Dalbavancin as sequential therapy in infective endocarditis: Real-life experience in elder and comorbid patients.

OBJECTIVES: This study aimed to evaluate the effectiveness of dalbavancin as sequential therapy in patients with infective endocarditis (IE) due to gram positive bacteria (GPB) in a real-life heterogenous cohort with comorbid patients. METHODS: A single center retrospective cohort study including all patients with definite IE treated with dalbavancin between January 2017 and February 2022 was developed. A 6-month follow-up was performed. The main outcomes were clinical cure rate, clinical and microbiological relapse, 6-month mortality, and adverse effects (AEs) rate. RESULTS: The study included 61 IE episodes. The median age was 78.5 years (interquartile range [IQR] 63.2-85.2), 78.7% were male, with a median Charlson comorbidity index of 7 (IQR 4-9) points. Overall, 49.2% suffered native valve IE. The most common microorganism was Staphylococcus aureus (26.3%) followed by Enterococcus faecalis (21.3%). The median duration of initial antimicrobial therapy and dalbavancin therapy were 27 (IQR 20-34) and 14 days (IQR 14-28) respectively. The total reduction of hospitalization was 1090 days. The most frequent dosage was 1500mg of dalbavancin every 14 days (96.7%). An AE was detected in 8.2% of patients, only one (1.6%) was attributed to dalbavancin (infusion reaction). Clinical cure was achieved in 86.9% of patients. One patient (1.6%) with Enterococcus faecalis IE suffered relapse. The 6-month mortality was 11.5%, with only one IE-related death (1.6%). CONCLUSION: This study shows a high efficacy of dalbavancin in a heterogeneous real-world cohort of IE patients, with an excellent safety profile. Dalbavancin allowed a substantial reduction of in-hospital length of stay.

Evaluación de la formación de biopelículas en aislamientos bacterianos y fúngicos por el método semicuantitativo de microtitulación con cristal violeta y el cualitativo de agar con rojo Congo / Assessment of biofilms formation of bacterial and fungal isolates using qualitative Congo red agar and semiquantitative crystal violet microtiter methods

Introducción. El 65 % de las infecciones humanas son producidas por bacterias o levaduras, cuya capacidad de formar biopelículas las hace más resistentes a los antimicrobianos y antifúngicos. Objetivo. Determinar la capacidad de formación de biopelículas en aislamientos bacterianos y fúngicos por medio de los métodos cuantitativo de microtitulación con cristal violeta y cualitativo de cultivo en agar con rojo Congo. Materiales y métodos. Con el método cuantitativo, se utilizaron los medios de cultivo infusión cerebro-corazón, tripticasa de soya y Müeller-Hinton para aislamientos bacterianos; para levaduras, se usaron caldo infusión cerebro-corazón y Sabouraud dextrosa. Para el método cualitativo de cultivo en agar, se utilizaron los mismos medios de cultivo más una solución con 3 % de rojo Congo y 10 % de dextrosa. Cómo método de referencia, se utilizó la propuesta de Stepanovic et al. Resultados. Se evaluaron 103 aislamientos bacterianos y 108 de levaduras. No es recomendable sustituir el caldo infusión cerebro-corazón por los caldos tripticasa de soya y Müeller-Hinton en el método cuantitativo, para evaluar la formación de biopelículas en los aislamientos bacterianos. El medio Sabouraud dextrosa, en caldo y agar, puede sustituir al de infusión de cerebro-corazón para evaluar la formación de biopelículas en levaduras, tanto por el método cuantitativo como por el cualitativo. Conclusión. El estudio de las biopelículas en el laboratorio de microbiología, a partir del método cualitativo de cultivo en agar con rojo Congo, es un procedimiento sencillo, rápido y de bajo costo, que proporciona información útil para el diagnóstico y la terapéutica de infecciones persistentes causadas por bacterias y levaduras.

Introduction. Sixty-five percent of human infections are caused by bacteria or yeasts able to form biofilms. This feature makes them more resistant to antimicrobials and antifungals. Objective. To determine biofilm formation capacity of bacterial and fungal isolates by quantitative crystal violet microtiter and qualitative Congo red agar methods. Materials and methods. Brain-heart infusion, trypticase soy broth and Müeller-Hinton culture media were used in bacterial isolates for the quantitative method; brain-heart infusion broth and Sabouraud dextrose were used for yeasts. The same culture media plus 3% Congo red and 10% dextrose were used to apply the qualitative method in agar. The proposal by Stepanovic, et al. was used as a reference method. Results. We evaluated 103 bacterial isolates and 108 yeasts isolates. We did not recommend substitute brain-heart infusion broth for trypticase soy and Müeller-Hinton broths for biofilm formation assessment in bacterial isolates using the quantitative method. Sabouraud dextrose medium, both broth and agar, can replace brain-heart infusion to assess biofilm formation in yeasts, quantitatively and qualitatively. Conclusion. The study of biofilms in the microbiology laboratory, using Congo red agar qualitative method, is a simple, fast, and inexpensive procedure that provides precise information for the diagnosis and treatment of persistent infections caused by bacteria and yeasts.

Cambios en la resistencia antibiótica en episodios de bacteriospermia sintomática: Evolución en un área de salud del sudeste español / Antibiotic resistance changes in episodes of symptomatic bacteriospermia: development in a health area of southeast Spain

Objetivo: La prostatitis crónica bacteriana (PCB) es una entidad de difícil diagnóstico clínico y tratamiento, siendo el estudio microbiológico del semen la principal prueba diagnóstica. Este estudio tuvo como objetivo determinar la etiología y la resistencia antibiótica en pacientes con bacteriospermia sintomática (BPS) en nuestro medio. Material y métodos: Se ha realizado un estudio descriptivo, transversal y retrospectivo, en un Hospital Regional del sudeste español. Los participantes fueron pacientes asistidos en las consultas del Hospital con clínica compatible con PCB entre 2016 y 2021. Se recogieron y analizaron los resultados del estudio microbiológico de la muestra de semen. Se evaluó la etiología y la tasa de resistencia antibiótica de los episodios de BPS. Resultados: El principal microorganismo detectado es Enterococcus faecalis (34,89%), seguido por Ureaplasma spp. (13,74%) y Escherichia coli (10,98%). La tasa de resistencia antibiótica de E. faecalis a las quinolonas (11%) es inferior a estudios previos, mientras que, para E. coli ha sido superior (35%). Destaca la baja tasa de resistencia que muestran E. faecalis y E. coli a fosfomicina y nitrofurantoína. Conclusiones: En las BPS las bacterias grampositivas y las atípicas se establecen como los principales agentes causales de esta entidad. Esto obliga a replantear la estrategia terapéutica utilizada, lo cual evitará el aumento en las resistencias antibióticas, las recidivas y la cronicidad de esta patología. (AU)

