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1.
Urol Case Rep ; 42: 102018, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35145876

RESUMO

Spontaneous rupture of the urinary bladder represents a rare condition that may complicate with paravesical abscess. Although Staphylococcus aureus may be a part of the intestinal tract flora, it is an unusual cause of abdominal or pelvic abscesses. We report the case of a male patient with spontaneous bladder perforation with osteomyelitis and paravesical abscess, secondary to community-acquired methicillin-resistant Staphylococcus aureus infection.

2.
Braz J Infect Dis ; 25(2): 101560, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33716018

RESUMO

OBJECTIVE: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. METHOD: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. RESULTS: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. CONCLUSION: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.


Assuntos
Anti-Infecciosos , Gestão de Antimicrobianos , Doenças Transmissíveis , Médicos , Assistência Ambulatorial , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Humanos , Infusões Parenterais , Pacientes Ambulatoriais , Prescrições
3.
Microb Pathog ; 150: 104644, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33259886

RESUMO

The emergence of invasive Haemophilus influenzae infections in vaccinated patient is a public health concern. We have investigated the genomic basis of invasiveness and possible vaccine failure in H. influenzae causing invasive disease in vaccinated and unvaccinated children in Brazil. Three H. influenzae strains isolated from blood cultures of pediatric patients were sequenced. Serotype, MLST, resistome and virulome were predicted using bioinformatic tools, whereas single nucleotide polymorphisms (SNPs) analysis of cap loci and the presence of the putative virulence-enhancing IS1016-bexA partial deletion were predicted in silico. Infections were caused by H. influenzae type a (Hia), type b (Hib) and nontypeable (NTHi), belonging to international high-risk clones of sequence types ST23, ST6 and ST368, respectively, which have been identified in North American, European and Asian countries. Convergence of ampicillin resistance and virulence in Hib-ST6 was supported by blaTEM-1B and deletion in the bexA gene, whereas presence of SNPs in the cap-b locus was associated with antigenic modifications of the capsule structure. Hia-ST23 and NTHi-ST368 strains carried galU, lpsA, opsX, rfaF, iga1, lgtC and lic1/lic2 virulence genes, associated with colonization, adaptation and damage to the lung, or invasiveness. In summary, deletion in the bexA gene and presence of SNPs in the cap locus of Hib could be contributing to invasive disease and possible vaccine failure in pediatric patients, whereas serotype replacement of Hib with type "a" and NTHi strains denotes the ability of non-vaccine serotypes to re-colonize vaccinated patients. Finally, the dissemination of international high-risk clones of H. influenzae emphasizes the importance of monitoring changes in the molecular epidemiology of invasive H. influenzae disease.


Assuntos
Infecções por Haemophilus , Vacinas Anti-Haemophilus , Ásia , Brasil , Criança , Células Clonais , Genômica , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/prevenção & controle , Haemophilus influenzae/genética , Humanos , Lactente , Tipagem de Sequências Multilocus , Sorotipagem
4.
Braz. j. infect. dis ; 25(2): 101560, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1278570

RESUMO

ABSTRACT Objective: In recent years, the use of outpatient parenteral antimicrobial therapy (OPAT) has increased, resulting in the need to ensure its rational and adequate utilization. This article describes the implementation of an antimicrobial stewardship program in the OPAT setting by a Health Maintenance Organization (HMO) and its results. Method: An infectious disease (ID) physician made routine assessments of all home care parenteral antimicrobial requests from February to December 2019. Information on diagnosis, renal function, weight, previous antimicrobials, and microbiology were gathered during remote evaluations. Prescription changes recommended by the ID specialist were not mandatory, but implemented by the primary provider as accepted. Antibiotic consumption data was analyzed from January 2018 to December 2019. An active screening was conducted for treatment failures: two or more treatment course requirements, or death within 15 days of the evaluation were reexamined. Results: A total of 506 antimicrobial requests were assessed. The most frequent diagnoses were urinary tract infection, pneumonia, and orthopedic surgical site infection. Six percent of evaluations were not completed due to insufficient information and 12% were requests by the primary physician for initial antimicrobial guidance. Of the 416 completed prescriptions evaluations, 58% had suggested changes, including different antimicrobials (40%), treatment duration (25%), and route of administration (23%). There was an increase in use of teicoplanin and meropenem, and a decrease in ceftriaxone, ertapenem, cefepime, amikacin and daptomycin use. The HMO's overall parenteral antimicrobial outpatient consumption, which had shown an upward trend over the previous year, decreased after program initiation. No major adverse results were detected in patients' clinical outcomes; two treatment failures were detected and promptly corrected; no deaths attributed to antibiotic changes were detected. Conclusion: Outpatient antimicrobial stewardship, through remote assessment by an ID specialist, was effective and safe in the OPAT setting.


