Frecuencia de Bacilos Gram Negativos en la cavidad bucal de estudiantes de una Universidad de Asunción

Introducción: La cavidad bucal hospeda una gran cantidad de microorganismos, como los bacilos Gram negativos, y entre ellas, bacterias de gran importancia médica debido a su capacidad de producir enfermedades graves para el ser humano, especialmente en pacientes inmunodeprimidos. El objetivo de este trabajo fue determinar la presencia de Bacilos Gram Negativos y sus patrones de resistencia a antibióticos, en una población estudiantil de la ciudad de Asunción, en los años 2019 y 2020. Materiales y métodos: Se realizó un estudio observacional, descriptivo de corte transversal, donde se realizaron hisopados de la cavidad bucal a 35 alumnos de entre 18 a 24 años, de una universidad privada en la ciudad de Asunción. Se requirió consentimiento informado firmado por los participantes y fueron excluidos quienes tuvieron tratamientos antibióticos. Las muestras fueron obtenidas con un hisopo de algodón, posteriormente se colocaron en un medio de transporte para luego ser cultivadas en Agar MacConkey. El cultivo se realizó por 48 horas a 37° centígrados, luego se procedió a la identificación bacteriana. Por último, se realizó el antibiograma. Resultados: De los 35 alumnos se encontró una frecuencia de 48,57% de bacilos Gram negativos. Cepas de Klebsiella pneumoniae fueron las más frecuentes (35,29%). Se observó que las bacterias eran altamente resistentes a la Amoxicilina/Ácido Clavulánico. Conclusiones: La presencia de estos tipos de microorganismos puede ser peligrosa para la salud general de las personas, específicamente de los pacientes con algún tipo de inmunodepresión, debido a la gran la resistencia a antibióticos presentadas por algunas cepas.

Introduction: The oral cavity hosts a large number of microorganisms, such as Gram negative bacilli, and among them, bacteria of great medical importance due to their capacity to cause serious diseases for humans, especially in immunosuppressed patients. The objective of this work was to determine the presence of Gram Negative Bacilli and their patterns of resistance to antibiotics, in a student population of the city of Asunción, in the years 2019 and 2020. Materials and methods: An observational, descriptive cross-sectional study was carried out, where oral cavity swabs were made from 35 students between 18 and 24 years of age, from a private university in the city of Asunción. Informed consent signed by the participants was required and those who had antibiotic treatments were excluded. The samples were obtained with a cotton swab, later they were placed in a transport medium to later be cultured in MacConkey Agar. The culture was carried out for 48 hours at 37° Celsius, then the bacterial identification was carried out. Finally, the antibiogram was performed. Results: Of the 35 students, a frequency of 48,57% of Gram negative bacilli was found. Klebsiella pneumoniae strains were the most frequent (35.29%). The bacteria were found to be highly resistant to Amoxicillin/Clavulanic Acid. Conclusions: The presence of these types of microorganisms can be dangerous for the general health of people, specifically of patients with some type of immunosuppression, due to the great resistance to antibiotics presented by some strains.

Infección urinaria de presentación atípica: caso clínico y revisión de literatura

Introducción: el síndrome de orina púrpura es una presentación clínica poco frecuente en el ámbito de urgencias, caracterizado por coloración anormal de la orina secundaria a una reacción química de algunos patógenos que producen infección de vías urinarias, siendo más frecuente en pacientes con múltiples comorbilidades y diferentes factores de riesgo. Objetivo: el objetivo de este manuscrito es presentar el caso de un paciente con síntomas atípicos de infección de vías urinarias. Presentación del caso: varón de 88 años de edad, con antecedente de diabetes mellitus no insulino-requiriente, con hiperplasia prostática benigna que ingresó al servicio de urgencias por síntomas irritativos urinarios asociados a uso de sonda vesical, con orina de coloración violeta en bolsa recolectora. El urocultivo reportó la presencia de Proteus vulgaris multisensible, por lo que se decidió dar manejo con cefepima de 1 gr cada ocho horas, con lo cual se obtuvo una adecuada evolución clínica. Discusión y conclusión: el síndrome de la bolsa de orina púrpura es una presentación clínica atípica, pero muy llamativa de la infección urinaria. Esta se genera como resultado de la conversión del triptófano en la dieta en indoxil sulfato que, una vez se elimina por la orina, se transforma en índigo (color violeta) e indirrubina (color rojo), dando este aspecto clínico.

