RESUMO
Urinary tract infections (UTIs) caused by anaerobic bacteria have scarcely been reported. Since anaerobic bacteria are commensals of the genitourinary tract, their presence in a urine sample adds ambiguity in making a definitive diagnosis of anaerobic UTI. It is well known that standard urine culture is the gold standard method for the detection, identification, and antimicrobial susceptibility testing of uropathogens. Nonetheless, both the difficulties in establishing them as pathogens and the scarcity of reported anaerobic UTI cases led to the discontinuation of routine urine culture under an anaerobic atmosphere (UCAA). On the other hand, it is important to emphasize that culture-independent methods, such as proteomics and molecular technics, may detect anaerobes directly on a urine sample. Anaerobes are not included in guidelines for the diagnosis and management of UTIs. At the same time, as fastidious uropathogens and antibiotic resistance become more common, accurate pathogen identification becomes even more important for effective UTI treatment. As a result, we conducted a review of the clinical context, pathogen antimicrobial susceptibility, and treatment of patients with anaerobic UTIs. Because UCAA is a contentious topic, we narrowed our search to cases with both negative standard urine culture and positive UCAA.
Assuntos
Anti-Infecciosos , Infecções Urinárias , Humanos , Bactérias Anaeróbias , Anaerobiose , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Anti-Infecciosos/uso terapêuticoRESUMO
Peptostreptococcus anaerobius is a gram-positive anaerobic coccus (GPAC) found in the gastrointestinal and vaginal microbiota. The organism is mainly found in polymicrobial and scarcely in monobacterial infections such as prosthetic and native endocarditis. Anaerobic bacteria have rarely been reported as the cause of urinary tract infection (UTI). Although GPAC are susceptible to most antimicrobials used against anaerobic infections, P. anaerobius has shown to be more resistant. Herein, we report a case of UTI caused by P. anaerobius from a 62-year-old man with a history of urological disease. Surprisingly, the microorganism was directly identified by Matrix-Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) from the urine sample. The isolate was successfully identified by phenotypic methods, MALDI-TOF MS, and 16S rRNA gene sequencing. P. anaerobius showed no ß-lactamase-producing activity, was resistant to penicillin, ampicillin, ciprofloxacin and levofloxacin, and displayed intermediate susceptibility to ampicillin-sulbactam and amoxicillin-clavulanic acid. Successful treatment was achieved with oral amoxicillin-clavulanic acid. Antimicrobial susceptibility testing (AST) should be performed on P. anaerobius isolates due to their unpredictable AST patterns and because empirically administered antimicrobial agents may not be active. This report shows that MALDI-TOF MS, directly used in urine specimens, may be a quick option to diagnose UTI caused by P. anaerobius or other anaerobic bacteria. This review is a compilation of monobacterial infections caused by P. anaerobius published in the literature, their pathogenicity, identification, and data about the antimicrobial susceptibility of P. anaerobius.
Assuntos
Infecções por Bactérias Gram-Positivas/microbiologia , Peptostreptococcus/classificação , Peptostreptococcus/fisiologia , Infecções Urinárias/microbiologia , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Técnicas de Tipagem Bacteriana , Suscetibilidade a Doenças , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem Molecular , Peptostreptococcus/efeitos dos fármacos , Peptostreptococcus/isolamento & purificação , RNA Ribossômico 16S/genética , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Resultado do Tratamento , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológicoRESUMO
Clinically significant NDM-1-producing Acinetobacter schindleri has not yet been described in the literature. We report the first case of bacteraemia due to an A. schindleri strain harbouring blaNDM-1 recovered from an immunocompromised patient. Our report reinforces the fact that NDM-1 can easily be acquired by Acinetobacter species.
