Epidemiología de las infecciones post osteosíntesis detectadas por baño de ultrasonido en el Servicio de Traumatología del Hospital Universitario de Caracas / Post osteosinthesis infections epidemiology by ultrasound bath in the trauma service of the University Hospital of Caracas

El objetivo de este trabajo es determinar la epidemiología de la infección post osteosíntesis a través de cultivos de fluidos sonicados en los pacientes del Hospital Universitario de Caracas en el período comprendido entre noviembre 2021-noviembre 2022. Se realizó un estudio observacional de tipo, serie de casos, a través de la revisión de historias médicas de todos los casos que acudieron con diagnóstico de infección post osteosíntesis a fin de determinar cuál agente causal fue el más común, factores de riesgo asociados y tratamiento de elección. Se incluyeron 10 pacientes, 70% de sexo masculino y edad promedio de 40,6±17,9 años. Los gérmenes aislados en el cultivo convencional fueron el SAMS, SAMR, Enterobacter cloacae, Staphylococcus coagulasa negativo (10,0% cada uno), el 60,0% de los cultivos en esta modalidad fueron negativos, en el cultivo de fluidos por baño de ultrasonido, el germen más frecuente fue el SAMR en el 30% de los casos, seguido del SAMS con 20%, en menor medida un caso de Staphylococcus coagulasa negativo y una infección polimicrobiana compuesta por K. pneumoniae, E. cloacae y Enterococo sp. El tratamiento médico consistió en antibioticoterapia vía endovenosa, se realizó de acuerdo al antibiograma obtenido del cultivo, el más empleado fue la cefazolina en 30% (en casos de SAMS), seguido de la vancomicina + meropenem y la vancomicina aislada en 20%. Todos los pacientes cumplieron tratamiento al menos por 4 semanas con evolución satisfactoria(AU)

The objective of this work is to determine the epidemiology of post-osteosynthesis infection through sonicated fluid cultures in patients at the Hospital Universitario de Caracas in the period between November 2021 and November 2022. An observational study of type, series of cases, through the review of the medical records of all the cases that presented with a diagnosis of post-osteosynthesis infection in order to determine which causative agent was the most common, associated risk factors and treatment of choice. 10 patients were included, 70% male and mean age 40.6 ± 17.9 years. The germs isolated in the conventional culture were SAMS, SAMR, Enterobacter cloacae, coagulase-negative Staphylococcus (10.0% each), 60.0% of the cultures in this modality were negative, in the culture of fluids by bath of On ultrasound, the most frequent germ was MRSA in 30% of cases, followed by SAMS with 20%, to a lesser extent a case of coagulase-negative Staphylococcus and a polymicrobial infection made up of K. pneumoniae, E. cloacae and Enterococcus sp. The medical treatment consisted of intravenous antibiotic therapy, it was carried out according to the antibiogram obtained from the culture, the most used was cefazolin in 30% (in cases of SAMS), followed by vancomycin + meropenem and vancomycin alone in 20%. All patients complied with treatment for at least 4 weeks with satisfactory evolution(AU)

Primeros aislados de Enterobacter cloacae complex co-productores de KPC y NDM en un hospital de segundo nivel en la Cuidad de Panamá / First isolates of Enterobacter cloacae complex co-producing KPC and NDM in a second level hospital in City of Panama

Resumen La aparición de Enterobacterales co-productores de dos o más carbapenemasas han despertado las alertas sanitarias en Latinoamérica. Las enterobacterias co-productoras de carbapenemasas KPC y NDM-1 son resistentes a casi todos los antibacterianos existentes. Panamá ha reportado la presencia de carbapenemasas KPC desde 2010 y NDM desde 2011; sin embargo, Enterobacterales con doble producción de carbapenemasas es un fenómeno reciente en nuestros hospitales. Presentamos los dos primeros aislados de Enterobacter cloacae complex co-productores de KPC y NDM, en un hospital de segundo nivel de la Ciudad de Panamá. El reforzamiento de los sistemas de vigilancia epidemiológica en los hospitales permite realizar una detección oportuna de estas nuevas combinaciones de mecanismos de resistencia; para así, implementar medidas de prevención y control de brotes.

Abstract Enterobacterales co-producing carbapenemases have awakened health alerts in Latin America. Carbapenemase-producing Enterobacterales harboring KPC and NDM-1 are resistant to almost all existing antibiotics. Panama reports KPC since 2010, and NDM since 2011, however, Enterobacterales with double carbapenemase production is new to our hospitals. We present the first two isolates of Enterobacter cloacae complex co-producing KPC and NDM, in a second level hospital in Panama City. Strengthening epidemiological surveillance systems in hospitals allows to carry out timely detection of these new combinations of resistance; to implement outbreak prevention and control measures.

