In vitro susceptibility to fosfomycin in clinical and environmental extended-spectrum beta-lactamase producing and/or ciprofloxacin-non-susceptible Escherichia coli isolates

ABSTRACT Extended-spectrum beta-lactamase producing and ciprofloxacin-non-susceptible Escherichia coli are clinical and environmental issues. We evaluated the susceptibility profile of fosfomycin in non-susceptible E. coli isolated from urine and the environment. We measured the activity of fosfomycin against 319 and 36 E. coli strains from urine and environmental isolates, respectively, collected from rivers. Fosfomycin resistance profiles were investigated using the minimal inhibitory concentration (MIC), according to the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST) guidelines. Antibiotic susceptibility testing revealed that 5% and 6.6% of urine samples were non-susceptible to fosfomycin according to CLSI and EUCAST guidelines, respectively. The fosfomycin MIC50/90 was 0.5/4 mg/L. Of the 36 E. coli isolates from river water, 11.1% and 13,8% were non-susceptible to fosfomycin according to CLSI and EUCAST, respectively (range ≤0.25 ≥512 mg/L). All the isolates with MIC ≥512 mg/L for fosfomycin showed the fosA3 gene. Fosfomycin resistance was more frequent in the environment than in clinical samples.

Chemical composition and biological activity of Baccharis erioclada DC. essential oil

Abstract The chemically complex essential oils of Baccharis species are associated with several biological activities, such as antimicrobial and antiulcerous properties. However, few studies have investigated Baccharis erioclada DC. Therefore, in this study, we aimed to characterize the essential oil of B. erioclada and evaluate its antioxidant, antimicrobial, and hemolytic potential. The essential oil was extracted by hydrodistillation using a Clevenger apparatus and analyzed via gas chromatography-mass spectrometry (GC-MS). Phosphomolybdenum complex formation, reducing antioxidant power, and thiobarbituric acid reactive substances (TBARS) methods were used to determine antioxidant potential. To evaluate the essential oil's antimicrobial activity, minimum inhibitory concentrations (MIC) in Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans were calculated. Hemolytic activity was determined in sheep red blood cells. Thirty-one compounds were identified via GC-MS analysis, representing 81.60% of the total essential oil. These compounds included: turmerone (27.97%), fokienol (13.47%), ledol (9.78%), and santalol (5.35%). The class of compounds identified was the oxygenated sesquiterpenes (62.52%). Antioxidant activity was confirmed via phosphomolybdenum complex formation and TBARS methods. Moderate antimicrobial activity and low hemolysis rates were displayed at concentrations of 250 and 500 µg/mL

Alterações celulares reativas frente ao morfotipo de lactobacilos vaginais / Reative cell changes against the morphotype of vaginal Lactobacillus

Objetivo: Identificar alterações reativas celulares predominantes frente ao infiltrado inflamatório e ao morfotipo lactobacilar vaginal. Métodos: Estudo descritivo qualitativo, calculado pelo Qui-quadrado com 198 amostras. Realizados esfregaços de raspado cervicovaginal pelo Papanicolaou e secreção de fundo de saco vaginal para pesquisa de microbiota vaginal pelo Gram. Resultados: Forma curta de lactobacilos em 186 (93,9%) amostras e longos em 12 (6,1%). Infiltrado inflamatório pelo Gram escasso em 90 (45,45%) e Papanicolaou escassos em 82 (41,04%). Fagocitose pelo Gram escasso em 51 (25,76%). Alterações reativas celulares pelo Papanicolaou: citólise escassa (23,74%), edema nuclear moderado (35,86%), cariomegalia escassa (13,64%), binucleação escassa (35,35%), micronúcleo escasso (2,52%) e paraqueratose moderada em (23,74%). Qui-quadrado significativo entre a quantificação de infiltrado inflamatório pelo Gram e Papanicolaou com p=0,037. 30 (15%) enquadraram-se no diagnóstico laboratorial de vaginose citolítica. Critérios não clássicos e de micronúcleo e paraqueratose presentes em amostras com dois critérios simultaneamente em 25%, três simultâneos em 4,0% e quatro simultâneos em 2,0%. Conclusão: Critérios não clássicos podem aumentar a sensibilidade dos testes citológicos no advento da citologia reflexiva nos testes de HPV.

