Lysine grafted poly(lactic acid): An intrinsically antimicrobial polymer.

Nosocomial infections or healthcare-associated infections, normally develops after the healthcare treatment in the hospital. Most of them are caused by infected medical devices. Plastics are the most common materials for manufacturing these devices because of their good processability, sterilization efficacy, ease of handling and harmlessness, however, it usually do not display antimicrobial properties. Here, in order to infer antimicrobial activity to poly(lactic acid), it was modified by maleation, followed by l-lysine grafting to its structure. The chemical modifications were confirmed by FTIR and 1H NMR analysis, indicating the success of the reactions. The antimicrobial activity was tested using Escherichia coli and Staphylococcus aureus and the results showed that the sample was capable of inhibiting about 99 % of the S. aureus growth by contact. The samples cytotoxicity was also tested using the L929 mouse cells and the results indicated no cytotoxic effect. These results indicated the sample antimicrobial potential, without affect the normal eukaryotic cells. In addition, the processability of the modified PLA (PLA-g-Lys) was improved without compromising its mechanical properties, as shown by thermal analysis and tensile tests. Thus, this novel PLA derivative can be seen as a promising material for future applications in the manufacturing of biomedical devices.

Linezolid and vancomycin for nosocomial infections in pediatric patients: a systematic review

Abstract Objective: To investigate the effectiveness of linezolid and vancomycin for the treatment of nosocomial infections in children under 12 years old. Data sources: This is a systematic review in which five randomized clinical trials about the effectiveness of linezolid and vancomycin, involving a total of 429 children with nosocomial infections, were evaluated. They were searched in scientific databases: PubMed, Bvs, and SciELO. Summary of findings: The main nosocomial infections that affected children were bacteremia, skin, and soft tissue infections followed by nosocomial pneumonia. Most infections were caused by Gram-positive bacteria, which all studies showed infections caused by Staphylococcus aureus, with methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci strains being isolated. Both linezolid and vancomycin showed high therapeutic efficacy against different types of nosocomial infections, ranging from 84.4% to 94% for linezolid and 76.9% to 90% for vancomycin. Patients receiving linezolid had lower rates of rash and red man syndrome compared to those receiving vancomycin. However, despite the adverse reactions, antimicrobials can be safely administered to children to treat nosocomial infections caused by resistant Gram-positive bacteria. Conclusion: Both linezolid and vancomycin showed good efficacy in the treatment of bacterial infections caused by resistant Gram-positive bacteria in hospitalized children. However, linezolid stands out regarding its pharmacological safety. Importantly, to strengthen this conclusion, further clinical trials are needed to provide additional evidence.

Construcción y validación de un cuestionario sobre actitudes hacia la higiene de manos / Construction and validation of a questionnaire on attitudes towards hand hygiene

INTRODUCCIÓN: La higiene de manos es la medida más eficaz para prevenir las infecciones asociadas al cuidado de la salud. Las actitudes hacia esta práctica tan sencilla, influyen en el grado de adherencia. OBJETIVO: Desarrollar y validar un instrumento para evaluar las actitudes hacia la higiene de manos en estudiantes de Licenciatura en Enfermería. MÉTODO: Se realizó un estudio observacional y de corte transversal. Una vez construido el instrumento se realizó la validez de contenido mediante el juicio de expertos. Para la validez de constructo se realizó análisis factorial exploratorio. Posteriormente se calculó la confiabilidad, que incluyó la consistencia interna y la estabilidad del cuestionario. RESULTADOS: Participaron 313 estudiantes de Licenciatura en Enfermería de ocho universidades de Argentina. Se calculó el Kaiser-Meyer-Olkin (KMO = 0,720) y se obtuvo una prueba de esfericidad de Bartlett significativa (x2 = 831,2; = 0,000). El análisis factorial exploratorio determinó la existencia de un único factor. El modelo explicó el 54% de la varianza. Se utilizó la implementación mejorada de la estimación Bayesiana EAP integrada en el programa FACTOR, que fue de 0,85 y se realizó test-retest utilizando análisis de correlación que arrojó un r = 0,64 (p ≤ 0,001). CONCLUSIONES: El cuestionario sobre actitudes hacia la higiene de manos (CAHM) presenta una adecuada validez y confiablidad, por lo que puede ser utilizado para indagar sobre este factor predisponente de adherencia hacia la higiene de manos.

BACKGROUND: Hand hygiene is the most effective measure to prevent health care-associated infections. Attitudes towards this simple practice influence the level of adherence. AIM: To develop and validate an instrument for the evaluation of attitudes towards hand hygiene in nursing students. METHOD: An observational and cross-sectional study was carried out. Once the instrument was constructed, content validity was carried out through expert judgment. For construct validity, exploratory factor analysis was performed. Subsequently, the analysis of construct validity and reliability was calculated, which included the internal consistency and stability of the questionnaire. RESULTS: 313 Nursing undergraduate students from 8 universities in Argentina participated. The Kaiser-Meyer-Olkin (KMO = 0.720) was calculated, and a significant Bartlett sphericity test was obtained (x2 = 831.2; = 0.000). The exploratory factor analysis determined the existence of a single factor. The model explained 54% of the variance. The improved implementation of the Bayesian EAP estimation integrated in the FACTOR program was used, which was 0.85; and test-retest was also performed using correlation analysis that yielded r = 0.64 (p ≤ 0.001). CONCLUSIONS: The Questionnaire on attitudes towards hand hygiene (CAHM) has adequate validity and reliability, so it can be used to investigate this predisposing factor of adherence to hand hygiene.