Abordaje interdisciplinario de endoftalmitis endógena neonatal. Reporte de caso / Interdisciplinary approach to endogenous neonatal endophthalmitis. Case report

La endoftalmitis endógena neonatal es una patología poco frecuente que puede causar daño ocular grave. Puede manifestarse en pacientes con comorbilidades, como nacimiento pretérmino, bajo peso al nacer, complicaciones posquirúrgicas perinatales o sepsis.El presente reporte de caso documenta a una paciente pretérmino que fue sometida a múltiples cirugías abdominales. Durante su internación, desarrolló sepsis, meningitis y endoftalmitis endógena neonatal. La frecuencia extremadamente baja de la endoftalmitis endógena a esta edad, la importancia de preservar la salud visual del paciente y el abordaje interdisciplinario son puntos importantes de aprendizaje en este caso.

Neonatal endogenous endophthalmitis is a rare condition that can cause serious eye injuries. It can manifest in patients with comorbidities, such as preterm birth, low birth weight, post-surgical perinatal complications, or sepsis.This case report documents a preterm patient who underwent multiple abdominal surgeries. During her hospitalization, she developed sepsis, meningitis and neonatal endogenous endophthalmitis. The extremely low frequency of endogenous endophthalmitis at this age, the importance of preserving the patient's visual health, and the interdisciplinary approach are important learning points in this case.

Antimicrobial resistance and antibiotic consumption in Mexican hospitals / Resistencia antimicrobiana y consumo de antibióticos en hospitales mexicanos

Abstract: Objective: To establish the current situation of antimicrobial resistance and antibiotic consumption in Mexican hospitals. Materials and methods: Antimicrobial susceptibility data from blood and urine isolates were collected. Defined daily dose (DDD) of antibiotic consumption/100 occupied beds (OBD) was calculated. Results: Study period: 2016 and 2017. Of 4 382 blood isolates, E. coli and K. pneumoniae were most frequently reported, with antimicrobial resistance >30% for most drugs tested, only for carbapenems and amikacin resistance were <20%. A. baumannii had antimicrobial resistance >20% to all drugs. Resistance to oxacillin in S. aureus was 20%. From 12 151 urine isolates, 90% corresponded to E. coli; resistance to ciprofloxacin, cephalosporins and trimethoprim/sulfamethoxazole was >50%, with good susceptibility to nitrofurantoin, amikacin and carbapenems. Global median antimicrobial consumption was 57.2 DDD/100 OB. Conclusions: This report shows a high antimicrobial resistance level in Gram-negative bacilli and provides an insight into the seriousness of the problem of antibiotic consumption.

Resumen: Objetivo: Establecer la situación actual de la resistencia antimicrobiana y el consumo de antibióticos en hospitales mexicanos. Material y métodos:F Se colectaron datos de susceptibilidad antimicrobiana de aislamientos de sangre y orina. Se calculó la dosis diaria definida (DDD) del consumo de antibióticos/100 estancias. Resultados: Periodo de estudio de 2016 a 2017. De 4 382 aislamientos en sangre, E. coli y K. pneumoniae fueron las más frecuentes, con resistencia >30% a la mayoría de las drogas evaluadas; sólo para carbapenémicos y amikacina la resistencia fue <20%. A. baumannii tuvo resistencia >20% a todos los fármacos. La resistencia a oxacilina en S. aureus fue de 20%. De 12 151 aislamientos en urocultivos, 90% correspondió a E. coli; la resistencia a ciprofloxacina, cefalosporinas y trimetoprima/sulfametoxazol fue >50%, con buena susceptibilidad a nitrofurantoína, amikacina y carbapenémicos. La mediana del consumo global de antibióticos en DDD/100 estancias fue de 57.2. Conclusiones: Este reporte muestra el nivel elevado de resistencia en bacilos Gram-negativos y brinda una perspectiva de la gravedad del problema del consumo de antibióticos.

Incidência e fatores de risco para infecções de sítio cirúrgico ortopédicas com uso de prótese: coorte não concorrente / Incidence and risk factors for orthopedic surgical site infections with prosthesis: non-concurrent cohort

