Asunto(s)
Diarrea/complicaciones , Miocarditis/etiología , Intoxicación Alimentaria por Salmonella/complicaciones , Salmonella enteritidis/aislamiento & purificación , Enfermedad Aguda , Adolescente , Técnicas de Diagnóstico Cardiovascular , Diarrea/microbiología , Heces/microbiología , Humanos , Inmunocompetencia , Masculino , Miocarditis/diagnóstico , Miocarditis/microbiología , Intoxicación Alimentaria por Salmonella/microbiologíaRESUMEN
An unusual multi-drug-resistant Pseudomonas aeruginosa (MDR-PA) was isolated in four patients whilst hospitalized in a French teaching hospital between May and August 2011. All four patients had undergone an oesophago-gastro-duodenoscopy with the same gastroscope over a five-month period. This endoscope was associated with a culture positive for the MDR-PA. Observations of endoscope reprocessing identified deviations from the agreed processes: insufficient initial cleaning, shortening of the immersion time and brushing time, insufficient channel flushing, and inadequate drying prior to storage. Since withdrawing the gastroscope and institution of strict adherence to the agreed processes, no other MDR-PA cases have been isolated.
Asunto(s)
Infección Hospitalaria/transmisión , Gastroscopía/efectos adversos , Infecciones por Pseudomonas/transmisión , Pseudomonas aeruginosa/enzimología , beta-Lactamasas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Infección Hospitalaria/microbiología , Desinfección/métodos , Farmacorresistencia Bacteriana Múltiple , Francia , Gastroscopios/microbiología , Adhesión a Directriz , Hospitales de Enseñanza , Humanos , Control de Infecciones/métodos , Persona de Mediana Edad , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/aislamiento & purificaciónRESUMEN
Nosocomial outbreaks of extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae are an increasing concern in neonatal intensive care units (NICUs). We describe an outbreak of ESBL-producing K. pneumoniae that lasted 5 months and affected 23 neonates in our NICU. Proton pump inhibitor and extended-spectrum cephalosporin exposure were significantly associated with the risk of ESBL-producing K. pneumoniae colonisation and/or infection. Thirty isolates recovered from clinical, screening and environmental samples in the NICU were studied by means of Raman spectroscopy, pulsed-field gel electrophoresis and repetitive extragenic palindromic polymerase chain reaction (rep-PCR). The Raman clustering was in good agreement with the results of the other two molecular methods. Fourteen isolates belonged to the Raman clone 1 and 16 to the Raman clone 3. Molecular analysis showed that all the strains expressed SHV-1 chromosomal resistance, plasmid-encoded TEM-1 and CTX-M-15 ß-lactamases. Incompatibility groups of plasmid content identified by PCR-based replicon typing indicated that resistance dissemination was due to the clonal spread of K. pneumoniae and horizontal CTX-M-15 gene transfer between the two clones.
Asunto(s)
Brotes de Enfermedades , Transmisión de Enfermedad Infecciosa , Unidades de Cuidado Intensivo Neonatal , Infecciones por Klebsiella/transmisión , Klebsiella pneumoniae/patogenicidad , beta-Lactamasas/metabolismo , Combinación Amoxicilina-Clavulanato de Potasio/farmacología , Técnicas de Tipificación Bacteriana , Cefotaxima/farmacología , Farmacorresistencia Bacteriana Múltiple , Electroforesis en Gel de Campo Pulsado , Femenino , Fómites/microbiología , Francia/epidemiología , Genes Bacterianos , Edad Gestacional , Humanos , Recién Nacido , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/genética , Masculino , Pruebas de Sensibilidad Microbiana , Plásmidos/genética , Plásmidos/metabolismo , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Espectrometría Raman , beta-Lactamasas/genéticaRESUMEN
Here we report a case of sustentorial brain abscess due to Listeria monocytogenes. Blood culture and procalcitonine blood measurement were negative. L. monocytogenes was isolated from CSF after inoculation in Castañeda medium.