Comparative genomic analysis of Pseudomonas aeruginosa strains susceptible and resistant to carbapenems and aztreonam isolated from patients with healthcare-associated infections in a Mexican hospital.

Pseudomonas aeruginosa (PA) is an important opportunistic pathogen that causes different infections on immunocompromised patients. Within PA accessory genome, differences in virulence, antibiotic resistance and biofilm formation have been described between strains, leading to the emergence of multidrug-resistant strains. The genome sequences of 17 strains isolated from patients with healthcare-associated infections in a Mexican hospital were genomically and phylogenetically analyzed and antibiotic resistance genes, virulence genes, and biofilm formation genes were detected. Fifteen of the 17 strains were resistant to at least two of the carbapenems meropenem, imipenem, and the monobactam aztreonam. The antibiotic resistance (mexA, mexB, and oprM) and the biofilm formation (pslA and pslD) genes were detected in all strains. Differences were found between strains in accessory genome size. The strains had different sequence types, and seven strains had sequence types associated with global high risk epidemic PA clones. All strains were represented in two groups among PA global strains. In the 17 strains, horizontally acquired resistance genes to aminoglycosides and beta-lactams were found, mainly, and between 230 and 240 genes that encode virulence factors. The strains under study were variable in terms of their accessory genome, antibiotic resistance, and virulence genes. With these characteristics, we provide information about the genomic diversity of clinically relevant PA strains.

Linezolid and vancomycin for nosocomial infections in pediatric patients: a systematic review.

OBJECTIVE: To investigate the effectiveness of linezolid and vancomycin for the treatment of nosocomial infections in children under 12 years old. DATA SOURCES: This is a systematic review in which five randomized clinical trials about the effectiveness of linezolid and vancomycin, involving a total of 429 children with nosocomial infections, were evaluated. They were searched in scientific databases: PubMed, Bvs, and SciELO. SUMMARY OF FINDINGS: The main nosocomial infections that affected children were bacteremia, skin, and soft tissue infections followed by nosocomial pneumonia. Most infections were caused by Gram-positive bacteria, which all studies showed infections caused by Staphylococcus aureus, with methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci strains being isolated. Both linezolid and vancomycin showed high therapeutic efficacy against different types of nosocomial infections, ranging from 84.4% to 94% for linezolid and 76.9% to 90% for vancomycin. Patients receiving linezolid had lower rates of rash and red man syndrome compared to those receiving vancomycin. However, despite the adverse reactions, antimicrobials can be safely administered to children to treat nosocomial infections caused by resistant Gram-positive bacteria. CONCLUSION: Both linezolid and vancomycin showed good efficacy in the treatment of bacterial infections caused by resistant Gram-positive bacteria in hospitalized children. However, linezolid stands out regarding its pharmacological safety. Importantly, to strengthen this conclusion, further clinical trials are needed to provide additional evidence.

[Eccema herpético en una paciente con dermatitis atópica].

Background: Eczema herpeticum is an infection caused by herpes simplex virus in patients with atopic dermatitis, among its complications we can find meningitis, encephalitis, acute liver failure, and Staphylococcus aureus infection. Case report: We report the case of a female patient of 5 years of age, with a history of atopic dermatitis complicated by eczema herpeticum, who was treated initially without relief. Her hospital stay was complicated with cross infections, which prolonged her course. Dermatology diagnosed eczema herpeticum. Immediately after the start of treatment, the patient showed improvement. Conclusions: Eczema herpeticum is a rare complication of atopic dermatitis, it must be suspected based on patient history and physical examination. Therefore, early recognition and diagnosis are of clinical importance. Without an appropriate approach, these patients can present shock, sepsis, and death.

Antecedentes: El eccema herpético es una infección causada por el virus del herpes simple, que afecta a pacientes con dermatitis atópica. Las principales complicaciones son meningitis, encefalitis, insuficiencia hepática aguda e infección por Staphylococcus aureus. Reporte de caso: Paciente pediátrica de 5 años, con antecedente de dermatitis atópica complicada con eccema herpético, que recibió tratamiento sin reacción satisfactoria. Durante la hospitalización tuvo infecciones nosocomiales que prolongaron su estancia. Luego de la evaluación por personal del servicio de Dermatología se estableció el diagnóstico de eccema herpético, con adecuado tratamiento, seguimiento y egreso sin complicaciones. Conclusiones: El eccema herpético es una complicación rara de la dermatitis atópica, que debe diagnosticarse con base en los antecedentes personales patológicos y la exploración física adecuada. La atención oportuna es de relevancia clínica, pues los pacientes pueden tener complicación serias (choque, sepsis, incluso la muerte). Palabras clave: Eccema herpético; dermatitis atópica; infección nosocomial; Staphylococcus aureus.