As cirurgias ortopédicas com uso de prótese são procedimentos utilizados para o tratamento de doenças em articulações. Embora seja um procedimento bastante utilizado, o paciente está sujeito as várias complicações e insucesso do tratamento. Entre essas complicações, a infecção de sítio cirúrgico (ISC) é uma das mais prevalentes, com incidências variando entre 1,4% e 12,6%. Para prevenir essa afecção, o acompanhamento da incidência e a monitorização de fatores de risco permitirão adoções de práticas de prevenção baseadas em evidências, visando uma assistência mais segura. Este estudo é uma coorte não concorrente de 149 pacientes submetidos à artroplastia total de quadril (ATQ) e artroplastia total de joelho (ATJ). O objetivo geral foi analisar os aspectos epidemiológicos das infecções de sitio cirúrgico nos pacientes submetidos à cirurgia ortopédica, no período de 2015 a 2018 em um hospital de grande porte de Belo Horizonte, Minas Gerais. Os objetivos específicos foram estimar a incidência das infecções de sítio cirúrgico; estimar a incidência de infecção de sítio cirúrgico (ISC) por topografia; identificar os fatores de risco associados à infecção ortopédica; identificar os microorganismos responsáveis pelas infecções e propor modelo preditivo multivariado. Na análise univariada, aplicou-se o teste não paramétrico de Mann Whitney. E para verificar a hipótese de associação entre as variáveis categóricas com os grupos, aplicouse o teste exato de Fisher. Na análise multivariada, aplicou-se o modelo de Regressão Logística (p-valor<0,05.) Foram notificadas seis ISC, com taxa global de 4,03%, todas caracterizadas como superficiais. Nos pacientes que foram submetidos à ATJ, a incidência de ISC foi de 2,94% e os que realizaram ATQ, 4,94%. Os fatores de risco identificados para ISC ortopédicas foram idade e hipertensão arterial sistêmica. Os microorganismos isolados foram Enterobacter cloacae, Acinetobacter baumannii e Stenotrophomonas maltophilia. As taxas de ISC encontradas neste estudo foram maiores que as recomendadas pelo NHSN/CDC.(AU)

Orthopedic surgeries with prosthesis are procedures used for the treatment of diseases in joints. Although it is a widely used procedure, the patient is subject to various complications and treatment failure. Among these complications, surgical site infection (SSI) is one of the most common, with incidence varying between 1.4% and 12.6%. To prevent this condition, monitoring incidence and monitoring risk factors will allow adoptions of evidencebased prevention practices for safer care. This study is a non-concurrent cohort of 149 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The general objective was to analyze the epidemiological aspects of surgical site infections in patients submitted to orthopedic surgery from 2015 to 2018 at a large hospital in Belo Horizonte, Minas Gerais. The specific objectives were to estimate the incidence of surgical site infections; to estimate the incidence of surgical site infection (SSI) by topography; identify the risk factors associated with orthopedic infection; identify the microorganisms responsible for infections and propose a multivariate predictive model. In the univariate analysis, the nonparametric Mann Whitney test was applied. And to verify the hypothesis of association between the categorical variables with the groups, Fisher's exact test was applied. In the multivariate analysis, the Logistic Regression model was applied (p-value <0.05). Six SSIs were reported, with an overall rate of 4.03%, all characterized as superficial. In patients who underwent TKA, the incidence of SSI was 2.94% and those who undergoing TKA, 4.94%. The risk factors identified for orthopedic SSIs were age and systemic arterial hypertension. The isolated microorganisms were Enterobacter cloacae, Acinetobacter baumannii and Stenotrophomonas maltophilia. The SSI rates found in this study were higher than those recommended by the NHSN / CDC.(AU)

Enfermedad granulomatosa crónica: infecciones múltiples como forma de presentación. Caso clínico pediátrico / Chronic granulomatous disease: multiple infections as clinical presentation. Pediatric case report

La enfermedad granulomatosa crónica es una inmunodeficiencia primaria infrecuente, debida a un defecto en la actividad microbicida de los fagocitos, originada por mutaciones en los genes que codifican alguna de las subunidades del complejo enzimático nicotinamida adenina dinucleótido fosfato oxidasa. La incidencia estimada es 1 en 250 000 recién nacidos vivos. Puede presentarse desde la infancia hasta la adultez, por lo general, en menores de 2 años. Las infecciones bacterianas y fúngicas, en conjunto con las lesiones granulomatosas, son las manifestaciones más habituales de la enfermedad. Los microorganismos aislados más frecuentemente son Aspergillus spp., Staphylococcus aureus, Serratia marcescens, Nocardia spp. Se reporta el caso clínico de un varón de 1 año de vida en el que se diagnosticó enfermedad granulomatosa crónica a partir de infecciones múltiples que ocurrieron simultáneamente: aspergilosis pulmonar invasiva, osteomielitis por Serratia marcescens y granuloma cervical por Enterobacter cloacae.

Chronic granulomatous disease is an uncommon primary immunodeficiency due to a defect of the killing activity of phagocytes, caused by mutations in any of the genes encoding subunits of the superoxide-generating phagocyte NADPH oxidase system. The incidence is 1 in 250 000 live births. It can occur from infancy to adulthood, usually in children under 2 years. Bacterial and fungal infections in association with granuloma lesions are the most common manifestations of the disease. Aspergillus species, Staphylococcus aureus, Serratia marcescens, Nocardia species are the most common microorganisms isolated. We describe here a case of a 1-year-old boy with chronic granulomatous disease and invasive pulmonary aspergillosis, Serratia marcescens osteomyelitis and Enterobacter cloacae cervical granuloma.

