Whole-genome analysis and description of an outbreak due to carbapenem-resistant Ochrobactrum anthropi causing pseudo-bacteraemias.

Ochrobactrum anthropi, a rare human pathogen, has been isolated predominantly from patients with catheter-related bacteraemia and rarely from other infections. In 2016, six cases of pseudo-bacteraemia caused by carbapenem-resistant O. anthropi isolates were recovered from an Argentinian hospital. The resistant phenotype exposed by the isolates caught our attention and led to an extensive epidemiologic investigation. Here we describe the characterization of a carbapenem-resistant O. anthropi outbreak whose probable cause was by contaminated collection tubes. The genome analysis of one strain revealed the presence of various resistant determinants. Among them, a metal-dependent hydrolase of the ß-lactamase superfamily I, phnP, was found. Lately the recovery of unusual multidrug-resistant pathogens in the clinical setting has increased, thus emphasizing the need to implement standardized infection control practice and epidemiologic investigation to identify the real cause of hospital outbreaks.

Molecular characterization of KPC-2-positive Klebsiella pneumoniae isolates from a neurosurgical centre in Argentina.

Carbapenem-resistant Enterobacteriaceae is a growing concern worldwide. Klebsiella pneumoniae is an important nosocomial pathogen with a high capacity for nosocomial spread. We described the occurrence of plasmid-encoded KPC-2-harbouring K. pneumoniae isolates recovered from a neurosurgical centre in Argentina. The blaKPC-2 gene was surrounded by ISkpn6 and ISkpn7.

Medical and revascularization management in acute coronary syndrome in renal patients.

Despite the high incidence of coronary artery disease in patients with renal impairment, its diagnosis and management remains difficult. The treatment of acute coronary syndrome in this particular group of patients is more complex than in patients with normal renal function. They have a high prevalence of asymptomatic cardiac ischemia. Abnormal baseline electrocardiogram (ECG) findings and nonspecific elevation of cardiac enzymes may be present. Studies are lacking regarding their management mainly because they have been excluded or were not studied as a subgroup in the clinical trials. Thrombolytics are underused during acute myocardial infarction. Heparin, mainly low-molecular weight heparin, for unstable angina and non-Q wave myocardial infarction, should be used with caution because the higher risk for bleeding. Other medications, such as aspirin, metoprolol, and nitroglycerin should be used as in the general population. The newer platelet glycoprotein IIb/IIIa inhibitors may need renal dose adjustment. Revascularization should be pursued if necessary by percutaneous coronary intervention or coronary artery bypass grafting. However, the prognosis and risk of revascularization versus medical therapy have not been determined yet.