Metabarcoding approach to identify bacterial community profiling related to nosocomial infection and bacterial trafficking-routes in hospital environments.

Nosocomial infections (NIs) appear in patients under medical care in the hospital. The surveillance of the bacterial communities employing high-resolution 16S rRNA profiling, known as metabarcoding, represents a reliable method to establish factors that may influence the composition of the bacterial population during NIs. The present study aimed to utilize high-resolution 16S rRNA profiling to identify high bacterial diversity by analyzing 11 inside and 10 outside environments from the General Hospital of Ribeirão Preto Medical School, Brazil. Our results identified a high bacterial diversity, and among these, the most abundant bacterial genera linked to NIs were Cutibacterium, Streptococcus, Staphylococcus, and Corynebacterium. A Acinetobacter was detected in cafeterias, bus stops, and adult and pediatric intensive care units (ICUs). Data suggest an association between transport and alimentation areas proximal to the hospital ICU environment. Interestingly, the correlation and clusterization analysis showed the potential of the external areas to directly influence the ICU pediatric department microbial community, including the outpatient's clinic, visitor halls, patient reception, and the closest cafeterias. Our results demonstrate that high-resolution 16S rRNA profiling is a robust and reliable tool for bacterial genomic surveillance. In addition, the metabarcoding approach might help elaborate decontamination policies, and consequently reduce NIs.

Comparative Genomic Analyses of Virulence and Antimicrobial Resistance in Citrobacter werkmanii, an Emerging Opportunistic Pathogen.

Citrobacter werkmanii is an emerging and opportunistic human pathogen found in developing countries and is a causative agent of wound, urinary tract, and blood infections. The present study conducted comparative genomic analyses of a C. werkmanii strain collection from diverse geographical locations and sources to identify the relevant virulence and antimicrobial resistance genes. Pangenome analyses divided the examined C. werkmanii strains into five distinct clades; the subsequent classification identified genes with functional roles in carbohydrate and general metabolism for the core genome and genes with a role in secretion, adherence, and the mobilome for the shell and cloud genomes. A maximum-likelihood phylogenetic tree with a heatmap, showing the virulence and antimicrobial genes' presence or absence, demonstrated the presence of genes with functional roles in secretion systems, adherence, enterobactin, and siderophore among the strains belonging to the different clades. C. werkmanii strains in clade V, predominantly from clinical sources, harbored genes implicated in type II and type Vb secretion systems as well as multidrug resistance to aminoglycoside, beta-lactamase, fluoroquinolone, phenicol, trimethoprim, macrolides, sulfonamide, and tetracycline. In summary, these comparative genomic analyses have demonstrated highly pathogenic and multidrug-resistant genetic profiles in C. werkmanii strains, indicating a virulence potential for this commensal and opportunistic human pathogen.

Healthcare Costs of Major Morbidities Associated with Prematurity in US Children's Hospitals.

OBJECTIVE: To evaluate the healthcare costs attributed to major morbidities associated with prematurity, namely, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and nosocomial infections. STUDY DESIGN: This was a retrospective analysis of infants born at 24-30 weeks of gestation, admitted to children's hospitals in the Pediatric Health Information System between 2009 and 2018. Charges were adjusted by geographical price index, converted to costs using cost-to-charge ratios, inflated to 2018 US$, and total costs were accumulated for the initial hospitalization. Quantile regressions, which are less prone to bias from extreme outliers, were used to examine the incremental costs attributed to each morbidity across the entire cost distribution, including the median. RESULTS: There were 19 232 patients from 30 children's hospitals who were eligible. Higher costs were seen in lower gestational age, more severe morbidity, and those with higher number of comorbidities. Patients with surgical NEC, severe ROP, and severe BPD were the costliest with median total costs of $430 860, $413 825, and $399 495, respectively. Quantile regressions showed surgical NEC had the highest adjusted median incremental total cost ($48 621; 95% CI, $39 617-$57 626) followed by severe BPD ($35 773; 95% CI, $32 018-$39 528) and severe ROP ($22 561; 95% CI, $16 699-$28 423). Quantile regressions also revealed that surgical NEC, severe BPD, and severe ROP had increasing incremental costs at higher total cost percentiles, indicating these morbidities have a greater cost impact on the costliest patients. CONCLUSIONS: Severe BPD, surgical NEC, and severe ROP are the costliest morbidities and contribute the most incremental costs especially for the higher costs patients.

Biofilm-forming microorganisms causing hospital-acquired infections from intravenous catheter: A systematic review.

The high prevalence of nosocomial infections is related to the use of medical insertion devices such as central venous catheters (CVCs). Most of the microorganisms causing nosocomial infections are biofilm producers, this characteristic allows them to adhere to abiotic surfaces and cause initial catheter infections that can lead to bloodstream infections. Our main goal in this systematic review was to evaluate the prevalence of biofilm among CVC-related infections, particularly among Intensive Care Unit (ICU) patients, in the studies applying different in vitro and in vivo methodologies. All studies reporting clinical isolates from patients with catheter-related nosocomial infections and biofilm evaluation published up to 24 June 2022 in the PubMed and Scopus databases were included. Twenty-five studies met the eligibility criteria and were included in this systematic review for analysis. Different methodologies were applied in the assessment of biofilm-forming microorganisms including in vitro assays, catheter-infected in vitro, and in vivo mouse models. The present study showed that between 59 and 100% of clinical isolates were able to form biofilms, and the prevalence rate of biofilm formation varied significantly between studies from different countries and regions. Among the clinical isolates collected in our study set, a wide variety of microorganisms including Gram-positive strains, Gram-negative strains, and Candida albicans were found. Many authors studied resistance mechanisms and genes related to biofilm development and surface adherence properties. In some cases, the studies also evaluated biofilm inhibition assays using various kinds of catheter coatings.