Background: Chronic bacterial prostatitis (CBP) is an entity of difficult clinical diagnosis and treatment, being the microbiological study of semen the main diagnostic test. This study aimed to determine the etiology and antibiotic resistance in patients with symptomatic bacteriospermia (SBP) in our environment. Material and methods: A cross-sectional and retrospective descriptive study has been carried out from a Regional Hospital of the Spanish Southeast. The participants were patients assisted in the consultations of the Hospital with clinic compatible with CBP, between 2016 and 2021. The interventions were collection and analysis of the results derived from the microbiological study of the semen sample. The main determinations were the etiology and rate of antibiotic resistance of BPS episodes are analyzed. Results: The main isolated microorganism is Enterococcus faecalis (34.89%), followed by Ureaplasma spp. (13.74%) and Escherichia coli (10.98%). The rate of antibiotic resistance of E. faecalis to quinolones (11%) is lower than previous studies, while for E. coli it has been higher (35%). The low rate of resistance shown by E. faecalis and E. coli to fosfomycin and nitrofurantoin stands out. Conclusions: In the SBP, gram-positive and atypical bacteria are established as the main causative agents of this entity. This forces us to rethink the therapeutic strategy used, which will avoid the increase in antibiotic resistance, recurrences, and chronicity of this pathology.

Detection of Cutibacterium acnes in Tissue Samples from Clean Primary Shoulder Surgeries - Part II / Detecção de Cutibacterium acnes em amostras de tecidos de cirurgias limpas primárias do ombro - Parte II

Abstract Objective Research and identification of Cutibacterium acnes (C. acnes) and other microorganisms in deeptissue samples collected in clean shoulder surgeries of patients who did not undergo any previous invasive joint procedure and who had no clinical history of infection. Methods We analyzed the results of cultures of intraoperative deep tissue samples from 84 patients submitted to primary clean shoulder surgery. Tubes containing culture medium were used for storage and transport of anaerobic agents, prolonged incubation time, and mass spectrometer for diagnosis of bacterial agents. Results Bacteria growth was evidenced in 34 patients (40.4%) of the 84 included in the study. Of these, 23 had growth of C. acnes in at least one sample of deep tissue collected, corresponding to 27.3% of the total patients. The second most common agent was Staphylococcus epidermidis, present in 7.2% of the total individuals included. We showed a higher relationship between sample positivity and males, a lower mean age, absence of diabetes mellitus, ASA I score, and antibiotic prophylaxis in anesthetic induction with cefuroxime. Conclusions A high percentage of isolates of different bacteria was found in shoulder tissue samples of patients undergoing clean and primary surgeries, who had no history of previous infection. Identification of C. acnes was high (27.6%), and Staphylococcus epidermidis was the second most frequent agent (7.2%).

Resumo Objetivo Pesquisa e identificação de Cutibacterium acnes (C. acnes) e de outros microrganismos em amostras de tecidos profundos coletados em cirurgias limpas de ombro em pacientes que não foram submetidos a nenhum procedimento invasivo articular prévio e que não possuíam antecedentes clínicos de infecção. Métodos Foram analisados os resultados das culturas de amostras de tecidos profundos intraoperatórias de 84 pacientes submetidos à cirurgia limpa primária do ombro. Foram utilizados tubos contendo meio de cultivo para armazenamento e transporte de agentes anaeróbicos, tempo prolongado de incubação e espectrômetro de massa para diagnósticos de agentes bacterianos. Resultados Foi evidenciado o crescimento de bactérias em 34 pacientes (40,4%) dos 84 incluídos no estudo. Desses, 23 apresentavam crescimento de C. acnes em pelo menos uma amostra de tecido profundo coletada, correspondendo a 27,3% do total de pacientes. O segundo agente mais encontrado foi o Staphylococcus epidermidis, presente em 7,2% do total de indivíduos incluídos. Evidenciamos maior relação da positividade de amostras com o gênero masculino, uma média de idade inferior, a ausência de diabetes mellitus, o escore ASA I e a profilaxia antibiótica na indução anestésica com cefuroxima. Conclusões Verificou-se um elevado percentual de isolados de diferentes bactérias em amostras de tecidos de ombros de pacientes submetidos a cirurgias limpas e primárias e sem histórico de infecção anterior. A identificação de C. acnes foi elevada (27,6%) e o Staphylococcus epidermidis foi o segundo agente mais frequente (7,2%).

Empiema pleural por Parvimonas micra en un paciente inmunocompetente: reporte de un caso / Pleural empyema by Parvimonas micra in an immunocompetent patient: a case report

Se presenta el caso de un paciente joven inmunocompetente, con antecedente de tuberculosis pulmonar, que acude al hospital por un cuadro clínico subagudo de fiebre persistente, baja de peso, disnea y abolición del murmullo vesicular. La tomografía de tórax mostró un extenso empiema en hemitórax izquierdo. Se le toman muestras para detección de gérmenes comunes y se le colocan un tubo de drenaje torácico y se inicia antibioticoterapia. La prueba de MALDI-TOF MS identificó a Parvimonas micra, una bacteria anaerobia, comensal de la flora oral, asociado a periodontitis severa, escasamente reportado en empiema pleural, especialmente, en personas inmunocompetentes. En la evaluación odontológica se realizó el diagnóstico de gingivitis y pericoronaritis de la tercera molar. El paciente evolucionó favorablemente. Se sugiere que, en casos de empiemas pleurales subagudos o crónicos, se debe considerar, además de las micobacterias, como agente etiológico al Parvimonas micra, y optar por exámenes como MALDI-TOF MS o secuenciamiento del 16S rRNA, colocación de tubo de tórax, cobertura antibiótica empírica y evaluación odontológica.

