Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Mais filtros

Base de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Int J Med Microbiol ; 308(2): 279-289, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29276044

RESUMO

Most multidrug-resistant (MDR) and extensively drug-resistant (XDR) P. aeruginosa strains belonged to epidemic high-risk (EHR) clones that succeeded worldwide in the context of hospital outbreaks. In order to study the intraclonal diversity in EHR P. aeruginosa, we selected clinical and environmental strains of the EHR clone ST308 that caused outbreak clusters over five years in a hospital and then persisted in the hospital environment during four additional years, causing sporadic infections. Unexpectedly, resistance phenotype was very diverse within the population, independently of the origin (environmental or human) and the period of isolation (during or after outbreaks). Most MDR/XDR strains belonged to clusters in pulsed-field gel electrophoresis (PFGE) while singleton strains instead displayed susceptible or moderately resistant phenotypes. High diversity was observed for motility and biofilm formation without correlation with the origin and the period. Resistance to biocides was not linked to epidemic success or to environmental persistence. Finally, the EHR clone ST308 did not display common adaptive traits, nor traits related to an origin or a period of isolation in the hospital. The major character of this EHR clone ST308 is its intraclonal diversity that probably warrants its adaptation and persistence in hospital whatever the conditions and therefore its epidemic behaviour. This diversity could result from adaptive radiation with the evolution of multiple lineages that fill available niches within a complex ecosystem such as a hospital.


Assuntos
Infecção Hospitalar/tratamento farmacológico , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa , Antibacterianos/farmacologia , Biofilmes/crescimento & desenvolvimento , Infecção Hospitalar/microbiologia , Eletroforese em Gel de Campo Pulsado , Hospitais , Humanos , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Sorotipagem
2.
Eur J Clin Microbiol Infect Dis ; 34(2): 287-301, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25169966

RESUMO

Propionibacterium acnes belongs to the normal skin microbiota, but it is also responsible for acne vulgaris and causes serious infections such as endocarditis and surgical site infections (SSI). The P. acnes population is structured into phylogenetic groups, with phylotype I being associated with acne. Herein, we explore the link between phylotypes and clinical origins in a collection of P. acnes isolated from different body sites, involved in deep infections or healthcare-associated infections (HAI), with particular emphasis on strains from cardiac SSI. Cardiac SSI have been further studied in terms of P. acnes population dynamics during the care pathway. The recA and tly genes phylotypes were compared to hemolytic behavior, susceptibility to antimicrobial agents, and clinical origins. An original approach of recA polymerase chain reaction temporal temperature gel electrophoresis (PCR-TTGE) was developed and applied for the direct identification of P. acnes phylotypes in surgical samples, in order to assess their temporal dynamics during the surgical course. Our results underlined the preferential involvement of IA-2/IB and II phylogroups in HAI and SSI. Unlike IA and II, type IA-2/IB presented a gradual increase with the depth of sampling in the peroperative phase of cardiac surgery. Phylotypes IA and IA-2/IB were both predominant in scar tissues and on postoperative skin, suggesting a specific predisposition to recolonize skin. Particular association of the phylotype IA-2/IB with SSI and its propensity to colonize wounds in cardiac surgery was observed. We assumed that the follow-up of P. acnes phylotypes during pathological processes could give new clues for P. acnes pathogenicity.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Infecções por Bactérias Gram-Positivas/microbiologia , Propionibacterium acnes/isolamento & purificação , Acne Vulgar/microbiologia , Proteínas de Bactérias/genética , Técnicas de Tipagem Bacteriana , Sequência de Bases , Humanos , Dados de Sequência Molecular , Fenótipo , Filogenia , Reação em Cadeia da Polimerase , Propionibacterium acnes/genética , Propionibacterium acnes/patogenicidade , Recombinases Rec A/genética , Análise de Sequência de DNA , Pele/microbiologia
3.
J Hosp Infect ; 104(1): 40-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31419468