Monkeypox Virus Transmission to Healthcare Worker through Needlestick Injury, Brazil.

We describe monkeypox virus (MPXV) transmission from a patient to a healthcare worker through needlestick injury. A lesion appeared at the inoculation site 5 days after injury. Blood tested MPXV-positive by PCR before symptoms worsened; blood remained MPXV-positive at discharge 19 days after symptom onset. Postexposure prophylaxis could prevent potential MPXV bloodborne transmission.

Efectividad de un programa de superación en la prevención de infecciones asociadas a la asistencia sanitaria aplicando la teoría ambientalista de Florence Nightingale / Effectiveness of an improvement program in the prevention of infections associated with health care applying the environmentalist theory of Florence Nightingale

Introducción: Las infecciones asociadas a la asistencia sanitaria son consideradas uno de los indicadores de calidad en la atención hospitalaria, estas tienen un origen multifactorial complejo, cuyos factores involucrados son difíciles de modificar; sin embargo, existe la posibilidad de intervenir en el personal. Objetivo: Evaluar la efectividad de un programa de superación en la prevención de infecciones asociadas a la asistencia sanitaria aplicando la teoría ambientalista de Florencia Nightingale. Métodos: Se realizó una investigación preexperimental longitudinal en servicios de mayor incidencia con estas infecciones en el Hospital General Mártires del 9 de abril, de Villa Clara en el periodo 2019-2020. La población 139 profesionales de enfermería con una muestra de 125, a los que se aplicó una encuesta y se realizó una observación participante. Asimismo, se recogió además el criterio de especialistas de grupos nominales. Resultados: 78,40 % licenciados en enfermería, 49,60 % con menos de 5 años de desempeño laboral. Sobre definición, localizaciones y gérmenes más frecuentes de IAAS antes de la capacitación 84,00 % tenían inadecuado conocimiento y después 92,80 %. En normas de prevención y control antes de aplicada la capacitación el lavado de manos sólo alcanzo 24,80 %; después 96,00 %. En la observación de procederes 77,60 % recibieron evaluación de inadecuado, perfeccionando estas técnicas en un 90,40 % después de aplicada la misma. La afectividad de la superación 95.20 %Conclusión: El programa de superación en la prevención de infecciones asociadas a la asistencia sanitaria aplicando la teoría ambientalista de Florencia Nightingale resultó efectivo, al actualizar conocimientos, modificar prácticas y actitudes al fomentar un entorno cordial.

Introduction: Health care-associated infections are considered one of the quality indicators in hospital care, they have a complex multifactorial origin, whose factors involved are difficult to modify, however, there is the possibility of intervening in the staff. Objective: To evaluate the effectiveness of an improvement program in the prevention of infections associated with health care applying the environmentalist theory of Florence Nightingale. Methods: A longitudinal pre-experimental investigation was carried out in services with the highest incidence of these infections at the Hospital General Mártires del 9 de abril, in Villa Clara in the period 2019-2020. The population was 139 nursing professionals with a sample of 125, to whom a survey was applied and a participant observation was carried out. The criteria of nominal group specialists were also collected.Results: 78.40% were nursing graduates, 49.60% with less than 5 years of work performance. About the definition, locations and most frequent germs of IAAS before the training, 84.00% had inadequate knowledge and after 92.80%. In prevention and control standards, before the training was applied, hand washing only reached 24.80% and after 96.00%. In the observation of procedures, 77.60% received an evaluation of inadequate, perfecting these techniques in 90.40% after applying it. The affectivity of overcoming was 95.20%. Conclusions: The improvement program in the prevention of infections associated with health care applying the environmentalist theory of Florence Nightingale was effective, updating knowledge, modifying practices and attitudes and promoting a pleasant environment

Is the Oral Cavity of Intensive Care Unit Pediatric Patients More Susceptible to Methicillin-Resistant Staphylococcus aureus Infection?

