The association of bacterial biofilm and middle ear mucosa in patients with mucosal chronic suppurative otitis media.

OBJECTIVES: To evaluate the bacterial biofilm's role in mucosal chronic suppurative otitis media (CSOM) utilizing scanning electron microscopy (SEM). METHODS: This study involved 123 participating patients with active and inactive mucosal CSOM who are undergoing tympanomastoid surgery. SEM was used to examine middle ear mucosa biopsies for the development of biofilms. Middle ear discharge or mucosal swabs from patients were cultured to detect any bacterial growth. The biofilm formation was correlated to the culture results. RESULTS: The biofilm was present in 69.9 % of patients (59% of them were with active mucosal CSOM) and absent in 30.1% of the patients (70% of them were with inactive mucosal CSOM), being more statistically significant in active mucosal CSOM (p-value = 0.003). A correlation that was statistically significant was found between active mucosal CSOM and higher grades (3 and 4) of biofilms (p-value <0.05). The mucosal CSOM type and the results of the culture had a relationship that was statistically significant (p-value <0.001). 60% of patients had positive culture (70% of them were with active mucosal CSOM). There was a statistically significant relation between Pseudomonas aeruginosa bacterial growth and active mucosal CSOM (p-value = 0.004) as well as higher grades of biofilms in mucosal CSOM. CONCLUSION: Mucosal CSOM, especially the active type, is a biofilm-related disease. There is a significant relation between the state of mucosal CSOM (active or inactive) and culture results with predominance of Pseudomonas aeruginosa bacterial growth in active mucosal CSOM and in higher grades of biofilms in mucosal CSOM.

[Agave fructanos promote in vitro biofilm formation with a probiotic consortium Lactobacillus delbrueckii ssp. lactis, L. delbrueckii ssp. bulgaricus and Streptococcus thermophilus]. / Los fructanos de agave promueven la formación de biopelícula in vitro en el consorcio probiótico Lactobacillus delbrueckii ssp. lactis, L. delbrueckii ssp. bulgaricus y Streptococcus thermophilus.

In recent years the relationship between the intestinal microbiota, the host and chronic non-communicable diseases has brought interest into the study of its formation and maintenance in the host. Lactic acid bacteria (BAL) are Gram-positive bacteria with probiotic activity, which have been associated with many health benefits, such as decreased body fat mass and lower risk of type II diabetes mellitus. One of the main colonization mechanisms and bacteria survival strategies is the production of biofilms and the use of prebiotics as substrates to achieve a balance within intestinal microbiota. However, there is not enough evidence to demonstrate the biofilm formation in the presence of agave fructans (AF). This study aimed to evaluate in vitro the biofilm formation in a consortium of lactic acid bacteria: Lactobacillus delbrueckii ssp. lactis, Lactobacillus delbrueckii ssp. bulgaricus y Streptococcus thermophilus in the presence of AF at different concentrations: 0%, 0,1%, 4%, 8% y 16%. The addition of 0,1% of AF correlates with the best capacity for biofilm formation. The findings imply the possibility of modulating the biofilm formation of lactic acid bacteria with AF. These results can contribute positively to the host, by generating intestinal homeostasis, colonization resistance, stability to food digestion and chemical modifications of drugs and carry out beneficial functions to the health.

Control de la biopelícula con materiales bioactivos en pacientes adolescentes: reporte de caso / Biofilm control with bioactive materials in adolescents' patients: case report

El objetivo del artículo es reportar el desempeño clínico en el control y disminución de la placa bacteriana en pacientes adolescentes mediante un gel y barniz con partículas S-PRG. Se realizaron tratamientos con materiales bioactivos con tecnología GIOMER en 2 pacientes. En el primer caso se realizó una profilaxis con Pro Care Gel (S-PRG) en un paciente de 15 años con problemas neuromotores para eliminar la placa y posteriormente, se aplicó un barniz con partículas de S-PRG para prevenir la formación de biofilm. En el segundo caso, un adolescente de 15 años normoreactivo con inflamación gingival recibió el tratamiento profilaxis con PRG Pro Care Gel.Se observó una disminución de placa bacteriana tras la profilaxis con el gel Pro Care y la aplicación del barniz en el primer caso. Además, existió una baja incidencia de biofilm incluso después de 11 meses de la aplicación del barniz. En el segundo caso, a las 2 horas de aplicación, se observó una disminución total de la placa. Clínicamente se observó el bueno desempeño clínico de los materiales con partículas de S-PRG, como lo demuestra la literatura científica en cuanto a la reducción de la formación de placa bacteriana en las estructuras dentarias, la desinflamación gingival, proporciona bienestar a los pacientes y restaura la salud bucal de forma menos invasiva.

The objective of the article is to report the clinical performance in the control and reduction of bacterial plaque in adolescent patients using a gel and varnish with S-PRG particles. Treatments with bioactive materials with GIOMER technology were performed in two patients. In the first case, prophylaxis was performed with Pro Care Gel (S-PRG) in a 15-year-old patient with neuromotor problems to eliminate plaque and subsequently, a varnish with S-PRG particles was applied to prevent biofilm formation. In the second case, a normal 15-year-old adolescent with gingival inflammation received prophylaxis treatment with PRG Pro Care Gel. A decrease in bacterial plaque was observed after prophylaxis with the Pro Care gel and the application of the varnish in the first case. Furthermore, there was a low incidence of biofilm even after 11 months of varnish application. In the second case, after 2 hours of application, a total decrease in plaque was observed. The good clinical performance of materials with S-PRG particles was clinically perceived, as demonstrated by the scientific literature in terms of reducing the formation of bacterial plaque in dental structures, gingival disinflammation, providing well-being to patients and restoring oral health in a less invasive way.