In vitro resistance of Enterobacter cloacae isolated from fresh seafood to colistin

Abstract INTRODUCTION: Enterobacter cloacae is a clinically important bacterium from the Enterobacteriaceae family. This study evaluated resistance of E. cloacae strains from fish (n=14) and shrimp (n=9) to colistin. METHODS: Biochemical identification and antimicrobial susceptibility tests were carried out in an automated Vitek®2 instrument. RESULTS: Colistin resistance was observed in 21.4% and 66.7% of the strains from fish and shrimp, respectively. We observed minimum inhibitory concentrations of ≥16 mg/L and ≤5 mg/L in 8 and 15 of all strains, respectively. CONCLUSIONS: Fish and shrimp can carry drug-resistant enterobacteria, which can be of clinical interest.

Detection of virulence and ß-lactamase encoding genes in Enterobacter aerogenes and Enterobacter cloacae clinical isolates from Brazil

ABSTRACT Enterobacter cloacae and E. aerogenes have been increasingly reported as important opportunistic pathogens. In this study, a high prevalence of multi-drug resistant isolates from Brazil, harboring several β-lactamase encoding genes was found. Several virulence genes were observed in E. aerogenes, contrasting with the E. cloacae isolates which presented none.

Evaluation of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Rio Grande do Sul, Brazil

Abstract INTRODUCTION: The rapid global spread of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to the health system. METHODS: We evaluated the antimicrobial susceptibility profiles of 70 CRE isolated in a tertiary hospital in Brazil between August and December 2015, and determined their resistance mechanisms. RESULTS: The most prevalent microorganism was Klebsiella pneumoniae (95.7%); it showed high-level resistance to carbapenems (>98%), with sensitivity to colistin (91.4%) and amikacin (98.6%). The bla KPC gene was detected in 80% of the CRE isolates. CONCLUSIONS: Evaluation of bacterial resistance contributes to an appropriate treatment, and the reduction of morbimortality and dissemination of resistance.

Antibacterial activity of essential oils of aloysia polystachya and lippia turbinata (Verbenaceae) / Actividad antibacteriana de los aceites esenciales de aloysia polystachya y lippia turbinata (Verbenaceae)

Aloysia polystachya and Lippia turbinata are medicinal and aromatic plants. Nevertheless, there are few reports in literature concerning the biological properties of species that grow in northeastern Argentina. The antibacterial activity and the chemical composition of both essential oils were evaluated in this work. The extraction was performed by steam distillation and their volatile compounds were determined by gas chromatography/mass spectrometry. The antibacterial activity was evaluated by disc diffusion and broth microdilution assay. The main compounds were carvone (78.9 percent) and limonene (14.2 percent) in A. polystachya and carvone (80.77 percent), limonene (8.73 percent), beta- caryophyllene (2.13 percent) and 1,8-cineole (1.70 percent) in L. turbinata. Both essential oils were bactericide against Escherichia coli ATCC 35218 and clinical isolates of Enterobacter cloacae and Klebsiella pneumoniae. Essential oil of A. polystachya was also bactericide against Staphylococcus aureus ATCC 29212, S. aureus ATCC 25923 and clinical strain of S. aureus methicillin susceptible.

Aloysia polystachya y Lippia turbinata son plantas medicinales y aromáticas. Hay pocos informes en la literatura sobre las propiedades biológicas de especies que crecen en el nordeste de Argentina. La actividad antibacteriana y la composición química de ambas especies se evaluaron en este trabajo. La extracción se realizó por destilación con vapor y sus compuestos se determinaron por cromatografía gaseosa/espectrometría de masa. La actividad antibacteriana fue evaluada por difusión en discos y microdilución en caldo. Los principales compuestos fueron carvona (78.9 por ciento) y limoneno (14.2 por ciento) en A. polystachya y carvona (80.77 por ciento), limoneno (8.73 por ciento), beta-cariofileno (2.13 por ciento) y 1,8-cineol (1.70 por ciento) en L. turbinata. Ambos aceites esenciales fueron activos contra Escherichia coli ATCC 35218 y aislamientos clínicos de Enterobacter cloacae y Klebsiella pneumoniae. El aceite esencial de A. polystachya fue bactericida contra Staphylococcus aureus ATCC 29212, S. aureus ATCC 25923 y aislamientos clínicos de S. aureus sensible a meticilina.

