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1.
J Hosp Infect ; 139: 161-167, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37343769

RESUMEN

BACKGROUND: Pseudomonas aeruginosa and other Gram-negative bacteria have the ability to persist in moist environments in healthcare settings, but their spread from these areas can result in outbreaks of healthcare-associated infections. METHODS: This study reports the investigation and containment of a multi-drug-resistant P. aeruginosa outbreak in three intensive care units of a Swiss university hospital. In total, 255 patients and 276 environmental samples were screened for the multi-drug-resistant P. aeruginosa outbreak strain. The environmental sampling and molecular characterization of patient and environmental strains, and control strategies implemented, including waterless patient care, are described. RESULTS: Between March and November 2019, the outbreak affected 29 patients. Environmental sampling detected the outbreak strain in nine samples of sink siphons of three different intensive care units with a common water sewage system, and on one gastroscope. Three weeks after replacement of the sink siphons, the outbreak strain re-grew in siphon-derived samples and newly affected patients were identified. The outbreak ceased after removal of all sinks in the proximity of patients and in medication preparation areas, and minimization of tap water use. Multi-locus sequence typing indicated clonality (sequence type 316) in 28/29 patient isolates and all 10 environmental samples. CONCLUSIONS: Sink removal combined with the introduction of waterless patient care terminated the multi-drug-resistant P. aeruginosa outbreak. Sinks in intensive care units may pose a risk for point source outbreaks with P. aeruginosa and other bacteria persisting in moist environments.


Asunto(s)
Infección Hospitalaria , Infecciones por Pseudomonas , Humanos , Pseudomonas aeruginosa , Tipificación de Secuencias Multilocus , Unidades de Cuidados Intensivos , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/microbiología , Agua
2.
Clin Microbiol Infect ; 25(4): 512.e7-512.e13, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30025835

RESUMEN

OBJECTIVES: Streptococcus pyogenes causes life-threatening invasive infections including necrotizing fasciitis (NF). Current treatment guidelines recommend the use of a cell-wall-active antibiotic combined with a protein synthesis inhibitor and surgical debridement in NF patients. Adjunctive therapy with intravenous immunoglobulin (IVIG) has been proposed for superantigen-associated streptococcal toxic shock syndrome. So far, benefits of IVIG treatment remain unclear and prospective clinical studies are scarce. Thus, we aimed to assess the effects of IVIG on virulence factor activity in vitro, ex vivo in patients and in vivo in a NF mouse model. METHODS: We investigated the effect of IVIG on the activity of the virulence factors streptolysin O (SLO), streptodornase 1 (Sda1), S. pyogenes cell envelope protease and streptococcal pyrogenic exotoxin B in vitro and ex vivo in patient sera. Additionally, we assessed the influence of IVIG on the clinical outcome in a murine NF model. RESULTS: In vitro, IVIG inhibited various streptococcal virulence factors. Further, IVIG treatment of group A Streptococcus-infected mice led to a reduced skin lesion size (median (interquartile range) day 3 intraperitoneal administration: 12 mm2 (9-14.5) vs. 4 mm2 (0.8-10.5), subcutaneous: 10.3 mm2 (6.9-18.6) vs. 0.5 mm2 (0.1-6.8)) and lower SLO activity. After treatment with IVIG, patient sera showed an elevated titre of specific SLO (7/9) and Sda1 (5/9) antibodies, reducing SLO and Sda1 activity. CONCLUSIONS: The clear reduction in disease severity in IVIG-treated mice and inhibition of virulence factor activity in mouse and human sera suggest that IVIG may be beneficial in invasive group A Streptococcus infections such as NF in addition to streptococcal toxic shock syndrome.