Background: Purple urine syndrome is a rare clinical presentation in the emergency room, characterized by abnormal colouration of the urine secondary to a chemical reaction of some pathogens that cause urinary tract infection, being more frequent in patients with multiple comorbidities and different risk factor's. Purpose: The objective of the article is present the case of a patient with atypical symptoms of urinary tract infection. Clinical case: An 88-year-old male, with a history of non-insulin diabetes mellitus, benign prostatic hyperplasia, who was admitted to the emergency room due to irritative urinary symptoms associated with the use of a urinary catheter, with purple urine in a collection bag. Urine culture reported the presence of multisensitive Proteus vulgaris, for which it was decided to give treatment with Cefepime 1 g every 8 hours, with which it was obtained with adequate clinical evolution. Conclusions: Purple urine bag syndrome is an atypical but very striking clinical presentation of urinary tract infection. This is generated as a result of the conversion of tryptophan in the diet into indoxyl sulfate, which, once it is eliminated in the urine, transforms into indigo (purple color) and indirubin (red color), giving this clinical appearance.

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli.

BACKGROUND: There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI. METHODS: We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software. RESULTS: A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate). CONCLUSIONS: There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.

[Current status of antimicrobial resistance in pediatric population in a Mexican hospital]. / Estado actual de resistencia antimicrobiana en población pediátrica en un hospital de México.

Background: Today bacterial resistance is a global problem, it is estimated that in 2050 it could reach 10 million deaths per year. Bacterial resistance can be caused by different mechanisms, in the case of beta-lactams they include the production of flow pumps, the modification or reduction of porin production, alteration of penicillin-binding proteins and production of an enzyme capable of inactivating the antibiotic. Objective: To describe the main bacterial agents reported in the Hospital para el Niño de Toluca and their sensitivity pattern. Material and methods: This is an observational, descriptive, retrospective cohort study, evaluated from January 1, 2018 to December 31, 2020, in hospitalized patients under 18 years of age, with confirmed infections from blood culture specimens, urine culture, fluid cerebrospinal and secretions. Results: 599 patients with positive cultures were reported. The five most frequently isolated agents were Staphylococci aureus, Escherichia coli, Klebsiella sp, Candida sp and Enterococci sp, Pseudomonas third in frequency in 2019 and fifth in 2020. The main isolated gram positive coconut was S. epidermidis with 52.3% in 2020 , while the BGN report an increase in positive ESBL organisms by 21.5% for 2020. Conclusions: S aureus, E coli, Klebsiella, Candida, and pseudomonas remain the main causative agents of infection. The GNBs showed an increase in frequency up to 21.5%, showing high resistance in fourth grade cephalosporins, gentamicin, ciprofloxacin and meropenem.

Introducción: hoy en día, la resistencia bacteriana es un problema mundial, se estima que en 2050 podría llegar a 10 millones de muertes por año. La resistencia bacteriana puede ser causada por diferentes mecanismos, en el caso de los betalactámicos incluyen la producción de bombas de flujo, la modificación o reducción de producción de porinas, alteración de las proteínas de unión a penicilina y producción de una enzima capaz de inactivar el antibiótico. Objetivo: describir los principales agentes bacterianos reportados en el Hospital para el Niño de Toluca y su patrón de sensibilidad. Material y métodos: se trata de un estudio observacional, descriptivo de cohorte retrospectivo, evaluado del 01 de enero 2018 al 31 de diciembre del 2020, en pacientes menores de 18 años hospitalizados, con infecciones confirmadas a partir de especímenes de hemocultivo, urocultivo, líquido cefalorraquídeo y secreciones. Resultados: se reportaron 599 pacientes con cultivos positivos. Los cinco agentes aislados con mayor frecuencia fueron Estafilococos aureus, Escherichia coli, Klebsiella sp, Candida sp y Enterococcus sp, pseudomonas tercer lugar en frecuencia en 2019 y quinto en 2020. El principal coco gram positivo aislado fue S. epidermidis con 52.3% en 2020, mientras que los BGN reportan un alza de los organismos BLEE positivos en 21.5% para 2020. Conclusiones: se mantienen como principales agentes causantes de infección S aureus, E coli, Klebsiella, Candida, enterococos y pseudomonas. Los BGN mostraron un incremento de frecuencia hasta 21.5%, mostrando resistencia alta en cefalosporinas de cuarta, gentamicina, ciprofloxacino y meropenem.

