RESUMO
A carbapenem-resistant Alcaligenes faecalis strain was isolated from a surveillance swab of a service member injured in Afghanistan. The isolate was positive for bla(NDM) by real-time PCR. Species identification was reevaluated on three identification systems but was inconclusive. Genome sequencing indicated that the closest relative was Acinetobacter schindleri and that bla(NDM-1) was carried on a plasmid that shared >99% identity with one identified in an Acinetobacter lwoffii isolate. The isolate also carried a novel chromosomally encoded class D oxacillinase.
Assuntos
Acinetobacter/enzimologia , Acinetobacter/genética , beta-Lactamases/genética , Acinetobacter/isolamento & purificação , Infecções por Acinetobacter/microbiologia , Afeganistão , Cromossomos Bacterianos , DNA Bacteriano/química , DNA Bacteriano/genética , Humanos , Dados de Sequência Molecular , Plasmídeos , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de DNARESUMO
Mupirocin is an antibiotic used for eradication and infection control of methicillin-resistant Staphylococcus aureus (MRSA). Mupirocin binds to the bacterial isoleucyl tRNA synthetase, thus disrupting bacterial protein synthesis. Four hundred nine MRSA clinical isolates collected in 2006 and 2007 at Madigan Army Medical Center were screened for mupirocin resistance by E test and polymerase chain reaction; 7 MRSA isolates (1.7%) were found to be fully resistant to mupirocin (minimum inhibitory concentration [MIC] by E test: > 1,024 microg/mL), 10 isolates (2.4%) had MIC values of 1 to 32 microg/mL, while 392 MRSA isolates (95.9%) had MIC values of < 1 microg/mL. No trend of increased mupirocin resistance was found when compared with subsequent years. These results show that mupirocin remains a valid infection control measure due to its unique mechanism of action and the high susceptibility rate of MRSA isolates. In addition, rapid screening by polymerase chain reaction of MRSA shows promise in assessing the fully resistant mupirocin phenotype.
Assuntos
Antibacterianos/farmacologia , Mupirocina/farmacologia , Inibidores da Síntese de Proteínas/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , District of Columbia , Farmacorresistência Bacteriana , Hospitais Militares , Humanos , Resistência a Meticilina , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Fatores de TempoRESUMO
BACKGROUND: Polyomavirus-associated nephropathy (PVAN) is a significant cause of allograft loss after renal transplantation. A noninvasive assay that can guide the evaluation of PVAN would be of clinical value. We compared the utility of BK virus (BKV) polymerase chain reaction (PCR) and urine cytology in screening for concurrent PVAN. METHODS: We used PCR to test urine and plasma samples from renal recipients simultaneously for BKV DNA. Additionally, we tested urine samples for decoy cells. Sample results were correlated with biopsy-proven PVAN. Receiver-operator characteristic curves were used to determine viral load thresholds associated with concurrent PVAN. RESULTS: In this cross-sectional study, BKV viruria, viremia, and urinary decoy cells were detected in 24%, 9%, and 13% of renal recipients, respectively. Among 114 patients who had renal allograft biopsy, four (3.5%) were diagnosed with PVAN. Using pathology as gold standard for the diagnosis of PVAN, BKV viremia threshold of >1.6E+04 copies/mL had 100% sensitivity, 96% specificity, 50% positive predictive value, and 100% negative predictive value. A BKV viruria threshold of >2.5E+07 copies/mL had 100% sensitivity, 92% specificity, 31% positive predictive value, and 100% negative predictive value. In contrast, urine decoy cells had 25% sensitivity, 84% specificity, 5% positive predictive value, and 97% negative predictive value for the diagnosis of concurrent PVAN. CONCLUSION: BKV PCR may be a clinically useful noninvasive test to identify renal recipients with concurrent PVAN. BKV DNA >1.6E+04 copies/mL of plasma and >2.5E+07 copies/mL of urine were highly associated with concurrent PVAN whereas a negative PCR test makes the diagnosis of PVAN highly unlikely.
Assuntos
Vírus BK/genética , Nefropatias/virologia , Transplante de Rim/efeitos adversos , Reação em Cadeia da Polimerase/métodos , Infecções por Polyomavirus/diagnóstico , Infecções Tumorais por Vírus/diagnóstico , Adulto , Idoso , Vírus BK/patogenicidade , Biomarcadores/sangue , Biomarcadores/urina , Biópsia , Estudos Transversais , DNA Viral/sangue , DNA Viral/genética , DNA Viral/urina , Feminino , Humanos , Rim/metabolismo , Rim/patologia , Rim/virologia , Nefropatias/metabolismo , Nefropatias/patologia , Transplante de Rim/patologia , Masculino , Pessoa de Meia-Idade , Infecções por Polyomavirus/genética , Infecções por Polyomavirus/metabolismo , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Infecções Tumorais por Vírus/genética , Infecções Tumorais por Vírus/metabolismo , Carga ViralRESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) and humanitarian missions are increasing worldwide. The prevalence of MRSA in the populations served may be unknown. A BRAVA (Blast Resuscitlation and Victim Assistance) mission was conducted at Battambang, Cambodia that included microbiology support. No MRSA was detected in our patients despite the reported increase in MRSA in Asia. Continued investigation is warranted for future missions.
