Assuntos
Medula Óssea/fisiopatologia , Células da Medula Óssea/fisiologia , Citocinas/metabolismo , Granulócitos/fisiologia , Hematopoese/fisiologia , Homeostase/fisiologia , Humanos , Sistema Imunitário/fisiopatologia , Memória Imunológica/fisiologia , Fibras Nervosas/fisiologia , Obesidade/fisiopatologia , Osteoporose/fisiopatologia , Plasmócitos/fisiologia , Células Estromais/fisiologiaRESUMO
BACKGROUND: The current increase in nosocomial infections caused by vancomycin-resistant enterococci (VRE) warrants improvement of detection methods and hygiene measures. Knowledge of the local epidemiology is important for monitoring compliance of medical personnel with hygiene measures. AIM: To evaluate semi-automated repetitive element palindromic polymerase chain reaction (rep-PCR) for rapid molecular typing of VRE. METHODS: Primary VRE isolates were collected during an observation period of one year and retrospectively typed by rep-PCR. Molecular typing was performed on isolates from two departments with elevated VRE rates and patients with increased risk for systemic VRE infections. Typing results were correlated with temporal and spatial information on patient moves, VRE laboratory results and multi-locus sequence typing (MLST). FINDINGS: Approximately 70% of VRE isolates within a department could be assigned to similarity clusters. Spread of VRE was limited to the individual departments. There was no evidence for spread of endemic VRE strains within the geographical catchment area of the hospital. Our results demonstrate the utility of rep-PCR typing on a department level. However, a Diversilab® threshold of ≥98% had to be applied to claim similarity, and suspected transmissions needed to be confirmed by vanA/B genotyping and compiled information on spatial and temporal patient contact. MLST verified the findings. CONCLUSION: Spread of predominantly detected vancomycin-resistant Enterococcus faecium was limited to the department level with no evidence for wider dissemination within the hospital. Well-standardized and validated (semi-)automated rep-PCR systems are useful for rapid detection of possible VRE transmission. However, suspected transmissions need to be confirmed by clinical and microbiological parameters.
Assuntos
Infecção Hospitalar/epidemiologia , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Epidemiologia Molecular/métodos , Tipagem Molecular/métodos , Reação em Cadeia da Polimerase/métodos , Enterococos Resistentes à Vancomicina/isolamento & purificação , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , DNA Bacteriano/genética , Enterococcus faecium/classificação , Enterococcus faecium/genética , Monitoramento Epidemiológico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/transmissão , Departamentos Hospitalares , Humanos , Epidemiologia Molecular/normas , Tipagem Molecular/normas , Reação em Cadeia da Polimerase/normas , Sequências Repetitivas de Ácido Nucleico , Estudos Retrospectivos , Análise Espaço-Temporal , Enterococos Resistentes à Vancomicina/classificação , Enterococos Resistentes à Vancomicina/genéticaRESUMO
BACKGROUND AND OBJECTIVES: Interventions to prevent and detect bacterial contamination of platelet concentrates (PCs) have reduced, but not eliminated the sepsis risk. Standardized bacterial strains are needed to validate detection and pathogen reduction technologies in PCs. Following the establishment of the First International Reference Repository of Platelet Transfusion-Relevant Bacterial Reference Strains (the 'repository'), the World Health Organization (WHO) Expert Committee on Biological Standardisation (ECBS) endorsed further repository expansion. MATERIALS AND METHODS: Sixteen bacterial strains, including the four repository strains, were distributed from the Paul-Ehrlich-Institut (PEI) to 14 laboratories in 10 countries for enumeration, identification and growth measurement on days 2, 4 and 7 after low spiking levels [10-25 colony-forming units (CFU)/PC bag]. Spore-forming (Bacillus cereusPEI-B-P-07-S, Bacillus thuringiensisPEI-B-P-57-S), Gram-negative (Enterobacter cloacaePEI-B-P-43, Morganella morganiiPEI-B-P-74, PEI-B-P-91, Proteus mirabilisPEI-B-P-55, Pseudomonas fluorescensPEI-B-P-77, Salmonella choleraesuisPEI-B-P-78, Serratia marcescensPEI-B-P-56) and Gram-positive (Staphylococcus aureusPEI-B-P-63, Streptococcus dysgalactiaePEI-B-P-71, Streptococcus bovisPEI-B-P-61) strains were evaluated. RESULTS: Bacterial viability was conserved after transport to the participating laboratories with one exception (M. morganiiPEI-B-P-74). All other strains showed moderate-to-excellent growth. Bacillus cereus, B. thuringiensis, E. coli, K. pneumoniae, P. fluorescens, S. marcescens, S. aureus and S. dysgalactiae grew to >106 CFU/ml by day 2. Enterobacter cloacae, P. mirabilis, S. epidermidis, S. bovis and S. pyogenes achieved >106 CFU/ml at day 4. Growth of S. choleraesuis was lower and highly variable. CONCLUSION: The WHO ECBS approved all bacterial strains (except M. morganiiPEI-B-P-74 and S. choleraesuisPEI-B-P-78) for repository enlargement. The strains were stable, suitable for spiking with low CFU numbers, and proliferation was independent of the PC donor.