RESUMO

BACKGROUND: Pseudomonas aeruginosa remains one of the most common nosocomial pathogens in intensive care units (ICUs). Although exogenous acquisition has been widely documented in outbreaks, its importance is unclear in non-epidemic situations. AIM: To elucidate the role of exogenous origin of P. aeruginosa in ICU patients. METHODS: A chronological analysis of the acquisition of P. aeruginosa was performed using samples collected in 2009 in the DYNAPYO cohort study, during which patients and tap water were screened weekly. Molecular relatedness of P. aeruginosa isolates was investigated by pulsed-field gel electrophoresis. Exogenous acquisition was defined as identification of a P. aeruginosa pulsotype previously isolated from another patient or tap water in the ICU. FINDINGS: The DYNAPYO cohort included 1808 patients (10,402 samples) and 233 water taps (4946 samples). Typing of 1515 isolates from 373 patients and 375 isolates from 81 tap water samples identified 296 pulsotypes. Analysis showed exogenous acquisition in 170 (45.6%) of 373 patients. The pulsotype identified had previously been isolated from another patient and from a tap water sample for 86 and 29 patients, respectively. The results differed according to the ICU. CONCLUSION: Exogenous acquisition of P. aeruginosa could be prevented in half of patients. The overall findings of this survey support the need for studies on routes of transmission and risk assessment approach to better define how to control exogenous acquisition in ICUs.


Assuntos
Surtos de Doenças/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Estudos de Coortes , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Eletroforese em Gel de Campo Pulsado/métodos , França/epidemiologia , Genótipo , Humanos , Programas de Rastreamento/métodos , Estudos Prospectivos , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/genética , Medição de Risco , Microbiologia da Água
4.
J Hosp Infect ; 98(1): 53-59, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28760634

RESUMO

BACKGROUND: Water networks in hospitals are frequently contaminated by opportunistic premise plumbing pathogens (OPPPs) leading to installation of antimicrobial filters on water points-of-use (POU) in order to limit patients' exposure. AIM: To assess the spread of OPPPs through secondary water routes (outside the plumbing system) in an adult haematology unit in which 52 out of 73 water POU were high risk for patients and protected by antimicrobial filters. METHODS: An observational audit identified six secondary water routes for which bacteria tracking and typing were performed in 315 surface samplings. Bacterial isolates were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and compared to the infra-species level by multiplex repetitive element sequence-based polymerase chain reaction and/or by restriction fragment length polymorphism in pulse-field gel electrophoresis. FINDINGS: Pseudomonas aeruginosa and Stenotrophomonas maltophilia, as well as non-pathogenic OPPP indicators, were detected in water collected upstream of antimicrobial filters. P. aeruginosa was the sole OPPP retrieved from tested surfaces (5.1%). The same clone of P. aeruginosa spread from water source to dry surfaces in the same room and cross-contaminated two sinks in different rooms. Three clones of non-pathogenic OPPP indicators spread more widely in different rooms. CONCLUSION: A strategy based on filtration of most (but not all) water POU in a haematology unit could be sufficient to limit the spread of OPPPs to the environment, provided a functional mapping of 'high-risk' POU has been undertaken. The residual spread of OPPPs and OPPP indicators linked to non-filtered water POU argues for careful monitoring of non-filtered water use.


Assuntos
Filtração , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/isolamento & purificação , Stenotrophomonas maltophilia/classificação , Stenotrophomonas maltophilia/isolamento & purificação , Microbiologia da Água , Técnicas de Genotipagem , Hospitais , Humanos , Reação em Cadeia da Polimerase , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
5.
J Hosp Infect ; 97(4): 414-417, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28669673

RESUMO

A case of occupational contamination of a healthcare worker by a pre-extensively drug-resistant (pre-XDR) Beijing strain of Mycobacterium tuberculosis at the University Hospital of Montpellier, France is reported. The index case was identified using genetic fingerprinting of isolates. This report underscores the risk of healthcare-associated contamination by pre-XDR tuberculosis (TB) in low-incidence countries and the importance of molecular tools for TB care. It also calls for increased vigilance in the management of multi-drug-resistant/XDR TB patients.