High prevalence of plasmid-mediated quinolone resistance determinants in Enterobacter cloacae isolated from hospitals of the Qazvin, Alborz, and Tehran provinces, Iran

Abstract: INTRODUCTION: Plasmid-mediated quinolone resistance (PMQR) is a growing clinical concern worldwide. The main aims of this study were to detect qnr-encoding genes and to evaluate the clonal relatedness of qnr-positive Enterobacter cloacae isolates. METHODS: A total of 116 E. cloacae isolates that were not susceptible to quinolone were obtained from seven hospitals in Tehran, five hospitals in Qazvin, and two hospitals in Karaj (Iran). Bacterial identification was performed using standard laboratory methods and API 20E strips. Quinolone resistance was determined using the Kirby-Bauer disk diffusion method according to the Clinical Laboratory Standards Institute (CLSI) guidelines. PCR and sequencing were employed to detect qnrA, qnrB, and qnrS genes, and clonal relatedness was assessed using the enterobacterial repetitive intergenic consensus (ERIC)-PCR method. RESULTS: In total, 45 (38.8%) and 71 (61.2%) of isolates showed high- and low-level quinolone resistance, respectively, and qnr-encoding genes were detected in 70 (60.3%) of them. qnrB1 [45 (38.8%) isolates] was the most commonly detected gene, followed by qnrS1 [28 (24.1%) isolates] and qnrB4 [18 (15.5%) isolates] either alone or in combination with other genes. The results of the ERIC-PCR revealed that 53 (75.7%) qnr-positive isolates were genetically unrelated. CONCLUSIONS: This study describes, for the first time, the high prevalence of the qnrB1, qnrS1, and qnrB4 genes among E. cloacae isolates in Iran. The detection of qnr genes emphasizes the need for establishing tactful policies associated with infection control measures in hospital settings in Iran.

KPC and VIM producing Enterobacter cloacae strain from a Hospital in Northeastern Venezuela / Enterobacter cloacae productor de KPC y VIM en un Hospital del Noreste de Venezuela

An 83-year-old male patient is admitted to the central hospital in Cumaná, Venezuela with severe urinary infection, history of hospitalizations and prolonged antimicrobial treatments. A strain of Enterobacter cloacae was isolated showing resistance to multiple types of antibiotics (only sensitive to gentamicin), with phenotype of serine- and metallo-carbapenemases. Both, blaVIM-2 and blaKPC genes were detected in the isolate. This is the first report of an Enterobacteriaceae species producing both KPC carbapenemase and VIM metallo carbapenemase in Venezuela. This finding has a great clinical and epidemiological impact in the region, because of the feasibility of transferring these genes, through mobile elements to other strains of Enterobacter and to other infection-causing species of bacteria.

En un paciente masculino de 83 años, que ingresó al Hospital de Cumaná, Venezuela, con diagnóstico de infección urinaria severa, antecedentes de hospitalización y diferentes tratamientos antimicrobianos durante largos periodos de tiempo, se aisló una cepa de Enterobacter cloacae, la cual evidenció resistencia a múltiples tipos de antibióticos (solo sensible a gentamicina) y con fenotipo de carbapenemasas de tipo serina y metalobetalactamasa. Los genes blaVIM-2 y blaKPC fueron detectados en esta cepa. Este representa el primer reporte de una especie de Enterobacteriaceae productora simultánea de carbapenemasa KPC y metalobetalactamasa VIM en Venezuela. Esto tiene un gran impacto clínico y epidemiológico en la región por la posibilidad de transferencia de estos genes a otras cepas de Enterobacter u otras especies bacterianas causantes de infecciones, por medio de elementos móviles.

Feasibility of biohydrogen production from industrial wastes using defined microbial co-culture

BACKGROUND: The development of clean or novel alternative energy has become a global trend that will shape the future of energy. In the present study, 3 microbial strains with different oxygen requirements, including Clostridium acetobutylicum ATCC 824, Enterobacter cloacae ATCC 13047 and Kluyveromyces marxianus 15D, were used to construct a hydrogen production system that was composed of a mixed aerobic-facultative anaerobic-anaerobic consortium. The effects of metal ions, organic acids and carbohydrate substrates on this system were analyzed and compared using electrochemical and kinetic assays. It was then tested using small-scale experiments to evaluate its ability to convert starch in 5 L of organic wastewater into hydrogen. For the one-step biohydrogen production experiment, H1 medium (nutrient broth and potato dextrose broth) was mixed directly with GAM broth to generate H2 medium (H1 medium and GAM broth). Finally, Clostridium acetobutylicum ATCC 824, Enterobacter cloacae ATCC 13047 and Kluyveromyces marxianus 15D of three species microbial co-culture to produce hydrogen under anaerobic conditions. For the two-step biohydrogen production experiment, the H1 medium, after cultured the microbial strains Enterobacter cloacae ATCC 13047 and Kluyveromyces marxianus 15D, was centrifuged to remove the microbial cells and then mixed with GAM broth (H2 medium). Afterward, the bacterial strain Clostridium acetobutylicum ATCC 824 was inoculated into the H2 medium to produce hydrogen by anaerobic fermentation. RESULTS: The experimental results demonstrated that the optimum conditions for the small-scale fermentative hydrogen production system were at pH 7.0, 35°C, a mixed medium, including H1 medium and H2 medium with 0.50 mol/L ferrous chloride, 0.50 mol/L magnesium sulfate, 0.50 mol/L potassium chloride, 1% w/v citric acid, 5% w/v fructose and 5% w/v glucose. The overall hydrogen production efficiency in the shake flask fermentation group was 33.7 mL/h-1.L-1, and those the two-step and the one-step processes of the small-scale fermentative hydrogen production system were 41.2 mLVh-1.L-1 and 35.1 mL/h-1.L-1, respectively. CONCLUSION: Therefore, the results indicate that the hydrogen production efficiency of the two-step process is higher than that of the one-step process.