Asunto(s)
Absceso Encefálico/diagnóstico , Listeria monocytogenes/fisiología , Listeriosis/diagnóstico , Meningitis por Listeria/diagnóstico , Absceso Encefálico/complicaciones , Absceso Encefálico/patología , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/patología , Humanos , Listeria monocytogenes/crecimiento & desarrollo , Listeria monocytogenes/aislamiento & purificación , Listeriosis/complicaciones , Listeriosis/patología , Imagen por Resonancia Magnética , Masculino , Meningitis por Listeria/complicaciones , Meningitis por Listeria/patología , Persona de Mediana EdadAsunto(s)
Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/aislamiento & purificación , Microbiología Ambiental , Metales Pesados/toxicidad , beta-Lactamasas/biosíntesis , Proteínas Bacterianas/biosíntesis , Cationes Bivalentes/toxicidad , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Humanos , Pruebas de Sensibilidad MicrobianaRESUMEN
The aim of the study was to determine predictive factors of epidemic extended spectrum beta-lactamase-producing Escherichia coli acquisition. All patients presenting any type of culture positive for ESBL-producing E. coli between November 2006 and October 2007 were included. An epidemic case was defined as a patient colonized with a clonal strain having epidemiological link with an another patient harbouring the same strain. Clinical and administrative data were recorded. Groups were compared by univariate and multivariate analysis using SAS software. Were included in this study 148 patients: 60 epidemic and 88 sporadic cases. Multivariate analysis showed several predictive factors of epidemic strain acquisition: female gender, high Charlson index, treatment by amoxicillin or ticarcillin-clavulanic acid, admission to emergency unit and hospitalisation in a high number of different care units. Identification of predictive factors of epidemic ESBL-producing E. coli strains acquisition may help to limit cross transmission of such strains.
Asunto(s)
Infección Hospitalaria/microbiología , Brotes de Enfermedades , Infecciones por Escherichia coli/microbiología , Proteínas de Escherichia coli/genética , Escherichia coli/enzimología , Resistencia betalactámica , beta-Lactamasas/genética , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Grupos Diagnósticos Relacionados , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Proteínas de Escherichia coli/metabolismo , Femenino , Francia/epidemiología , Unidades Hospitalarias , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Resistencia betalactámica/genética , beta-Lactamasas/metabolismoRESUMEN
AIM OF THE STUDY: To develop a fast and reliable real time PCR technique for detecting plasmid-mediated quinolone resistance genes qnrA, qnrB and qnrS. METHODS: A real-time PCR assay using SYBR Green I and Roche LightCycler(®) was developed to detect qnr genes. Detection of qnr genes was based on comparison of melting temperature differences with a positive control of each qnr genes. This assay was performed to study 138 isolates collected from diagnostic and screening samples in the Champagne-Ardenne region in 2004 (France). RESULTS: In optimized conditions, the three positive controls tested alone and with isolates confirmed the specificity of the PCR primers. Each PCR assay was able to test 30 strains in 60min for 1 qnr gene. Out of 138 isolates screened, 3.6 % isolates were positive for a qnrA1, 1.5 % for qnrS1 and no qnrB-like gene. Prevalence of qnr determinants was 5 % and reached 9.5 % in clinical isolates. CONCLUSION: Real-time PCR is a fast and reliable technique for screening of qnr-positive strains. This study shows a relatively high prevalence of qnr determinants (5 %) among ESBL-producing Enterobacteriaceae.
Asunto(s)
Proteínas Bacterianas/genética , Sistemas de Computación , Farmacorresistencia Bacteriana Múltiple/genética , Enterobacteriaceae/genética , Fluoroquinolonas/farmacología , Reacción en Cadena de la Polimerasa/métodos , Factores R/genética , beta-Lactamasas/genética , beta-Lactamas/farmacología , Antibacterianos/farmacología , Benzotiazoles , Citrobacter/efectos de los fármacos , Citrobacter/enzimología , Citrobacter/genética , Diaminas , Enterobacter/efectos de los fármacos , Enterobacter/enzimología , Enterobacter/genética , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Escherichia coli/genética , Proteínas de Escherichia coli/genética , Colorantes Fluorescentes , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/genética , Compuestos Orgánicos , QuinolinasRESUMEN
BACKGROUND AND PURPOSE: Nocardia species is an aerobic soil-saprophyte bacterium, responsible for rare opportunistic infections, mainly reported in immunocompromised patients. Nocardia brain abscess accounts for 1 to 2% of cerebral abscesses. Prognosis is poor. METHODS: We describe clinical, radiological and bacteriological findings along with therapeutic aspects for five patients and review the literature on Nocardia cerebral abscess. RESULTS: The clinical features of Nocardia brain abscess are insidious and nonspecific, occurring frequently with a medical background of obvious or latent immunodeficiency; fever, if any, is observed subordinate to extracerebral nocardiosis. Computerized tomography scan and conventional magnetic resonance (MR) scan show lesions with a necrotic core and multilobed thick walls enhancing after injection of gadolinium or iodine. Abscesses are mainly located in the brain stem, basal ganglia and cerebral cortex of the frontal, parietal and occipital lobes; cerebellar and spinal locations are uncommon. MR diffusion-weighted imaging with calculation of apparent diffusion coefficient and proton MR spectroscopy can provide additional data for accurate differential diagnosis between abscess and other necrotic lesions, such as tumor and cyst formations. Bacteriological identification has progressed with advances in molecular microbiology: 16S rRNA sequencing, allowing a more rapid routine identification of Nocardia strains from clinical samples. Clinical management of patients with a Nocardia brain abscess relies upon early use of intravenous antibiotics adapted to the strains identified and their susceptibility. Most Nocardia strains display susceptibility to cotrimoxazol, amikacin and linezolid, but develop beta-lactamase activity. CONCLUSIONS: Early pus samples, obtained by biopsy or surgical resection, are needed to establish a certain bacteriological diagnosis and initiate appropriate intravenous antibiotics.