Evaluation of Biological Activities of Quinone-4-oxoquinoline Derivatives against Pathogens of Clinical Importance.

BACKGROUND: Microbial resistance has become a worldwide public health problem and may lead to morbidity and mortality in affected patients. OBJECTIVES: Therefore, this work aimed to evaluate the antibacterial activity of quinone-4- oxoquinoline derivatives. METHODS: These derivatives were evaluated against Gram-positive and Gram-negative bacteria by their antibacterial activity, anti-biofilm, and hemolytic activities and in silico assays. RESULTS: The quinone-4-oxoquinoline derivatives presented broad-spectrum antibacterial activities and, in some cases, were more active than commercially available reference drugs. These compounds also inhibited bacterial adhesion, and the assays revealed seven non-hemolytic derivatives. The derivatives seem to cause damage to the bacterial cell membrane, and those containing the carboxyl group at the C-3 position of the 4-quinolonic nucleus were more active than those containing a carboxyethyl group. CONCLUSION: The isoquinoline-5,8-dione nucleus also favored antimicrobial activity. The study showed that the target of the derivatives must be a non-conventional hydrophobic allosteric binding pocket on the DNA gyrase enzyme.

Systematic review on efficacy of preventive measures for surgical site infection by multiple-drug resistant gram-negative bacilli

ABSTRACT Background: There are no specific recommendations for prevention of surgical site infection (SSI) caused by multidrug resistant Gram-negative bacilli (MDR-GNB). Our objective was to systematically review the literature evaluating the efficacy and safety of measures specifically designed to prevent MDR-GNB SSI. Methods: We searched MEDLINE, EMBASE, CINAHL and LILACS databases up to February 18, 2020. Randomized trials and observational cohort studies evaluating the efficacy of preventive measures against MDR-GNB SSI in adult surgical patients were eligible. We evaluated methodological quality of studies and general quality of evidence using Newcastle-Ottawa scale, Cochrane ROBINS-I and GRADE method. Random-effects meta-analyses were performed using Review Manager V.5.3 software. Results: A total of 10,663 titles by searching databases were identified. Two retrospective observational studies, comparing surgical antibiotic prophylaxis (SAP) with or without aminoglycoside in renal transplantation recipients, and one non-randomized prospective study, evaluating ertapenem vs. cephalosporin plus metronidazole for SAP in extended spectrum beta-lactamase producing Enterobacteriales carriers undergoing colon surgery, were included. Risk of bias was high in all studies. Meta-analysis was performed for the renal transplantation studies, with 854 patients included. Combined relative risk (RR) for MDR GNB SSI was 0.57 (95%CI: 0.25-1.34), favoring SAP with aminoglycoside (GRADE: moderate). Conclusions: There are no sufficient data supporting specific measures against MDR-GNB SSI. Prospective, randomized studies are necessary to assess the efficacy and safety of SAP with aminoglycoside for MDR-GNB SSI prevention among renal transplantation recipients and other populations. PROSPERO 2018 CRD42018100845.

Factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de Cartagena-Colombia / Prognostic factors for mortality caused by an infectious agent in a high complexity hospital in Cartagena-Colombia

Introducción: La identificación de los principales factores clínico-epidemiológicos que determinan causas de mortalidad en pacientes hospitalizados es una necesidad apremiante, principalmente cuando los esfuerzos realizados en la actualidad no permiten asumir acciones fundamentadas en la identificación de las causas de dicho evento. Objetivo: Establecer cuáles son los factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de la ciudad de Cartagena- Colombia. Material y Métodos: Se realizó un estudio de casos y controles retrospectivo, con muestra proyectada de 86 casos y 258 controles, en una relación 1:3, que cumplieron con los criterios de elegibilidad respectivos y en los que realizaron análisis bivariados y posteriormente un análisis multivariado que incluyó métodos de regresión logística binaria. Resultados: El riesgo de mortalidad en el análisis multivariado está determinado por variables como sexo masculino (ORa 1,695 IC 95 por ciento: 1,005-2,856); Cáncer (ORa 2,389 IC 95 por ciento 1,230-4,642); inmunosupresión (ORa 3,211 IC 95 por ciento 1,004-10,26); Ventilación mecánica (ORa 2,541 IC 95 por ciento 1,128-5,722); Estancia en la UCI (ORa 2,331 IC 95 por ciento1,227-4,425) e Infección por bacterias productoras de carbapenemasas (ORa 4,778 IC95 por ciento 1,313-17,38). Conclusiones: En pacientes masculinos con cáncer o cualquier otra forma de inmunosupresión, en los que se requiera el uso del ventilador mecánico o estancia en la unidad de cuidado intensivo y que además desarrollen infecciones por bacterias productoras de carbapenemasas existe mayor riesgo de muerte por agente infeccioso(AU)

Introduction: The identification of the main epidemiological clinical factors that determine the causes of mortality in hospitalized patients is a pressing need, mainly when the efforts made at present do not allow us to take actions based on the identification of the causes of the aforementioned event. Objective: To identify the prognostic factors for mortality caused by infectious agents in a high complexity hospital in the city of Cartagena, Colombia. Material and Methods: A retrospective case-control study was conducted in 86 cases and 258 control samples that met the eligibility criteria, at the 1: 3 ratio. Bivariate analyses and a subsequent multivariate analysis that included binary logistic regression methods were also performed. Results: In the multivariate analysis, the risk of mortality is determined by variables such as male sex (ORa 1,695 95 percent CI: 1.005-2.856); cancer (ORa 2,389 95 percent CI 1,230-4,642); immunosuppression (ORa 3.211 95 percent CI 1.004-10.26); mechanical ventilation (ORa 2.541 95 percent CI 1.128-5.722); stay in the ICU (ORa 2,331 95 percent CI 1,227-4,425) and infection caused by carbapenemase-producing bacteria (ORa 4,778 95 percent CI 1,313-17.38). Conclusions: Male patients with cancer or any other form of immunosuppression who require the use of a mechanical ventilator or admission to the intensive care unit who also develop infections caused by carbapenemase-producing bacteria, are at greater risk of death from an infectious agent(AU)

Delftia acidovorans pneumonia with lung cavities formation / Neumonia con formación de cavidades pulmonares causada por Delftia acidovorans

Abstract Case Description: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. Clinical Finding: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. Treatment and outcomes: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. Clinical Relevance: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.

Resumen Descripción del caso: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. Hallazgo clínico: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. Tratamiento y resultados: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. Relevancia clínica: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.

Delftia acidovorans pneumonia with lung cavities formation.

CASE DESCRIPTION: A 52-year-old female patient was admitted to our clinic with complaints of cough, sputum, fever and fatigue. The patient has been receiving immunosuppressive therapy for thrombocytopenic purpura for 5 years. CLINICAL FINDING: Inspiratory crackles were heard on both hemithorax. Oxygen saturation measured with the pulse oximeter was 97%. Chest X-ray showed diffuse reticular opacities that were more prominent in the upper zones of both lungs. WBC counts were 17,600 mm3 and Platelet counts were 29,000 mm3. Thorax CT showed that there were many thin-walled cavities and millimetric nodules accompanied by ground-glass infiltrates in the upper and middle lobes. Gram staining of bronchial fluid, taken by bronchoscopy, revealed Gram-negative bacilli and intense polymorphonuclear leukocytes. The bacteria were defined as Delftia acidovorans by BD Phoenix automated system. TREATMENT AND OUTCOMES: The patient was hospitalized with suspicion of opportunistic pulmonary infections and cavitary lung disease. After the empirical treatment of intravenous piperacillin-tazobactam and oral clarithromycin, her clinical and radiological findings significantly regressed, and she was discharged with outpatient follow-up. CLINICAL RELEVANCE: This is the first example of cavitary pneumonia due to Delftia acidovorans in an immunocompromised patient. We would like to emphasize that Delftia pneumonia should be considered in the differential diagnosis of pulmonary cavitary involvement in such patients.