RESUMO
Seven metallo-ß-lactamase-positive isolates of Serratia marcescens were recovered from three patients hospitalized in a neonatal ward in an Argentinean hospital during the period July-September 2011. All the isolates were multidrug-resistant, they belonged to a single clone, and carried a blaVIM-16 -containing class I integron structure. This represents the first nosocomial outbreak of metallo-ß-lactamase in Enterobacteriaceae in Argentina.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Serratia/epidemiologia , Serratia marcescens/enzimologia , beta-Lactamases/genética , beta-Lactamases/metabolismo , Argentina/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Humanos , Recém-Nascido , Masculino , Epidemiologia Molecular , Tipagem Molecular , Infecções por Serratia/microbiologia , Serratia marcescens/isolamento & purificaçãoRESUMO
From June to December 2004, thirty-three carbapenem-resistant Acinetobacter baumannii isolates recovered from twenty nine patients at the intensive care unit in Hospital de Clínicas, Universidad de Buenos Aires, were studied. The isolates were categorized by molecular methods as: clone I (n = 14), clone IV (n = 7), clone III (n = 6), clone VI (n = 3), clone II (n = 2) and clone X (n = 1). Twenty one isolates were recovered from lower respiratory tract samples, 11 of which belonged to clone I. Clone III isolates were mainly recovered from non-respiratory samples (5/6). Clone IV isolates were recovered from patients not receiving previous imipenem therapy. The majority of the isolates belonging to clones I and IV were able to survive on inert materials for more than 5 days, whereas adhesion to catheters was observed in isolates belonging to clones I and III, especially in those related to bacteremia. Clone III isolates showed colistin, gentamicin and levofloxacin susceptibility, whereas clone I isolates and most from clone IV were only susceptible to colistin and tetracyclines.
Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Surtos de Doenças , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/efeitos dos fármacos , Adulto , Argentina/epidemiologia , Aderência Bacteriana , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Células Clonais/efeitos dos fármacos , Infecção Hospitalar/epidemiologia , Reservatórios de Doenças , Farmacorresistência Bacteriana Múltipla , Contaminação de Equipamentos , Hospitais Universitários , Hospitais Urbanos , Humanos , Unidades de Terapia Intensiva , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Resistência beta-LactâmicaRESUMO
Entre junio y diciembre de 2004 se estudiaron 33 aislamientos de Acinetobacter baumannii resistentes a los carbapenemes, aislados de materiales clínicos de 29 pacientes internados en la unidad de cuidados intensivos del Hospital de Clínicas de la Universidad de Buenos Aires. La distribución clonal de esos aislamientos fue la siguiente: clon I (n = 14), clon IV (n = 7), clon III (n = 6), clon VI (n = 3), clon II (n = 2) y clon X (n = 1).Veintiún aislamientos se recuperaron de materiales del tracto respiratorio inferior, 11 de ellos pertenecieron al clon I. Casi todos los aislamientos pertenecientes al clon III (5/6) se recuperaron de materiales no respiratorios, y todos los del clon IV se recuperaron de pacientes que no recibieron imipenem. En los aislamientos pertenecientes a los clones I y III se observó una mayor adherencia a catéteres, principalmente en los asociados con bacteriemias. La mayoría de los aislamientos de los clones I y IV sobrevivieron en materiales inertes durante un período superior a los 5 días. La totalidad de los aislamientos del clon III fueron sensibles a colistina, gentamicina y levofloxacina, mientras que los del clon I y la mayoría de los del clon IV sólo fueron sensibles a colistina y tetraciclinas.
From June to December 2004, thirty-three carbapenem-resistant Acinetobacter baumannii isolates recovered from twenty nine patients at the intensive care unit in Hospital de Clínicas, Universidad de Buenos Aires, were studied. The isolates were categorized by molecular methods as: clone I (n = 14), clon IV (n = 7), clone III (n = 6), clone VI (n = 3), clone II (n = 2) and clone X (n = 1). Twenty one isolates were recovered from lower respiratory tract samples, 11 of which belonged to clon I. Clone III isolates were mainly recovered from non-respiratory samples (5/6). Clone IV isolates were recovered from patients not receiving previous imipenem therapy. The majority of the isolates belonging to clones I and IV were able to survive on inert materials for more than 5 days, whereas adhesion to catheters was observed in isolates belonging to clones I and III, especially in those related to bacteremia. Clone III isolates showed colistin, gentamicin and levofloxacin susceptibility, whereas clone I isolates and most from clone IV were only susceptible to colistin and tetracyclines.