We present the case of a young immunocompetent patient, with a history of pulmonary tuberculosis, who attended the hospital with a subacute clinical picture of persistent fever, weight loss, dyspnea and abolition of vesicular murmur. Chest CT scan showed an extensive empyema in the left hemithorax. Samples were taken for detection of common germs. Then, a chest drainage tube was placed and antibiotic therapy started. The MALDI-TOF MS test identified Parvimonas micra, an anaerobic bacterium, commensal to the oral flora, associated with severe periodontitis, but rarely reported in cases of pleural empyema, especially in immunocompetent patients. Gingivitis and pericoronaritis of the third molar were diagnosed during oral evaluation. The patient progressed favorably. Parvimonas micra should be considered as a possible etiological agent in cases of subacute or chronic pleural empyema, in addition to mycobacteria. Tests such as MALDI-TOF MS or 16S rRNA sequencing, chest tube placement, empirical antibiotic coverage and an adequate oral evaluation should be considered in these cases.

Detection of Cutibacterium acnes in Tissue Samples from Primary Clean Shoulder Surgeries - Part I / Detecção de Cutibacterium acnes em amostras de tecidos de cirurgias limpas primárias do ombro - Parte I

Abstract Objective The present study aimed to identify bacterial agents in shoulder surgery specimens from patients with no history of previous shoulder infection or surgery. Methods Tendon, bursa, and bone specimens were collected during surgery, stored in sterile dry bottles, and sent to a hospital-associated laboratory for culture growth analysis in media for aerobic and anaerobic agents. Findings from 141 samples from 47 shoulders were analyzed. Results The cultures were negative in 46 cases (97.8%) and in 140 samples (99.2%). The culture was positive in a single patient, with growth of Staphylococcus hominis from one of three specimens collected. Conclusions The rates of bacterial growth were not consistent with the international literature, indicating the low effectiveness of laboratory methods used in Brazil.

Resumo Objetivo Identificar agentes bacterianos em amostras de cirurgias do ombro de pacientes sem histórico de infecção e de cirurgias prévias no ombro. Métodos Amostras de tendão, bursa e osso foram coletadas no intraoperatório, armazenadas em frascos estéreis a seco e enviadas para análise de crescimento de cultura em meios para agentes aeróbios e anaeróbios no laboratório credenciado ao hospital. Foram analisados os resultados de 141 amostras de 47 ombros. Resultados Obtivemos resultados de culturas negativas em 46 casos (97,8%) e em 140 amostras (99,2%). Apenas um paciente apresentou resultado positivo, com crescimento bacteriano do Staphylococcus hominis em uma das três amostras coletadas. Conclusões Não evidenciamos taxas de crescimento bacteriano condizentes com a literatura internacional, alertando para a baixa eficácia dos métodos laboratoriais utilizados no nosso país.

An unexpected pathogen causing multiple intra-abdominal abscesses in an immunocompetent patient / Un patógeno inesperado como causa de múltiples abscesos intrabdominales en un paciente inmunocompetente

Abstract Streptococcus constellatus is a member of the group now called Streptococcus anginosus. This microorganism is part of the normal oropharyngeal, gastrointestinal and genitourinary microbiota. However, it may cause serious infections such as pharyngitis, bacteremia and invasive pyogenic infections in immunocompromised patients. We report the first case in Colombia of an adult male with no relevant medical history and with an unusual presentation of infection by S. constellatus and whose laboratory results showed an important systemic inflammatory response and radiographic evidence of abdominal involvement with poor response to medical and surgical management. Since there are few reports in international medical journals about intra-abdominal infection by S. constellatus and taking into consideration the need of a multidisciplinary intervention, this report may be of interest for both clinical and surgical practitioners.

Resumen Streptococcus constellatus es un miembro del grupo ahora llamado Streptococcus anginosus. Este microorganismo es parte de la microbiota orofaríngea, gastrointestinal y genitourinaria normal. Sin embargo, puede causar infecciones graves como faringitis, bacteriemia e infecciones piógenas invasivas en pacientes inmunocomprometidos. Presentamos el primer caso en Colombia de un hombre adulto sin antecedentes médicos relevantes y con una presentación inusual de infección por S. constellatus, dada por una gran respuesta inflamatoria sistémica y evidencia radiográfica de afectación abdominal con mala respuesta al tratamiento médico y quirúrgico. Dado que hay pocos informes en revistas médicas internacionales sobre la infección intraabdominal por S. constellatus y teniendo en cuenta la necesidad de intervenciones multidisciplinarias, este reporte puede ser de interés tanto para los médicos clínicos como para los quirúrgicos.

What's new in mechanisms of antibiotic resistance in bacteria of clinical origin?

The discovery, commercialization and administration of antibiotics revolutionized the world of medicine in the middle of the last century, generating a significant change in the therapeutic paradigm of the infectious diseases. Nevertheless, this great breakthrough was soon threatened due to the enormous adaptive ability that bacteria have, through which they are able to develop or acquire different mechanisms that allow them to survive the exposure to antibiotics. We are faced with a complex, multifactorial and inevitable but potentially manageable threat. To fight against it, a global and multidisciplinary approach is necessary, based on the support, guidance and training of the next generation of professionals. Nevertheless, the information published regarding the resistance mechanisms to antibiotics are abundant, varied and, unfortunately, not always well structured. The objective of this review is to structure the, in our opinion, most relevant and novel information regarding the mechanisms of resistance to antibiotics that has been published from January 2014 to September 2019, analysing their possible clinical and epidemiological impact.

Factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de Cartagena-Colombia / Prognostic factors for mortality caused by an infectious agent in a high complexity hospital in Cartagena-Colombia

Introducción: La identificación de los principales factores clínico-epidemiológicos que determinan causas de mortalidad en pacientes hospitalizados es una necesidad apremiante, principalmente cuando los esfuerzos realizados en la actualidad no permiten asumir acciones fundamentadas en la identificación de las causas de dicho evento. Objetivo: Establecer cuáles son los factores pronósticos de mortalidad por agente infeccioso en un hospital de alta complejidad de la ciudad de Cartagena- Colombia. Material y Métodos: Se realizó un estudio de casos y controles retrospectivo, con muestra proyectada de 86 casos y 258 controles, en una relación 1:3, que cumplieron con los criterios de elegibilidad respectivos y en los que realizaron análisis bivariados y posteriormente un análisis multivariado que incluyó métodos de regresión logística binaria. Resultados: El riesgo de mortalidad en el análisis multivariado está determinado por variables como sexo masculino (ORa 1,695 IC 95 por ciento: 1,005-2,856); Cáncer (ORa 2,389 IC 95 por ciento 1,230-4,642); inmunosupresión (ORa 3,211 IC 95 por ciento 1,004-10,26); Ventilación mecánica (ORa 2,541 IC 95 por ciento 1,128-5,722); Estancia en la UCI (ORa 2,331 IC 95 por ciento1,227-4,425) e Infección por bacterias productoras de carbapenemasas (ORa 4,778 IC95 por ciento 1,313-17,38). Conclusiones: En pacientes masculinos con cáncer o cualquier otra forma de inmunosupresión, en los que se requiera el uso del ventilador mecánico o estancia en la unidad de cuidado intensivo y que además desarrollen infecciones por bacterias productoras de carbapenemasas existe mayor riesgo de muerte por agente infeccioso(AU)

Introduction: The identification of the main epidemiological clinical factors that determine the causes of mortality in hospitalized patients is a pressing need, mainly when the efforts made at present do not allow us to take actions based on the identification of the causes of the aforementioned event. Objective: To identify the prognostic factors for mortality caused by infectious agents in a high complexity hospital in the city of Cartagena, Colombia. Material and Methods: A retrospective case-control study was conducted in 86 cases and 258 control samples that met the eligibility criteria, at the 1: 3 ratio. Bivariate analyses and a subsequent multivariate analysis that included binary logistic regression methods were also performed. Results: In the multivariate analysis, the risk of mortality is determined by variables such as male sex (ORa 1,695 95 percent CI: 1.005-2.856); cancer (ORa 2,389 95 percent CI 1,230-4,642); immunosuppression (ORa 3.211 95 percent CI 1.004-10.26); mechanical ventilation (ORa 2.541 95 percent CI 1.128-5.722); stay in the ICU (ORa 2,331 95 percent CI 1,227-4,425) and infection caused by carbapenemase-producing bacteria (ORa 4,778 95 percent CI 1,313-17.38). Conclusions: Male patients with cancer or any other form of immunosuppression who require the use of a mechanical ventilator or admission to the intensive care unit who also develop infections caused by carbapenemase-producing bacteria, are at greater risk of death from an infectious agent(AU)

What's new in mechanisms of antibiotic resistance in bacteria of clinical origin? / ¿Qué novedades hay en los mecanismos de resistencia a antimicrobianos en bacterias de origen clínico?

The discovery, commercialization and administration of antibiotics revolutionized the world of medicine in the middle of the last century, generating a significant change in the therapeutic paradigm of the infectious diseases. Nevertheless, this great breakthrough was soon threatened due to the enormous adaptive ability that bacteria have, through which they are able to develop or acquire different mechanisms that allow them to survive the exposure to antibiotics. We are faced with a complex, multifactorial and inevitable but potentially manageable threat. To fight against it, a global and multidisciplinary approach is necessary, based on the support, guidance and training of the next generation of professionals. Nevertheless, the information published regarding the resistance mechanisms to antibiotics are abundant, varied and, unfortunately, not always well structured. The objective of this review is to structure the, in our opinion, most relevant and novel information regarding the mechanisms of resistance to antibiotics that has been published from January 2014 to September 2019, analysing their possible clinical and epidemiological impact.(AU)

El descubrimiento, la comercialización y la administración de antibióticos revolucionó la medicina a mediados del siglo pasado, generando un cambio significativo en el paradigma terapéutico de las enfermedades infecciosas. Sin embargo, este avance no tardó en verse amenazado debido a la enorme capacidad que tienen las bacterias para desarrollar o adquirir distintos mecanismos que les permiten sobrevivir a los antibióticos. Nos encontramos frente a una amenaza compleja, multifactorial e inevitable, pero potencialmente manejable. Para luchar contra ella es necesario un abordaje multidisciplinar basado en el apoyo, la orientación y el entrenamiento de la próxima generación de profesionales. No obstante, la información publicada referente a nuevos mecanismos de resistencia a antibióticos es abundante, variada y, desgraciadamente, no siempre bien estructurada. El objetivo de esta revisión es ordenar la información, a nuestro juicio más relevante y novedosa, que se ha publicado en referencia los nuevos mecanismos de resistencia a los antibióticos desde enero de 2014 hasta septiembre de 2019, analizando su posible impacto clínico y epidemiológico.(AU)

Desenvolvimento e validação de um aplicativo móvel para identificação de bactérias Gram-positivas e Gram-negativas / Development and validation of a mobile application to identify Gram-positive and Gram-negative bacteria

Objetivo: A internet e os smartphones estão fortemente presentes no cotidiano mundial. Além de proporcionarem comunicação e lazer, os smartphones, por meio de aplicativos, são portas de entrada para as tecnologias da informação e comunicação, recursos utilizados por docentes e discentes como metodologia científica de ensino-aprendizado. Além disso, atuam como ferramenta de apoio para profissionais. As evoluções científicas também abrangem a microbiologia clínica, onde é possível observar a inclusão de recursos tecnológicos com o objetivo de minimizar o tempo de análise e assegurar a qualidade dos resultados; entretanto, a automatização ainda é uma realidade distante em muitos laboratórios do Brasil, portanto, o objetivo desta pesquisa foi desenvolver e validar a funcionalidade de um aplicativo como ferramenta de apoio para discentes e profissionais de microbiologia clínica. Métodos: Pesquisa metodológica, aplicada e de produção tecnológica, realizada de abril a outubro de 2019. Foi escolhida a metodologia de Galvis-Panqueva, que compõe as etapas de construção e validação. Ao final das etapas que compõem a validação, 16 discentes da Ulbra Canoas e oito profissionais de microbiologia clínica avaliaram o aplicativo quanto às percepções como usuários. Após esta avaliação, obteve-se o Índice de Validade de Conteúdo. Resultados: O Índice de Validade de Conteúdo entre os profissionais foi de 0,97 e entre os discentes foi de 0,94, valores aceitáveis para validação. Conclusão: Os resultados atingiram o objetivo proposto e corrobora com demais pesquisas da mesma linha metodológica. O aplicativo atendeu aos critérios de desenvolvimento e validação e mostrou-se uma boa ferramenta de apoio para discentes e profissionais de microbiologia clínica.