Calidad microbiológica: detección de Aeromonas sp y Pseudomonas sp en garrafones provenientes de pequeñas plantas purificadoras de agua / Microbiological quality: detection of Aeromonas sp and Pseudomonas sp in jugs from small water purification establishments

RESUMEN Las plantas purificadoras de agua que carecen de un adecuado sistema de control de calidad pueden generar problemas de salud pública. El objetivo de este estudio fue examinar la calidad microbiológica del agua proveniente de pequeñas plantas purificadoras de la ciudad de Puebla, así como, determinar la existencia de bacterias Aeromonas sp y Pseudomonas sp, y caracterizar si presentan un fenotipo patógeno oportunista. Se recolectaron 70 muestras de garrafones de agua de 25 establecimientos. La cuantificación bacteriana se realizó mediante el método de goteo en placa. Se comprobaron los géneros microbianos mediante análisis bioquímico. En las cepas que mostraron discrepancia se utilizó la identificación molecular con base a secuencias parciales del gen 16S rRNA para confirmar su especie y se les evaluaron sus características de patogenicidad: multirresistencia a antibióticos, producción de biopelícula y actividad hemolítica. El 40 % de las plantas purificadoras no cumplieron con la calidad microbiológica del agua para consumo humano. El 41.4 % de los garrafones de agua muestreados incumplió la normativa, presentando coliformes totales 35.7 %, Pseudomonas 30 %, Enterococcus faecalis 8.6 % y bacterias coliformes fecales el 5.7 %. Se obtuvieron 56 aislados, provenientes de los 29 garrafones contaminados; 10 de ellos se caracterizaron molecularmente, resultando 7 aislados relacionados con especies diferentes de P. aeruginosa y 3 con especies de Aeromonas. De los aislados de Pseudomonas, 5 presentaron resistencia a 2 familias de antibióticos y 2 mostraron multirresistencia. El 36 % de los 10 aislados produjeron hemólisis y biopelícula. Dos cepas de Aeromonas mostraron resistencia a Cefalosporina 3a generación pero no produjeron hemólisis. Los 10 aislados analizados fueron clasificados como no patógenos. Es necesario un seguimiento sanitario más estricto para lograr el cumplimiento de las normas nacionales e internacionales relacionadas con el consumo de agua purificada, para evitar dañar la salud de los consumidores.

ABSTRACT Water purification establishments that lack an adequate quality control system can cause public health problems. The objective of this study was to examine the microbiological quality of water from small purification establishments in the city of Puebla, as well as to determine the existence of Aeromonas sp and Pseudomonas sp bacteria, and to characterize whether they present an opportunistic pathogenic phenotype. 70 water jug samples were collected from 25 establishments. Bacterial quantification was performed using the drop plate method. Microbial genera were determined by biochemical analysis using the standard methodology. In the strains that showed discrepancy, molecular identification based on partial sequences of the 16S rRNA gene was used to confirm their species, and their pathogenic characteristics were evaluated: multiresistance to antibiotics, biofilm production, and hemolytic activity. The results showed that 40 % of the purification establishments did not comply with the microbiological quality of water for human consumption. Similarly, 41.4 % of the jugs of water sampled failed to comply with the regulations, presenting total coliforms 35.7 %, Pseudomonas 30 %, Enterococcus faecalis 8.6 % and fecal coliform bacteria 5.7 %. Likewise, 56 isolates were obtained from the 29 contaminated jugs, of which 10 were molecularly characterized, resulting in 4 different species for P. aeruginosa and 3 for Aeromonas. Of the 7 Pseudomonas isolates, 5 presented resistance to 2 families of antibiotics and 2 showed multiresistance. In total, 36 % of the 10 isolates produced hemolysis and biofilm. Two Aeromonas strains showed resistance to 3rd generation Cephalosporin but did not produce hemolysis. The 10 isolates analyzed were classified as non-pathogenic. A stricter sanitary monitoring is necessary to achieve compliance with national and international standards related to the consumption of purified water, to avoid harming the health of consumers.

Characterization, antifungal susceptibility and virulence of Candida parapsilosis complex isolates in a tertiary hospital in Cantabria, Northern Spain.

INTRODUCTION: The correct identification of the species within the Candida parapsilosis complex has become relevant due to the resistance of Candida metapsilosis to antifungals. We describe the characteristics of the Candida parapsilosis complex isolates, with respect to antifungal resistance and biofilm formation. METHODS: We perform a descriptive cross-sectional study in 30 strains, collected in a tertiary hospital. All strains, were identified by Vitek2, Vitek-MS™ systems and by ITS sequencing. The antifungal susceptibility profile was obtained with Sensititre™ panels, while biomass production and metabolic activity were quantified by means of crystal violet and XTT reduction assay, respectively. RESULTS: There was a 100% correlation between Vitek-MS™ and ITS sequencing. All isolates were susceptible to the nine antifungals tested. The metabolic activity and biomass production tests did not show any difference among the subtypes. CONCLUSIONS: The Vitek-MS™ system provides acceptable identification. We did not find significant differences neither in azole resistance nor in biofilm formation.

Characterization, antifungal susceptibility and virulence of Candida parapsilosis complex isolates in a tertiary hospital in Cantabria, Northern Spain / Caracterización, sensibilidad antifúngica y virulencia de aislamientos del complejo Candida parapsilosis en un hospital terciario en Cantabria, norte de España

Introduction: The correct identification of the species within the Candida parapsilosis complex has become relevant due to the resistance of Candida metapsilosis to antifungals. We describe the characteristics of the Candida parapsilosis complex isolates, with respect to antifungal resistance and biofilm formation. Methods: We perform a descriptive cross-sectional study in 30 strains, collected in a tertiary hospital. All strains, were identified by Vitek2, Vitek-MS™ systems and by ITS sequencing. The antifungal susceptibility profile was obtained with Sensititre™ panels, while biomass production and metabolic activity were quantified by means of crystal violet and XTT reduction assay, respectively. Results: There was a 100% correlation between Vitek-MS™ and ITS sequencing. All isolates were susceptible to the nine antifungals tested. The metabolic activity and biomass production tests did not show any difference among the subtypes. Conclusions: The Vitek-MS™ system provides acceptable identification. We did not find significant differences neither in azole resistance nor in biofilm formation.(AU)