Objective: The aim of this study was to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the oral cavity of pediatric patients hospitalized at an intensive care unit (ICU). Methodology: Thirty ICU patients (group 1) and 30 healthy patients (group 2), between 1 and 12 years of age, matched by sex and age, were selected from a public hospital in Brazil. After oral examinations, biological specimens (nostril swab, oral mucosa, and supragingival biofilm) were collected from both groups to verify the presence of Staphylococcus aureus. Identification occurred after growth in Tryptic Soy Broth with 7.5% of NaCl for 48 hours, growth in Mannitol Salt Agar, gram staining, catalase, and coagulase tests. S. aureus isolates were submitted to antibiotic sensitivity test. Results: Only 36.7% of patients in the ICU perform oral hygiene during the hospitalization period and 41.7% presented high level of dental biofilm accumulation. The presence of S. aureus was similar in patients from group 1 (43.3%, 13) and group 2 (50.0%, 15) (p = 0.60). Both groups presented 18 samples each that tested positive for S. aureus. However, when considering patients infected by MRSA, the prevalence was higher in group 1 (eight; 26.7%) than in group 2 (five; 16.7%) but no statistical difference was observed (p = 0.53). In group 1, nine MRSA samples were resistant to erythromycin and seven to clindamycin. In group 2, two MRSA samples were resistant to erythromycin and two to clindamycin. Conclusions: Although ICU children did not show a significant higher carriage of MRSA when compared with the healthy group in the population studied, the number of highly resistant strains in the oral cavity isolated from ICU patients adds an important risk factor to be considered by the medical team as possible source of systemic infections, extended hospital stay, and poor outcomes.

Portación nasal de Staphylococcus aureus en el personal de salud de áreas críticas de un Hospital Pediátrico durante julio-setiembre 2018 / Nasal carriage of Staphylococcus aureus in health personnel in critical areas of a Pediatric Hospital during July-September 2018 / Transporte nasal de Staphylococcus aureus em profissionais de saúde em áreas críticas de um Hospital Pediátrico durante julho-setembro de 2018

Las infecciones intrahospitalarias (IIH) son causa de elevada morbimortalidad y representan un problema sanitario importante. El personal de salud es reservorio y potencial transmisor de los agentes etiológicos de las mismas. S. aureus es uno de los microorganismos implicados, por lo tanto es importante conocer la frecuencia de portación en el personal de salud y establecer el perfil de susceptibilidad antimicrobiana para contribuir con la elaboración de medidas de prevención incluyendo actividades educativas. Objetivo: Conocer la frecuencia de portación de S. aureus, distribución y antibiotipos de las cepas presentes en el personal sanitario del Hospital Pediátrico de Referencia (HPR). Materiales y métodos: Se realizó un estudio descriptivo durante el periodo julio-setiembre del año 2018. Se incluyeron muestras de hisopados nasales de trabajadores de la salud de distintas áreas de internación que consintieron participar en el estudio. Se excluyeron aquellos que recibieron antibióticos dentro de los 3 meses previos al estudio. Las muestras fueron sembradas en agar sangre ovina al 5% (ASO) y se incubaron a 35-37ºC en aerobiosis por 24-48 horas. La identificación de las colonias sospechosas de Staphylococcus aureus por métodos convencionales y MALDI-TOF. El patrón de resistencia antimicrobiana de S. aureus se detectó por disco-difusión. En los cultivos resistentes a meticilina (SAMR) se determinó la presencia del gen mecA y se realizó la tipificación del SCCmec por pruebas de reacción en cadena de polimerasa. Resultados: Se obtuvieron 225 hisopados a partir de 225 trabajadores, presentaron desarrollo 212. En 49 se recuperaron cultivos de S. aureus. Correspondieron a SAMR 11 de las 49 cepas, todas portaban el gen mecA. Hubo predominio en el personal de enfermería (7/11), en los servicios de hemato-oncología (3/11) y cuidados intensivos neonatales (4/11). Asociaron resistencia a macrólidos y clindamicina 8 de 11 aislamientos SAMR, a gentamicina 2 y a mupirocina uno. El SCCmec más frecuentemente identificado fue el tipo IV (7/11). Conclusiones: Los resultados muestran la presencia de cepas SAMR entre el personal de salud del CHPR y aportan información complementaria para efectuar prevención y control de las IIH, actuando sobre todo en el personal de salud encargado de la atención de pacientes susceptibles.

Hospital-acquired infections (IIH) are a cause of high morbidity and mortality and represent a major health problem. Health personnel are reservoirs and potential transmitters of their etiological agents. S. aureus is one of the microorganisms involved, therefore it is important to know the frequency of carriage in health personnel and establish the antimicrobial susceptibility profile to contribute to the development of prevention measures, including educational activities. Objective: To know the frequency of carriage of S. aureus, distribution and antibiotypes of the strains present in the health personnel of the Reference Pediatric Hospital (HPR). Materials and methods: A descriptive study was carried out during the period July-September 2018. Nasal swab samples from health workers from different hospitalization areas who agreed to participate in the study were included. Those who received antibiotics within 3 months prior to the study were excluded. The samples were seeded in 5% sheep blood agar (ASO) and incubated at 35-37ºC in aerobiosis for 24-48 hours. Identification of suspicious Staphylococcus aureus colonies by conventional methods and MALDI-TOF. The antimicrobial resistance pattern of S. aureus was detected by disc diffusion. In methicillin-resistant cultures (MRSA), the presence of the mecA gene was determined and SCCmec was typified by polymerase chain reaction tests. Results: 225 swabs were obtained from 225 workers, 212 showed development. S. aureus cultures were recovered from 49. 11 of the 49 strains corresponded to MRSA, all of them carried the mecA gene. There was a predominance in the nursing staff (7/11), in the hematology-oncology services (3/11) and neonatal intensive care (4/11). They associated resistance to macrolides and clindamycin in 8 of 11 MRSA isolates, 2 to gentamicin, and 1 to mupirocin. The most frequently identified SCCmec was type IV (7/11). Conclusions: The results show the presence of MRSA strains among the health personnel of the CHPR and provide complementary information to carry out prevention and control of IIH, acting especially on the health personnel in charge of the care of susceptible patients.