Assuntos
Adulto , Humanos , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/isolamento & purificação , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Surtos de Doenças , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/efeitos dos fármacos , Argentina/epidemiologia , Aderência Bacteriana , Resistência beta-Lactâmica , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Células Clonais/efeitos dos fármacos , Infecção Hospitalar/epidemiologia , Reservatórios de Doenças , Farmacorresistência Bacteriana Múltipla , Contaminação de Equipamentos , Hospitais Universitários , Hospitais Urbanos , Unidades de Terapia Intensiva , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentaçãoRESUMO
Enterobacter spp. es un patógeno intrahospitalario que presenta múltiples mecanismos de resistencia a los antibióticos b-lactámicos. Se caracterizaron fenotípica y genotípicamente las diferentes b-lactamasas presentes en 27 aislamientos consecutivos e ininterrumpidos de Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes). También se evaluó la habilidad de diferentes métodos fenotípicos para detectar b-lactamasas de espectro extendido (BLEE) en estos microorganismos. En 15/27 aislamientos (63%) se observó resistencia a las cefalosporinas de tercera generación. En 12 de los aislamientos resistentes se detectó un alto nivel de producción de cefalosporinasa cromosómica, siendo 6 de ellos también productores de PER-2. Dicha resistencia en los 3 aislamientos restantes se debió exclusivamente a la presencia de BLEE, PER-2 en 2 de ellos y CTX-M-2 en un caso. Sólo CTX-M-2 se detectó con todas las cefalosporinas probadas en los ensayos de sinergia, utilizando el método de difusión, mientras que cefepima mejoró la detección de PER-2 en 7/8 aislamientos productores de esta BLEE, 4/8 utilizando la prueba de doble disco y 7/8 comparando discos de cefepima con y sin el agregado de ácido clavulánico. El método de dilución empleado solo detectó 1/9 BLEE al comparar las cefalosporinas con y sin el agregado de inhibidor.
Enterobacter spp. are becoming increasingly frequent nosocomial pathogens with multiple resistance mechanism to b-lactam antibiotics. We carried out the phenotypic and genotypic characterization of beta-lactamases in 27 Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes), as well as the ability of different extended spectrum b-lactamase (ESBL) screening methods. Resistance to third generation cephalosporins was observed in 15/27 (63%) isolates. Twelve resistant isolates produced high level chromosomal encoded AmpC b-lactamase; 6 of them were also producers of PER-2. Resistance to third generation cephalosporins in the remaining 3 isolates was due to the presence of ESBLs, PER-2 in 2 cases, and CTX-M-2 in the other. Only CTX-M-2 production was detected with all tested cephalosporins using difusion synergy tests, while cefepime improved ESBLs detection in 7/8 PER-2 producers, 4/8 in the inhibitor aproximation test and 7/8 with double disk test using cefepime containing disk with and without clavulanic acid. Dilution method, including cephalosporins with and without the inhibitor detected 1/9 ESBLs producers.
Assuntos
Humanos , Resistência às Cefalosporinas , Cefalosporinas/farmacologia , Enterobacter aerogenes/efeitos dos fármacos , Enterobacter cloacae/efeitos dos fármacos , Resistência às Cefalosporinas/genética , Cefalosporinas/classificação , Farmacorresistência Bacteriana Múltipla/genética , Enterobacter aerogenes/enzimologia , Enterobacter aerogenes/genética , Enterobacter cloacae/enzimologia , Enterobacter cloacae/genética , Infecções por Enterobacteriaceae/microbiologia , Genótipo , Ponto Isoelétrico , Testes de Sensibilidade Microbiana , Fenótipo , beta-Lactamases/genéticaRESUMO
Gram-negative nonfermentative bacilli (NFB) are widely spread in the environment. Besides of difficulties for identification, they often have a marked multiresistance to antimicrobial agents, including those active against Pseudomonas aeruginosa. The objective of this study was to evaluate the 'in vitro' activity of different antimicrobial agents on 177 gram-negative nonfermentative bacilli isolates (excluding Pseudomonas aeruginosa and Acinetobacter spp.) isolated from clinical specimens. Minimum inhibitory concentrations (MIC) were determined according to the Mueller Hinton agar dilution method against the following antibacterial agents: ampicillin, piperacillin, piperacillin-tazobactam, sulbactam, cefoperazone, cefoperazone-sulbactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, colistin, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, rifampin, norfloxacin, ciprofloxacin and minocycline. Seven isolates: Sphingobacterium multivorum (2), Sphingobacteriumspiritivorum (1), Empedobacterbrevis (1), Weeksella virosa (1), Bergeyella zoohelcum (1) and Oligella urethralis (1), were tested for amoxicillin-clavulanic acid and ampicillin-sulbactam susceptibility, and susceptibility to cefoperazone or sulbactam was not determined. Multiresistance was generally found in Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans, and Ochrobactrum anthropi isolates. On the other hand, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, and Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa and Oligella urethralis were widely susceptible to the antibacterial agents tested. As a result of the wide variation in antimicrobial susceptibility shown by different species, a test on susceptibility to different antibacterial agents is essential in order to select an adequate therapy. The marked multiresistance evidenced by some species, prompts the need to develop new antimicrobial agents active against this group of bacteria and to search for synergistic combinations.