Introducción: La correcta identificación del complejo Candida parasilopsis es relevante debido a la resistencia antifúngica de Candida metasilopsis. Describimos las características de aislados del complejo Candida parapsilosis respecto a la resistencia antifúngica y formación de biopelícula. Métodos: Se realiza un estudio descriptivo transversal de 30 cepas recolectadas en un hospital terciario. Todas se identificaron por los sistemas Vitek2, MALDI-TOF MS Vitek-MSTM y por secuenciación de las regiones ITS. La sensibilidad antifúngica se realizó con paneles SensititreTM. Para la producción de biomasa y la actividad metabólica se emplearon la medición de cristal violeta y el ensayo de reducción de XTT, respectivamente. Resultados: Hubo una correlación del 100% entre Vitek-MSTM y la secuencia de ITS. Todos los aislados fueron sensibles a los 9 antifúngicos evaluados. Los ensayos de actividad metabólica y producción de biomasa no arrojaron diferencias entre los subtipos. Conclusiones: El sistema Vitek-MSTM proporciona una identificación aceptable. No encontramos diferencias significativas ni en la resistencia a azoles ni en la formación de biopelículas.(AU)

Salivary Streptococcus mutans colony-forming unit count in patients with and without orthodontic appliances / Recuento de unidades formadoras de colonias de Streptococcus mutans salivares en pacientes con y sin aparatología ortodóntica

ABSTRACT Orthodontic appliances promote the accumulation of biofilm in the oral cavity and increase counts of Streptococcus mutans (S. mutans). However, there are few comparative studies of the effects generated by the interaction of saliva and microorganisms in absence and presence of orthodontic appliances. Aim: The aim of this study was to determine the S. mutans colony-forming unit count (CFU/mL) in participants with and without fixed orthodontic appliances. Materials and Method: It was an observational cross-sectional study on 21 participants, all over 18 years of age, non-smokers, without removable oral appliances, who had not been under antibiotic treatment within the previous three months. Sociodemographic variables, oral hygiene habits, S. mutans CFU/mL count, and salivary pH were assessed. Saliva samples were collected, and the data was analyzed using Fisher's exact and Kruskal Wallis tests. A p-value<0.05 was considered statistically significant. Results: Fourteen (66.7%) of the participants were female; average age was 20.4 ± 2.2 years. The group without fixed orthodontic appliances had the highest salivary S. mutans CFU/mL count (Me: 56.0×103, IQR: 9.2×103 - 75.5×103), but there was no statistically significant difference between groups (p=0.7459). There was a statistically significant difference in salivary pH, with the metal orthodontic appliance group having the lowest pH (p=0.0478). No statistically significant difference in salivary S. mutans CFU/mL count was found between groups. Salivary pH was lower in the group with metal appliances than in the groups with non-metal appliances and without appliances.

RESUMEN Se ha reportado que la aparatología ortodóntica promueve la acumulación de biofilm en la cavidad bucal y aumenta los recuentos bacterianos de Streptococcus mutans (S. mutans). Sin embargo, los estudios comparativos sobre los efectos generados por la interacción de la saliva y los microorganismos en ausencia y presencia de aparatología ortodóntica son limitados. Determinar el recuento de Unidades Formadoras de Colonias (UFC/mL) de S. mutans en participantes con y sin aparatología ortodóntica fija. Materiales y Método: se realizó un estudio observacional de corte transversal con 21 participantes, todos mayores de 18 años, no fumadores, sin ningún tipo de aparatología oral removible y sin antecedentes de tratamiento antibiótico en los tres meses previos. Se evaluaron variables sociodemográficas, hábitos de higiene oral, recuento de UFC/mL de S. mutans y pH salival. Se recolectaron muestras salivales y los datos se analizaron mediante las pruebas Exacto de Fisher y Kruskal Wallis. Un valor de p ≤0,05 se consideró estadísticamente significativo. Resultados: participaron catorce (66,7%) mujeres; la edad promedio fue de 20.4 ± 2.2 años. El grupo sin ortodoncia fija presentó el mayor recuento de UFC/mL de S. mutans salival (Me: 56,0×103, RIC: 9,2×103 - 75,5×103), pero no hubo una diferencia estadísticamente significativa entre los grupos (p=0,7459). Con relación al pH salival, se observó una diferencia estadísticamente significativa, siendo el grupo de ortodoncia metálica el que presentó el pH más bajo (p=0,0478). Aunque no se encontró una diferencia estadísticamente significativa en el recuento de UFC/mL de S. mutans salival entre los grupos, el pH salival del grupo de aparatología metálica fue más bajo en comparación con los grupos no metálicos y sin aparatología.

Analysis of biofilm production and expression of adhesion structures of circulating Clostridioides difficile strains from Mexico.

INTRODUCTION: Clostridioides difficile biofilms are believed to protect the pathogen from antibiotics, in addition to potentially contributing to recurrent infections. METHODOLOGY: Biofilm production of 102 C. difficile isolates was determined using the crystal violet staining technique, and detachment assays were performed. The expression levels of cwp84 and slpA genes were evaluated by real-time PCR on selected isolates. RESULTS: More than 70% of isolates (75/102) were strong biofilm producers, and the highest detachment of biofilm was achieved with the proteinase K treatment (>90%). The overall mean expression of cwp84 was higher in RT027 than in RT001 (p=0.003); among strong biofilm-producing strains, the slpA expression was lower in RT027 than in RT001 (p<0.000). CONCLUSIONS: Proteins seem to have an important role in the biofilm's initial adherence and maturation. slpA and cwp84 are differentially expressed by C. difficile ribotype and biofilm production level.

Analysis of biofilm production and expression of adhesion structures of circulating Clostridioides difficile strains from Mexico / Análisis de la producción de biopelícula y expresión de estructuras de adhesión de cepas circulantes de Clostridioides difficile en México

Introduction: Clostridioides difficile biofilms are believed to protect the pathogen from antibiotics, in addition to potentially contributing to recurrent infections. Methodology: Biofilm production of 102 C. difficile isolates was determined using the crystal violet staining technique, and detachment assays were performed. The expression levels of cwp84 and slpA genes were evaluated by real-time PCR on selected isolates. Results: More than 70% of isolates (75/102) were strong biofilm producers, and the highest detachment of biofilm was achieved with the proteinase K treatment (>90%). The overall mean expression of cwp84 was higher in RT027 than in RT001 (p=0.003); among strong biofilm-producing strains, the slpA expression was lower in RT027 than in RT001 (p<0.000). Conclusions: Proteins seem to have an important role in the biofilm's initial adherence and maturation. slpA and cwp84 are differentially expressed by C. difficile ribotype and biofilm production level.(AU)