Asunto(s)
Absceso Encefálico/patología , Nocardiosis/patología , Anciano , Antibacterianos/uso terapéutico , Apraxias/etiología , Encéfalo/microbiología , Absceso Encefálico/tratamiento farmacológico , Absceso Encefálico/microbiología , Femenino , Gota/complicaciones , Humanos , Huésped Inmunocomprometido , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Nocardiosis/tratamiento farmacológico , Nocardiosis/cirugía , Sarcoidosis Pulmonar/complicaciones , Silicosis/complicaciones , Fumar , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
This paper confirms the important role of rodents to be maintenance hosts of leptospires. Their role is related to renal carriage and shedding of leptospires into urine, thus contaminating fresh water. Serological and carriage of feral rodents trapped in France were determined by MAT and hap1PCR specific for pathogenic leptospires. In same areas, fresh water samples were analyzed by hap1PCR. The overall seroprevalence was 44% in 649 rodents and was similar regardless of the species. Seroprevalence for leptospirosis is about 20-53% according to species. hap1PCR (516 kidneys) showed that renal carriage was higher in brown rats (34.7%) and muskrats (15.8%) than in coypus (3.3%). hap1PCR demonstrates a significative difference (P-value > 10(-12)) for the renal carriage between the different species: muskrats and rats are more efficient maintenance hosts than coypu but all infect water. Moreover 5/38 water samples associated with human cases were hap1PCR positive and 1/113 in controlled waters.
Asunto(s)
Arvicolinae/microbiología , Leptospira/aislamiento & purificación , Leptospirosis/veterinaria , Ratas/microbiología , Enfermedades de los Roedores , Microbiología del Agua , Animales , ADN Bacteriano/genética , ADN Bacteriano/aislamiento & purificación , Monitoreo del Ambiente , Monitoreo Epidemiológico , Francia/epidemiología , Agua Dulce/microbiología , Humanos , Riñón/microbiología , Leptospira/genética , Leptospirosis/epidemiología , Leptospirosis/microbiología , Reacción en Cadena de la Polimerasa , Enfermedades de los Roedores/epidemiología , Enfermedades de los Roedores/microbiología , Estudios SeroepidemiológicosAsunto(s)
Infección Hospitalaria/microbiología , Enterobacter cloacae , Microbiología Ambiental , Klebsiella pneumoniae , beta-Lactamasas , Argelia , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Infección Hospitalaria/prevención & control , Enterobacter cloacae/efectos de los fármacos , Enterobacter cloacae/enzimología , Enterobacter cloacae/genética , Enterobacter cloacae/aislamiento & purificación , Unidades Hospitalarias , Humanos , Control de Infecciones/métodos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , beta-Lactamasas/genética , beta-Lactamasas/aislamiento & purificaciónRESUMEN
OBJECTIVES: To assess the frequency and diversity of extended spectrum beta-lactamases (ESBLs) in the Champagne-Ardenne region France, and to identify genetic elements associated with the bla(CTX-M) genes. METHODS: During 2004, all the non-duplicate isolates of Pseudomonas aeruginosa and Acinetobacter baumannii resistant to ceftazidime and of Enterobacteriaceae intermediate or resistant to ceftazidime and/or cefotaxime, screening samples excluded, were collected in 10 public hospitals and 3 private clinics. bla genes were sequenced and bla(CTX-M) environment characterized by PCR mapping. RESULTS: In Enterobacteriaceae (138/21 861; 0.6%), ESBLs were predominantly TEM-24 (n = 52; 37.7%) and CTX-M-15 (n = 37; 26.8%). Three new enzymes were identified, CTX-M-61 (CTX-M-1 group), TEM- and SHV-type. A. baumannii (n = 5) produced VEB-1 and P. aeruginosa (n = 2) SHV-2a. ISEcp1 was detected in 22/27 strains, disrupted in 7 of them. The IS903-like element was downstream of bla(CTX-M-14) and bla(CTX-M-16). ISCR1 was found upstream of bla(CTX-M-2) and bla(CTX-M-9), and ISCR1 and bla(CTX-M-2) were located on a sul1-type class 1 integron. In comparison with 2001-02, ESBL distribution among Enterobacteriaceae showed an increase in CTX-M-type (44.9% vs 3.7% P < 10(-7)) due to Escherichia coli CTX-M-15 and to the almost total disappearance of TEM-3 (0.9% vs 51.2%). E. coli was the most frequent species (50.0% vs 5.1% in 1998) despite a similar prevalence to that in 1998 (0.5% vs 0.2%). CONCLUSIONS: A careful detection of bla(CTX-M)-type spread to other species would help to anticipate clonal endemics such as those observed in Enterobacter aerogenes TEM-24.