Actividad inhibitoria de dihidroxifenil propenona sobre betalactamasas de Enterobacter cloacae: estudio preliminar en el desarrollo de fármacos para enfrentar la resistencia bacteriana / Inhibitory activity of dihydroxy-phenyl-propenone on betalactamase of Enterobacter cloacae : Preliminary study for drug development to overcome bacterial resistance

Introducción . Los microorganismos patógenos como Enterobacter cloacae producen betalactamasas que les confieren resistencia frente a los antibióticos betalactámicos; se ha identificado, además, la actividad limitada de los inhibidores enzimáticos, de modo que la única posibilidad de enfrentar la resistencia es el diseño de nuevos fármacos y su uso racional. Objetivo. Evaluar el efecto de la chalcona dihidroxifenil propenona sobre un aislamiento clínico de E. cloacae y sobre la betalactamasa aislada a partir de este microorganismo resistente como un aporte en la búsqueda de compuestos inhibidores de las betalactamasas. Materiales y métodos. Se sintetizó la chalcona dihidroxifenil propenona y se evaluó su efecto sobre el aislamiento clínico de E. cloacae para determinar la concentración inhibitoria mínima mediante el método de microdilución en caldo y con la betalactamasa purificada mediante cromatografía de afinidad se realizaron estudios espectrofotométricos de cinética enzimática. Resultados. La concentración inhibitoria mínima de la dihidroxifenil propenona sobre E. cloacae fue de 35 µg/ml; el porcentaje de recuperación de la betalactamasa a partir del microorganismo fue de 31,75 %; en el estudio cinético se evidenció actividad inhibitoria de acuerdo con los parámetros cinéticos de V max =1,7 x 10 -3 µM/minuto y K M´ =2330 µM. Conclusión. La chalcona dihidroxifenil propenona ejerce su actividad inhibitoria por medio de la interacción con la betalactamasa y, de esta manera, protege la integridad estructural de los antibióticos betalactámicos; dicho efecto sinérgico la convierte en un compuesto promisorio en la búsqueda de alternativas para enfrentar la resistencia bacteriana.

Introduction: Enterobacter cloacae is a pathogenic microorganism with the ability to produce betalactamase enzymes, which makes them resistant to betalactamic antibiotics. Additionally, the limited activity of enzymatic inhibitors has been identified, and, therefore, the design of new drugs and the promotion of their rational use are the only possibilities to overcome this problem. Objective: The aim of this research was to evaluate the effect of dihydroxy-phenyl-propenone on a clinical isolate of E. cloacae , as well as its activity on a betalactamase isolated from this resistant microorganism in order to contribute to the search for new betalactamase inhibitors. Materials and methods: Dihydroxy-phenyl-propenone chalcone was synthesized and evaluated on a clinical isolate of E. cloacae to determine the minimum inhibitory concentration by broth microdilution; once the betalactamase enzyme was purified by affinity chromatography, a spectrophotometric analysis was done to evaluate its kinetic activity. Results: The minimum inhibitory concentration value of dihydroxy-phenyl-propenone on E. cloacae was 35 µg/ml; the recovery percentage of the betalactamase from the microorganism was 31.75% and the kinetic parameters were V max =1.7 x 10 -3 µM/min and K M = 2330 µM, which show an important inhibitory activity. Conclusion: Dihydroxy-phenyl-propenone has shown inhibitory activity on betalactamase enzymes and the ability to protect the chemical integrity of betalactamic antibiotics; this synergistic effect turns it into a promising compound in the search for new alternatives to overcome bacterial resistance.