Assuntos
Plaquetas/microbiologia , Segurança do Sangue/normas , Transfusão de Plaquetas , Bancos de Espécimes Biológicos , Escherichia coli/crescimento & desenvolvimento , Humanos , Klebsiella pneumoniae/crescimento & desenvolvimento , Padrões de Referência , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus epidermidis/crescimento & desenvolvimento , Organização Mundial da SaúdeRESUMO
Ensuring microbiological safety in advanced-therapy medicinal products is still a big challenge for manufacturers. There are fundamental problems, especially in cell-based medicinal products, regarding sterility of source materials, short shelf-life of final products, and the selection of suitable microbiological methods. Different from classical medicinal products, there is the need to evaluate a large number of possible risks and to calculate the risk-benefit balance. Depending on the source material, the presence of micro-organisms with specific growth requirements has to be considered. They cannot be detected by conventional testing methods, but may replicate after the application of the preparation in the recipient. Mycoplasmas are the primary representatives of these contaminants and specific testing procedures are required. Additionally, depending on the source and processing of the biological material, specific testing methods for mycobacteria and other contaminants should be included. Alternative microbiological methods (e.g. NAT, flow cytometry) should be applied in order to reduce the time to detection and to provide reliable results before application of a preparation, but should be also assessed for their possible use for the detection of conventionally undetectable micro-organisms.
Assuntos
Produtos Biológicos/efeitos adversos , Produtos Biológicos/normas , Terapia Baseada em Transplante de Células e Tecidos/efeitos adversos , Terapia Baseada em Transplante de Células e Tecidos/normas , Desinfecção/normas , Contaminação de Medicamentos/prevenção & controle , Técnicas Microbiológicas/normas , Segurança do Paciente/normas , Automação Laboratorial , Europa (Continente) , Humanos , Mycoplasma/isolamento & purificação , Mycoplasma/patogenicidadeRESUMO
Acinetobacter baumannii is an emerging nosocomial pathogen primarily in countries with a high prevalence of multidrug resistance. Here we report the detection of a bla OXA23 carbapenemase-producing A. baumannii strain in a German patient with prosthetic hip joint infection following several hip joint surgeries but no history of foreign travel.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Humanos , Masculino , ReoperaçãoRESUMO
Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Recently, rifaximin, a non-absorbable antibiotic which is used to prevent recurrent hepatic encephalopathy, has been proposed as effective prophylaxis for SBP. Here, we present an unusual case of SBP under treatment with rifaximin. A 50-year-old woman with liver cirrhosis was admitted because of tense ascites and abdominal pain. She was under long-term oral prophylaxis with rifaximin due to hepatic encephalopathy. Paracentesis revealed SBP caused by Pasteurella multocida, which was sensitive to multiple antibiotics, including rifaximin. Treatment with ceftriaxone resulted in rapid resolution of the peritonitis and restoration of the patient. Since P. multocida is usually transmitted from pets, the patient's cat was tested and could be identified as the most likely source of infection. This case should elicit our awareness that uncommon pathogens and unusual routes of transmission may lead to SBP, despite antibacterial prophylaxis with non-absorbable antibiotics. Nevertheless, such infections may still remain sensitive to systemic therapy with conventional antibiotics.
Assuntos
Anti-Infecciosos/uso terapêutico , Antibioticoprofilaxia/métodos , Cirrose Hepática/complicações , Infecções por Pasteurella/diagnóstico , Pasteurella multocida/isolamento & purificação , Peritonite/diagnóstico , Rifamicinas/uso terapêutico , Ceftriaxona/uso terapêutico , Feminino , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções por Pasteurella/microbiologia , Infecções por Pasteurella/patologia , Infecções por Pasteurella/prevenção & controle , Pasteurella multocida/efeitos dos fármacos , Peritonite/microbiologia , Peritonite/patologia , Peritonite/prevenção & controle , Rifaximina , Resultado do TratamentoAssuntos
Antifúngicos/uso terapêutico , Artrite/tratamento farmacológico , Artrite/microbiologia , Candida/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Pessoa de Meia-Idade , Condicionamento Pré-Transplante/métodos , Transplante AutólogoAssuntos
Antibacterianos/uso terapêutico , Infecções por Clostridium/prevenção & controle , Clostridium/isolamento & purificação , Osteomielite/tratamento farmacológico , Osteomielite/prevenção & controle , Tíbia/patologia , Fraturas da Tíbia/terapia , Administração Oral , Cefuroxima/uso terapêutico , Doença Crônica , Clindamicina/uso terapêutico , Clostridium/efeitos dos fármacos , Clostridium/genética , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Quimioterapia Combinada , Alemanha , Humanos , Infusões Intravenosas , Imageamento por Ressonância Magnética , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Osteomielite/microbiologia , Radiografia , Recidiva , Tíbia/diagnóstico por imagem , Tíbia/microbiologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/microbiologia , Fraturas da Tíbia/patologiaRESUMO
A dysregulation of apoptosis or an ineffective clearance of apoptotic material is suspected to be involved in the pathogenesis of systemic lupus erythematodes. Subcellular fragments such as apoptotic bodies (ABs) have been recognized as modulators of intercellular communication and immune function. In this context, we have been interested whether nuclear and cytoplasmic antigens are relocated into ABs. In the present study, we characterized ABs isolated from apoptozing lymphoblasts. We found an accumulation of the linker-histone (histone 1) as well as the core-histones (histone 2A, histone 2B, histone 3, histone 4) in ABs. Further, they contained DNA, RNA and the ribonuclear protein La/SSB. Proteins such as cytochrome c, HSP 70, prohibitin, p53, nuclear matrix antigen or lamin B were excluded from ABs. The content of ABs differed from that observed in membrane microparticles isolated from viable cells. Formation of ABs occurred early during apoptosis. It was observed before DNA-degradation or phosphatidylserine exposure was detected. ABs were engulfed by monocyte-derived phagocytes. These findings suggest that immunogenic molecules are actively translocated into ABs followed by a rapid engulfment of the latter by environmental phagocytes. In autoimmune diseases, a defect in the clearance of ABs or AB formation may contribute to the development of autoimmunity.