Asunto(s)
Cisteína Endopeptidasas/inmunología , Desoxirribonucleasa I/inmunología , Fascitis Necrotizante/terapia , Inmunoglobulinas Intravenosas/uso terapéutico , Infecciones Estreptocócicas/terapia , Streptococcus pyogenes/inmunología , Streptococcus pyogenes/patogenicidad , Estreptolisinas/inmunología , Animales , Proteínas Bacterianas/inmunología , Método Doble Ciego , Fascitis Necrotizante/microbiología , Humanos , Ratones , Ratones Endogámicos C57BL , Placebos , Infecciones Estreptocócicas/microbiología
3.
J Infect ; 78(6): 439-444, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30965066

RESUMEN

OBJECTIVES: Synovial fluid C-reactive protein (syCRP) has been recently described as a new biomarker in preoperative diagnostics to identify periprosthetic joint infections (PJI). The aim of this study was to evaluate syCRP in a large cohort of patients with suspected PJI and to calculate the optimal cut-off to diagnose PJI. METHODS: Between September 2015 and June 2017, we prospectively included patients with suspected PJI, in which syCRP was additionally measured along with routine preoperative diagnostic serum and synovial biomarkers. We analysed the sensitivity and specificity of syCRP using receiver operating characteristic curves. RESULTS: We included 192 cases (hip n = 80, knee n = 91, shoulder n = 21) with a final diagnosis of PJI in 26 cases (14.0%). Combined for all joints, the syCRP values were significantly higher in the PJI group than in the no PJI group (median: 13.8 vs. 0 mg/l; p < 0.001). The optimal cut-off (Youden Index: 0.71) for the PJI diagnosis combined for all joints was at a syCRP value of 2.9 mg/l with a sensitivity of 88%, a specificity of 82%, and a negative predictive value of 98%. CONCLUSIONS: SyCRP features high negative predictive value but is not useful as a single diagnostic parameter in suspected periprosthetic joint infection (PJI).


Asunto(s)
Proteína C-Reactiva/análisis , Infecciones Relacionadas con Prótesis/diagnóstico , Líquido Sinovial/química , Adulto , Anciano , Anciano de 80 o más Años , Artritis Infecciosa/cirugía , Biomarcadores , Sedimentación Sanguínea , Femenino , Humanos , Articulaciones/microbiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad
4.
Clin Microbiol Infect ; 24(11): 1212.e1-1212.e6, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-29496595

RESUMEN

OBJECTIVES: The antimicrobial peptide α-defensin has recently been introduced as a potential 'single' biomarker with a high sensitivity and specificity for the preoperative diagnosis of periprosthetic joint infections (PJIs). However, most studies assessed the benefits of the test with exclusion of patients with rheumatic diseases. We aimed to evaluate the α-defensin test in a cohort study without exclusion of people with inflammatory diseases. METHODS: Between June 2016 and June 2017, we prospectively included cases with a suspected PJI and an available lateral flow test α-defensin (Synovasure®) in synovial fluid. We compared the test result to the diagnostic criteria for PJIs published by an International Consensus Group in 2013. RESULTS: We included 109 cases (49 hips, 60 knees) in which preoperative α-defensin tests had been performed. Among these, 20 PJIs (16 hips, four knees) were diagnosed. Preoperative α-defensin tests were positive in 25 cases (22.9%) with a test sensitivity and specificity of 90% and 92.1% (95% CI 68.3%-98.8% and 84.5%-96.8%, respectively), and a high negative predictive value of 97.6% (95% CI 91.7%-99.4%). We interpreted seven α-defensin tests as false positive, mainly in cases with inflammatory rheumatic diseases, including crystal deposition diseases. CONCLUSIONS: A negative synovial α-defensin test can reliably rule out a PJI. However, the test can be false positive in conjunction with an underlying non-infectious inflammatory disease. We therefore propose to use the α-defensin test only in combination with Musculoskeletal Infection Society criteria and assessment for crystals in synovial aspirates.


Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Inflamación/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , alfa-Defensinas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Líquido Sinovial/química , alfa-Defensinas/química
5.
Int J Antimicrob Agents ; 50(1): 55-62, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28506804

RESUMEN

Mycobacterium tuberculosis (MTB) is notorious for persisting within host macrophages. Efflux pumps decrease intracellular drug levels, thus fostering persistence of MTB during therapy. Isoniazid (INH) and pyrazinamide (PZA) are substrates of the efflux pump breast cancer resistance protein-1 (BCRP-1), which is inhibited by chloroquine (CQ). In this study, BCRP-1 was found to be expressed on macrophages of human origin and on foamy giant cells at the site of MTB infection. In the current in vitro study, interferon-gamma (IFNγ) increased the expression of BCRP-1 in macrophages derived from the human monocytic leukaemia cell line THP-1. Using a BCRP-1-specific fluorescent dye and radioactively labelled INH, it was demonstrated that efflux from macrophages increased upon activation with IFNγ. CQ was able to inhibit active efflux and augmented the intracellular concentrations both of INH and the dye. In agreement, CQ and specific inhibition of BCRP-1 increased the antimycobacterial activity of INH against intracellular MTB. Although PZA behaved differently, CQ had comparable advantageous effects on the intracellular pharmacokinetics and activity of PZA. The adjunctive effects of CQ on intracellular killing of MTB were measurable at concentrations achievable in humans at approved therapeutic doses. Therefore, CQ, a widely used and worldwide available drug, may potentiate the efficacy of standard MTB therapy against bacteria in the intracellular compartment.


Asunto(s)
Antituberculosos/farmacología , Cloroquina/farmacología , Sinergismo Farmacológico , Isoniazida/farmacología , Macrófagos/efectos de los fármacos , Mycobacterium tuberculosis/efectos de los fármacos , Pirazinamida/farmacocinética , Transportador de Casetes de Unión a ATP, Subfamilia G, Miembro 2/antagonistas & inhibidores , Humanos , Macrófagos/inmunología , Proteínas de Neoplasias/antagonistas & inhibidores , Células THP-1
6.
Am J Clin Pathol ; 106(3): 378-83, 1996 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-8816598

RESUMEN

Forty-eight clinical strains that were tentatively identified as Corynebacterium minutissimum on the basis of standard biochemical reactions (Hollis-Weaver tables) as well as by the use of the API (RAPID) Coryne system were examined further. Two different groups of strains were observed. The first group (including the type strain of C minutissimum) contained 27 strains showing creamy colonies. These strains grew homogeneously in 6.5% NaCl broth, exhibited DNase activity, were susceptible to the vibriocidal compound O/129, produced succinic acid, and contained mycolic acids. The second group comprised 21 strains with dry colonies. They grew in clumps at the surface of 6.5% NaCl broth, DNase activity was not detected, they were resistant against O/129, produced large amounts of propionic acid, and mycolic acids were not detected. In combination with quantitative DNA-DNA hybridizations, it was demonstrated that strains of the second cluster belonged, in fact, to C amycolatum. Furthermore, it was observed that a few C minutissimum strains may also ferment mannitol. These data indicate that the clinical microbiologist must be careful not to misidentify C amycolatum strains as C minutissimum.


Asunto(s)
Infecciones Bacterianas/microbiología , Corynebacterium/aislamiento & purificación , Corynebacterium/clasificación , Corynebacterium/citología , Corynebacterium/metabolismo , Humanos , Pruebas de Sensibilidad Microbiana , Especificidad de la Especie
8.
BMJ Case Rep ; 20102010 Dec 29.
Artículo en Inglés | MEDLINE | ID: mdl-22802471

RESUMEN

In a patient with mediastinitis after cardiac surgery Paenibacillus pasadenensis was detected in his sternal wound. Paenibacilli are gram-positive, aerobic, bacteria related to bacilli. Until recently these organisms were not known to cause human disease. A few cases of human infection caused by another member of this genus, P alvei, have been reported. The authors describe the first infection with P pasadenensis in humans. P pasadenensis was detected by broad-range bacterial 16S rRNA PCR. Treatment consisted of surgical debridement and antibiotics, vancomycin and ciprofloxacin followed by clindamycin and ciprofloxacin, resulting in complete recovery.


