RESUMO
Different syndromes are involved in human psittacosis (flu-like syndrome, atypical pneumonia up to lacrimal gland lymphoma). Diagnostic methods include serology, culture, and PCR. The rate of Chlamydia psittaci (Cp) positive tests among exposed workers is still unknown. Our study aimed to assess the rate of positive tests among workers who have contact with carrier birds in natural reserves from Buenos Aires, Argentina. Secondary aims were to analyze risk factors linked to these outcomes and the occurrence of signs that suggest psittacosis. Nasopharyngeal swabs and serum pairs were collected from employees who had interacted with confirmed carrier birds. Those with detectable DNA of Cp and/or anti-Chlamydia spp. antibody baseline titer ≥ 160 mUI/ml, or at least quadruplicating, were considered positive. Activities performed with or near birds, personal protective equipment use, and previous chronic conditions were assessed. Possible Cp-related pathologies were evaluated during follow-up. A total of 63 exposed workers (71.4% men) with a median age of 35.7 years (IQR 26-39) were evaluated to detect 28.6% positives. Respiratory chronic conditions were the unique factor associated with positive tests (OR 5.2 [1.5-18.5] p < .05). Surprisingly, about a third of the workers resulted positive and all responded to medical treatment, none developing an acute atypical pneumonia syndrome associated with classical presentation of psittacosis. Active testing for early diagnosis and proper treatment in zoological workers exposed to carrier or potentially carrier birds is strongly suggested as part of zoonotic diseases preventive measures.
Assuntos
Aves , Chlamydophila psittaci , Exposição Ocupacional , Psitacose , Animais , Argentina/epidemiologia , Psitacose/diagnóstico , Psitacose/veterinária , Chlamydophila psittaci/isolamento & purificação , Humanos , Adulto , Masculino , Feminino , Exposição Ocupacional/efeitos adversos , Fatores de Risco , Portador Sadio , Pessoa de Meia-IdadeRESUMO
INTRODUCCIÓN: La restricción programada (RP) de antimicrobianos puede disminuir selectivamente la tasa de infecciones por determinados microorganismos. En este sentido, los bacilos gramnegativos productores de beta-lactamasas AmpC (BGN-blaAmpC) son seleccionados por el sobreuso de cefalosporinas de tercera generación (C3G). Estas bacterias, también adquieren genes y co-producen otras beta-lactamasas, como las de Nueva Delhi (BGN-blaNDM). OBJETIVOS: Disminuir la tasa de aislamiento de BGN-blaAmpC y BGN-blaNDM en cultivos de pacientes de la UCI luego de una RP de C3G en el marco de un brote nosocomial por estos microrganismos. MATERIALES Y MÉTODOS: Estudio cuasi-experimental, previo (P1= 12 meses) y posterior (P2= 12 meses) a una RP de C3G en un hospital de adultos, donde, en el contexto de brote mencionado, se aplicaron medidas de control de infecciones generales. El uso de antimicrobianos se expresó como "porcentaje de los días de tratamiento (%DDT)"/100 camas ocupadas al día (100-COD). Se compararon las tasas de aislamiento de BGN-blaAmpC y BGN-blaNDM en hemocultivos (HC), mini-lavados bronquio-alveolares (mB) y urocultivos (UC) en la UCI. RESULTADOS: En P2 el consumo de C3G fue 2,5% DDT/100-COD. Hubo un descenso en los aislamientos de BGN-blaAmpC en HC (RR 0,48 [0,2-0,9] p < 0,02) y mB (RR 0,52 [0,3-0,9] p < 0,02), así como también de BGN-blaNDM en HC (RR 8,1 [1,6-39,4] p < 0,00). Conclusiones: La RP de C3G se asoció con la reducción de los BGN-blaAmpC y BGN-blaNDM en HC, así como de los BGN-blaAmpC mB.
BACKGROUND: Programmed restriction (PR) of antimicrobials can selectively decrease the rate of infections by certain microorganisms. In this sense, AmpC beta-lactamase-producing gram-negative bacilli (GNB-blaAmpC) are selected for the overuse of third generation cephalosporins (3GC). These bacteria also acquire genes and co-produce other β-lactamases, such as New Delhi ones (GNB-blaNDM). AIM: To decrease the isolation rate of GNB- blaAmpC and GNB- blaNDM in cultures from ICU patients after a PR of 3GC. METHODS: Quasi-experimental study, before (P1= 12 months) and after (P2= 12 months) a PR of 3GC in an adults' hospital. The use of antibiotics was expressed as "percentage days of treatment (%DOT)" /100 beds occupied per day (100-BOD). The rates of GNB-blaAmpC and GNB-blaNDM were compared in blood cultures (BC), mini-bronchio alveolar lavages (mB) and urine cultures (UC) in the ICU. RESULTS: In P2, 3GC consumption was 2.5% DOT/100-COD. There was a decrease in GNB-blaAmpC from BC (RR 0.48 [0.2-0.9] p < 0.02) and mB (RR 0.52 [0.3-0.9] p < 0.02), as well as of GNB-blaNDM from BC (RR 8.1 [1.6-39.4] p < 0.00). Conclusions: PR of 3GC was linked to the reduction of GNB-blaAmpC and GNB-blaNDM in BC, as well as GNB-blaAmpC in mB from ICU patients.