An unusual case of Brodie's abscess in the humerus of an adult female.

Brodie's abscess is a manifestation of subacute to chronic osteomyelitis, characterized as intraosseous abscess formation, usually on the metaphysis of the long tubular bones in the lower extremities of male pediatric patients. Clinically, Brodie's abscess presents with atraumatic bone pain of an insidious onset, with absence of systemic findings. Delay in diagnosis is common, as diagnostic imaging, followed by biopsy for culture and histologic examination are generally required to secure a diagnosis of Brodie's abscess. Treatment of Brodie's abscess is non-standardized, and usually consists of surgical debridement and antibacterial therapy. Despite the variability in therapeutic approaches, outcomes of Brodie's abscess treated with surgery and antibiotics are favourable. Herein we report a case of a delayed diagnosis of Brodie's abscess in the upper extremity of an adult female. While she improved with treatment of Brodie's abscess, the case serves to remind clinicians to consider this entity in adult individuals who present with atraumatic bone pain.

Diagnosis and Prevention of Periprosthetic Joint Infections by Staphylococcus aureus after Hip Fracture: A Systematic Review of the Literature.

Hip arthroplasties are surgical procedures widely performed all over the world, seeking to return functionality, relieve pain, and improve the quality of life of patients affected by osteoarthritis, femoral neck fractures, osteonecrosis of the femoral head, among other etiologies. Periprosthetic joint infections are one of the most feared complications due to the high associated morbidity and mortality, with a high number of pathogens that may be associated with its etiology. The aim of the present study was to analyze aspects correlated with the occurrence of infection, diagnosis and prevention of periprosthetic joint infections in the hip associated with Staphylococcus aureus after corrective surgery for hip fractures. This is a systematic review of the literature carried out in the databases indexed in the Medical Literature Analysis and Retrieval System Online (MEDLINE) carried out in accordance with the precepts established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Twenty studies that addressed the diagnosis and prevention of periprosthetic joint infections after hip fractures were selected for analysis. It is observed that there is no consensus in the literature on preventive measures for the occurrence of such infectious processes. Among the risk factors for the occurrence and severity of infections by S. aureus after hip arthroplasties, obesity, longer surgical time, older age, immunosuppression, recent use of antibiotics, and multicomorbidities were mentioned. The use of biomarkers for early diagnosis, as well as screening, decolonization, and antibiotic prophylaxis processes are among the preventive procedures proposed in the literature.

Host Soluble Factors Cause Changes in Staphylococcus epidermidis Antibiotic Susceptibility and Biofilm Formation Ability.

Staphylococcus epidermidis is a major nosocomial pathogen with a remarkable ability to adhere to the surfaces of indwelling medical devices and form biofilms. Unlike other nosocomial pathogens, the interaction of S. epidermidis with host factors has not been the focus of substantial research. This study aimed to assess the alterations in the antibiotic susceptibility and biofilm formation ability of S. epidermidis in the presence of host serum factors. S. epidermidis strain RP62A was cultured in a laboratory culture medium with or without human serum/plasma, and changes in antibiotic susceptibility, biofilm formation, and gene expression were evaluated. The data obtained revealed that exposure to host serum factors increased the susceptibility of S. epidermidis to glycopeptide antibiotics and was also detrimental to biofilm formation. Gene expression analysis revealed downregulation of both dltA and fmtC genes shortly after human serum/plasma exposure. The importance of transferrin-mediated iron sequestration as a host anti-biofilm strategy against S. epidermidis was also emphasized. We have demonstrated that serum factors play a pivotal role as part of the host's anti-infective strategy against S. epidermidis infections, highlighting the importance of incorporating such factors during in vitro studies with this pathogen.

Long term longitudinal follow-up of an AD-HIES cohort: the impact of early diagnosis and enrollment to IPINet centers on the natural history of Job's syndrome.