As infecções hospitalares (HII) são causa de alta morbidade e mortalidade e representam um importante problema de saúde. Os profissionais de saúde são reservatórios e potenciais transmissores de seus agentes etiológicos. O S. aureus é um dos micro-organismos envolvidos, por isso é importante conhecer a frequência de portadores em profissionais de saúde e estabelecer o perfil de suscetibilidade antimicrobiana para contribuir no desenvolvimento de medidas de prevenção incluindo atividades educativas. Objetivo: Conhecer a frequência de portadores de S. aureus, distribuição e antibiótipos das cepas presentes no pessoal de saúde do Hospital Pediátrico de Referência (HPR). Materiais e métodos: Foi realizado um estudo descritivo durante o período de julho a setembro de 2018. Foram incluídas amostras de swab nasal de profissionais de saúde de diferentes áreas de internação que concordaram em participar do estudo. Aqueles que receberam antibióticos nos 3 meses anteriores ao estudo foram excluídos. As amostras foram semeadas em 5% de ágar sangue de carneiro (ASO) e incubadas a 35-37ºC em aerobiose por 24-48 horas. Identificação de colônias suspeitas de Staphylococcus aureus por métodos convencionais e MALDI-TOF. O padrão de resistência antimicrobiana de S. aureus foi detectado por difusão em disco. Em culturas resistentes à meticilina (MRSA), a presença do gene mecA foi determinada e SCCmec foi tipificado por testes de reação em cadeia da polimerase. Resultados: 225 swabs foram obtidos de 225 trabalhadores, 212 apresentaram desenvolvimento. Culturas de S. aureus foram recuperadas de 49. 11 das 49 cepas correspondiam a MRSA, todas carregavam o gene mecA. Houve predominância na equipe de enfermagem (7/11), nos serviços de hematologia-oncologia (3/11) e de terapia intensiva neonatal (4/11). Eles associaram resistência a macrolídeos e clindamicina em 8 de 11 isolados de MRSA, 2 à gentamicina e 1 à mupirocina. O SCCmec mais frequentemente identificado foi o tipo IV (7/11). Conclusões: Os resultados mostram a presença de cepas de MRSA entre os profissionais de saúde do CHPR e fornecem informações complementares para realizar a prevenção e controle da HII, atuando principalmente sobre os profissionais de saúde responsáveis ​​pelo atendimento de pacientes suscetíveis.

Synergistic activity between beta-lactams and igy antibodies against Pseudomonas aeruginosa in vitro.

Multi-drug resistant Pseudomonas aeruginosa is a gram-negative bacillus responsible for nosocomial infections. Immunoglobulin Y (IgY) is a chicken immunoglobulin used for research, immunodiagnosis, and immunotherapy. IgY presents antimicrobial properties and it is under investigation for use as an adjunct to prophylactic therapies. The current study aimed to assess the synergistic action between anti-P aeruginosa IgY and the beta-lactams ceftazidime, imipenem, and meropenem. IgY antibodies were obtained from laying hens immunized with SPM-1 producing P. aeruginosa (Pa48spm-1+) or VIM-2 producing P. aeruginosa (Pa23vim-2 +). The antimicrobial activity of IgY antibodies was evaluated by the growth inhibition test, and the synergistic effect was assessed by determination of the fractional inhibitory concentration index. Anti-Pa48spm-1+ IgY shows antimicrobial activity at 1.25 mg/ml and anti-Pa23vim-2+ IgY shows antimicrobial activity at 2.5 mg/ml. The fractional inhibitory concentration indices of anti-Pa48spm-1+ IgY and ceftazidime, or imipenem, or meropenem at 72 h of experiment were 0.189, 0.209, and 0.440, respectively. For anti-Pa23vim-2+ IgY, the fractional inhibitory concentration indices were 0.440 with ceftazidime, 0.453 with imipenem, and 0.441 with meropenem at 72 h. We conclude that there is a synergistic action between anti-P. aeruginosa IgY and the antimicrobials tested. Further studies are necessary to investigate the mechanisms associated with this action.

Molecular and Phenotypic Characterization of a Multidrug-Resistant Escherichia coli Coproducing OXA-232 and MCR-1.1 in Argentina.

The spread of carbapenem-resistant Enterobacterales has raised concern in clinical settings due to the limited therapeutic options available. OXA-48-like enzymes are still sporadic in South America. The aim of this study was to characterize a multidrug-resistant Escherichia coli isolate from a hospitalized patient in Buenos Aires city. The isolate was characterized phenotypically by determination of its susceptibility pattern, synergistic and colorimetric tests, and molecularly, by PCR, whole genome sequencing, and plasmid analysis. It belonged to ST-744, phylogroup A, and serotype O162/O89: H9. It remained susceptible to ceftazidime, meropenem, aminoglycosides, trimethoprim/sulfamethoxazole, and tigecycline. The presence of blaOXA-232 harbored by a nonconjugative plasmid ColKp3, and blaCTX-M-14, mcr-1.1, and fosL1 in 2 conjugative plasmids, together with their genetic environment, was revealed. To the best of our knowledge, this is the first report of the coproduction of the enzyme OXA-232 and the mcr-1.1 gene in an E. coli clinical isolate in South America in a patient who had not received colistin therapy.