Assuntos
Antibacterianos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Resistência a Medicamentos , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Testes de Sensibilidade MicrobianaRESUMO
Los bacilos gram-negativos no fermentadores se encuentran ampliamente distribuidos en el medio ambiente. Además de causar dificultades en la identificación, a menudo presentan una marcada multirresistencia a los antimicrobianos incluyendo aquellos activos frente a Pseudomonas aeruginosa. El objetivo de este trabajo fue evaluar la actividad "in vitro" de diferentes antimicrobianos sobre 177 aislamientos de bacilos gram-negativos no fermentadores (excluidos Pseudomonas aeruginosa y Acinetobacter spp.) provenientes de especimenes clínicos. Las concentraciones inhibitorias mínimas (CIM) se determinaron por el método de dilución en agar Mueller Hinton frente a los siguientes antibacterianos: ampicilina, piperacilina, piperacilina-tazobactama, sulbactama, cefoperazona, cefoperazona-sulbactama, ceftazidima, cefepima, aztreonam, imipenem, meropenem, colistina, gentamicina, amicacina, trimetoprima-sulfametoxazol (TMS), cloranfenicol, eritromicina, rifampicina, norfloxacina, ciprofloxacina y minociclina. Sobre siete aislamientos: Sphingobacterium multivorum (2), Sphingobacterium spiritivorum (1), Empedobacter brevis (1), Weeksella virosa (1), Bergeyella zoohelcum (1) y Oligella urethralis (1) se ensayó la sensibilidad a amoxicilina-ácido clavulánico y ampicilina-sulbactama y no se determinó la actividad de cefoperazona ni de sulbactama. La multirresistencia fue comúnmente observada en los aislamientos de Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans y Ochrobactrum anthropi. En cambio, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa y Oligella urethralis, fueron ampliamente sensibles a los antibacterianos ensayados. Debido a la gran variabilidad observada en la sensibilidad a los antimicrobianos en las distintas especies, se hace imprescindible realizar la prueba de sensibilidad a los antibacterianos a fin de abordar la elección correcta del mismo. Debido a la marcada multirresistencia de algunas especies, surge la necesidad del desarrollo de nuevos agentes antimicrobianos que posean actividad sobre este grupo de bacterias, así como tambien la búsqueda de combinaciones sinérgicas.
Gram-negative nonfermentative bacilli (NFB) are widely spread in the environment. Besides of difficulties for identification, they often have a marked multiresistance to antimicrobial agents, including those active against Pseudomonas aeruginosa. The objective of this study was to evaluate the ‘in vitro' activity of different antimicrobial agents on 177 gram-negative nonfermentative bacilli isolates (excluding Pseudomonas aeruginosa and Acinetobacter spp.) isolated from clinical specimens. Minimum inhibitory concentrations (MIC) were determined according to the Mueller Hinton agar dilution method against the following antibacterial agents: ampicillin, piperacillin, piperacillin-tazobactam, sulbactam, cefoperazone, cefoperazone-sulbactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, colistin, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, rifampin, norfloxacin, ciprofloxacin and minocycline. Seven isolates: Sphingobacterium multivorum (2 ), Sphingobacterium spiritivorum (1), Empedobacter brevis (1), Weeksella virosa (1), Bergeyella zoohelcum (1) and Oligella urethralis (1), were tested for amoxicillin-clavulanic acid and ampicillin-sulbactam susceptibility, and susceptibility to cefoperazone or sulbactam was not determined. Multiresistance was generally found in Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans, and Ochrobactrum anthropi isolates. On the other hand, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, and Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa and Oligella urethralis were widely susceptible to the antibacterial agents tested. As a result of the wide variation in antimicrobial susceptibility shown by different species, a test on susceptibility to different antibacterial agents is essential in order to select an adequate therapy. The marked multiresistance evidenced by some species, prompts the need to develop new antimicrobial agents active against this group of bacteria and to search for synergistic combinations.