DESCRIPCIÓN DEL CASO: Una mujer de 52 años llegó a la clínica con tos, esputo, fiebre y fatiga. El paciente estuvo recibiendo terapia inmunosupresora durante 5 años para el tratamiento de la púrpura trombocitopénica. HALLAZGO CLÍNICO: se escucharon crepitaciones inspiratorias en ambos hemitórax. La saturación de oxígeno fue del 97%. La radiografía de tórax mostró opacidades reticulares difusas que eran más prominentes en las zonas superiores de ambos pulmones. Los recuentos de leucocitos fueron de 17,600 mm3 y los recuentos de plaquetas fueron de 29,000 mm3. La TC de tórax mostró muchas cavidades de pared delgada y nódulos milimétricos acompañados de infiltrados vitrales en los lóbulos superior y medio. La tinción de Gram del líquido bronquial reveló bacilos gramnegativos y leucocitos polimorfonucleares. Las bacterias fueron identificadas como Delftia acidovorans. TRATAMIENTO Y RESULTADOS: La paciente fue hospitalizado con una sospecha de infección oportunista pulmonar y enfermedad pulmonar cavitaria. Después del tratamiento empírico de piperacilina-tazobactam intravenosa y claritromicina oral, los síntomas y signos retrocedieron significativamente, y fue dada de alta con seguimiento ambulatorio. RELEVANCIA CLÍNICA: este es el primer registro de neumonía cavitaria causado por Delftia acidovorans en una paciente inmunocomprometida. Enfatizamos que la neumonía por Delftia debe considerarse en el diagnóstico diferencial de la afectación de la cavidad pulmonar en tales pacientes.

Genome misclassification of Klebsiella variicola and Klebsiella quasipneumoniae isolated from plants, animals and humans.

OBJECTIVE: Due to the fact that K. variicola, K. quasipneumoniae and K. pneumoniae are closely related bacterial species, misclassification can occur due to mistakes either in normal biochemical tests or during submission to public databases. The objective of this work was to identify K. variicola and K. quasipneumoniae genomes misclassified in GenBank database. MATERIALS AND METHODS: Both rpoB phylogenies and average nucleotide identity (ANI) were used to identify a significant number of misclassified Klebsiella spp. genomes. RESULTS: Here we report an update of K. variicola and K. Quasipneumoniae genomes correctly classified and a list of isolated genomes obtained from humans, plants, animals and insects, described originally as K. pneumoniae or K. variicola, but known now to be misclassified. CONCLUSIONS: This work contributes to recognize the extensive presence of K. variicola and K. quasipneumoniae isolates in diverse sites and samples.

Klebsiella variicola and Klebsiella quasipneumoniae with capacity to adapt to clinical and plant settings.

OBJECTIVE: To compare the genetic determinants involved in plant colonization or virulence in the reported genomes of K. variicola, K. quasipneumoniae and K. pneumoniae. MATERIALS AND METHODS: In silico comparisons and Jaccard analysis of genomic data were used. Fimbrial genes were detected by PCR. Biological assays were performed with plant and clinical isolates. RESULTS: Plant colonization genes such as cellulases, catalases and hemagglutinins were mainly present in K. variicola genomes. Chromosomal ß-lactamases were characteristic of this species and had been previously misclassified. K. variicola and K. pneumoniae isolates produced plant hormones. CONCLUSIONS: A mosaic distribution of different virulence- and plant-associated genes was found in K. variicola and in K. quasipneumoniae genomes. Some plant colonizing genes were found mainly in K. variicola genomes. The term plantanosis is proposed for plant-borne human infections.