Infecciones urinarias nosocomiales en un hospital universitario: prevalencia, factores predisponentes y agentes etiológicos en salas de cuidados moderados

Resumen: Introducción: Las infecciones nosocomiales constituyen uno de los principales problemas sanitarios a nivel mundial. Una de las más frecuentes es la infección del tracto urinario, cuya frecuencia reportada en Uruguay fue de 9,8% en unidades de Cuidados Intensivos al año 2013. El objetivo fue determinar la prevalencia de infecciones urinarias nosocomiales en salas de cuidados moderados de un hospital universitario, conocer los factores de riesgo asociados a las mismas y el perfil microbiológico de los microorganismos causales. Metodología: Estudio de corte transversal, en salas de cuidados moderados de un hospital terciario y universitario de Montevideo, desde el 1 de agosto de 2017 hasta el 31 de julio de 2018. Se incluyeron pacientes que cumplieron criterios diagnósticos de infección urinaria nosocomial, con urocultivo compatible obtenido luego de 3 días del ingreso. Se completó la recolección de variables mediante entrevista con el paciente y revisión de historia clínica. Resultados: La prevalencia de infección urinaria nosocomial fue de 1,08% en el período de estudio. La mediana de edad fue 62,5 años y 52,3% eran de sexo masculino. La mediana de internación fue de 15 días, la mayoría en salas de Medicina Interna. El 93,2% presentó al menos un factor de riesgo, destacando la exposición a catéter urinario en el 68,3%. El 52,3% de los casos presentó infección urinaria asociada a catéter. El total de los aislamientos microbiológicos fue bacteriano, 84% de bacterias Gram negativas. Klebsiella pneumoniae fue el más prevalente (39,2%), seguido de Escherichia coli (34,2%). Las bacterias Gram positivas correspondieron en su totalidad a Enterococcus spp. Las bacterias Gram negativas mostraron tasas de resistencia mayores al 20% para múltiples antibióticos de varias categorías y 42,1% presentó betalactamasa de espectro extendido. Conclusiones: Las infecciones urinarias nosocomiales en cuidados moderados se presentaron en pacientes con internación prolongada y múltiples comorbilidades. Destaca la exposición a catéter urinario, con un elevado porcentaje de infecciones asociadas al mismo. Los microorganismos causales fueron altamente resistentes a múltiples antibióticos.

Abstract: Introduction: Nosocomial infections are one of the main health problems worldwide. One of the most frequent is urinary tract infection, whose frequency reported in Uruguay was 9.8% in Intensive Care Units in 2013. The objective was to determine the prevalence of nosocomial urinary tract infections in moderate care wards of a universitary hospital, know the risk factors associated with them and the microbiological profile of the causal microorganisms. Methodology: Cross-sectional study, in moderate care wards of a tertiary and universitary hospital in Montevideo, from August 1, 2017 to July 31, 2018. Patients who met diagnostic criteria for nosocomial urinary tract infection were included, with compatible urine culture obtained after 3 days of admission. Variables collection was made through an interview with the patient and a review of the clinical history. Results: The prevalence of nosocomial urinary tract infection was 1.08% during the study period. The median age was 62.5 years and 52.3% were male. The median hospital stay was 15 days, most of them in Internal Medicine wards. 93.2% presented at least one risk factor, highlighting exposure to urinary catheter in 68.3%. 52.3% of the cases presented catheter-associated urinary tract infection. The total of the microbiological isolates was bacterial, 84% of Gram negative bacteria. Klebsiella pneumoniae was the most prevalent (39.2%), followed by Escherichia coli (34.2%). The Gram-positive bacteria corresponded entirely to Enterococcus spp. Gram-negative bacteria showed resistance rates greater than 20% for multiple antibiotics from various categories and 42.1% had extended-spectrum beta-lactamase. Conclusions: Nosocomial urinary tract infections in moderate care occur in patients with prolonged hospitalization and multiple comorbidities. Exposure to urinary catheter stands out, with a high percentage of infections associated with it. The causative microorganisms were highly resistant to multiple antibiotics.