Objective: Identify predominant cells reactive changes against the inflammatory infiltrate and the lactobacillary vaginal morphotype. Methods: Qualitative descriptive study, calculated by chi-square with Alterações celulares reativas frente ao morfotipo de lactobacilos vaginais 228 RBAC. 2019;51(3):219-29 Neves JJ, Reche PM, Ravelli APX, Ito CAS, Fagundes GL, Machado EP 198 samples. Cervicovaginal scrapings were realized by the Papanicolaou, and vaginal pouch fundus secretion to investigate the vaginal microbiota by Gram. Results: Short form of lactobacilli in 186 (93.9%) samples and long in 12 (6.1%). Inflammatory infiltrate by Gram, scarce in 90 (45.45%) and Papanicolaou in 82 (41.04%). Fagocytosis by Gram, scarce in 51 (25.76%). Papanicolaou cells reactive changes: scarce cytolysis (23.74%), moderate nuclear swelling (35.86%), scarce caryomegaly (13.64%), scarce binucleation (35.35%), scarce micronucleus (2.52% ) and moderate parakeratosis (23.74%). Significant chi-square between the quantification of inflammatory infiltrate by Gram and Papanicolaou with p = 0.037. 30 (15%) were in the laboratory diagnosis of CV. Non-classical criteria, and micronucleus and parakeratosis present in samples with two criteria simultaneously in 25%, three simultaneous in 4.0% and four simultaneous in 2.0%. Conclusion: Non-classical criteria may increase the sensitivity of cytological tests in the advent of refletive cytology in the HPV tests.

Risco presumido para doenças cardiovasculares em servidores de uma universidade estadual do Paraná, Brasil / Presued risk of cardiovascular diseases of employeesof a paraná staate university, Brazil

Segundo o Ministério da Saúde, há uma carência de informações epidemiológicas relativas a fatores de risco relacionados às doenças crônicas não transmissíveis e que podem ser evitáveis, em sua maioria, com a modificação de estilo de vida, detecção precoce e o controle oportuno, Dentre estas, destacam-se as doenças cardiovasculares, as quais, segundo dados da Secretaria de Saúde do Paraná, apresentam maior impacto sobre a mortalidade, O objetivo deste trabalho foi avaliar a saúde dos servidores da Universidade Estadual de Ponta Grossa por meio do risco total presumido em desenvolver doenças do aparelho circulatório, de acordo com o Escore de Framingham e ocorrência de fatores de risco modificáveis, Para tanto, aplicou-se inquérito epidemiológico e determinaram-se parâmetros antropométricos, parâmetros laboratoriais e pressão arterial, As análises laboratoriais foram realizadas no Laboratório Universitário de Análises Clínicas em rotina automatizada, Os resultados revelaram o risco absoluto de infarto (calculado usando o Escore de Framingham) e morte em 10 anos, Segundo este critério, 78 dos 86 voluntários enquadraram-se em baixo risco no desenvolvimento de doenças cardiovasculares, Entretanto, a ocorrência de fatores de risco modificáveis, como sobrepeso e obesidade, tabagismo e hipertensão, aponta para a necessidade de medidas educativas e preventivas em relação aos fatores de risco observados nos servidores da Universidade, os quais devem ser alvos de um programa de saúde que contemple esses aspectos...

According to the Ministry of Health there is a lack of epidemiological information regarding risk factors related to chronic diseases that may be preventable, mostly, with the modification of lifestyle, early detection and timely control. Among these, there are the cardiovascular diseases, which, according to the Department of Health of Paraná, have greater impact on mortality. The aim of this study was to evaluate the health of servers from the Paraná State University of Ponta Grossa through the assumed total risk in developing cardiovascular diseases, according to the Framingham Score and the occurrence of modifiable risk factors. Therefore, it was applied an epidemiological survey and anthropometric parameters, laboratory parameters and blood pressure were determined. Laboratory analyzes were performed at the University Laboratory of Clinical Analyses in automated routine. The results revealed the absolute risk (calculated using the Framingham Score) of myocardial infarction and death in 10 years. According to this criterion, 78 of the 86 volunteers were classified at low risk of developing cardiovascular disease. However, the occurrence of modifiable risk factors, such as overweight and obesity, smoking and hypertension, points to the need for educational and preventive measures in relation to the risk factors noted in the University’s servers, which should be targeted for a health program that addresses these issues...