Assuntos
Humanos , Antibacterianos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Resistência a Medicamentos , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Testes de Sensibilidade MicrobianaRESUMO
Enterobacter spp. are becoming increasingly frequent nosocomial pathogens with multiple resistance mechanism to beta-lactam antibiotics. We carried out the phenotypic and genotypic characterization of beta-lactamases in 27 Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes), as well as the ability of different extended spectrum-lactamase (ESBL) screening methods. Resistance to third generation cephalosporins was observed in 15/27 (63%) isolates. Twelve resistant isolates produced high level chromosomal encoded AmpC beta-lactamase; 6 of them were also producers of PER-2. Resistance to third generation cephalosporins in the remaining 3 isolates was due to the presence of ESBLs, PER-2 in 2 cases, and CTX-M-2 in the other. Only CTX-M-2 production was detected with all tested cephalosporins using difusion synergy tests, while cefepime improved ESBLs detection in 7/8 PER-2 producers, 4/8 in the inhibitor approximation test and 7/8 with double disk test using cefepime containing disk with and without clavulanic acid. Dilution method, including cephalosporins with and without the inhibitor detected 1/9 ESBLs producers.
Assuntos
Resistência às Cefalosporinas , Cefalosporinas/farmacologia , Enterobacter aerogenes/efeitos dos fármacos , Enterobacter cloacae/efeitos dos fármacos , Resistência às Cefalosporinas/genética , Cefalosporinas/classificação , Farmacorresistência Bacteriana Múltipla/genética , Enterobacter aerogenes/enzimologia , Enterobacter aerogenes/genética , Enterobacter cloacae/enzimologia , Enterobacter cloacae/genética , Infecções por Enterobacteriaceae/microbiologia , Genótipo , Humanos , Ponto Isoelétrico , Testes de Sensibilidade Microbiana , Fenótipo , beta-Lactamases/genéticaRESUMO
Infections produced by multidrug resistant organisms are one of the greatest problems in health centers. Often, only polymyxines show good activity "in vitro" against the carbapenem resistant gram-negative strains; but the National Committee for Clinical Laboratory Standards (NCCLS) documents do not currently provide interpretative criteria for testing the polymyxines. The antimicrobial activity of colistin, and the correlation between the agar dilution test and disk diffusion test were evaluated against 186 gram-negative strains isolated at the Hospital de Clínicas "José de San Martín" of Buenos Aires city. All susceptibility tests were performed according to the NCCLS recommendations. Were evaluated two breakpoints, NCCLS 1981 (< or = 8 mm and > or = 11 mm), and R. Jones 2001 (< or = 11 mm and > or = 14 mm). Discrepancies on interpretative category were found (0.5% minor; 2.2% major and 4.4% very major) with NCCLS 1981, and (18.9% minor; 3.8% major and 0.5% very major) with R. Jones 2001 criteria. Conclusions. In spite of the fact that the breakpoint used by R. Jones 2001 decreases the very major error but increases the minor error, according to our results we recommend the use of MIC methods to assist the therapeutic application of colistin; however resistance to colistin was not detected with zone diameters > or = 16 mm.
Assuntos
Colistina/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Testes de Sensibilidade Microbiana/normas , Adulto , Criança , Difusão , Farmacorresistência Bacteriana Múltipla , Determinação de Ponto Final , Reações Falso-Positivas , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Testes de Sensibilidade Microbiana/métodos , Polimixinas/farmacologia , Estudos ProspectivosRESUMO
Las infeccionesproducidas por microorganismos multirresistentes son uno de los mayores problemas en los centros asistenciales. Frecuentemente, sólo las polimixinas muestran actividad “in vitro” frente a aislamientos de bacilos gram-negativos resistentes a los carbapenemes. Sin embargo, el National Committee for Clinical Laboratory Standards (NCCLS) no incluye, actualmente, recomendaciones para la realización de las pruebas de sensibilidad para este grupo de antibióticos. Se determinóla actividad de colistín y la correlación entre las pruebas de difusión y dilución de este antibiótico frente a 186 aislamientos contemporáneos en el Hospital de Clínicas “José de San Martín”, siguiendo las recomendaciones generales del NCCLS. Se evaluaron dos puntos de corte: NCCLS 1981 (resistente £ 8 mm y sensible > 11mm) y R. Jones 2001 (resistente £ 11mm y sensible > 14mm). Utilizando el punto de corte del NCCLS 1981 se cometieron los siguientes errores: 0,5% “minor”; 2,2% “major” y 4,4% “very major”, mientras que con el propuesto por R. Jones 2001: 18,9% “minor”; 3,8% “major” y 0,5% “very major”. En conclusión, dado que el punto de corte utilizado por R. Jones 2001 disminuye el error “very major” pero aumenta el “minor” se recomienda la utilización de la concentración inhibitoria mínima (CIM) para confirmar la sensibilidad a colistín cuando sea usada en el tratamiento de infecciones, sin embargo no se detectó resistencia a colistín con halos de inhibición > a 16 mm.