Assuntos
Humanos , Médicos , Doenças Transmissíveis/tratamento farmacológico , Gestão de Antimicrobianos , Anti-Infecciosos/uso terapêutico , Pacientes Ambulatoriais , Prescrições , Assistência Ambulatorial , Infusões Parenterais , Antibacterianos/uso terapêutico
5.
Pathog Dis ; 75(9)2017 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-29228178

RESUMO

The emergence of hypervirulent Klebsiella pneumoniae (hvKP) with multidrug resistance (MDR) profile is a worrisome public health issue. We report the first draft genome sequence of a hypermucoviscous (positive string test) and MDR K. pneumoniae serotype K19, belonging to ST29, isolated from human infection. This strain harboured multiple antimicrobial resistance genes, including blaCTX-M-15, besides yersiniabactin and type 3 fimbriae virulence genes. In vivo experiments carried out with the Galleria mellonella infection model revealed that K. pneumoniae K19/ST29 killed 100% of the larvae at 24 h post-infection, in a similar way to the known hypermucoviscous hvKP K1/ST23 lineage.


Assuntos
Genoma Bacteriano , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Análise de Sequência de DNA , beta-Lactamases/metabolismo , Animais , Modelos Animais de Doenças , Farmacorresistência Bacteriana Múltipla , Humanos , Klebsiella pneumoniae/isolamento & purificação , Larva/microbiologia , Larva/fisiologia , Lepidópteros/microbiologia , Lepidópteros/fisiologia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Virulência , Fatores de Virulência/genética
6.
Rev Inst Med Trop Sao Paulo ; 51(4): 203-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19739000

RESUMO

Extended-spectrum beta-lactamases (ESBL) in enterobacteria are recognized worldwide as a great hospital problem. In this study, 127 ESBL-producing Enterobacteriaceae isolated in one year from inpatients and outpatients at a public teaching hospital at São Paulo, Brazil, were submitted to analysis by PCR with specific primers for bla SHV, bla TEM and bla CTX-M genes. From the 127 isolates, 96 (75.6%) Klebsiella pneumoniae, 12 (9.3%) Escherichia coli, 8 (6.2%) Morganella morganii, 3 (2.3%) Proteus mirabilis, 2 (1.6%) Klebsiella oxytoca, 2 (1.6%) Providencia rettgeri, 2 (1.6%) Providencia stuartti, 1 (0.8%) Enterobacter aerogenes and 1 (0.8%) Enterobacter cloacae were identified as ESBL producers. Bla SHV, bla TEM and bla CTX-M were detected in 63%, 17.3% and 33.9% strains, respectively. Pulsed field gel eletrophoresis genotyping of K. pneumoniae revealed four main molecular patterns and 29 unrelated profiles. PCR results showed a high variety of ESBL groups among strains, in nine different species. The results suggest the spread of resistance genes among genetically different strains of ESBL-producing K. pneumoniae in some hospital wards, and also that some strongly related strains were identified in different hospital wards, suggesting clonal spread in the institutional environment.


Assuntos
Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/genética , beta-Lactamases/biossíntese , Brasil , Farmacorresistência Bacteriana Múltipla/genética , Eletroforese em Gel de Campo Pulsado , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/prevenção & controle , Escherichia coli/isolamento & purificação , Genótipo , Hospitais de Ensino , Humanos , Klebsiella pneumoniae/genética , Reação em Cadeia da Polimerase , beta-Lactamases/genética
7.
Rev. Inst. Med. Trop. Säo Paulo ; 51(4): 203-209, July-Aug. 2009. ilus, tab
Artigo em Inglês | LILACS | ID: lil-524375

RESUMO

Extended-spectrum β-lactamases (ESBL) in enterobacteria are recognized worldwide as a great hospital problem. In this study, 127 ESBL-producing Enterobacteriaceae isolated in one year from inpatients and outpatients at a public teaching hospital at São Paulo, Brazil, were submitted to analysis by PCR with specific primers for blaSHV, blaTEM and blaCTX-M genes. From the 127 isolates, 96 (75.6 percent) Klebsiella pneumoniae, 12 (9.3 percent) Escherichia coli, 8 (6.2 percent) Morganella morganii, 3 (2.3 percent) Proteus mirabilis, 2 (1.6 percent) Klebsiella oxytoca, 2 (1.6 percent) Providencia rettgeri, 2 (1.6 percent) Providencia stuartti, 1 (0.8 percent) Enterobacter aerogenes and 1 (0.8 percent) Enterobacter cloacae were identified as ESBL producers. BlaSHV, blaTEM and blaCTX-M were detected in 63 percent, 17.3 percent and 33.9 percent strains, respectively. Pulsed field gel eletrophoresis genotyping of K. pneumoniae revealed four main molecular patterns and 29 unrelated profiles. PCR results showed a high variety of ESBL groups among strains, in nine different species. The results suggest the spread of resistance genes among genetically different strains of ESBL-producing K. pneumoniae in some hospital wards, and also that some strongly related strains were identified in different hospital wards, suggesting clonal spread in the institutional environment.