Job's syndrome, or autosomal dominant hyperimmunoglobulin E syndrome (AD-HIES, STAT3-Dominant Negative), is a rare inborn error of immunity (IEI) with multi-organ involvement and long-life post-infective damage. Longitudinal registries are of primary importance in improving our knowledge of the natural history and management of these rare disorders. This study aimed to describe the natural history of 30 Italian patients with AD-HIES recorded in the Italian network for primary immunodeficiency (IPINet) registry. This study shows the incidence of manifestations present at the time of diagnosis versus those that arose during follow up at a referral center for IEI. The mean time of diagnostic delay was 13.7 years, while the age of disease onset was < 12 months in 66.7% of patients. Respiratory complications, namely bronchiectasis and pneumatoceles, were present at diagnosis in 46.7% and 43.3% of patients, respectively. Antimicrobial prophylaxis resulted in a decrease in the incidence of pneumonia from 76.7% to 46.7%. At the time of diagnosis, skin involvement was present in 93.3% of the patients, including eczema (80.8%) and abscesses (66.7%). At the time of follow-up, under therapy, the prevalence of complications decreased: eczema and skin abscesses reduced to 63.3% and 56.7%, respectively. Antifungal prophylaxis decreased the incidence of mucocutaneous candidiasis from 70% to 56.7%. During the SARS-CoV-2 pandemic, seven patients developed COVID-19. Survival analyses showed that 27 out of 30 patients survived, while three patients died at ages of 28, 39, and 46 years as a consequence of lung bleeding, lymphoma, and sepsis, respectively. Analysis of a cumulative follow-up period of 278.7 patient-years showed that early diagnosis, adequate management at expertise centers for IEI, prophylactic antibiotics, and antifungal therapy improve outcomes and can positively influence the life expectancy of patients.

Diagnosis, evolution, and treatment of a patient with pyomyositis / Diagnóstico, evolução e tratamento de paciente com piomiosite

Pyomyositis is a deep muscle infection of bacterial origin and subacute, which can evolve with multiple intramuscular abscesses. Despite being characterized as an affection of tropical zones, its incidence in temperate zones has been increasing due to immunosuppression factors, such as infection by the human immunodeficiency virus (HIV) and some types of immunosuppressive treatments. Even though it has been known for over a century, it is a rare and potentially serious condition that can lead to septic shock and death. This is a case report of a descriptive nature, which found the relevance of knowledge about this condition for an early diagnosis, enabling positive prognostic repercussions.

A piomiosite é uma infecção muscular profunda, de origem bacteriana e caráter subagudo, que pode evoluir com abcessos intramusculares múltiplos. Apesar de ser caracterizada como uma afecção de zonas tropicais, sua incidência em zonas temperadas vem aumentando por fatores de imunossupressão, como a infecção pelo vírus da imunodeficiência humana (HIV) e alguns tipos de tratamentos imunossupressivos. Mesmo sendo conhecida há mais de um século, é uma condição rara e potencialmente grave, podendo levar ao choque séptico e óbito. Trata-se de um relato de caso de caráter descritivo, que constatou a relevância do conhecimento desta afecção para um diagnóstico precoce, possibilitando repercussões prognósticas positivas.

Piomiositis en pediatría: experiencia de 10 años en un hospital pediátrico de alta complejidad en Argentina

Introducción: La piomiositis es una infección bacteriana agudasubaguda del músculo esquelético. Objetivo: Estimar la incidencia de piomiositis en pacientes internados, describir e identificar factores de riesgo para bacteriemia y hospitalización, y evaluar diferencias entre Staphylococccus aureus sensible y resistente a meticilina (SASM y SARM). Pacientes y Métodos: Estudio descriptivo, retrospectivo, observacional, con pacientes de 1 mes a 18 años de edad, internados entre el 1 de enero de 2008 y 31 de diciembre de 2018. Variables: sexo, edad, hacinamiento en el hogar, existencia de lesión previa, estacionalidad, localización anatómica e imágenes, antibioterapia previa, estadio clínico, parámetros de laboratorio, cultivos y antibiograma, días de tratamiento intravenoso (IV), de internación, de fiebre y bacteriemia. Resultados: Se incluyeron 188 pacientes. Incidencia: 38,9 casos / 10.000 admisiones (IC95 % 33,7 - 44,9). Días de internación y tratamiento IV: 11 (RQ 8-15 y RQ 8-14, respectivamente). El desarrollo de bacteriemia se asoció a PCR elevada (p = 0,03) y fiebre prolongada (p < 0,001). No hubo diferencias en la evolución y parámetros de laboratorio entre SASM y SARM. La leucocitosis (p = 0,004), neutrofilia (p = 0,005) y bacteriemia (p = 0,001) se asociaron a mayor estadía hospitalaria. Conclusiones: Este estudio recaba la experiencia de más de 10 años de niños internados con diagnóstico de piomiositis y proporciona información sobre sus características. Se describen parámetros asociados a bacteriemia y estadía hospitalaria.