Klebsiella variicola and Klebsiella quasipneumoniae with capacity to adapt to clinical and plant settings / Klebsiella variicola y Klebsiella quasipneumoniae con capacidad para adaptarse al ambiente clínico y a las plantas

Abstract: Objective: To compare the genetic determinants involved in plant colonization or virulence in the reported genomes of K. variicola, K. quasipneumoniae and K. pneumoniae. Materials and methods: In silico comparisons and Jaccard analysis of genomic data were used. Fimbrial genes were detected by PCR. Biological assays were performed with plant and clinical isolates. Results: Plant colonization genes such as cellulases, catalases and hemagglutinins were mainly present in K. variicola genomes. Chromosomal β-lactamases were characteristic of this species and had been previously misclassified. K. variicola and K. pneumoniae isolates produced plant hormones. Conclusions: A mosaic distribution of different virulence- and plant-associated genes was found in K. variicola and in K. quasipneumoniae genomes. Some plant colonizing genes were found mainly in K. variicola genomes. The term plantanosis is proposed for plant-borne human infections.

Resumen: Objetivo: Comparar genes de colonización de plantas o de virulencia en los genomas reportados de K. variicola, K. quasipneumoniae y K. pneumoniae. Material y métodos: Se utilizaron análisis in silico y de Jaccard. Por PCR se detectaron genes de fimbrias. Se realizaron ensayos biológicos con aislados de plantas y clínicos. Resultados: Los genes de colonización de plantas como celulasas, catalasas y hemaglutininas se encontraron principalmente en genomas de K. variicola. Las β-lactamasas cromosómicas son características de la especie y en algunos casos estaban mal clasificadas. K. variicola y K. pneumoniae producen hormonas vegetales. Conclusiones: Se encontró una distribución en mosaico de los genes de asociación con plantas y de virulencia en K. variicola y K. quasipneumoniae. Principalmente en K. variicola se encontraron algunos genes involucrados en la colonización de plantas. Se propone el término plantanosis para las infecciones humanas de origen vegetal.

Genome misclassification of Klebsiella variicola and Klebsiella quasipneumoniae isolated from plants, animals and humans / Clasificación errónea de aislados de Klebsiella variicola y Klebsiella quasipneumoniae obtenidos de plantas, animales y humanos

Abstract: Objective: Due to the fact that K. variicola, K. quasipneumoniae and K. pneumoniae are closely related bacterial species, misclassification can occur due to mistakes either in normal biochemical tests or during submission to public databases. The objective of this work was to identify K. variicola and K. quasipneumoniae genomes misclassified in GenBank database. Materials and methods: Both rpoB phylogenies and average nucleotide identity (ANI) were used to identify a significant number of misclassified Klebsiella spp. genomes. Results: Here we report an update of K. variicola and K. Quasipneumoniae genomes correctly classified and a list of isolated genomes obtained from humans, plants, animals and insects, described originally as K. pneumoniae or K. variicola, but known now to be misclassified. Conclusions: This work contributes to recognize the extensive presence of K. variicola and K. quasipneumoniae isolates in diverse sites and samples.

Resumen: Objetivo: Identificar genomas mal clasificados de K. variicola, y K. quasipneumoniae en la base de datos del GenBank. Material y métodos: En el presente estudio se usaron tanto análisis filogenéticos usando rpoB como la identidad media de nucleótidos (ANI, por sus siglas en ingles) para identificar un número significativo de genomas del género Klebsiella. Resultados: Se reportó una actualización de genomas de K. variicola y K. quasipneumoniae correctamente clasificados y una lista de aquellos aislamientos obtenidos de seres humanos, plantas, animales e insectos, descritos originalmente como K. pneumoniae o K. variicola pero ahora se conoce que están mal clasificados. Conclusiones: Este trabajo contribuye a la presencia extensiva de aislamientos de K. variicola y K. quasipneumoniae en diversos sitios y muestras.