Asunto(s)
Acinetobacter baumannii/enzimología , Enterobacteriaceae/enzimología , Pseudomonas aeruginosa/enzimología , beta-Lactamasas/clasificación , beta-Lactamasas/aislamiento & purificación , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/genética , Antibacterianos/farmacología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/genética , Francia/epidemiología , Humanos , Vigilancia de la Población , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/genética , Factores de TiempoRESUMEN
Nocardia ignorata is a recently described species identified on the basis of a single isolate of unknown origin. Here we describe the epidemiological, phenotypic, and phylogenetic characteristics of this new species, based on five new clinical and soil isolates.
Asunto(s)
Nocardiosis/microbiología , Nocardia/clasificación , Nocardia/aislamiento & purificación , Sistema Respiratorio/microbiología , Microbiología del Suelo , Proteínas Bacterianas/genética , Técnicas de Tipificación Bacteriana , ADN Bacteriano/análisis , ADN Ribosómico/análisis , Europa (Continente)/epidemiología , Proteínas de Choque Térmico/genética , Humanos , Kuwait/epidemiología , Nocardia/genética , Nocardia/fisiología , Nocardiosis/epidemiología , Fenotipo , Filogenia , Reacción en Cadena de la Polimerasa/métodos , ARN Ribosómico 16S/genéticaRESUMEN
A nonchromogenic Mycobacterium species was isolated from an AIDS patient with acute lymphadenitis. On the basis of the results of conventional tests, the strain appeared to be an atypical nonphotochromogenic Mycobacterium kansasii strain. Sequencing of the 16S rRNA gene revealed a unique nucleic acid sequence, suggesting that the isolate represents an undescribed pathogenic species.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , ADN Ribosómico/genética , Linfadenitis/etiología , Linfadenitis/microbiología , Infecciones por Mycobacterium/diagnóstico , Mycobacterium/aislamiento & purificación , Secuencia de Bases , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Mycobacterium/clasificación , Mycobacterium/genética , ARN Ribosómico 16S/genéticaRESUMEN
PURPOSE: Bacillary endophthalmitis occurring after penetrating ocular trauma with an intraocular foreign body is always associated with poor visual outcome. Bacilli cause fulminant infection associated with tissue damage in the intraocular structures. CASE REPORTS: Our series consisted of four patients with penetrating ocular trauma and endophthalmitis caused by B. cereus or B. licheniformis. Three eyes ultimately developed phtisis. Only on eye recovered good vision (2.5/10 P4). DISCUSSION: Recommended early treatment includes topical, subconjunctival, parenteral antibiotics. A review of the literature indicates that intravitreal antibiotic infusion is crucial for sufficient concentration to control infection. Early vitrectomy is recommended in the management of endophthalmitis. Vitreous and intraocular foreign bodies should be cultured to identify pathogens and ascertain antibiotic susceptibilities.
Asunto(s)
Infecciones por Bacillaceae/etiología , Infecciones por Bacillaceae/terapia , Bacillus cereus , Endoftalmitis/etiología , Endoftalmitis/terapia , Lesiones Oculares Penetrantes/complicaciones , Administración Tópica , Adulto , Antibacterianos/uso terapéutico , Infecciones por Bacillaceae/diagnóstico , Niño , Terapia Combinada , Endoftalmitis/diagnóstico , Femenino , Humanos , Infusiones Parenterales , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Agudeza Visual , Vitrectomía , Cuerpo VítreoRESUMEN
Coagulase-negative Staphylococci (CNS), considered for many years to be commensal bacteria of the skin are now recognized as major agents of nosocomial infection. Bacterial factors (increased resistance), host factors (immune status) and multiplication of the portals of entry (presence of foreign material) have contributed to the increased incidence of nosocomial infections. The importance of the role of NCS in urology is due to their great capacity to colonize catheters and most prostheses. The particular organization of these bacteria into a conglomerate called biofilm is responsible for prosthetic infections, which can impair renal function and can sometimes be life-threatening. The authors review the current increase of the number of CNS isolated in urology departments and describe the various therapeutic strategies that can be proposed to eradicate these bacteria.