Objective: The internet and smartphones are strongly present in the daily world. In addition to providing communication and leisure, smartphones, through applications, are the gateway to Information and Communication Technologies, a resource used by teachers and students as a scientific teaching-learning methodology. In addition, they act as a support tool for professionals. Scientific developments also include clinical microbiology, where it is possible to observe the inclusion of technological resources in order to minimize the analysis time and ensure the quality of the results. However, automation is still a distant reality in many laboratories in Brazil, therefore, the objective of this research was to develop and validate the functionality of an application as a support tool for students and professionals in clinical microbiology. Methods: Methodological, applied and technological production research, carried out from April to October 2019. The GalvisPanqueva methodology was chosen, which comprises the stages of construction and validation. At the end of the steps that make up the validation, 16 students from the Ulbra Canoas and eight professionals of clinical microbiology evaluated the application regarding their perceptions as users. Afterwards, the Content Validity Index was obtained. Results: The Content Validity Index among professiona was 0,97 and among students it was 0,94, acceptable values for validation. Conclusion: The results achieved the proposed objective and corroborates with other researches of the same methodological line. The application met the development and validation criteria and proved to be a good support tool for students and professionals in clinical microbiology.

Determinación de la contaminación bacteriana en conos de gutapercha en una clínica odontológica docente / Determination of bacterial contamination in gutapercha cones in an university dental clinic

Objetivo: El objetivo de este estudio fue determinar la contaminación bacteriana de los conos de gutapercha de tipo beta (ß) en los tiempos 0, 24, 47 y 72 horas de las diferentes proveedurías de la Clínica Odontológica de la Universidad Científica del Sur (Lima, 2020). Materiales y métodos: Se obtuvo 16 conos de gutapercha tipo beta (ß) de empaques cerrados bajo medidas asépticas, los cuales fueron colocados en viales con 2 ml de caldo BHI y, posteriormente, fueron sembrados en agar BHI, así como en medios selectivos agar manitol salado y agar MacConkey. Pasadas las 24 horas de incubación a 37 °C, se realizó la lectura de las placas y el conteo de UFC. El mismo procedimiento se realizó para los tiempos 24, 48 y 72 horas, lo que dio un total de 64 conos de gutapercha tipo ß. Resultados: Se observó que el nivel de contaminación bacteriana fue el mismo tanto entre las distintas proveedurías como a las 0, 24, 48 y 72 horas. Solo se hallaron diferencias estadísticamente significativas (p = 0,044) entre los distintos tiempos de la proveeduría número 5. Finalmente, todas las muestras sometidas a la prueba de la coagulasa arrojaron resultados negativos. Conclusión: Los conos de gutapercha de tipo beta (ß) se contaminaron por igual producto de su almacenamiento y manipulación, independientemente de la proveeduría en la que permanecieron. (AU)

Objective: The purpose of this study was to determinate the bacterial contamination of Beta (ß) gutta-percha cones at 0, 24, 47 and 72 hours of the different supplies of the Universidad Científica del Sur, Lima 2020. Materials and Methods: 16 ß-type gutta-percha cones were obtained of sealed packages under aseptic measurements, they were placed in vials with 2ml BHI and subsequently planted in BHI agar plates as well as in selective medias as Salted mannitol agar and MacConkey agar after 24 hours of incubation at 37 ° the plates were read and count in CFU, the same procedure was performed for the other times evaluated 24, 48 and 72 hours, giving a total of 64 ß-type gutta-percha cones. Results: It was observed that the level of bacterial contamination was the same among the different supplies in all the establish times of in this study 0, 24, 48 and 72 hours. Therefore, there were no significant differences in the level of bacterial contamination between the supplies. On the other hand, only statistically significant differences (p = 0.044) were found between the different times of the supply number 5. Finally, all the samples submitted to the coagulase test had a negative result. Conclusion: The gutta-percha cones of type ß were contaminated equally regardless of the supply in which they were stored or manipulated. (AU)

Potencial antimicrobiano e caracterização fitoquímica de extratos da casca do caule de Drimys brasiliensis Miers (Winteraceae) / Antimicrobial potential and phytochemical investigation of stem bark extracts from Drimys brasiliensis Miers (Winteraceae)

Introdução: na área da saúde, a resistência aos antimicrobianos tem se constituído um grave problema, fazendo com que a busca por alternativas farmacológicas assuma grande importância. Produtos de origem natural, como extratos de plantas, têm sido pesquisados para uso potencial no tratamento antibacteriano. Drimys brasiliensis Miers (Winteraceae) é uma árvore nativa do Brasil que tem sido utilizada como medicinal. Objetivo: investigar o perfil fitoquímico e a atividade antimicrobiana de amostras obtidas a partir de extratos da casca do caule de Drimys brasiliensis. Metodologia: frações de características químicas variadas foram obtidas a partir de extratos da casca do caule da planta. Realizou-se o screening fitoquímico destas frações através de reações gerais de caracterização e cromatografia em camada delgada. As amostras foram testadas por difusão em ágar e por microdiluição contra bactérias Grampositivas e Gram-negativas e contra uma levedura. Resultados: o perfil fitoquímico mostrou diferenças entre as frações analisadas. Alcaloides foram detectados nas frações mais apolares. Taninos e flavonoides estavam presentes nas amostras mais polares e obtidas sem o uso de calor. As amostras com maior atividade antimicrobiana foram as obtidas com os solventes hexano e diclorometano, de características mais apolares. Destaca-se a atividade contra Bacillus cereus, Staphylococcus epidermidis, Staphylococcus aureus resistente à meticilina e Candida albicans. Conclusão: extratos da casca do caule de Drimys brasiliensis apresentam potencial ntimicrobiano, com destaque para as frações mais apolares contra bactérias gram positivas.