Results of high-risk neutropenia therapy of hematology-oncology patients in a university hospital in Uruguay.

BACKGROUND: Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. METHODS: A retrospective cohort study (2011-2012) was conducted of patients with high-risk neutropenia in a hematology-oncology service. RESULTS: Forty-four episodes of 17 patients with a median age of 48 years (range: 18-78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia isolated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. CONCLUSION: The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (front-line antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol.

Results of high-risk neutropenia therapy of hematology-oncology patients in a university hospital in Uruguay

Background: Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. Methods: A retrospective cohort study (2011-2012) was conducted of patients with high-risk neutropenia in a hematology-oncology service. Results: Forty-four episodes of 17 patients with a median age of 48 years (range: 18-78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia iso- lated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. Conclusion: The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (frontline antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol. .

Acinetobacter spp. e Pseudomonas aeruginosa resistentes aos carbapenêmicos no Hospital Universitário de Santa Maria, Rio Grande do Sul / Carbapenem-resistant Acinetobacter spp. and Pseudomonas aeruginosa at the University Hospital of Santa Maria, Rio Grande do Sul state, Brazil

Objetivos: Avaliar as características de sensibilidade a antimicrobianos de Acinetobacter spp. e Pseudomonas aeruginosa resistentes aos carbapenêmicos, isolados entre agosto de 2011 a janeiro de 2012 de pacientes internados no Hospital Universitário de Santa Maria, na cidadede Santa Maria, Rio Grande do Sul, Brasil.Métodos: Foi realizado um estudo retrospectivo através da consulta ao banco de dados do Laboratório de Microbiologia, onde foram incluídos todos os isolados de Acinetobacter spp. e P. aeruginosa provenientes de diferentes espécimes clínicos coletados de pacientes internados que apresentaram resistência ou perfil intermediário aos antimicrobianos carbapenêmicos de uso neste nosocômio (imipenem, meropenem e ertapenem) verificados através de metodologia convencional pela técnica de difusão do disco (Kirby-Bauer) ou metodologia automatizada (MicroScan® ? Siemens) de acordo com as normas preconizadas pelo Clinical and Laboratory Standards Institute.Resultados: No período estudado foram encontradas 58 amostras de bacilos Gram-negativos não fermentadores resistentes aos carbapenêmicos, sendo 32 do gênero Acinetobacter e 26 P. aeruginosa. Acinetobacter spp. foi mais isolado na Unidade de Tratamento Intensivo, enquanto P. aeruginosa prevaleceu no Pronto Atendimento e no Ambulatório. Ambos os microrganismos provieram principalmente de secreções respiratórias.Conclusões: Neste estudo Acinetobacter spp. e P. aeruginosa apresentaram elevada resistência aos antimicrobianos. A polimixina B mostrou-se um bom antimicrobiano para o tratamento de infecções por microrganismos resistentes aos carbapenêmicos neste nosocômio.

Aims: To evaluate the characteristics of antimicrobial susceptibility of carbapenem-resistant Acinetobacter spp. and Pseudomonas aeruginosaisolated from August 2011 to January 2012 from inpatients at the University Hospital of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.Methods: A retrospective study was conducted by consulting the database of the Microbiology Laboratory, which included all isolates ofAcinetobacter spp. and P. aeruginosa from different clinical specimens collected from hospitalized patients who had resistant or intermediate profile to carbapenemic antimicrobials used in this hospital (imipenem, meropenem and ertapenem) verified through conventional methodologyby disc diffusion (Kirby-Bauer) or automated method (MicroScan® ? Siemens) according to the standards recommended by the Clinical andLaboratory Standards Institute.Results: In the studied period 58 samples of nonfermenters Gram-negative bacilli resistant to carbapenems were found, 32 of the genus Acinetobacter and 26 of P. aeruginosa. Acinetobacter spp. was more isolated in the intensive care unit, while P. aeruginosa prevailed in the emergency and outpatient departments. Both microorganisms came mainly from respiratory secretions.Conclusions: In this study, Acinetobacter spp. and P. aeruginosa showed high antimicrobial resistance. Polymyxin B was a good antimicrobial for the treatment of infections caused by microorganisms resistant to carbapenems in this hospital.