Introducción: Se cree que las biopelículas de Clostridioides difficile (C. difficile) protegen al patógeno de los antibióticos, además de contribuir potencialmente a las infecciones recurrentes. Metodología: Se determinó la producción de biopelículas de 102 aislados de C. difficile, mediante la técnica de tinción con violeta cristal y se realizaron ensayos de desprendimiento. Los niveles de expresión de los genes cwp84 y slpA se evaluaron mediante PCR en tiempo real en aislados seleccionados. Resultados: Más del 70% de los aislados (75/102) fueron fuertes productores de biopelículas y el mayor desprendimiento de biopelícula se logró con el tratamiento con proteinasa K (> 90%). La expresión media global de cwp84 fue mayor en RT027 que en RT001 (p = 0,003); entre las cepas productoras fuertes de biopelícula, la expresión de slpA fue menor en RT027 que en RT001 (p < 0,000). Conclusiones: Las proteínas parecen tener un papel importante en la adhesión y maduración inicial de las biopelículas; slpA y cwp84 se expresan de forma diferente según el ribotipo de C. difficile y el nivel de producción de biopelículas.(AU)

Salmonella entérica serovar Enteritidis biofilm lifestyle induces lower pathogenicity and reduces inflammatory response in a murine model compared to planktonic bacteria / Salmonella entérica serovar Enteritidis en biopelícula induce una menor patogenicidad y respuesta inflamatoria en un modelo murino que su contraparte planctónica

Abstract Salmonella enterica serovar Enteritidis (S. Enteritidis) is the most frequent serovar involved in human salmonellosis. It has been demonstrated that about 80% of infections are related to biofilm formation. There is scant information about the pathogenicity of S. Enteritidis and its relationship to biofilm production. In this regard, this study aimed to investigate the differential host response induced by S. Enteritidis biofilm and planktonic lifestyle. To this purpose, biofilm and planktonic bacteria were inoculated to BALB/c mice and epithelial cell culture. Survival studies revealed that biofilm is less virulent than planktonic cells. Reduced signs of intestinal inflammation and lower bacterial translocation were observed in animals inoculated with Salmonella biofilm compared to the planktonic group. Results showed that Salmonella biofilm was impaired for invasion of non-phagocytic cells and induces a lower inflammatory response in vivo and in vitro compared to that of planktonic bacteria. Taken together, the outcome of Salmonella-host interaction varies depending on the bacterial lifestyle.

Resumen Salmonella entérica serovar Enteritidis (S. Enteritidis) es la serovariedad más frecuentemente aislada en la salmonelosis humana. Se ha demostrado que alrededor del 80% de las infecciones están relacionadas con la formación de biopelículas. Sin embargo, la información disponible acerca de la patogenicidad de S. Enteritidis y su relación con la producción de biopelículas es escasa. Este trabajo tuvo como objetivo investigar la respuesta diferencial del huésped frente a S. Enteritidis en sus 2 estilos de vida: biopelícula y planctónico. Para ello, se inocularon bacterias en estado de biopelícula o planctónico en ratones BALB/c y cultivo de células epiteliales. Los estudios de supervivencia revelaron que Salmonella en biopelícula fue menos virulenta que su contraparte planctónica. Los animales inoculados con biopelículas presentaron una mayor conservación estructural del intestino y una menor translocación bacteriana que el grupo planctónico. Asimismo, Salmonella en biopelícula mostró una capacidad deficiente para invadir células no fagocíticas e indujo una menor respuesta inflamatoria in vivo e in vitro que las bacterias planctónicas. Se concluye que el resultado de la interacción Salmonella-huésped depende del estilo de vida bacteriano.

Capacidade de formação de biofilmes e perfil de resistência de Acinetobacter baumannii isolados em unidades de terapia intensiva: uma revisão sistemática

Introdução: Acinetobacter baumanni é um cocobacilo Gram negativo responsável por elevadas taxas de infecções relacionadas à assistência à saúde (IRAS). Apresenta alto nível de resistência intrínseca a antimicrobianos, além da capacidade de adquirir resistência a carbapenêmicos e polimixinas. Ainda, A. baumannii possui habilidade para produzir biofilmes em superfícies abióticas e bióticas, o que favorece a infecção de pacientes gravemente enfermos internados em unidades de terapia intensiva (UTI). Deve ser ressaltado que bactérias envolvidas em biofilmes apresentam maior resistência aos antimicrobianos, atribuída a fatores bioqúmicos, moleculares e as condições dos hospedeiros, o que dificulta o tratamento dessas infecções. Objetivos: Avaliar a produção de biofilme por isolados de A. baumannii recuperados de pacientes internados em UTIs, bem como operfil de susceptibilidade a antimicrobianos (aminoglicosídeos, tigeciclina, carbapenêmicos e polimixinas) entre esses isolados. Métodos: Foi realizada uma revisão sistemática de acordo com os critérios Prisma nos bancos de dados Pubmed/Medline, Scopus, Lilacs, Scielo, e Web of Science. Resultados: Foram incluídos um total de 12 artigos que avaliaram 1006 isolados clínicos de A. baumannii, os quais todos foram resistentes aos carbapenê-micos. No entanto, a maioria dos isolados permaneceu sensível as polimixinas B e E(94,46%). A porcentagem dos isolados produtores de biofilme foi alta (96,3%), e neste estudo não fica clara a relação entre a habilidade de produzir biofilmes e a resistência aos antimicrobianos analisados. Conclusão: Mais estudos devem ser conduzidos para monitorar a resistência aos antimicrobianos em A. baumannii, sobretudo em produtores de biofilme, visto que o manejo terapêutico das infecções ocasionadas por essas linhagens torna-se mais complexo e desafiador.