Infections produced by multidrug resistant organisms are one of the greatest problems in health centers. Often, only polymyxines show good activity “in vitro” against the carbapenem resistant gram-negative strains; but the National Committee for Clinical Laboratory Standards (NCCLS) documents do not currently provide interpretative criteria for testing the polymyxines.The antimicrobial activity ofcolistin,and the correlation betweenthe agar dilution test and disk diffusion test were evaluated against 186 gram-negative strains isolated at the Hospital de Clínicas “José de San Martín” of Buenos Aires city. All susceptibility tests were performed according to the NCCLS recommendations. Were evaluated two breakpoints, NCCLS 1981 (£ 8mm and >11mm), and R. Jones 2001 (£ 11 mm and > 14 mm). Discrepancies on interpretative category were found (0.5% minor; 2.2% major and 4.4% very major) with NCCLS 1981, and (18.9% minor; 3.8% majorand 0.5% very major) with R. Jones 2001 criteria. Conclusions. In spite of the fact that the breakpoint used by R. Jones 2001decreases the very major error but increases the minor error, according to our results we recommend the use of MIC methods to assist the therapeutic application of colistin; however resistance to colistin was not detected with zone diameters > 16mm.
Assuntos
Adulto , Criança , Humanos , Colistina/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Testes de Sensibilidade Microbiana/normas , Difusão , Farmacorresistência Bacteriana Múltipla , Determinação de Ponto Final , Reações Falso-Positivas , Infecções por Bactérias Gram-Negativas/microbiologia , Testes de Sensibilidade Microbiana/métodos , Estudos Prospectivos , Polimixinas/farmacologiaRESUMO
Sixteen co-cultures composed of four bacteria and four fungi grown on sugarcane bagasse pith were tested for phenanthrene degradation in soil. The four bacteria were identified as Pseudomonas aeruginose, Ralstonia pickettii, Pseudomonas sp. and Pseudomonas cepacea. The four fungi were identified as: Penicillium sp., Trichoderma viride, Alternaria tenuis and Aspergillus terrus that were previously isolated from different hydrocarbon-contaminated soils. Fungi had a statistically significant positive (0.0001
Assuntos
Fenantrenos/metabolismo , Microbiologia do Solo , Poluentes do Solo/metabolismo , Bactérias , Biodegradação Ambiental , Fungos , Fenantrenos/isolamento & purificação , Eliminação de Resíduos , Saccharum , Poluentes do Solo/isolamento & purificaçãoRESUMO
We evaluated retrospectively 96 patients older than 64 years admitted with the diagnosis of Community Acquired Pneumonia (CAP) in order to describe the clinical features, evaluate severity and assess prognostic factors. During an 18-month period 100 cases of CAP were included. Average age was 82.3 years +/- 8.3 (+/- SD). By the time of admission, cough and fever were found in 35% of cases and 48% had altered mental status. Fourteen per cent needed mechanical ventilation. Etiology was determined in 21% of cases. Most common pathogens were S. pneumoniae (38.1%), S. aureus (19%) and H. infuenzae (14.3%). Overall mortality was 29%. The most commonly present criteria of severity were tachypnea (respiratory rate > 30) and a PaO2/FIO2 ratio < 250. Severe pneumonia was found in 60% of patients and mortality in that group was 40%. Multivariate analysis demonstrated that some independent prognostic factors were associated with higher mortality: requirement of vasopressors (Odds Ratio [OR] = 22.0; 95% confidence interval [CI] = 1.9-249.5), oliguria (OR = 9.9; CI = 1.5-66.2), previous neurologic disease (OR = 8.2; CI = 1.8-36.6), PaCO2 > 44 mm/Hg (OR = 6.9; CI = 1.1-43.2), and creatinine > 1.4 mg/dl (OR = 4.7; CI = 1.2-19.1). We conclude that CAP features in elderly patients requiring hospitalization are atypical, severe presentations are frequent and mortality is high. Prognostic factors as found in this study can help the evaluating physician to identify those who require special care.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Hospitalização , Pneumonia Bacteriana/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Análise Multivariada , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/mortalidade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
Ketorolac is a new non-steroidal anti-inflammatory drug (NSAID) having a potent nonopioid analgesic activity. Administered by continuous subcutaneous infusion (CSI), its analgesic efficacy has been documented in the treatment of somatic and visceral cancer pain whilst it has been shown to be ineffective in the treatment of neuropathic pain. Here is a description of a cancer patient with neuropathic pain unresponsive to anticonvulsant or antidepressant drugs administered in association or not with oral opioids but who was successfully treated with ketorolac alone via CSI. Furthermore, the analgesia lasted over 75 days of treatment without any significant renal and gastric side effects.