Assuntos
Pessoal de Saúde , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/isolamento & purificação , Exposição Ocupacional , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/transmissão , Impressões Digitais de DNA , França , Genótipo , Humanos , Tipagem Molecular , Mycobacterium tuberculosis/genética
6.
J Hosp Infect ; 92(1): 73-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26542949

RESUMO

BACKGROUND: The emergence and spread of carbapenemase-producing Enterobacteriaceae (CPE) have become a major public health problem. Control and prevention of CPE infections hinge on isolation precautions for carriers and active screening and follow-up of contacts. AIM: To implement an open registry of cases and contacts for acute outbreak management, long-term data collection and epidemiological investigation. METHODS: All cases, defined as patients (infected or colonized) with a CPE-positive culture during their hospitalization, and contacts (e.g. patients cared for by the same healthcare team as a case) were registered in an ongoing database. Hospital stays were cross-referenced for every new entry and epidemiological links (e.g. shared contacts) investigated. All cases and contacts not cleared by complete screening were registered on an active list. FINDINGS: Between October 2012 and November 2014, we registered 30 cases and 1268 contacts, among which 24 were linked to two or three separate cases. Only 6.5% of contacts fulfilled complete screening with three rectal swabs, and 1145 contacts are still registered on the active surveillance list. Two outbreaks (12 and nine cases) occurred nine months apart. Cross-referencing of hospital stays using the registry revealed epidemiological links between seemingly unrelated cases of CPE-positive patients and suggested an environmental source of transmission, which was demonstrated thereafter. CONCLUSION: We implemented a simple and multi-purpose tool to manage CPE episodes and investigate epidemiological links. Efforts are necessary to improve screening of contact patients who may be occult sources of transmission. A regional registry could be helpful.


Assuntos
Proteínas de Bactérias/metabolismo , Busca de Comunicante , Transmissão de Doença Infecciosa/prevenção & controle , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/enzimologia , Controle de Infecções/métodos , Sistema de Registros , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/transmissão , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Clin Microbiol Infect ; 22(8): 737.e1-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27269884

RESUMO

Roseomonas spp. are increasingly involved in human infectious diseases. The environmental source for infection is generally admitted in published cases owing to the origin of most Roseomonas species and to their affiliation to the family Acetobacteraceae in Rhodospirillales, which mainly groups environmental bacteria. For a better delineation of Roseomonas habitat and infectious reservoir, we related phenotype, phylotype (16S rRNA gene), genomotype (pulsed-field gel electrophoresis) and origin of 33 strains isolated from humans, hospital environment and natural environment. Genetic and metagenomic databases were also surveyed. The population structure of the genus showed clades associated with humans, whereas others grouped environmental strains only. Roseomonas mucosa is the main human-associated species and the study supported the idea that opportunistic infections due to this species are related to the patient skin microbiota rather than to the environment. In contrast, some strains belonging to other species isolated from patients with cystic fibrosis were related to environmental clades, suggesting an exogenous source for patient colonization. Accurate knowledge about the reservoirs of opportunistic pathogens that have long been considered of environmental origin is still needed and would be helpful to improve infection control and epidemiological survey of emerging human pathogens.