SUMMARY Introduction: Acinetobacter baumanni is a Gram-negative coccobacillus responsible for high rates of healthcare-related infections (HAI). It has a high level of intrinsic resistance to antimicrobials, in addition to the ability to acquire resistance to carbapenems and polymyxins. Furthermore, A. baumannii has the ability to produce biofilms on abiotic and biotic surfaces, which favors the infection of critically ill patients admitted to intensive care units (ICU). It should be noted that bacteria involved in biofilms have greater resistance to antimicrobials, attributed to biochemical and molecular factors and the conditions of the hosts, which makes the treatment of these infections difficult. Objectives: To evaluate the biofilm production by A. baumannii isolates recovered from ICU patients, as well as the antimicrobial susceptibility profile (aminoglycosides, tigecycline, carbapenems and polymyxins) among these isolates. Methods: A systematic review was performed according to PRISMA criteria in the PUBMED/MEDLINE, Scopus, LILACS, SciELO, and Web of Science databases. Results: A total of 12 articles that evaluated 1006 clinical isolates of A. baumannii, all of which were resistant to carbapenems, were included. However, most isolates remained sensitive to polymyxins B and E (94.46%). The percentage of biofilm-producing isolates was high (96.3%), and in this study the relationship between the ability to produce biofilms and resistance to the analyzed antimicrobials is not clear. Conclusion: More studies should be conducted to monitor antimicrobial resistance in A. baumannii, especially in biofilm producers, as the therapeutic management of infections caused by these strains becomes more complex and challenging.

Introducción: Acinetobacter baumanni es un cocobacilo gramnegativo responsable de altas tasas de infecciones relacionadas con la salud. Tiene un alto nivel de resistencia intrínseca a los antimicrobianos, además de la capacidad de adquirir resistencia a los carbapenémicos y polimixinas. Además, A. baumannii tiene la capacidad de producir biopelículas en superficies abióticas y bióticas, lo que favorece la infección de pacientes críticos ingresados en unidades de cuidados intensivos (UCI). Cabe señalar que las bacterias involucradas en biofilms tienen mayor resistencia a los antimicrobianos, atribuida a factores bioquímicos y moleculares y a las condiciones de los hospedadores, lo que dificulta el tratamiento de estas infecciones. Objetivos: Evaluar la producción de biofilm por aislamientos de A. baumannii recuperados de pacientes de UCI, así como el perfil de susceptibilidad antimicrobiana (amino-glucósidos, tigeciclina, carbapenémicos y polimixinas) entre estos aislamientos. Métodos: Se realizó una revisión sistemática según los criterios Prisma en las bases de datos Pubmed / Medline, Scopus, Lilacs, SciELO y Web of Science. Resultados: Se incluyeron un total de 12 artículos que evaluaron 1006 aislamientos clínicos de A. baumannii, todos ellos resistentes a carbapenémicos. Sin embargo, la mayoría de los aislados permanecieron sensibles a las polimixinas B y E (94,46%). El porcentaje de aislamientos productores de biopelículas fue alto (96,3%), y en este estudio no está clara la relación entre la capacidad de producir biopelículas y la resistencia a los antimicrobianos analizados. Conclusión: Se deben realizar más estudios para monitorear la resistencia a los antimicrobianos en A. baumannii, especialmente en productores de biopelículas, ya que el manejo terapéutico de las infecciones causadas por estas cepas se vuelve más complejo y desafiante.

Avaliação do efeito antiaderente dos óleos essenciais de Eucalyptus globulus e Eucalyptus citriodora contra cepa de Staphylococcus aureus

Introdução: O biofilme dental é uma estrutura complexa formada a partir da adesão de variadas células microbianas à película adquirida sobre a estrutura dentária. Essas células se aderem umas às outras enquanto sintetizam uma matriz extracelular, tornando-se uma comunidade altamente organizada, o que dificulta sua remoção e promove uma resistência aos antimicrobianos. A presença de Staphylococcus aureus no biofilme oral pode causar um desequilíbrio na microbiota facilitando o início de um processo de doença. Objetivo: Avaliar a capacidade antiaderente do Eucalyptus globulus e Eucalyptus citriodora contra cepas de Staphylococcus aureus. Resultados: Foi possível observar que o óleo essencial de Eucalyptus globulus inibiu a formação do biofilme com uma concentração inibitória mínima de aderência (CIMA) semelhante ao digluconato de clorexidina 0,12 %, ambos de 1:8. O óleo essencial de Eucalyptus citriodora não impediu a aderência bacteriana às paredes do tubo em nenhuma concentração avaliada. Conclusão: Que apenas o óleo essencial da espécie Eucalyptus globulus possui atividade antiaderente contra Staphylococcus aureus, podendo ser utilizado como produto alternativo para controle do biofilme.

SUMMARY Introduction: Dental biofilm is a complex structure formed from the adhesion of various microbial cells to the film acquired on the dental structure. These cells adhere to each other while synthesizing an extracellular matrix, becoming a highly organized community, which makes it difficult to remove and promotes resistance to antimicrobials. The presence of Staphylococcus aureus in the oral biofilm can cause an disturb in the microbiota, facilitating the beginning of a disease process. Aim: To evaluate the non-adherent ability of Eucalyptus globulus and Eucalyptus citriodora against Staphylococcus aureus strains. Results: It was possible to observe that the essential oil of Eucalyptus globulus inhibited the formation of the biofilm with a Minimum Adhesive Inhibitory Concentration (MAIC) similar to 0.12 % chlorhexidine digluconate, both of 1:8. The essential oil of Eucalyptus citriodora did not prevent bacterial adherence to the tube walls in any evaluated concentration. Conclusion: Only the essential oil of the species Eucalyptus globulus has non-adherent activity against Staphylococcus aureus and can be used as an alternative product to control the biofilm.

Introducción: La biopelícula dental es una estructura compleja formada por la adhesión de varias células microbianas a la película adquirida en la estructura del diente. Estas células se adhieren entre sí mientras sintetizan una matriz extracelular, convirtiéndose en una comunidad altamente organizada, lo que dificulta su eliminación y promueve la resistencia a los antimicrobianos. La presencia de Staphylococcus aureus en el biofilm oral puede provocar un desequilibrio en la microbiota facilitando el inicio de un proceso patológico. Objetivo: Evaluar la capacidad antiadherente de Eucalyptus globulus y Eucalyptus citriodora frente a cepas de Staphylococcus aureus. Resultados: Se pudo observar que el aceite esencial de Eucalyptus globulus inhibió la formación de biopelículas con una concentración mínima inhibidora de adhesión (CIMA) equivalente al 0,12 % de gluconato de clorhexidina, ambos de 1:8. El aceite esencial de Eucalyptus citriodora no previno la adhesión bacteriana a las paredes del tubo en ninguna concentración evaluada. Conclusión: Que solo el aceite esencial de la especie Eucalyptus globulus tiene actividad anti-adherente contra Staphylococcus aureus, y puede usarse como producto alternativo para el control de biopelículas.

Susceptibility to Vancomycin of Biofilm Producing Staphylococci Isolated from Tertiary Care Hospital of Nepal / Susceptibilidad a la vancomicina de estafilococos productores de biopelículas aislados del hospital de atención terciaria de Nepal

Background: Methicillin resistance and biofilm-producing Staphylococci are emerging as multidrug-resistant strains narrowing the efficacy of antimicrobial therapy. Although vancomycin is used as the drug of choice to treat such isolates, different studies worldwide have documented the emergence of strains that are intermediately susceptible or resistant to this antibiotic. Objective: The study aimed to determine the minimum inhibitory concentration of vancomycin to methicillin-resistant and biofilm-producing staphylococci isolated from different clinical specimens. Methods: 375 staphylococci isolated from different clinical specimens over one year were included in the study. Biofilm formation was determined by the Tissue culture plate method (TCP), and ica genes were identified by Polymerase Chain Reaction (PCR). Antibiotic susceptibility and methicillin resistance were done following Clinical and Laboratory Standards Institute (CLSI) guidelines. The minimum inhibitory concentration (MIC) of vancomycin in all isolates was determined by the agar dilution method. Results:Among 375 Staphylococci studied, 43% and 57% represented S. aureus and Coagulase-Negative Staphylococci (CNS), respectively. The rate of Methicillin-Resistant S. aureus (MRSA) and Methicillin-Resistant Coagulase Negative Staphylococci (MRCNS) were 81.4% and 66.8% respectively and determined by the disc diffusion method. The most potential antibiotics were tetracycline and chloramphenicol showing sensitivity to more than 90% isolates. The Minimum Inhibitory Concentration (MIC) value of oxacillin for staphylococci ranged from 0.125-32 µg/ml. Oxacillin agar diffusion method showed 51.6% and 79.9% isolates as MRSA and MRCNS, respectively, revealing a very high percentage of S. aureus and CNS isolates as methicillin-resistant. All isolates had susceptible vancomycin MICs that ranged from 0.125-2 µg/ml. Two S. aureus isolated from Central Venous Catheter (CVC) and catheter specimens were detected with intermediate susceptibility to vancomycin. Similarly, three CNS isolated from blood, CVC, and wound/pus (w/p) were intermediately susceptible to vancomycin. Strong biofilm formation was observed in 22.1% of clinical isolates, and the ica gene was detected among 22.9% of isolates. Only one S. aureus detected as a biofilm producer by the TCP method was found to have intermediate susceptibility to vancomycin. Conclusions: The increment in vancomycin MIC among methicillin-resistant and biofilm-producing staphylococci is alarming. Strict control measures to prevent methicillin-resistant isolates spread and routine surveillance for vancomycin-resistant isolates must be incorporated in hospitals to prevent antimicrobial treatment failure

Antecedentes: Los estafilococos resistentes a la meticilina y productores de biopelículas están surgiendo como cepas multirresistentes que reducen la eficacia del tratamiento antimicrobiano. Aunque la vancomicina se utiliza como fármaco de elección para tratar dichos aislados, diferentes estudios realizados en todo el mundo han documentado la aparición de cepas intermedias susceptibles o resistentes a este antibiótico. Objetivo: El estudio tenía como objetivo determinar la concentración mínima inhibitoria de la vancomicina para los estafilococos resistentes a la meticilina y productores de biofilm aislados de diferentes muestras clínicas. Métodos: Se incluyeron en el estudio 375 estafilococos aislados de diferentes muestras clínicas durante un año. La formación de biopelículas se determinó mediante el método de la placa de cultivo de tejidos (TCP), y los genes ica se identificaron mediante la reacción en cadena de la polimerasa (PCR). La susceptibilidad a los antibióticos y la resistencia a la meticilina se realizaron siguiendo las directrices del Clinical and Laboratory Standards Institute (CLSI). La concentración inhibitoria mínima (MIC) de vancomicina en todos los aislados se determinó por el método de dilución en agar. Resultados:Entre los 375 estafilococos estudiados, el 43% y el 57% representaban S. aureus y estafilococos coagulasa-negativos (ECN), respectivamente. La tasa de S. aureus resistente a la meticilina (SARM) y de estafilococos coagulasa negativos resistentes a la meticilina (ECNM) fue del 81,4% y el 66,8%, respectivamente, y se determinó por el método de difusión de discos. Los antibióticos más potenciales fueron la tetraciclina y el cloranfenicol, que mostraron una sensibilidad superior al 90% de los aislados. El valor de la concentración inhibitoria mínima (CIM) de la oxacilina para los estafilococos osciló entre 0,125-32 µg/ml. El método de difusión en agar de la oxacilina mostró que el 51,6% y el 79,9% de los aislados eran SARM y MRCNS, respectivamente, lo que revela que un porcentaje muy elevado de los aislados de S. aureus y CNS son resistentes a la meticilina. Todos los aislados tenían MIC de vancomicina susceptibles que oscilaban entre 0,125-2 µg/ml. Se detectaron dos S. aureus aislados de muestras de catéteres venosos centrales (CVC) y catéteres con una susceptibilidad intermedia a la vancomicina. Del mismo modo, tres S. aureus aislados de sangre, CVC y herida/pus (w/p) fueron intermedianamente susceptibles a la vancomicina. Se observó una fuerte formación de biopelículas en el 22,1% de los aislados clínicos, y se detectó el gen ica en el 22,9% de los aislados. Sólo un S. aureus detectado como productor de biopelículas por el método TCP resultó tener una susceptibilidad intermedia a la vancomicina. Conclusiones: El incremento de la MIC de vancomicina entre los estafilococos resistentes a la meticilina y productores de biofilm es alarmante. Para evitar el fracaso del tratamiento antimicrobiano, deben incorporarse en los hospitales medidas de control estrictas para prevenir la propagación de los aislados resistentes a la meticilina y una vigilancia rutinaria de los aislados resistentes a la vancomicina