Otomastoiditis caused by Sphingomonas paucimobilis: case report and literature review.

Sphingomonas paucimobilis is an aerobic Gram-negative bacillus that, although rare in humans, most commonly infects immunocompromised and hospitalized patients. Among the 59 pediatric cases of S. paucimobilis infection reported in the literature, the most common diagnosis involves isolated bacteremia. These cases are related to sporadic or epidemic infections. Death related to this infection occurred in only one case. The authors report a case of an 11-year-old boy with the diagnosis of Sphingomonas paucimobilis otomastoiditis and a thorough review of the literature on this infection in pediatrics. The patient presented a 20-day history of fever, otalgia, otorrhea, and progressive retroauricular swelling with protrusion of the left ear; despite 15 days of amoxicillin regimen. His past medical history included chronic bilateral otitis media, but no cause of immunosuppression was found. A brain computed tomography scan showed left otomastoiditis associated with a large circumscribed fluid collection with deep involvement of the soft tissues of the temporal region, including the subperiosteal space. Blood tests showed neutrophilia and elevated C-reactive protein. Surgical manipulation of the cited collection drained a large amount of a fetid purulent secretion. Ceftazidime and clindamycin were empirically initiated. The outcome was favorable, with fever defervescence and resolution of the scalp deformation. Culture of the drained secretion was positive for S. paucimobilis. Ciprofloxacin was scheduled for a further 10 days after discharge. The follow-up showed complete recovery. As far as we know, this is the first case of S. paucimobilis otomastoiditis, complicated with subperiosteal abscess in an immunocompetent child. The authors call attention to the increasing number of reports on S. paucimobilis infection over the years, and therefore to the importance of this pathogen, which was previously underestimated.

Gram-negative osteomyelitis: clinical and microbiological profile

INTRODUCTION: Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature. OBJECTIVES AND METHODS: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. RESULTS: Most patients were men (63 percent), with median age of 42 years, affected by chronic osteomyelitis (43 percent) or acute osteomyelitis associated to open fractures (32 percent), the majority on the lower limbs (71 percent). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60 percent, relapse 19 percent, amputation 7 percent, and death 5 percent. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25 percent), Acinetobacter baumannii (21 percent) e Pseudomonas aeruginosa (20 percent). Susceptibility to carbapenems was about 100 percent for Enterobacter sp., 75 percent for Pseudomonas aeruginosa and 60 percent for Acinetobacter baumannii. CONCLUSION: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

Meningoencefalitis letal por Salmonella B

La meningoencefalitis por bacilos gramnegativos ha ido incrementándose desde la década de los 70, con una mayor incidencia en niños pequeños, aunque existe una tendencia a aumentar en pacientes de la 3ra. edad. Dentro de este grupo de microorganismos, la causada por Salmonella sp, por su poca frecuencia, resulta una rareza. En este caso se presenta a una paciente de 80 años de edad con cuadro clínico de meningoencefalitis, que en el estudio del líquido cefalorraquídeo se aisló Salmonella grupo B serotipo typhimurium; la paciente fallece a los 5 días de su ingreso. La meningoencefalitis por Salmonella sp debe tenerse en cuenta en pacientes menores de 2 años de edad y ancianos, por la severidad del cuadro clínico y elevada mortalidad.

Meningoencephalitis caused by gram-negative bacilli has increased since the 1970s, with a higher incidence in little children , although there is a a trend to rise in the elderly. Within this group of micororganisms, the meningoencephalitis caused by Salmonella sp is rare, since it is not very common. The case of an 80-year-old female patient with a clinical picture of meningoencephalitis is reported. Salmonella typhimurium serogroup B was isolated from the cerebrospinal fluid. The patient died 5 days after being admitted in the hospital. The meningoencephalitis caused by Salmonella sp should be taken into consideration in children under 2 and in the elederly because of the severity of the clinical picture and the elevated mortality.