Asunto(s)
Infecciones por Bacterias Grampositivas/complicaciones , Mediastinitis/microbiología , Paenibacillus , Infección de la Herida Quirúrgica/etiología , Anciano , Puente Cardiopulmonar , Humanos , Masculino , Datos de Secuencia Molecular , Paenibacillus/genética , Nave Espacial
9.
Infection ; 36(4): 314-21, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18648747

RESUMEN

BACKGROUND: Staphylococcus lugdunensis endocarditis has been associated with an aggressive course. The aim of this study was to determine factors associated with the development of endocarditis in patients with S. lugdunensis bacteremia. METHODS: A retrospective analysis of all patients with S. lugdunensis bacteremia in three tertiary care centers in Switzerland was performed. Data regarding medical history, symptoms, and susceptibility of S. lugdunensis isolates were collected. Our results were reviewed in the context of the current literature. RESULTS: A total of 28 patients with S. lugdunensis bacteremia were identified. Of the 13 patients with endocarditis, all were community acquired. Cardiac surgery was performed in 85% of these patients; mortality was 23%, reflecting the aggressive course of this disease. In contrast, in the 15 patients without endocarditis, no complications associated with S. lugdunensis bacteremia were observed. In 73%, a probable source was identified in the form of a venous catheter or other foreign device. Only three of these episodes were community acquired. No difference was observed in susceptibility of the S. lugdunensis isolates to penicillin, which was 77% in endocarditis isolates, and 87% in isolates of bacteremia without endocarditis, respectively. CONCLUSION: S. lugdunensis bacteremia is associated with endocarditis in up to 50% of patients. Every patient with community-acquired S. lugdunensis bacteremia should be carefully examined for signs of endocarditis. Once S. lugdunensis endocarditis is diagnosed, close monitoring is essential and surgical treatment should be considered early. In the nosocomial setting, endocarditis is far less frequent, and S. lugdunensis bacteremia is usually associated with a catheter or other foreign materials.


Asunto(s)
Bacteriemia/complicaciones , Bacteriemia/microbiología , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/mortalidad , Catéteres de Permanencia/efectos adversos , Catéteres de Permanencia/microbiología , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/mortalidad , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Penicilinas/farmacología , Penicilinas/uso terapéutico , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/mortalidad , Staphylococcus/efectos de los fármacos , Suiza , Resultado del Tratamiento
10.
Infection ; 33(3): 148-50, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15940416

RESUMEN

A 29-year-old man with rapidly destructive Staphylococcus epidermidis endocarditis after mitral valve reconstruction is presented. Resistance to rifampin and teicoplanin occurred during antibiotic treatment resulting in clinical failure and valve destruction. Subsequently, the patient was successfully treated, by combining valve replacement with antibiotic therapy including quinupristin/dalfopristin, levofloxacin, and vancomycin. In conclusion, S. epidermidis can cause rapid valve destruction with large vegetations, and combination of surgery and antibiotic therapy may be necessary.


Asunto(s)
Endocarditis Bacteriana/microbiología , Infecciones Estafilocócicas/diagnóstico , Staphylococcus epidermidis/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Progresión de la Enfermedad , Farmacorresistencia Bacteriana Múltiple , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/cirugía , Humanos , Masculino , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus epidermidis/efectos de los fármacos
11.
Eur J Clin Microbiol Infect Dis ; 24(2): 153-5, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15711784

RESUMEN

Reported here is a case of a patient with pulmonary arterial hypertension related to HIV (PAHRH) in which lipodystrophy necessitated interruption of highly active antiretroviral therapy (HAART) and long-term survival was the outcome. Although previous studies have suggested antiretroviral therapy may benefit patients with this rare complication of HIV infection, no worsening of PAHRH was observed when HAART was interrupted. Clinical and echocardiographic parameters remained stable during 7 months of follow up. In cases in which HAART is associated with relevant toxicity, interruption of HAART in patients with PAHRH can be considered, but should be used only if no alternatives are available. Close follow-up is warranted.


Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/complicaciones , Hipertensión Pulmonar/etiología , Adulto , Esquema de Medicación , Infecciones por VIH/tratamiento farmacológico , Humanos , Hipertensión Pulmonar/tratamiento farmacológico , Masculino , Tasa de Supervivencia , Resultado del Tratamiento
12.
Klin Monbl Augenheilkd ; 222(3): 226-30, 2005 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-15785986

RESUMEN

BACKGROUND: With increasing migration tropical diseases such as Loa loa infections are becoming more frequent in Europe. While the ocular diagnosis is usually straight forward, systemic work-up and treatment requires an interdisciplinary approach. We review the diagnostic and therapeutic work-up of ocular Loa loa infections based on a series of 4 cases that presented between 1998 and 2004. HISTORY AND SIGNS: The first symptoms in all cases were ocular irritations occurring 2 months to 8 years after a trip to West Africa. One case presented with a swollen upper eyelid without a visible worm. In three patients microfilariae were detected in the blood. THERAPY AND OUTCOME: In two cases visible subconjunctival worms could be removed under the slit lamp. Three cases required systemic treatment as inpatients while one case could be observed without systemic treatment. All 4 cases had a favourable outcome with complete eradication of the disease. CONCLUSION: Surgical removal of adult Loa loa worms from the subconjunctival space only improves the ocular symptoms. An interdisciplinary approach (ophthalmology, infectious disease and parasitology) for a systemic work-up and treatment is usually required.


Asunto(s)
Infecciones Parasitarias del Ojo/diagnóstico , Loa , Loiasis/diagnóstico , Adolescente , Adulto , Albendazol/administración & dosificación , Animales , Camerún , Terapia Combinada , Conjuntiva/parasitología , Conjuntiva/cirugía , Infecciones Parasitarias del Ojo/etiología , Infecciones Parasitarias del Ojo/terapia , Femenino , Humanos , Loiasis/etiología , Loiasis/terapia , Masculino , Microfilarias , Persona de Mediana Edad , Grupo de Atención al Paciente , Viaje
13.
Infection ; 31(2): 86-91, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12682813

RESUMEN

BACKGROUND: DNA of Tropheryma whipplei, the etiologic agent of Whipple's disease, has recently been detected in the saliva of healthy subjects. In this pilot study we searched for the habitat of T. whipplei within the oral cavity. MATERIALS AND METHODS: Samples from different oral sites were obtained from periodontically healthy volunteers, patients with progressive periodontitis and Chinese subjects with necrotizing ulcerative gingivitis or gingivitis. Quantitative real-time PCR was performed using T. whippleispecific primers, human beta-globin-specific primers to control for tissue DNA extraction and PCR reaction and broad-range eubacterial primers to control for bacterial DNA extraction. T. whipplei specificity of multiple amplicons was confirmed by sequencing. The detection limit of the method was 10 ag of T. whipplei DNA, corresponding to one to five bacteria under reference assay conditions. RESULTS: T. whipplei was found in the oral cavity of four out of ten healthy individuals from hospital staff and in three out of nine periodontitis patients, but in none of the individuals from China. All positive samples derived from subgingival and gingival sulcus plaque containing between 10(3) and 5 x 10(5) cells ml(-1) of plaque suspension, whereas saliva, smooth surface plaque and samples from the tongue or cheeks were negative. CONCLUSION: Our results suggest that T. whipplei colonizes the human body via the oral cavity and that bacterial plaques of the gingival crevice and the gingival sulcus/pocket may serve as a natural primary habitat.


Asunto(s)
Actinomycetales/aislamiento & purificación , Placa Dental/microbiología , Encía/microbiología , Gingivitis/microbiología , Periodontitis/microbiología , Actinomycetales/genética , Actinomycetales/crecimiento & desarrollo , Adulto , Estudios de Cohortes , ADN Bacteriano/análisis , Placa Dental/epidemiología , Ambiente , Estudios Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Temperatura
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