Caries radicular: actualización sobre una patología de creciente interés

La caries radicular es un proceso dinámico de destrucción localizada de las superficies radiculares, dependiente de biopelícula. Esta patología afecta principalmente a la población adulta mayor con superficies radiculares expuestas y altera su calidad de vida. Las vulnerabilidades y multimorbilidades, frecuentes en este grupo de edad, limitan el autocuidado oral y son criterios para considerar en la comprensión y manejo de la patología. El diagnóstico de las lesiones de caries radicular implica conocimiento de la estructura radicular sana, los factores indicadores o de riesgo, los mecanismos de desarrollo de las lesiones y los criterios para su detección y valoración. La elección correcta de opciones de manejo tanto del riesgo como de las lesiones de caries, enfocada en la preservación de la estructura, evidencia la comprensión de la caries radicular. La caries radicular plantea un desafío para la academia, los sistemas de salud, la práctica clínica dental y la población, debido a que sus indicadores están aumentando en relación con el envejecimiento poblacional y la mayor conservación de dientes naturales. El propósito de esta revisión de tema fue presentar el estado del entendimiento actual de caries radicular. Se incluyeron 81 artículos publicados entre 1971 y 2021, sobre embriogénesis de la raíz; prevalencia, etiopatogenia; características de las lesiones; diagnóstico y propuestas de manejo a nivel del riesgo individual y de las lesiones. Esta actualización es pertinente por el reto que conlleva la presencia cada vez mayor de esta patología, junto con sus consecuencias. El planteamiento de su estado del arte sugiere áreas de investigación.

Root caries is a dynamic process of localized destruction of the root surfaces, dependent on the biofilm. Its pathology mainly affects the elderly toothed population with exposed root surfaces and disrupts their quality of life. Vulnerabilities and multimorbidities, frequent in this age group, limit oral self-care and are criteria to be considered in understanding and managing the disease. The root caries lesions diagnosis implies knowledge about the healthy root structure, indicators or risk factors, caries lesions development mechanism, and the detection and assessment criteria. The correct selection of caries risk and management options preserving tooth structure shows the understanding of root caries. The root caries represents a challenge for academia, health systems, dental practice, and the population because its indicators are increasing related to aging population and greater conservation of natural teeth. This review aimed to present the state of the current understanding of root caries. Eighty-one papers published between 1971 and 2021 were included. This considered root embryogenesis; the current understanding of root caries, its prevalence and etiopathogenesis; characteristics of the lesions; diagnosis, and care proposals both at the individual risk level, and at the lesions level. This update is relevant due to the risk that the increasing presence of this pathology carries, together with its consequences. The statement of its state of the art suggests areas of research.

The classification of Staphylococcus aureus strains by biofilm production differs depending on the method used.

INTRODUCTION: Strains can be classified in terms of biofilm production from quantitative absorbance values collectively by dividing strains into tertile ranks or individually by calculating the optical density for the negative control. However, these methods have not been compared in a large sample of Staphylococcus aureus strains. Therefore, our objective was to analyze the agreement between both methods in terms of biomass production and metabolic activity of their biofilm. METHODS: We classified 233 S. aureus strains by biomass production and metabolic activity using the crystal violet and XTT assays, respectively. Strains were classified as low, moderate, or high biofilm producers according to tertile or optical density. RESULTS: We found no agreement between both methods (p<0.001 and p=0.028, respectively). CONCLUSIONS: We consider strains' biofilm classification by optical density to be a more reliable method, as it depends on the individual absorbance of each strain.

The classification of Staphylococcus aureus strains by biofilm production differs depending on the method used / La clasificación de cepas de Staphylococcus aureus según la producción de biopelícula varía dependiendo del método utilizado

IntroductionStrains can be classified in terms of biofilm production from quantitative absorbance values collectively by dividing strains into tertile ranks or individually by calculating the optical density for the negative control. However, these methods have not been compared in a large sample of Staphylococcus aureus strains. Therefore, our objective was to analyze the agreement between both methods in terms of biomass production and metabolic activity of their biofilm.MethodsWe classified 233 S. aureus strains by biomass production and metabolic activity using the crystal violet and XTT assays, respectively. Strains were classified as low, moderate, or high biofilm producers according to tertile or optical density.ResultsWe found no agreement between both methods (p<0.001 and p=0.028, respectively).ConclusionsWe consider strains’ biofilm classification by optical density to be a more reliable method, as it depends on the individual absorbance of each strain.

IntroducciónLas cepas se pueden clasificar en términos de producción de biopelícula a partir de valores cuantitativos de absorbancia dividiendo de forma colectiva las cepas en rangos por terciles o individualmente calculando la densidad óptica para el control negativo. Sin embargo, estos métodos no se han comparado en una gran muestra de cepas de Staphylococcus aureus. Por lo tanto, nuestro objetivo fue analizar la concordancia entre ambos métodos en términos de producción de biomasa y actividad metabólica de la biopelícula.MétodosSe clasificaron 233 cepas de S. aureus por producción de biomasa y actividad metabólica utilizando los ensayos de cristal violeta y de XTT, respectivamente. Las cepas se clasificaron como altamente, moderadamente o bajamente productoras de biopelícula según terciles o densidad óptica.ResultadosNo encontramos concordancias entre ambos métodos (p<0,001 y p=0,028, respectivamente).ConclusionesConsideramos que la clasificación del biofilm de cepas por densidad óptica es un método más fiable, ya que depende de la absorción individual de cada cepa.

Estudio de la actividad antimicrobiana de Xenophyllum poposum sobre microorganismos de la cavidad bucal por el método de difusión radial / Study of the antimicrobial activity of Xenophyllum poposum on microorganisms of the oral cavity by the radial diffusion method

Resumen En este estudio se evaluó la actividad antimicrobiana in vitro de extractos de Xenophyllum poposum sobre microorganismos bucales como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans y Veillonella sp. Se empleó el método de difusión radial en agar y como controles negativo y positivo de inhibición se emplearon etanol y clorhexidina al 0,12% (Plac out NF®) respectivamente. Los extractos con mayor actividad antimicrobiana fueron el etanólico y el clorofórmico. La diferencia entre ambos no fue estadísticamente significativa (p≥0,05). Tampoco se observó diferencia significativa con respecto a la clorhexidina, excepto sobre Veillonella sp., ya que el extracto etanólico presentó halos de inhibición significativamente menores sobre este microorganismo. Esto es importante ya que Veillonella se considera indicador de salud en relación a la caries dental. En base a esto, el extracto etanólico de Xenophyllum poposum podría ser usado como control químico de la biopelícula dental.