Beta-lactamases de espectro estendido (ESBL) em enterobactérias são reconhecidas mundialmente como um grande problema hospitalar. Neste estudo, 127 Enterobacteriaceae produtoras de ESBL isoladas por um ano, de pacientes internados e ambulatoriais de um hospital público de ensino em São Paulo, Brasil, foram submetidas à análise pela PCR com iniciadores específicos para os genes blaSHV, blaTEM e blaCTX-M. Dos 127 isolados, 96 (75,6 por cento) K. pneumoniae, 12 (9,3 por cento) E. coli, 8 (6,2 por cento) M. morganii, 3 (2,3 por cento) Proteus mirabilis, 2 (1,6 por cento) Klebsiella oxytoca, 2 (1,6 por cento) Providencia rettgeri, 2 (1,6 por cento) Providencia stuartti, 1 (0,8 por cento) Enterobacter aerogenes e 1 (0,8 por cento) Enterobacter cloacae foram identificados como produtores de ESBL. BlaSHV, blaTEM e blaCTX-M foram detectados em 63 por cento, 17,3 por cento e 33,9 por cento das cepas, respectivamente. A genotipagem de K. pneumoniae por eletroforese em campo pulsado revelou quatro padrões moleculares principais e 29 perfis não relacionados. Os resultados da PCR demonstraram alta variedade de grupos de ESBL entre as cepas, em nove espécies diferentes. Os resultados sugerem a disseminação de genes de resistência entre cepas geneticamente diferentes de K. pneumoniae produtoras de ESBL em algumas unidades do hospital, e também que algumas cepas fortemente relacionadas foram identificadas em unidades hospitalares diferentes, sugerindo disseminação clonal no ambiente da instituição.


Assuntos
Humanos , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/genética , beta-Lactamases/biossíntese , Brasil , Farmacorresistência Bacteriana Múltipla/genética , Eletroforese em Gel de Campo Pulsado , Infecções por Enterobacteriaceae/prevenção & controle , Enterobacteriaceae/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Genótipo , Hospitais de Ensino , Klebsiella pneumoniae/genética , Reação em Cadeia da Polimerase , beta-Lactamases/genética
8.
J Pediatr (Rio J) ; 82(4): 313-6, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16912835

RESUMO

OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSIONS: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.


Assuntos
Surtos de Doenças , Dermatoses da Mão/microbiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/enzimologia , Onicomicose/microbiologia , beta-Lactamases/metabolismo , Brasil/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Surtos de Doenças/prevenção & controle , Mãos/microbiologia , Dermatoses da Mão/prevenção & controle , Humanos , Recém-Nascido , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/prevenção & controle , Infecções por Klebsiella/transmissão , Klebsiella pneumoniae/isolamento & purificação , Onicomicose/prevenção & controle , Equipe de Assistência ao Paciente
9.
J. pediatr. (Rio J.) ; 82(4): 313-316, Jul.-Aug. 2006. graf
Artigo em Inglês | LILACS | ID: lil-435519

RESUMO

OBJETIVO: Descrever surto por Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido em berçário de risco intermediário. MÉTODOS: Após identificação dos primeiros casos, a situação foi conduzida como surto, sendo intensificadas as medidas básicas de prevenção de infecções hospitalares e investigadas possíveis fontes de disseminação da bactéria. RESULTADOS: O surto durou 6 meses e atingiu 36 recém-nascidos, causando sete infecções e 29 colonizações. Na primeira fase do surto, os portadores evoluíram com infecção, porém, na segunda fase, os portadores eram assintomáticos e só foram identificados por culturas de vigilância. O surto foi resolvido após identificação e tratamento de profissional de saúde que apresentava onicomicose e era portadora de Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido nas mãos. CONCLUSÃO: Detecção e controle da disseminação oculta da bactéria multirresistente entre os recém-nascidos de menor risco evitou sua instalação endêmica no berçário, bem como a conseqüente exposição dos pacientes mais graves e suscetíveis à infecção.


OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSION: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.


Assuntos
Humanos , Recém-Nascido , Surtos de Doenças , Dermatoses da Mão/microbiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/enzimologia , Onicomicose/microbiologia , beta-Lactamases/metabolismo , Brasil/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Surtos de Doenças/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Dermatoses da Mão/prevenção & controle , Mãos/microbiologia , Unidades de Terapia Intensiva Neonatal , Infecções por Klebsiella/prevenção & controle , Infecções por Klebsiella/transmissão , Klebsiella pneumoniae/isolamento & purificação , Onicomicose/prevenção & controle , Equipe de Assistência ao Paciente
10.
J Clin Microbiol ; 43(1): 516-9, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15635033

RESUMO

A multiresistant Klebsiella pneumoniae isolate was taken from the blood of a 75-year-old patient with nosocomial pneumonia who developed septic shock and failed therapy with imipenem. The isolate presented an MIC of imipenem of 128 microg/ml, and the production of a metallo-beta-lactamase was confirmed by phenotypic and genotypic techniques. We here report, for the first time, the detection of a metalloenzyme (IMP-1)-producing K. pneumoniae clinical strain in Latin America. The gene responsible for this phenotype was found to be bla(IMP-1), carried in a class 1 integron.


Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , beta-Lactamases/biossíntese , Idoso , Antibacterianos/farmacologia , Brasil/epidemiologia , Evolução Fatal , Humanos , Imipenem/farmacologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Masculino , Testes de Sensibilidade Microbiana , beta-Lactamases/genética
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