ABSTRACT
Introduction: Early and adequate treatment of bloodstream infections decreases patient morbidity and mortality. The objective is to develop a preliminary method for rapid antibiotic susceptibility testing (RAST) in enterobacteria with inducible chromosomal AmpC. Methods: RAST was performed directly on spiked blood cultures of 49 enterobacteria with inducible chromosomal AmpC. Results were read at 4, 6 and 8h of incubation. Commercial broth microdilution was considered the reference method. Disks of 10 antibiotics were evaluated. Results: The proportion of readable tests at 4h was 85%. All RAST could be read at 6 and 8h. For most antibiotics, the S or R result at 4, 6 and 8h was greater than 80% after tentative breakpoints were established and Area of Technical Uncertainty was defined. Conclusions: This preliminary method seems to be of practical use, although it should be extended to adjust the breakpoints and differentiate them by species.(AU)
Introducción: El tratamiento precoz y adecuado de las bacteriemias disminuye la morbilidad y mortalidad de los pacientes. El objetivo es desarrollar un método preliminar de pruebas rápidas de sensibilidad antibiótica (PRSA) en enterobacterias con AmpC cromosómica inducible. Métodos: Las PRSA se realizaron directamente de hemocultivos simulados positivos para 49 enterobacterias con AmpC cromosómica inducible. Los resultados se leyeron a las 4, 6 y 8 horas de incubación. La microdilución en caldo comercial se consideró el método de referencia. Se evaluaron discos de 10 antibióticos. Resultados: La proporción de pruebas legibles a las 4 horas fue del 85%. Todas las PRSA pudieron leerse a las 6 y 8 horas. Para la mayoría de los antibióticos, el resultado S o R a las 4, 6 y 8 horas fue superior al 80%, después de que se establecieran puntos de corte provisionales y se definiera el área de incertidumbre técnica. Conclusiones: Este método preliminar parece ser de utilidad práctica, aunque debería ampliarse para ajustar los puntos de corte y diferenciar por especies.(AU)
Subject(s)
Humans , Male , Female , Anti-Bacterial Agents , Microbial Sensitivity Tests , Enterobacteriaceae , Anti-Bacterial Agents/pharmacology , beta-LactamasesABSTRACT
INTRODUCTION: Early and adequate treatment of bloodstream infections decreases patient morbidity and mortality. The objective is to develop a preliminary method for rapid antibiotic susceptibility testing (RAST) in enterobacteria with inducible chromosomal AmpC. METHODS: RAST was performed directly on spiked blood cultures of 49 enterobacteria with inducible chromosomal AmpC. Results were read at 4, 6 and 8h of incubation. Commercial broth microdilution was considered the reference method. Disks of 10 antibiotics were evaluated. RESULTS: The proportion of readable tests at 4h was 85%. All RAST could be read at 6 and 8h. For most antibiotics, the S or R result at 4, 6 and 8h was greater than 80% after tentative breakpoints were established and Area of Technical Uncertainty was defined. CONCLUSIONS: This preliminary method seems to be of practical use, although it should be extended to adjust the breakpoints and differentiate them by species.
Subject(s)
Blood Culture , Enterobacteriaceae , Humans , Microbial Sensitivity Tests , beta-Lactamases/genetics , Anti-Bacterial Agents/pharmacologyABSTRACT
Escherichia coli isolates that are resistant to cefixime and amoxicillin/clavulanic acid, but apparently susceptible to cefuroxime, with no ESBL identified, were initially detected in Madrid from urine samples in 2019. Throughout 2020 and 2021, all cases of community UTI by E. coli from six health areas in Madrid were studied. A representative sample of 23 cases was selected for further studies. The broth microdilution method and the agar diffusion method were performed to determine the antibiotic susceptibility. WGS was carried out for phylogeny, resistome and virulome analysis. Community consumption of third-generation oral cephalosporins in Madrid (2017-2021) was analyzed. A total of 582 (1.3%) E. coli isolates had the mentioned resistance profile. The mutation at position -32 (T > A) of the AmpC promoter was found in 21 isolates. No plasmid AmpC- or ESBL-encoding genes were detected. A cluster of 20 ST12 isolates was detected by cgMLST. A 6.2% increase in the consumption of third-generation oral cephalosporins, especially cefixime, was observed in Madrid. Chromosomal AmpC-hyperproducing ST12 E. coli isolates could be implicated in the increase in community UTI cases by cefixime-resistant isolates, which correlates with an increasing trend of cefixime consumption.
Subject(s)
Humans , Male , Female , Child , Pneumococcal Infections , Streptococcus pneumoniae , Polymerase Chain Reaction , Pneumococcal Vaccines , Spain , Pediatrics , Communicable DiseasesABSTRACT
Introducción. La pentalogía de Cantrell es un padecimiento congénito raro; reportados 90 casos en la literatura y descrito por Cantrell-Heller-Ravitch, se caracteriza por: hernia diafragmática anterior, onfalocele, pericardio diafragmático, anomalías congénitas intracardiacas y tercio inferior del esternón. Caso clínico. Recién nacida (RN) femenina de término, eutrófica, producto de la cuarta gestación, madre de 36 años, originaria de Guadalajara y residente de Pto. Vallarta. Antecedentes de: tabaquismo y alcoholismo, asmática tratada con salbutamol durante la gestación, infección de vías urinarias y cervicovaginitis tratada, preeclampsia 4 meses previos al parto, sin manejo, diagnosticada por ecosonograma obstétrico a las 35.2 semanas de gestación con presencia de onfalocele y ectopia cordis; interrumpiendo la gestación vía abdominal, obteniéndose RN con los defectos mencionados, además de cardiopatía intracardiaca (atresia pulmonar, transposición de vasos, comunicación interventricular e interauricular). Falleció a los 5 días de vida. Conclusión. Los casos de supervivencia reportados en la literatura son excepcionales (variantes no graves), siendo las cardiopatías determinantes del pronóstico.
Introduction. The pentalogy of Cantrell is a infrequent congenital syndrome. There are 90 cases reported in the literature, described by Cantrell-Heller-Ravitch and characterized by hernia of the anterior diaphragm, omphalocele, diaphragmatic pericardium, congenital heart defect and in the lower sternum. Case report. Female newborn delivered at term, product of the 4th pregnancy from a 36 year-old mother with history of smoking and alcoholism, asthma treated with salbutamol during pregnancy, urogenital tract infection treated, preeclampsia in the 4th month of gestation non-treated. Diagnosis by ultrasound at 35.2 weeks of pregnancy of omphalocele and ectopia cordis; abdominal delivery of the newborn with the defects described above, associated with intracardiac lesions: pulmonary atresia, vascular transposition, ventricular septal defect and atrial septal defect. The infant died on the 5th day. Conclusion. The survival rate in cases reported in literature is rare and depends on the complexity of the cardiac defect.