Introduction: in the health field, antimicrobial resistance has been a serious issue, making the search for pharmacological alternatives very important. Natural products, such as plant extracts, have been researched for potential use in antibacterial treatment. Drimys brasiliensis Miers (Winteraceae) is a tree native to Brazil that has been medicinally used. Objective: to investigate the phytochemical profile and antimicrobial activity of samples obtained from Drimys brasiliensis stem bark extracts. Methodology: fractions of different chemical characteristics were obtained from extracts of the stem bark. Phytochemical screening of these fractions was performed by general reactions and thin layer chromatography. Samples were tested by agar diffusion and microdilution against Gram-positive and Gram-negative bacteria and yeast. Results: the phytochemical profile showed differences between the analyzed fractions. Alkaloids were detected in the most nonpolar fractions. Tannins and flavonoids were present in the most polar samples and obtained without the use of heat. The samples with the highest antimicrobial activity were those obtained with hexane and dichloromethane solvents, which present the most nonpolar characteristics. We highlight the activity against Bacillus cereus, Staphylococcus epidermidis, Methicillin resistant Staphylococcus aureus and Candida albicans. Conclusion: Drimys brasiliensis stem bark extracts have antimicrobial potential, especially the most nonpolar fractions against gram positive bacteria.

Hemocultivos en el Servicio de Pediatría del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo", Solca-Guayaquil / Blood cultures in the Pediatric Service of the "Dr. Juan Tanca Marengo", National Oncology Institute of Solca-Guayaquil

Introducción: La creciente resistencia antibiótica de los microorganismos aislados en cultivos de sangre en pacientes neutropénicos hace necesaria la continua monitorización del antibiograma para vigilar la cambiante susceptibilidad antibiótica. El objetivo de este estudio fue identificar a los microorganismos aislados de hemocultivos y su sensibilidad, en niños con cáncer ingresados en un Instituto Oncológico. Métodos: El presente es un estudio prospectivo de datos recolectados de junio 2017 a junio 2018, con aislamiento de cultivos de sangre en pacientes neutropénicos febriles hospitalizados en el área de pediatría del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" Solca, Guayaquil. Resultados: Fueron 183 pacientes, 133 (72 %) con neoplasias hematológicas y 50 (28 %) con tumores sólidos. Se tomaron 265 hemocultivos. 100 reportes (38 %) fueron positivos, 66 % fueron bacterias Gram-Positivas y 34 % Gram- negativas. Las bacterias más frecuentes 20 % E. epidermidis, 18 % E. aureus, 17 % E. haemolyticus, 12 % E. Coli. Las bacterias Gram-positivas fueron 100% sensibles al linezolid, vancomicina y tigacilina. Las Gram-negativas mantienen una sensibilidad de 91% a la amikacina, 59% a cefepime, 59% a ceftazidima, 77% a ciprofloxacina, 68% a imipenem, 76 % a meropenem, 56% a piperacilina- tazobactam, 100% al colistin y 97% a la tigeciclina. La Klebsiella Pneumoniae productora de Carbapenemasa (KPC) multirresistente fue sensible 100% a tigaciclina y colistin y 50% a la amikacina. Conclusión: La incidencia fue mayor para Gram- positivos. Existe una buena sensibilidad a la vancomicina, linezolid y tigaciclina para bacterias Gram- positivas; y a la amikacina, colistin y tigacilina para las Gram- negativas. Las bacterias KPC multiresistentes fueron solamente sensibles a tigeciclina y colistin.

Introduction: The increasing antibiotic resistance of isolated microorganisms in blood cultures in neutropenic patients makes it necessary to continuously monitor the antibiogram to monitor the changing antibiotic susceptibility. The objective of this study was to identify during one year the isolated microorganisms of blood cultures and their sensitivity, in children with cancer admitted to an Oncological Institute. Methods: This is a prospective study of data collected from June 2017 to June 2018, with isolation of blood cultures in febrile neutropenic patients hospitalized in the pediatric area of the National Oncology Institute "Dr. Juan Tanca Marengo "Solca, Guayaquil. Results: There were 183 patients, 133 (72%) with hematological malignancies and 50 (28%) with solid tumors. In this group 265 blood cultures were taken. 100 reports (38%) were positive, 66% were Gram-Positive bacteria and 34% Gram-negative. The most frequent bacteria 20% E. epidermidis, 18% E. aureus, 17% E. haemolyticus, 12% E. Coli, 10% Staphylococcus hominis, 9% Klebsiella Pneumoniae, 6% Pseudomona species, 5% Acinetobacter, Gram bacteria -positives were 100% sensitive to linezolid, vancomycin and tigacillin; while Gram-negatives maintain a sensitivity of 91% to amikacin, 59% to cefepime, 59% to ceftazidime, 77% to ciprofloxacin, 68% to imipenem, 76% to meropenem, 56% to piperacillin-tazobactam, 100% at colistin and 97% at tigecycline. An increase in multi-resistant Carbapenemase-producing Klebsiella Pneumoniae (KPC) was observed, 100% sensitive to tigacycline and colistin and 50% to amikacin. Conclusion: The incidence was higher for gram-positive bacteria. There is a good sensitivity to vancomycin, linezolid and tigacycline for gram-positive bacteria; and to amikacin, colistin and tigacillin for Gram-negatives. The multi-resistant KPC bacteria were only sensitive to tigecycline and colistin.

Epidemiological profile and vaccination coverage in splenectomy patients in a health area of Murcia (1993-2012). / Perfil epidemiológico y cobertura vacunal en pacientes esplenectomizados en un área sanitaria de Murcia (1993-2012).

OBJECTIVE: Splenectomy patients have a high risk of suffering severe infections, many of them preventable by vaccination. The aim of the study was to analyse the clinical epidemiological characteristics and vaccine coverage of these patients in Health Area III of the Region of Murcia. METHOD: A cross-sectional study was conducted on a population of patients that were splenectomised during the period 1993-2012, according to the Register of the Basic Minimum Data Set. Patients were classified on the basis of splenectomy (neoplasm, haematological diseases, trauma, and others), vaccination, and vital status, using official records of health data. Statistical analysis was performed using SPSS 21.0 statistics program. RESULTS: The sample consisted of 196 patients, of which 68.4% (n=134) were male. The mean age at which they underwent splenectomy was 50.1 years (SD: 22.2). The most common reason for removal of the spleen was neoplasia in 39.1% (n=59). Splenectomy due to trauma reasons was associated with lower patient age (p<.001) and male gender (p=.03). Vaccination coverage for Streptococcus pneumoniae was 23.8%, 5.7% for Neisseria meningitidis C, and 8.6% for Haemophilus influenzae B. Only 2.9% of patients were correctly vaccinated for all three. CONCLUSIONS: Vaccination coverage was insufficient for this fragile patient profile. It should be taken into account in the early detection and counselling in this group so susceptible to disease, with nurses being a decisive part in the process.