Assuntos
Infecções por Bactérias Gram-Negativas/microbiologia , Methylobacteriaceae , Microbiota , Infecções Oportunistas/microbiologia , Pele/microbiologia , Antibacterianos/farmacologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Microbiologia Ambiental , Genoma Bacteriano , Humanos , Metagenoma , Metagenômica/métodos , Methylobacteriaceae/classificação , Methylobacteriaceae/efeitos dos fármacos , Methylobacteriaceae/genética , Testes de Sensibilidade Microbiana , Filogenia , RNA Ribossômico 16S/genética
8.
J Hosp Infect ; 93(3): 235-9, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27210271

RESUMO

The non-tuberculous mycobacteria (NTM) Mycobacterium wolinskyi caused bacteraemia and massive colonization of an aortic prosthesis in a patient 16 days after cardiac surgery, necessitating repeat surgery and targeted antimicrobial chemotherapy. The infection control team investigated the source and conditions of infection. Peri-operative management of the patient complied with recommendations. The environmental investigation showed that although M. wolinskyi was not recovered, diverse NTM species were present in water from point-of-use taps and heater-cooler units for extracorporeal circulation. This case and increasing evidence of emerging NTM infections in cardiac surgery led to the implementation of infection control procedures in cardiac surgery wards.


Assuntos
Aorta/cirurgia , Bacteriemia/diagnóstico , Microbiologia Ambiental , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Infecções Relacionadas à Prótese/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Bacteriemia/microbiologia , Equipamentos e Provisões/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/microbiologia , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/microbiologia
9.
Ann Fr Anesth Reanim ; 2(4): 296-9, 1983.
Artigo em Francês | MEDLINE | ID: mdl-6650933

RESUMO

A case is reported of acute fatty liver occurring in an Addisonian woman with a twin pregnancy. It is pointed out that Sheehan's syndrome or acute fatty liver of pregnancy is an exceptional cause of jaundice in pregnancy. Its severity is due to the syndrome, associating hepatic failure and renal, pancreatic and haemorrhagic complications. The history of the pregnancy and the past medical history are of less import for the outcome. The best treatment is delivery by caesarean section, together with symptomatic treatment of the complications. In case of jaundice of unknown aetiology in late pregnancy, the advantages of an early diagnosis by transjugular hepatic biopsy are discussed.


Assuntos
Doença de Addison/complicações , Fígado Gorduroso/etiologia , Complicações na Gravidez , Doença Aguda , Adulto , Cesárea , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/patologia , Feminino , Humanos , Icterícia/etiologia , Fígado/patologia , Gravidez , Terceiro Trimestre da Gravidez , Gravidez Múltipla , Gêmeos
10.
Ann Fr Anesth Reanim ; 2(2): 86-8, 1983.
Artigo em Francês | MEDLINE | ID: mdl-6625250

RESUMO

A case of post-partum cardiomyopathy probably due to salbutamol is described. The patient was a young primipara without any cardiovascular disease. She presented a sudden left ventricular failure after Caesarean section for twins: salbutamol had not been given for a week. After 10 days' treatment with diuretics and vasodilators, the patient was cured, no sequellae remaining. It seemed the mechanism was multifactorial: direct myocardial injury, a reduction in the number of receptors, peripheral haemodynamic changes.


Assuntos
Albuterol/efeitos adversos , Cardiomiopatias/induzido quimicamente , Transtornos Puerperais/induzido quimicamente , Adulto , Albuterol/uso terapêutico , Cardiomiopatias/fisiopatologia , Cesárea , Feminino , Humanos , Trabalho de Parto Prematuro/tratamento farmacológico , Gravidez , Gravidez Múltipla
11.
J Hosp Infect ; 88(2): 103-8, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25155240

RESUMO

BACKGROUND: Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear. AIM: To identify individual and environmental ICU risk factors for P. aeruginosa acquisition. METHODS: A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥ 24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model. FINDINGS: Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa. Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward 'nine equivalents of nursing manpower use score' (NEMS) [hazard ratio (HR): 1.47 for ≥ 30 points; 95% confidence interval (CI): 1.06-2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09-2.84). CONCLUSION: Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition.


Assuntos
Infecção Hospitalar/etiologia , Farmacorresistência Bacteriana , Contaminação de Equipamentos , Unidades de Terapia Intensiva , Infecções por Pseudomonas/etiologia , Respiração Artificial/efeitos adversos , Microbiologia da Água , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecção Hospitalar/microbiologia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA