuras asociadas (PEA), de bacteriemias a punto de partida de un foco en PEA y de infecciones por S. aureus de inicio en el hospital (χ²; p < 0,005). La meticilino-resistencia (SAMR) aumentó del 28 al 78% en PP; en PA se mantuvo alrededor del 50%, con reducción significativa de la resistencia acompañante a antimicrobianos no betalactámicos en los SAMR de ambas poblaciones. En S. aureus documentados de infecciones de inicio en la comunidad (SAMR-CO) del último trienio, el porcentaje de meticilino-resistencia resultó del 57% en PP y 37% en PA; en infecciones con inicio en el hospital fue del 43 y el 63%, respectivamente. Si bien demostramos que S. aureus continúa siendo un patógeno asociado al ámbito nosocomial, hubo un aumento de infecciones por SAMR-CO, con compromiso en PEA en ambas poblaciones.
A twelve-year retrospective review of Staphylococcus aureus infections in adult and pediatric patients (AP and PP respectively) assisted in the Hospital Interzonal General de Agudos Evita in Lanús was performed to determine the incidence, foci of infection, the source of infection and to analyze the profile of antimicrobial resistance. An amount of 2125 cases of infection in AP and 361 in PP were documented. The incidence in AP decreased significantly in the last three years (χi²; p < 0.05); in PP it increased significantly during the last five years (χ²; p < 0.0001). In both populations was detected a notable increase in skin infections and associated structures (PEA) in bacteremia to the starting point of a focus on PEA, and in total S. aureus infections of hospital-onset (χ²; p < 0.005). Methicillin-resistance (MRSA) increased from 28 to 78% in PP; in AP it remained around 50%, with significant reduction in accompanying antimicrobial resistance to non-β-lactams in both groups of MRSA. In S. aureus documented from community onset infections (CO-MRSA) in the last three years, the percentage of methicillin-resistance was 57% in PP and 37% in AP; in hospital-onset infections it was 43% and 63% respectively. Although data showed that S. aureus remains a pathogen associated with the hospital-onset, there was an increase of CO-MRSA infections with predominance in PEA in both populations.
Subject(s)
Humans , Male , Female , Staphylococcal Infections/etiology , Staphylococcal Infections/epidemiology , Cross Infection/epidemiology , Staphylococcus aureus/drug effects , Cross Infection/drug therapy , Incidence , Methicillin-Resistant Staphylococcus aureusABSTRACT
A twelve-year retrospective review of Staphylococcus aureus infections in adult and pediatric patients (AP and PP respectively) assisted in the Hospital Interzonal General de Agudos Evita in Lanús was performed to determine the incidence, foci of infection, the source of infection and to analyze the profile of antimicrobial resistance. An amount of 2125 cases of infection in AP and 361 in PP were documented. The incidence in AP decreased significantly in the last three years (χi2; p<0.05); in PP it increased significantly during the last five years (χ2; p<0.0001). In both populations was detected a notable increase in skin infections and associated structures (PEA) in bacteremia to the starting point of a focus on PEA, and in total S. aureus infections of hospital-onset (χ2; p < 0.005). Methicillin-resistance (MRSA) increased from 28 to 78% in PP; in AP it remained around 50%, with significant reduction in accompanying antimicrobial resistance to non-ß-lactams in both groups of MRSA. In S. aureus documented from community onset infections (CO-MRSA) in the last three years, the percentage of methicillin-resistance was 57% in PP and 37% in AP; in hospital-onset infections it was 43% and 63% respectively. Although data showed that S. aureus remains a pathogen associated with the hospital-onset, there was an increase of CO-MRSA infections with predominance in PEA in both populations.
Subject(s)
Community-Acquired Infections , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Adult , Anti-Bacterial Agents , Child , Cross Infection , Humans , Methicillin Resistance , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Retrospective Studies , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureusABSTRACT
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of both nosocomial and community-acquired infections. We describe an outbreak caused by the MRSA Pediatric clone expressing an unusual lincosamide resistant phenotype. Between January and May 2006, an MRSA outbreak was detected at the Neonatal Unit of Hospital Interzonal General de Agudos "Evita", Buenos Aires Province, Argentina that affected ten patients. Seven isolates from seven patients plus five MRSA recovered from health care workers (nasal carriage) were studied. Two phenotypes were observed: (i) ELCi (10), resistance to erythromycin and lincomycin and inducible resistance to clindamycin; (ii) ELiCi (2), resistance to erythromycin and inducible resistance to lincomycin and clindamycin. All 12 MRSA were resistant to oxacillin, erythromycin and gentamicin. Isolates expressing the ELCi-phenotype showed lincomycin MIC values between 16 and 32mg/L, while the remaining 2 isolates with ELiCi-phenotype presented a MIC value of 0.5mg/L. No differences were observed between the clindamycin MIC values in both phenotypes, ranging 0.25-0.5mg/L. Isolates showing ELCi-phenotype harbored ermC plus lnuA genes, and the other two only ermC gene. All 12 isolates were genetically related and belonged to the Pediatric clone (ST100) harboring a new variant of SCCmecIV. This is the first MRSA outbreak expressing an unusual ELCi phenotype due to a combination of ermC plus lnuA genes.
Subject(s)
Bacterial Proteins/metabolism , Cross Infection/epidemiology , Methicillin-Resistant Staphylococcus aureus/metabolism , Staphylococcal Infections/transmission , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , Cross Infection/drug therapy , Cross Infection/microbiology , Cross Infection/transmission , Disease Outbreaks , Drug Resistance, Multiple, Bacterial/drug effects , Genetic Variation , Humans , Infant, Newborn , Infectious Disease Transmission, Patient-to-Professional , Intensive Care Units, Neonatal , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Patient Care Team , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiologyABSTRACT
From August 2008 to December 2011, six metallo-ß-lactamase-producing isolates, four Enterobacter cloacae, one Klebsiella oxytoca and one Citrobacter freundii, were detected at Hospital Interzonal General de Agudos "Evita" in Lanús. All six isolates showed multiresistant profiles and the presence of the blaIMP-8 gene. Five isolates also expressed PER-2 extended spectrum ß-lactamase. The blaIMP-8 gene was found as the first cassette in a class 1 integron. However, the 3´ conserved sequence could not be detected in three isolates. In all cases, blaIMP-8 was transferred by conjugation to azide-resistant Escherichia coli J53. PFGE analysis revealed that the four E. cloacae isolates were not genetically related. These are the first metallo-ß-lactamases detected in this institution and our results suggest a possible intra- and inter-species horizontal dissemination of blaIMP-8.
Subject(s)
Enterobacteriaceae/enzymology , beta-Lactamases , Aged , Aged, 80 and over , Argentina , Enterobacteriaceae/genetics , Enterobacteriaceae/isolation & purification , Female , Hospitals , Humans , Male , Middle Aged , beta-Lactamases/geneticsABSTRACT
From August 2008 to December 2011, six metallo-ß-lactamase-producing isolates, four Enterobacter cloacae, one Klebsiella oxytoca and one Citrobacter freundii, were detected at Hospital Interzonal General de Agudos "Evita" in Lanús. All six isolates showed multiresistant profiles and the presence of the blaIMP-8 gene. Five isolates also expressed PER-2 extended spectrum ß-lactamase. The blaIMP-8 gene was found as the first cassette in a class 1 integron. However, the 3´ conserved sequence could not be detected in three isolates. In all cases, blaIMP-8 was transferred by conjugation to azide-resistant Escherichia coli J53. PFGE analysis revealed that the four E. cloacae isolates were not genetically related. These are the first metallo-ß-lactamases detected in this institution and our results suggest a possible intra- and inter-species horizontal dissemination of blaIMP-8.
Subject(s)
Enterobacteriaceae/enzymology , beta-Lactamases , Argentina , Enterobacteriaceae/genetics , Enterobacteriaceae/isolation & purification , Female , Hospitals , Humans , Aged , Male , Middle Aged , beta-Lactamases/geneticsABSTRACT
From August 2008 to December 2011, six metallo-ß-lactamase-producing isolates, four Enterobacter cloacae, one Klebsiella oxytoca and one Citrobacter freundii, were detected at Hospital Interzonal General de Agudos "Evita" in Lanús. All six isolates showed multiresistant profiles and the presence of the blaIMP-8 gene. Five isolates also expressed PER-2 extended spectrum ß-lactamase. The blaIMP-8 gene was found as the first cassette in a class 1 integron. However, the 3´ conserved sequence could not be detected in three isolates. In all cases, blaIMP-8 was transferred by conjugation to azide-resistant Escherichia coli J53. PFGE analysis revealed that the four E. cloacae isolates were not genetically related. These are the first metallo-ß-lactamases detected in this institution and our results suggest a possible intra- and inter-species horizontal dissemination of blaIMP-8.