Resumo: Introdução: As infecções hospitalares são um dos principais problemas sanitários a nível mundial. Uma das mais frequentes é a infecção do trato urinário, cuja frequência relatada no Uruguai foi de 9,8% nas Unidades de Terapia Intensiva em 2013. O objetivo foi determinar a prevalência de infecções do trato urinário hospitalares em enfermarias de cuidados moderados de um hospital universitário, conhecer os fatores de risco associados e o perfil microbiológico dos microrganismos causadores. Metodologia: Estudo de corte transversal, em salas de cuidados moderados de um hospital terciário e universitário de Montevidéu, de 1º de agosto de 2017 a 31 de julho de 2018. Foram incluídos pacientes que preencheram os critérios diagnósticos para infecção do trato urinário hospitalar, com urocultura compatível obtida após 3 dias de admissão. A coleta de variáveis foi completada por meio de entrevista com o paciente e revisão da história clínica. Resultados: A prevalência de infecção urinária hospitalar foi de 1,08% no período estudado. A média de idade foi de 62,5 anos e 52,3% eram do sexo masculino. A média de permanência hospitalar foi de 15 dias, a maioria em enfermarias de Clínica Médica. O 93,2% apresentaram pelo menos um fator de risco, destacando-se a exposição ao cateter urinário em 68,3%. O 52,3% dos casos apresentaram infecção do trato urinário associada ao cateter. O total de isolados microbiológicos foi bacteriano, 84% de bactérias Gram-negativas. Klebsiella pneumoniae foi a mais prevalente (39,2%), seguida de Escherichia coli (34,2%). As bactérias Gram-positivas corresponderam inteiramente a Enterococcus spp . As bactérias Gram-negativas apresentaram taxas de resistência superiores a 20% para vários antibióticos de várias categorias e 42,1% apresentaram betalactamasa de espectro estendido. Conclusões: Infecções do trato urinário hospitalares em cuidados moderados ocorreram em pacientes com internação prolongada e múltiplas comorbidades. Destaca-se a exposição ao cateter urinário, com alto percentual de infecções associadas a ele. Os microrganismos causadores foram altamente resistentes a múltiplos antibióticos.

Pan-Resistome Insights into the Multidrug Resistance of Acinetobacter baumannii.

Acinetobacter baumannii is an important Gram-negative opportunistic pathogen that is responsible for many nosocomial infections. This etiologic agent has acquired, over the years, multiple mechanisms of resistance to a wide range of antimicrobials and the ability to survive in different environments. In this context, our study aims to elucidate the resistome from the A. baumannii strains based on phylogenetic, phylogenomic, and comparative genomics analyses. In silico analysis of the complete genomes of A. baumannii strains was carried out to identify genes involved in the resistance mechanisms and the phylogenetic relationships and grouping of the strains based on the sequence type. The presence of genomic islands containing most of the resistance gene repertoire indicated high genomic plasticity, which probably enabled the acquisition of resistance genes and the formation of a robust resistome. A. baumannii displayed an open pan-genome and revealed a still constant genetic permutation among their strains. Furthermore, the resistance genes suggest a specific profile within the species throughout its evolutionary history. Moreover, the current study performed screening and characterization of the main genes present in the resistome, which can be used in applied research to develop new therapeutic methods to control this important bacterial pathogen.

An improved proposal for using laminar copper as a biocidal material in touch surfaces in a hospital Intensive Care Unit (ICU).

The use of copper for reducing nosocomial infections or healthcare-acquired infections (HAI) has been carried out in intensive care units (ICU) by replacing some objects generally made of stainless steel or other materials with solid pieces of copper. The authors' proposal for a sustainable use of copper consists of introducing it in a "lamina + adhesive" format. This proposal has been tested in an ICU at the Ceuta Hospital in Spain. It has been found to provide an equally efficient solution as antibacterial material than the usual "solid" format, but with only a layer of 50 microns of copper, which is a high-cost and limited resource. After that intervention, some improvements are also proposed: a standardization of the pieces chosen to cover with a lamina of copper for saving material; and another method of replacement aiming to lower the time that the ICU cannot be used. To ensure that the proposed bonding method is harmless to human health and the adhesive does not interfere with the indoor environment by releasing toxic chemicals, the "lamina + adhesive" sheet has been further tested. The results and proposals are briefly shown.

Antimicrobial metal-based nanoparticles: a review on their synthesis, types and antimicrobial action.

The investigation of novel nanoparticles with antimicrobial activity has grown in recent years due to the increased incidence of nosocomial infections occurring during hospitalization and food poisoning derived from foodborne pathogens. Antimicrobial agents are necessary in various fields in which biological contamination occurs. For example, in food packaging they are used to control food contamination by microbes, in the medical field the microbial agents are important for reducing the risk of contamination in invasive and routine interventions, and in the textile industry, they can limit the growth of microorganisms due to sweat. The combination of nanotechnology with materials that have an intrinsic antimicrobial activity can result in the development of novel antimicrobial substances. Specifically, metal-based nanoparticles have attracted much interest due to their broad effectiveness against pathogenic microorganisms due to their high surface area and high reactivity. The aim of this review was to explore the state-of-the-art in metal-based nanoparticles, focusing on their synthesis methods, types, and their antimicrobial action. Different techniques used to synthesize metal-based nanoparticles were discussed, including chemical and physical methods and "green synthesis" methods that are free of chemical agents. Although the most studied nanoparticles with antimicrobial properties are metallic or metal-oxide nanoparticles, other types of nanoparticles, such as superparamagnetic iron-oxide nanoparticles and silica-releasing systems also exhibit antimicrobial properties. Finally, since the quantification and understanding of the antimicrobial action of metal-based nanoparticles are key topics, several methods for evaluating in vitro antimicrobial activity and the most common antimicrobial mechanisms (e.g., cell damage and changes in the expression of metabolic genes) were discussed in this review.