Abstract In this study, the in vitro antimicrobial activity of Xenophyllum poposum extracts on oral microorganisms such as Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans, Veillonella sp. was evaluated. The radial diffusion method in agar was used and 0.12% ethanol and chlorhexidine (Plac out NF®) were used as negative and positive inhibition controls, respectively. The extracts with the highest antimicrobial activity were the ethanolic and chloroform extracts. The difference between the two was not statistically significant (p≥0.05). No significant difference was observed with respect to chlorhexidine, except on Veillonella sp., since the ethanolic extract presented significantly lower inhibition halos on this microorganism. This is important as Veillonella is considered an indicator of health in relation to dental caries. Based on this, the ethanolic extract of Xenophyllum poposum could be used as chemical control of dental biofilm.

Resumo Neste estudo, a atividade antimicrobiana de extratos de Xenophyllum poposum sobre microrganismos orais como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans e Veillonella sp. Foi utilizado o método de difusão radial em ágar e etanol 0,12% e clorexidina (Plac out NF®) como controles de inibição negativa e positiva, respectivamente. Os extratos com maior atividade antimicrobiana foram os extratos etanólico e clorofórmio. A diferença entre os dois não foi estatisticamente significativa (p≥0,05). Não foi observada diferença significativa em relação à clorexidina 0,12%, exceto em Veillonella sp., uma vez que o extrato etanólico apresentou halos de inibição significativamente menores neste microrganismo. Isso é importante, pois a Veillonella é considerada um indicador de saúde em relação à cárie dentária. Com base nisso, o extrato etanólico de Xenophyllum poposum pode ser utilizado como controle químico do biofilme dental.

Salmonella enterica serovar Enteritidis biofilm lifestyle induces lower pathogenicity and reduces inflammatory response in a murine model compared to planktonic bacteria.

Salmonellaenterica serovar Enteritidis (S. Enteritidis) is the most frequent serovar involved in human salmonellosis. It has been demonstrated that about 80% of infections are related to biofilm formation. There is scant information about the pathogenicity of S. Enteritidis and its relationship to biofilm production. In this regard, this study aimed to investigate the differential host response induced by S. Enteritidis biofilm and planktonic lifestyle. To this purpose, biofilm and planktonic bacteria were inoculated to BALB/c mice and epithelial cell culture. Survival studies revealed that biofilm is less virulent than planktonic cells. Reduced signs of intestinal inflammation and lower bacterial translocation were observed in animals inoculated with Salmonella biofilm compared to the planktonic group. Results showed that Salmonella biofilm was impaired for invasion of non-phagocytic cells and induces a lower inflammatory response in vivo and in vitro compared to that of planktonic bacteria. Taken together, the outcome of Salmonella-host interaction varies depending on the bacterial lifestyle.

Enterobacterales productores de carbapenemasas en sifones de lavamanos de una Unidad de Paciente Crítico

Resumen Introducción: Enterobacterales productores de carbapenemasas (EPC) son una importante causa de infecciones asociadas a la atención en salud (IAAS). El principal reservorio de EPC lo constituyen pacientes infectados y colonizados, sin embargo, también se han identificado reservorios ambientales. Objetivo: Detectar la presencia de EPC en los sifones de lavamanos de la unidad de cuidados críticos de pacientes quemados adultos (UPC QMD) y unidad de cuidados críticos de pacientes pediátricos crónicos (UCEP). Método: Se recolectaron cuatro muestras de sifones de los lavamanos ubicados en el interior de las unidades de pacientes en UCEP y 10 de UPC QMD. A las muestras se les realizó estudio fenotípico y molecular para detección de carbapenemasas en el Instituto de Salud Pública de Chile. Resultados: En los sifones estudiados de UCEP no se aislaron cepas de EPC. En UPC QMD, 50% de los sifones estudiados se aislaron cepas de EPC. Conclusiones: En UPC QMD se objetivó la presencia de EPC en una alta proporción de los sifones de lavamanos testeados, lo que demuestra un reservorio ambiental de bacterias multi-resistentes.

Abstract Introduction: Carbapenemase-producing Enterobacterales (CPE) are an important cause of health care associated infections (HAI). The main reservoir is constituted by infected and colonized patients; however, environmental reservoirs have also been identified. Objective: To detect the presence of CPE in the sink traps of the critical care unit for adult burn patients (UPC QMD) and the critical care unit for chronic pediatric patients (UCEP). Material and Method: Four samples of trap were collected from the sinks located inside the patient units at PICU and 10 at UPC QMD. The samples underwent a phenotypic and molecular study for the detection of carbapenemases at the Institute of Public Health of Chile. Results: In the UCEP no EPC strains were isolated. In UPC QMD, CPE was detected in 50% of the traps. Conclusions: In UPC QMD, the presence of CPE was observed in a high proportion of the tested sinks traps, which shows an environmental reservoir of multi-resistant bacteria.

[Individualized antifungal therapy in critically ill patients with invasive fungal infection]. / Tratamiento antifúngico individualizado en el paciente crítico con infección fúngica invasora.

Invasive candidiasis (IC) is the most common invasive fungal infection (IFI) affecting critically ill patients, followed by invasive pulmonary aspergillosis (IPA). International guidelines provide different recommendations for a first-line antifungal therapy and, in most of them, echinocandins are considered the first-line treatment for IC, and triazoles are so for the treatment of IPA. However, liposomal amphotericinB (L-AmB) is still considered a second-line therapy for both clinical entities. Although in the last decade the management of IFI has improved, several controversies persist. The antifungal drugs currently available may have a suboptimal activity, or be wrongly used in certain IFI involving critically ill patients. The aim of this review is to analyze when to provide individualized antifungal therapy to critically ill patients suffering from IFI, emphasizing the role of L-AmB. Drug-drug interactions, the clinical status, infectious foci (peritoneal candidiasis is discussed), the fungal species involved, and the need of monitoring the concentration of the antifungal drug in the patient are considered.