Morbimortality study of infection in patients undergoing different types of dialysis in a renal replacement therapy center

INTRODUCTION: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of infection and increased mortality. OBJECTIVES: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. METHODS: This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). RESULTS: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13-5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. CONCLUSIONS: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group. .

Análise comparativa de duas metodologias para a identificação de cilindros hemáticos urinários / Comparative analysis of two methodologies for the identification of urinary red blood cell casts

INTRODUÇÃO: A presença de hemácias dismórficas na urina é um forte indicativo da origem glomerular do sangramento, sendo uma ferramenta importante no diagnóstico de glomerulonefrites. Os cilindros hemáticos geralmente acompanham as hemácias dismórficas, sendo também fortes indicadores de hematúria glomerular, embora não sejam encontrados com frequência no exame parcial de urina. OBJETIVO: Comparar duas técnicas de concentração de amostras em uma série de exames de urina com hematúria dismórfica. MATERIAL E MÉTODOS: Foram selecionadas 249 amostras com hematúria dismórfica a partir de 4.277 amostras de urina de rotina. As amostras foram processadas utilizando-se duas técnicas: a convencional e a de concentração. O percentual de identificação dos cilindros hemáticos foi comparado de acordo com a metodologia utilizada. RESULTADOS: A presença de cilindros hemáticos pela técnica de concentração foi estatisticamente maior (52,6 por cento) em comparação com a positividade pela metodologia convencional (8,4 por cento) (p < 0,001). DISCUSSÃO E CONCLUSÃO: Sugere-se que a técnica convencional não concentrou suficientemente a amostra de urina e os cilindros hemáticos ficaram no sobrenadante, sendo descartados. A utilização da técnica de concentração aumentou a sensibilidade técnica para a pesquisa dos cilindros hemáticos. Portanto, a técnica de concentração, associada à presença de hemácias dismórficas, mostrou-se útil para aumentar a concordância dos dois parâmetros laboratoriais para a detecção da hematúria de origem glomerular como auxílio diagnóstico das glomerulopatias, importante causa de doença renal crônica.

INTRODUCTION: Dysmorphic red blood cells (RBCs) in the urine are a strong indicator of a glomerular bleeding source. RBC casts, which while generally following RBC dysmorphism are not frequently seen on routine urinalysis, are also important indicators of glomerular hematuria. OBJECTIVE: This study tested the superiority of a urine concentration technique (CT) over the standard method (SM) for RBC cast identification in a group of patients suspected of glomerular hematuria. MATERIAL AND METHODS: Of a total of 4,227 routine urinary samples, 249 with dysmorphic hematuria were selected. The samples were processed according to two techniques: standard method (SM) and concentration technique (CT). The percentages of RBC cast identification according to each method were compared. RESULTS: The CT showed a higher rate of RBC casts (52.6 percent) compared to the SM (8.4 percent) (p < 0.001). DISCUSSION AND CONCLUSION: We suggest that the SM did not sufficiently concentrate the urine sample, the RBC casts remaining in the supernatant and being discarded. The CT increased the sensitivity of the RBC cast yield. The CT, associated with the presence of RBC dysmorphism, was useful to increase the agreement of the two parameters used for identification of glomerular-based bleeding and the diagnosis of glomerular diseases, important causes of chronic kidney disease.