Avaliação in vitro da influência de lactobacillus casei na aderência de enterobacter cloacae em células epiteliais da mucosa jugal / In vitro evaluation of the influence of Lactobacillus casei in the adherence of Enterobacter cloacae in the oral epithelial cells of oral mucosa

Probióticos são bactérias que apresentam efeitos benéficos à saúde do hospedeiro, devido à capacidade de modular a resposta imune e melhorar as propriedades da microbiota intestinal. A maior eficácia dos probióticos tem sido relacionada à capacidade de adesão à superfície da mucosa e células epiteliais prevenindo a instalação de patógenos. O presente trabalho teve por objetivo verificar, in vitro, a aderência de Enterobacter cloacae, Lactobacillus casei e sua associação em células epiteliais da mucosa jugal. Em um pool de células epiteliais da mucosa jugal (105 céls/mL) previamente preparadas foram adicionadas suspensões (1,5 x 108 céls/mL) de L. casei, E. cloacae e de ambos. Após incubação, células e microrganismos foram filtrados e a partir da membrana filtrante, foram obtidas células com microrganismos aderidos, das quais foram confeccionados esfregaços corados pelo método de Gram. Foram avaliadas cem células realizando-se contagem do número de bactérias aderidas às mesmas. Os resultados obtidos foram analisados pelo teste t de Student. A aderência de L. casei às células epiteliais da mucosa jugal foi superior a de E. cloacae quando incubadas isoladamente (p= 0,0175) ou quando associadas (p= 0,0000). A associação entre L. casei e E. cloacae reduziu (p= 0,0000) a aderência de E. cloacae, portanto, L. casei apresentou, in vitro, aderência favorável às células da mucosa e interferiu negativamente na aderência de E. cloacae...

Probiotics are beneficial bacteria that have effects on the health of the host due to the ability to modulate the immune response and improve the properties of the intestinal microbiota. The greater efficacy of probiotics has been related to their capacity to adhere to the mucosal surface epithelial cells and preventing the onset of pathogens. The aim of this work was to verify, in vitro, the adherence of Enterobacter cloacae and Lactobacillus casei, alone or associated, to the epithelial cells of the human oral mucosa. Suspensions of L. casei and/or E. cloacae were incubated with a suspension of epithelial cells, filtered through a membrane and the retained material was transferred to glass sheets and stained by the Gram method. One hundred epithelial cells were analyzed for counting of the adhered bacteria. The results were compared and analyzed using Student t test. It was observed that the adherence of L. casei to the epithelial cells was higher than the adherence of E. cloacae, when incubated alone (p = 0.0175) or associated (p = 0.0000). L. casei was also able to reduce significantly the adherence of E. cloacae to oral epithelial cells. In conclusion, L. casei has more ability to adhere to epithelial cells, in vitro, suggesting that this microorganism could compete and probably avoid the colonization of E. cloacae on oral mucosa...

Contaminación de cepillos dentales denominados antibacteriales. Estudio in vitro / Effectiveness of antibacterial dental brushes. In vitro stud

Introducción: La contaminación del cepi - llo dental es importante para la salud oral y general, puesto que facilita la higiene oral. Como se contamina después del uso, pue- de ser fuente de infecciones. Los cepillos antibacteriales controlan la contaminación. Obtetivo: Se determinó la efectividad de los cepillos dentales antibacteriales en la inhibición del crecimiento de microorga- nismos patogénicos como A. actinomyce - temcomitans y E. cloacae . En este estudio se incluyeron, tres marcas de cepillos dentales que fueron Oral-B® antibacterial y Colgate® antibacterial incluido un cepillo convencional no antibacterial de la marca Colgate. Materiales y métodos: Un total de 48 cepillos fueron inoculados, 24 con A. ac- tinomycetemcomitans y 24 con E.cloacae y la viabilidad microbiana fue establecida después de diversos tiempos así: 24 horas, 4 días, 12 días y 24 días, en un experimento por duplicado al evaluar el crecimiento bacteriano. Resultados: A las 24 horas los cepillos cumplen con su poder antibacterial incluido el cepillo convencional, el cepillo Oral-B® antibacterial y el Colgate®antibacterial inhibieron completamente el crecimiento de las colonias de el A. actinomycete - mcomitans , mientras que el cepillo Oral B antibacterial permitió el crecimiento de E. cloacae . Finalmente se encontró que con el paso de tiempo 24 días, los cepillos dentales perdieron el efecto antibacterial contra ambos organismos. Conclusión: Los cepillos antibacteriales logran inhibir el crecimiento de A. acti - nomycetemcomitans entre las 24 horas y los 4 días, pero su efecto antibacterial se pierde con el tiempo. Un microorganismo súper-infectante como el E. cloacae es más resistente contra antibacteriales presentes en los cepillos dentales...(Au)

