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2.
Microb Drug Resist ; 20(4): 270-4, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24520822

RESUMO

This study characterized an IncL/M-like plasmid containing a bla(OXA-48)-encoding gene from a clinical isolate of Klebsiella pneumoniae, denoted as E71T. Investigation of this plasmid sequence identified unique regions of interest along with conserved regions detected in eight other clinical carbapenem-resistant isolates. A 63-kb plasmid (pE71T) from K. pneumoniae E71T was sequenced and found to be highly similar to the recently published K. pneumoniae pOXA-48a (JN626286). Two copies of the insertion sequence element IS1R were identified, one of which was located adjacent to the bla(OXA-48)-encoding gene forming part of a composite transposon Tn1999.2 and the second located 16-kb downstream. Plasmid profiling and PCR assays confirmed that the pE71T backbone was conserved among the eight other clinical bla(OXA-48)-positive isolates, and in all cases, the OXA-48 genes were part of the Tn1999.2 composite transposon. This is the first report of a bla(OXA-48) and IS1R arrangement-containing plasmid in Ireland.


Assuntos
Elementos de DNA Transponíveis , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/genética , Plasmídeos/química , Resistência beta-Lactâmica/genética , beta-Lactamases/genética , Antibacterianos/metabolismo , Antibacterianos/uso terapêutico , Sequência de Bases , Carbapenêmicos/metabolismo , Carbapenêmicos/uso terapêutico , Sequência Conservada , Expressão Gênica , Humanos , Irlanda , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , beta-Lactamases/metabolismo
4.
Am J Infect Control ; 41(6): 554-7, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23149086

RESUMO

BACKGROUND: Information on infection prevention and control (IPC) and antimicrobial stewardship activities in Irish long-term care facilities (LTCFs) is limited. METHODS: A survey detailing IPC and antimicrobial stewardship activities, including staffing and bed capacity, was circulated to Irish LTCFs. RESULTS: Sixty-nine LTCFs (61 public, 8 private) were surveyed, 56 (81%) of which had an IPC practitioner. Thirty-five (51%) LTCFs had an IPC committee that met on average 5 times (range, 1-10) during the previous year. LTCFs with IPC practitioners based solely in the facility (n = 17) were more likely to have an IPC committee (P = .027). Antimicrobial guidelines were available in 28% (n = 19) and 16% (n = 11) had an antimicrobial stewardship committee in place. Medical care was provided by general practitioners in 51% (n = 35), by physicians employed by the LTCFs in 35% (n = 24), or by both in 14% (n = 10). Medical care and activities were coordinated in 45% (n = 31) of LTCFs. These LTCFs were more likely to have an IPC committee (P < .001), medical staff training (P < .001), and antimicrobial guidelines (P = .005) in place. CONCLUSION: There are significant gaps in Irish LTCFs' IPC and antibiotic stewardship programs and governance structures, highlighting the need for specific LTCF national initiatives.


Assuntos
Anti-Infecciosos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Controle de Infecções/métodos , Controle de Infecções/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Infecção Hospitalar/prevenção & controle , Humanos , Controle de Infecções/normas , Irlanda/epidemiologia , Guias de Prática Clínica como Assunto , Prevalência , Inquéritos e Questionários
5.
J Clin Pathol ; 65(12): 1132-5, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22918888

RESUMO

AIMS: Infection following transplantation is a cause of morbidity and mortality. Perfusion fluid (PF) used to preserve organs between recovery and transplantation represents a medium suitable for the growth of microbes. We evaluated the relevance of positive growth from PF sampled before the implantation of kidney or kidney-pancreas (KP) allografts. METHODS: Between January 2007 and January 2011, 548 kidney/KP transplants were performed in our centre. A retrospective review of patient records with culture-positive PF was performed. RESULTS: PF was received from 483 (88%) patients, of which 35 (7%, 95% CI 5.3% to 9.9%) were positive for bacteria (31/483, 6.4%, 95% CI 4.6% to 9.8%) and fungi (4/483, 0.8%, 95% CI 0.3% to 2.1%). Thirty-two of the 35 culture-positive PF (91.4%, 95% CI 77.6% to 97%) were considered insignificant. The remaining three patients developed sepsis postoperatively, which was considered to be possibly related to growth in PF; Escherichia coli in one and Klebsiella pneumoniae in two. Of the non-skin flora bacteria cultured from PF, six were resistant to the prophylactic antibiotic given intraoperatively, but only one developed infection postoperatively (E coli, resistant to the co-amoxiclav). CONCLUSIONS: Significant attributable morbidity associated with PF-positive culture results was relatively rare. Culture of organisms other than Enterobacteriaceae or fungi are likely to represent contamination.


Assuntos
Infecções/diagnóstico , Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Perfusão/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Complicações Pós-Operatórias/microbiologia , Valor Preditivo dos Testes , Estudos Retrospectivos
7.
Br J Neurosurg ; 25(2): 289-91, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21158511

RESUMO

A 58-year old male presented with meningitis associated with subgaleal and subdural collections 6 weeks following a temporal craniotomy for resection of recurrent glioblastoma multiforme and Gliadel wafer implantation. Candida parapsilosis was cultured from cerebrospinal fluid (CSF) and Gliadel wafers removed during surgical debridement. He was successfully treated with liposomal amphotericin B. To our knowledge, this is the first reported case of Candida parapsilosis meningitis secondary to Gliadel wafer placement.


Assuntos
Candidíase/microbiologia , Implantes de Medicamento/efeitos adversos , Meningite Fúngica/microbiologia , Materiais Biocompatíveis , Neoplasias Encefálicas/cirurgia , Candidíase/tratamento farmacológico , Carmustina , Terapia Combinada/métodos , Ácidos Decanoicos/uso terapêutico , Glioblastoma/cirurgia , Humanos , Masculino , Meningite Fúngica/tratamento farmacológico , Pessoa de Meia-Idade , Poliésteres/uso terapêutico , Resultado do Tratamento
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