Assuntos
Analgésicos não Narcóticos/administração & dosagem , Neoplasias Faciais/complicações , Hemangiossarcoma/complicações , Nariz , Dor/tratamento farmacológico , Tolmetino/análogos & derivados , Humanos , Injeções Subcutâneas , Cetorolaco , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Tolmetino/administração & dosagemRESUMO
10 patients with the acquired immunodeficiency syndrome whose respiratory failure due to Pneumocystis carinii pneumonia (PCP) was deteriorating rapidly had 7 days of intravenous methylprednisolone added to their antibiotic regimen. 8 similar patients were treated with antibiotic therapy alone. 9 of the 10 methylprednisolone-treated patients survived their episode of PCP, compared with 2 of the 8 conventionally treated patients. Clinical improvement was evident within 2 days of the start of steroid therapy, and in none of the 10 patients did clinical deterioration or recurrence of PCP occur on cessation of steroid therapy. In 1 steroid-treated patient disseminated herpes zoster developed 2 days after discontinuation of methylprednisolone. Methylprednisolone seems to be a useful adjunctive therapeutic agent for patients with AIDS in whom Pneumocystis carinii is the sole respiratory pathogen.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Corticosteroides/uso terapêutico , Pneumonia por Pneumocystis/tratamento farmacológico , Doença Aguda , Adulto , Ensaios Clínicos como Assunto , Seguimentos , Homossexualidade , Humanos , Masculino , Metilprednisolona/uso terapêuticoRESUMO
Con el objeto de estudiar los resultados histopatologicos comparativos en cirugia colonica utilizando suturas manuales y mecanicas fueron operados 18 perros. Se evaluaron las caracteristicas macro y microscopicas de ambas suturas, hallandose diferencias significativas en los procesos de necrosis y neoformacion
Assuntos
Animais , Cães , Colo , Técnicas de Sutura , NecroseRESUMO
Se presenta un caso poco frecuente de hidatidosis peritoneal solitaria y primitiva. Se analizan los posibles mecanismos de produccion y se insiste en el hecho de que si bien son de observacion excepcional no dejan de ser posibles y pueden demostrarse por los metodos actuales de diagnostico
Assuntos
Adulto , Humanos , Equinococose , Cisto Mesentérico , PeritônioRESUMO
Se presenta un estudio basado en 38 pacientes con traumatismos hepaticos producidos por armas de fuego, poniendo enfasis en la ausencia de sintomatologia especifica y en el valor de la puncion abdominal.Su tratamiento es quirurgico, con hemostasia directa de los puntos sangrantes y eliminacion de los restos desvitalizados.Los autores puntualizan que deben evitarse las suturas en masa y la creacion de espacios muertos. Reconocen la utilidad de la maniobra de Pringle y el valor practico de las ligaduras de la arteria hepatica o de sus ramas a nivel del hilio (maniobra de eleccion). Insisten en el valor de los drenajes. Las complicaciones mas frecuentes han sido las septicas y las hemorragicas, necesitando reoperaciones en algunos casos