Objective: Toothbrush contamination is important to the oral health and the general health. Toothbrush is recommended to the regular elimination of the bacterial plaque; however it is also a potential source infec - tion since it gets contaminated. Antibacte - rial toothbrushes were introduced to control the microbial contamination. Materials and methods: The effectiveness of antibacterial toothbrushes on the growth inhibition of A. actinomycetemcomitans , and E. cloacae were determined. This study included, three brands of dental brushes which were Oral-B® antibacterial Colgate® antibacterial I and as control one conventional dental brush non-antibacterial of Colgate. Materials and methods: A total of 48 dental brushes were inoculated, 24 with A. actinomycetemcomitans and 24 with E. cloacae and the microbial viability was established after diverse times as follows: 24 hours, 4 days, 12 days and 24 days, in an experiment for duplicate, evaluating the bacterial growth. Results: At 24 hours the dental brushes fulfill their antibacterial efficacy including the conventional dental brush, The Oral-B® antibacterial toothbrush and the Colgate® antibacterial controlled completely the growth of the colonies of the A. actinomy- cetemcomitans , while the Oral-B anti - bacterial toothbrush allowed E. cloacae's growth. Finally after 24 days it was found that the inoculation the dental brushes does not inhibited either the A. actinomycete - mcomitans or neither the E. cloacae . Conclusions: The antibacterial brushes are able to inhibit the growth of A. actinomyce - temcomitans between 24 hours to 4 days, but this antibacterial effect is lost over the time. A super-infectious microorganism such as E. cloacae is more resistant to antibacterials present on dental brushes...(Au)

Molecular epidemiology of CTX-M producing Enterobacteriaceae isolated from bloodstream infections in Rio de Janeiro, Brazil: emergence of CTX-M-15

OBJECTIVE: The present studywas designed to evaluate the molecular epidemiology of CTX-M producing Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli isolated from bloodstream infections at tertiary care hospitals in the State of Rio de Janeiro, Brazil. MATERIAL AND METHODS: A total of 231 nonduplicate Enterobacteriaceae were isolated from five Brazilian hospitals between September 2007 and September 2008. The antimicrobial susceptibility testing was performed by disk diffusion method according to the Clinical Laboratory Standard Institute. Isolates showing resistance to third-generation cephalosporins were screened for ESBL activity by the double-disk synergy test. The presence of blaCTX-M , blaCTX-M-15 and blaKPC genes was determined by Polymerase Chain Reaction (PCR) amplification andDNA sequencing. The molecular typing of CTX-M producing isolateswas performed by pulsed-field gel electrophoresis (PFGE). RESULTS AND DISCUSSION: Ninety-three isolates were screened as ESBL positive and 85 (91%) were found to carry CTX-M-type, as follows: K. pneumoniae 59 (49%), E. cloacae 15 (42%), and E. coli 11 (15%). Ten isolates resistant for carbapenems in K. pneumoniae were blaKPC-2 gene positive. Among CTX-M type isolates, CTX-M-15 was predominant in more than 50% of isolates for K. pneumoniae, E. coli, and E. cloacae. PFGE analysis of CTX-M producing isolates showed the predominance of CTX-M-15 in 10 of 24 pulsotypes in K. pneumoniae, 6 of 13 in E. cloacae and 3 of 6 in E. coli. CTX-M-15 was also predominant among KPC producing isolates. In conclusion, this study showed that CTX-M-15 was circulating in Rio de Janeiro state in 2007-2008. This data reinforce the need for continuing surveillance because this scenario may have changed over the years.

Incidencia y etiología de la bacteriemia asociada al uso de catéteres venosos centrales en una unidad de cuidados intensivos pediátricos / Incidence and etiology of bacteremia associated with the use of central venous catheters in a pediatric intensive care unit

Las infecciones intrahospitalarias determinan un aumento en la morbimortalidad de los pacientes. La infección asociada al uso de catéteres intravenosos es la más frecuente en las unidades de cuidado intensivos. Objetivo: determinar la incidencia y etiología de bacteriemia asociada al uso de catéteres venosos centrales en la Unidad de Cuidados Intensivos de Niños (UCIN) del Centro Hospitalario Pereira Rossell. Material y método: se realizó un estudio descriptivo observacional entre el 1 de diciembre de 2009 hasta el 1 de julio de 2010. Se incluyeron todos los pacientes hospitalizados en UCIN, que cumplieran con la definición de paciente de Unidad de Cuidado Intensivo del National Nosocomial Infections Surveillance (NNIS) y que portaran un catéter venoso central. La fuente de recolección de datos fueron las historias clínicas. Resultados: se incluyeron 94 niños con vías centrales, un total de 109 vías, 988 días de cateterización. Se identificaron cinco casos de bacteriemias asociadas al catéter, una densidad de incidencia de bacteriemia asociada al catéter de 5.06 casos por cada 1000 días de cateterización. Los gérmenes aislados fueron Staphylococcus coagulasa negativo, Staphylococcus aureus, Klebsiella oxytoca, Enterobacter cloacae y Candida albicans. En todos los casos el tiempo de positivización diferencial del hemocultivo obtenido del catéter venoso fue menor a 2 horas frente al obtenido por punción periférica. Conclusiones: el valor hallado de incidencia de infección asociada al uso de catéter fue elevado y es necesario implementar medidas destinadas a disminuirla...