Quinolone-resistant Escherichia coli

Quinolones (nalidixic acid - NAL, norfloxacin - NOR, ciprofloxacin - CIP and gatifloxacin - GAT) were tested against Escherichia coli isolated from urine (385 patient samples) by disk diffusion (DD) and agar dilution (AD) methods. Fifty-three samples (13.8 percent) were classified as resistant to at least one of the quinolones tested. CIP and NOR susceptibilities were the same (91.4 percent) and they were similar to GAT (92.7 percent). Susceptibility to NAL, detected by the disk diffusion method, was used to predict susceptibility to NOR, CIP and GAT by the agar dilution method. The sensitivity and specificity of NAL were 100 percent and 95 percent, respectively. Twelve samples were analyzed for mutations in the quinolone resistance-determining region (QRDR) of the gyrA and parC genes. Sequencing of these genes failed to find any mutations in the quinolone-sensitive isolates. However, three mutations were observed in the isolates resistant to all the quinolones tested - two in gyrA and one in parC. A single mutation in gyrA was found in the strains that were resistant to nalidixic acid but fluoroquinolone-sensitive. These findings support the suggestion that NAL could be used as a marker for susceptibility to fluoroquinolones in routine microbiology laboratories. The overall resistance rate to quinolones in the present study was 13.8 percent, which is higher than that observed in other studies carried out in developed countries. Our findings serve as a warning that resistance to this group of antimicrobial agents is increasing.

Infecção do trato urinário: comparação entre o perfil de susceptibilidade e a terapia empírica com antimicrobianos / Urinary tract infection: comparison between susceptibility profile and empirical therapy with antimicrobials

A infecção do trato urinário (ITU) é uma das doenças infecciosas mais comuns, perdendo em freqüência somente para as infecções respiratórias. No presente trabalho foram estudadas 106 uroculturas positivas de pacientes hospitalizados na Santa Casa de Misericórdia de Ponta Grossa, Paraná, Brasil. As bactérias isoladas foram classificadas, segundo sua origem: 68 (64,25%) em comunitária e 38 (35,8%) em hospitalar. Enterobactérias predominaram entre os isolados (82,1%). A susceptibilidade geral foi de 89,8% nitrofurantoína, 84% norfloxacina, 82% gentamicina, 75,3% cefalotina, 63,4% sulfazotrim e 45,7% ampicilina. Dos 94 prontuários estudados em 80,8% (76/94) constavam antibióticos prescritos. Em 62,8% (59/94) deles iniciou-se o tratamento empiricamente e em 18% (17/94) aguardou-se o resultado do antibiograma para a tomada de decisão. Na comparação entre o perfil de susceptibilidade, observado no antibiograma, com as prescrições empíricas, observou-se que em 81,4% (48/59) dos prontuários os antimicrobianos prescritos apresentaram sensibilidade no antibiograma e em 18,6% (11/59) estavam resistentes. O antibiótico mais prescrito empiricamente foi a norfloxacina, onde as Escherichia coli isoladas de infecções comunitárias e hospitalares apresentaram taxa de resistência de 11,6% e 15,8%, respectivamente. Outras Enterobactérias apresentaram taxas de 5,9% e 12,5%. As taxas de resistência inferiores a 20%, entre os principais agentes, mostram que a norfloxacina é adequada para ser utilizada como terapia empírica.

Urinary tract infection (UTI) is one of the most common infectious diseases, second in frequency only to respiratory infections. In the present work, 106 positive urine cultures were studied from patients hospitalized at Santa Casa de Misericórdia de Ponta Grossa, Paraná, Brazil. The isolated bacteria were classified, according to their source: 68 (64.2%) into community and 38 (35.8%) hospital bacteria. Enterobacteria were the most common among the isolates (82.1%). General susceptibility was 89.8% to nitrofurantoin, 84% to norfloxacin, 82% to gentamicin, 75.3% to cephalotin, 63.4% to sulfamethoxazole/trimethoprim, and 45.7% to ampicillin. Among the 94 patient records studied, 80.8% (76/94) indicated that antibiotics had been prescribed. In 62.8% (59/94) of them, treatment was started empirically, and in 18% (17/94) a decision was made only upon receiving the antibiogram result. In the comparison between the susceptibility profile revealed by the antibiogram and the empirical prescriptions, it was verified that the antibiogram showed sensitivity to the prescribed antimicrobials in 81.4% (48/59) of the patient records, while 18.6% (11/59) indicated resistance. The most frequently prescribed antibiotic was norfloxacin wherein Escherichia coli isolated from community and hospital infections showed resistance rates of 11.6% and 15.8%, respectively. Other Enterobacteria showed rates of 5.9% and 12.5%. Resistance rates lower than 20% among the most important agents indicated that norfloxacin is suitable to be used as empirical therapy.