Perfil de resistencia bacteriana en hospitales y clínicas en el departamento del Cesar (Colombia) / Bacterial resistance profile and clinical hospital department of Cesar (Colombia)

Introducción: la resistencia a los antimicrobianos es un problema de salud pública cuyo tratamiento puede ser difícil y costoso. Objetivo: analizar el fenotipo de resistencia antimicrobiana en bacterias aisladas en hospitales y clínicas del departamento del Cesar (Colombia) durante 2014. Materiales y métodos: se realizó un estudio descriptivo en cinco laboratorios clínicos del departamento. Se utilizó el software Whonet 5.6 para el análisis de datos y se reportaron los perfiles de resistencia. Resultados: las principales bacterias Gram negativas aisladas en la Unidad de Cuidados Intensivos fueron Klebsiella pneumoniae (18,8%), Pseudomonas aeruginosa (15,0%) y Escherichia coli (13,8%). En los demás servicios predominaron Escherichia coli (36,4%) y Staphylococcus aureus (15,5%). En la Unidad de Cuidados Intensivos la mayor resistencia fue a la ampicilina-sulbactam y las cefalosporinas de tercera y cuarta generación en los aislados de Klebsiella pneumoniae (46,2%, 28,3% y 29,1%, respectivamente) y de Escherichia coli (21,8%, 21,8% y 23,0%, respectivamente). En los aislados de Acinetobacter la resistencia fue mayor que en los de Pseudomonas aeruginosa, con predominio a la ceftriaxona y la cefepima (51,1%) en los aislados de la Unidad de Cuidados Intensivos. En los aislamientos de Staphylococcus aureus y Staphylococcus epidermidis se observó resistencia a la oxacilina en el 61,0% y 81,8% de los provenientes de la Unidad de Cuidados Intensivos, y en el 48,7% y el 89,7% de las demás unidades, respectivamente. Conclusiones: se observaron altas frecuencias de resistencia antibiótica por lo que reforzar la vigilancia epidemiológica a nivel local permitirá disminuir la resistencia bacteriana en los ambientes intrahospitalarios. (AU)

Introduction: Antimicrobial resistance is a public health problem that implies difficult and expensive treatments. Objective: to analyze the antimicrobial resistance phenotypes in bacterias isolated in hospitals and clinics in the department of Cesar (Colombia) during 2014. Materials and methods: A descriptive study was conducted in five clinical laboratories of the department. Data were analyzed using Whonet 5.6 software and profiles of bacterial resistance were reported. Results: Gram-negative bacteria more isolated in Intensive Care Unit were Klebsiella pneumoniae (18.8%), Pseudomonas aeruginosa (15.0%) and Escherichia coli (13.8%). In the non-Intensive Care Unit service Escherichia coli (36.4%) and Staphylococcus aureus (15.5%) predominated. In the Intensive Care Unit service a higher resistance was obtained to ampicillin-sulbactam and third and fourth generation of cephalosporins in Klebsiella pneumonia isolates (28.3%, 29.1% and 29.1%, respectively), and Escherichia coli isolates (21.8%, 21.8% y 23.0%, respectively). In Acinetobacter isolates the resistance was higher than Pseudomonas aeruginosa isolates, with a predominance of resistance to ceftriaxone and cefepime (51.1%) of Intensive Care Unit isolates. In Staphylococcus aureus and Staphylococcus epidermidis isolates the resistance to oxacillin were observed in 61.0% y 81.8% in Intensive Care Unit isolates and 48.7% and 89.7% in the others services, respectively. Conclusions: High frequencies of antibiotic resistance were observed. Therefore, reinforcing local epidemiological surveillance will allow decreasing bacterial resistance in hospital settings. (AU)

Actinomicosis Torácica / Thoracic Actinomycosis

La actinomicosis torácica es una infección bacteriana lentamente progresiva, producida por bacterias grampositivas anaerobias o microaerófilas que colonizan la orofaringe y el tracto gastrointestinal. Su baja frecuencia en la actualidad y sus distintas ubicaciones anatómicas constituyen un desafío diagnóstico para las distintas especialidades de la medicina. En este trabajo se presenta el caso de un paciente de 44 años de edad, con antecedentes de salud, que ingresa en el Hospital Regional de Zacapa en Guatemala por fístulas en hemitórax izquierdo y neumonía en vértice homolateral de 6 meses de evolución, interpretado inicialmente como tuberculosis pulmonar. Luego de exámenes complementarios y otros como Radiografía de Tórax, Baciloscopia, VIH y Cultivo de secreción de la lesión, se realizó Biopsia de la lesión, observándose gránulos de azufre con abundante tejido de granulación y celularidad compatible con Actinomyces israelii(AU)

Thoracic actinomycosis is a slowly progressing bacterial infection caused by gram-positive anaerobic or microaerophilic bacteria that colonize oropharynx and gastrointestinal tract. Its low frequency at present and its different anatomical locations are a diagnostic challenge for various medical specialties. The case of a 44-year-old man with health history is presented here. This patient was admitted at Zacapa Regional Hospital in Guatemala due to a fistula in left chest and pneumonia in ipsilateral vertex for six months, initially it was interpreted as pulmonary tuberculosis. After further examination and studies such as chest x-rays, smear, HIV and culture of discharge of the injury, this patient underwent a biopsy of the lesion, showing sulfur granules and abundant granulation tissue and Actinomyces israelii compatible cellularity(AU)

Actinomicosis Torácica / Thoracic Actinomycosis

La actinomicosis torácica es una infección bacteriana lentamente progresiva, producida por bacterias grampositivas anaerobias o microaerófilas que colonizan la orofaringe y el tracto gastrointestinal. Su baja frecuencia en la actualidad y sus distintas ubicaciones anatómicas constituyen un desafío diagnóstico para las distintas especialidades de la medicina. En este trabajo se presenta el caso de un paciente de 44 años de edad, con antecedentes de salud, que ingresa en el Hospital Regional de Zacapa en Guatemala por fístulas en hemitórax izquierdo y neumonía en vértice homolateral de 6 meses de evolución, interpretado inicialmente como tuberculosis pulmonar. Luego de exámenes complementarios y otros como Radiografía de Tórax, Baciloscopia, VIH y Cultivo de secreción de la lesión, se realizó Biopsia de la lesión, observándose gránulos de azufre con abundante tejido de granulación y celularidad compatible con Actinomyces israelii(AU)

Thoracic actinomycosis is a slowly progressing bacterial infection caused by gram-positive anaerobic or microaerophilic bacteria that colonize oropharynx and gastrointestinal tract. Its low frequency at present and its different anatomical locations are a diagnostic challenge for various medical specialties. The case of a 44-year-old man with health history is presented here. This patient was admitted at Zacapa Regional Hospital in Guatemala due to a fistula in left chest and pneumonia in ipsilateral vertex for six months, initially it was interpreted as pulmonary tuberculosis. After further examination and studies such as chest x-rays, smear, HIV and culture of discharge of the injury, this patient underwent a biopsy of the lesion, showing sulfur granules and abundant granulation tissue and Actinomyces israelii compatible cellularity(AU)

Características clínico-epidemiológicas de 17 pacientes con infección asociada con catéter de venoso central, hospitalizados en la Unidad de Cuidado Intensivo adultos. Clínica Cardiovascular Santa María, 2010 / Clinical and epidemiological characteristics of 17 patients with central venous catheterassociated infections, hospitalized in the critical intensive care unit. Clinica Cardiovascular Santa Maria, 2010 / Características clínico-epidemiológicas de 17 pacientes com infecção associada a cateter de venoso central, hospitalizados na unidade de cuidado intensivo adultos. Clínica Cardiovascular Santa Maria, 2010

Objetivo: describir las características clínico-epidemiológicas de las infecciones asociadas con catéter venoso central de 17 pacientes hospitalizados en la Unidad de Cuidado Intensivo de la Clínica Cardiovascular Santa María (CCVSM). Metodología: estudio descriptivo retrospectivo del tipo series casos, realizado entre enero y diciembre de 2010 y la fuente de información fue la historia clínica. Se hizo análisis descriptivo de los datos. La utilizó la definición de infección asociada con catéter venoso central de los Centros para la Prevención y Control de Enfermedades (CDC). Resultados: durante el 2010 se diagnosticó infección por catéter venoso central a 17 pacientes, los cuales tuvieron una edad mediana de 68 (RIC=55-68) años. El 64.7% de sexo masculino. Los antecedentes personales más frecuentes fueron los asociados con enfermedad cardiovascular. La mediana de días estancia hospitalaria fue de 54 días (RIC=25-83). Por sitio anatómico de inserción del catéter, el 58.8% fue yugular y el 41.2% restante subclavio. La mediana en días de uso de catéter venoso central fue de nueve días (RIC=6.5-17.5). Las especies identificadas más frecuentes relacionadas con infección asociada al cuidado de la salud fueron: S. epidermidis (21.1%), E. cloacae, K. pneumoniae y S. marcescens (cada uno con 10.3%). Conclusiones: las características clínicas y epidemiológicas de los casos de infección asociada con CVC en la UCI de la CCVSM son similares a las encontradas en otros estudios en el ámbito mundial.

Objective: To describe the clinical and epidemiologic characteristics of the infections associated to central venous catheter use in 17 patients hospitalized in the critical intensive care unit of Clínica Cardiovascular Santa María. Methods: A restrospective descriptive case series study was conducted between January and December of 2010. The source of information was the medical record. Descriptive analysis of the data was performed. The definition of infection associated with central venous catheter of the Centers for Disease Control and Prevention (CDC) was used. Results: During 2010, central venous catheter infection was diagnosed in 17 patients, the median age was 68 (IQR=55-68). A 64.7% of the patients were male. The most common personal antecedents were those associated with cardiovascular disease. The median length of hospital stay was 54 days (IQR=25-83). Catheter insertion by anatomic site was 58.8% jugular and 41.2% subclavian. The median duration of central venous catheter placement was 9 days (IQR=6.5-17.5). The most common identified species related with healthcare associated infections (HAIs) of CVC were: s. epidermidis (21.1%), and e.cloacae,K. pneumoniae and s. marcescens (10.3%each).Conclusions: The clinical and epidemiological characteristics of cases of central venous catheter-associated infection in the ICU of the CCVSM are similar to those found in other studies worldwide

Objetivo: descrever as características clínico-epidemiológicas das infecções associadas a cateter venoso central de 17 pacientes hospitalizados na Unidade de Cuidado Intensivo da Clínica Cardiovascular Santa Maria (CCVSM). Metodologia: estudo descritivo retrospectivo do tipo séries casos, realizado entre janeiro e dezembro de 2010, a fonte de informação foi a história clínica. Realizou-se análise descritiva dos dados. Utilizou-A a definição de infecção associada a cateter venoso central dos Centros para a Prevenção e Controle de Doenças (CDC).Resultados: durante o 2010 se diagnosticou infecção por cateter venoso central a 17 pacientes, os quais tiveram uma idade média de 68 (RIC=55-68) anos. O 64.7% deles foram de sexo masculino. Os antecedentes pessoais mais frequentes foram os sócios a doença cardiovascular. A média de dias estadia hospitalar foi de 54 dias (RIC=25-83). Por lugar anatômico de inserção do cateter, o 58.8% foi jugular e o 41.2% restante subclávio. A média em dias de uso de cateter venoso central foi de nove dias (RIC=6.5-17.5). As espécies identificadas mais frequentes relacionadas a infecção associada ao cuidado da saúde foram: s. epidermidis (21.1%), e. cloacae, K. pneumoniae e s. marcescens (cada um com 10.3%). Conclusões: As características clínicas e epidemiológicas dos casos de infecção associada a CVC na UCI da CCVSM são similares às encontradas em outros estudos no âmbito mundial