Background: Pyomyositis is an acute-subacute bacterial infection of skeletal muscle. Aim: To estimate the incidence of pyomyositis in hospitalized patients, describe and identify risk factors for bacteremia and hospitalization, and evaluate differences between MSSA and MRSA. Methods: Descriptive, retrospective, observational study with patients aged 1 month to 18 years hospitalized between January, 1, 2008 and December 1, 2018. Variables: sex, age, home overcrowding, previous injury, seasonality, anatomical location and images, previous antibiotherapy, clinical stage, laboratory, cultures and antibiogram, days of intravenous (IV) treatment, hospitalization, fever and bacteremia. Results: 188 patients were included. Incidence: 38.9 cases/10,000 admissions (95% CI 33.7 - 44.9). Days of hospitalization and IV treatment: 11 (RQ 8-15 and RQ 8-14, respectively). The development of bacteremia was associated with elevated CRP (p = 0.03) and prolonged fever (p < 0.001). There were no differences in the evolution and laboratory parameters between MSSA and MRSA. Leukocytosis (p = 0.004), neutrophilia (p = 0.005), and bacteremia (p = 0.001) were associated with a longer hospital stay. Conclusions: This study collects the experience of more than 10 years of hospitalized children diagnosed with pyomyositis and provides information on its characteristics. Parameters associated with bacteremia and hospital stay are described.

Simultaneous Production of Antibacterial Protein and Lipopeptides in Bacillus tequilensis, Detected by MALDI-TOF and GC Mass Analyses.

As antibiotic resistance is nowadays one of the important challenges, efforts are crucial for the discovery of novel antibacterial drugs. This study aimed to evaluate antimicrobial/anticancerous activities of halophilic bacilli from the human microbiota. A spore-forming halotolerant bacterium with antibacterial effect against Staphylococcus aureus was isolated from healthy human feces. The antibacterial protein components of the extracted supernatant were identified by SDS-PAGE and zymography. The MALDI-TOF, GC mass, and FTIR analyses were used for peptide and lipopeptide identification, respectively. The stability, toxicity, and anticancerous effects were investigated using MTT and Flow cytometry methods. According to the molecular analysis, the strain was identified as Bacillus tequilensis and showed potential probiotic properties, such as bile and acid resistance, as well as eukaryotic cell uptake. SDS-PAGE and zymography showed that 15 and 10-kDa fragments had antibacterial effects. The MALDI-TOF mass analysis indicated that the 15-kDa fragment was L1 ribosomal protein, which was the first report of the RpL1 in bacilli. GC-mass and FTIR analyses confirmed the lipopeptide nature of the 10-kDa fragment. Both the extracted fractions (precipitation or "P" and chloroform or "C" fractions) were stable at < 100 °C for 10 min, and their antibacterial effects were preserved for more than 6 months. Despite its non-toxicity, the P fraction had anticancer activities against MCF7 cells. The anticancer and antibacterial properties of B. tequilensis, along with its non-toxicity and stability, have made it a potential candidate for studying the beneficial probiotic properties for humans and drug production.

The Golden Grapes of Wrath - Staphylococcus aureus Bacteremia: A Clinical Review.

Staphylococcus aureus bacteremia is common and associated with fatality rates approximating 25%. We provide a brief overview of S. aureus bacteremia from a clinical and microbiological lens and review the relevant evidence and literature gaps in its management. Using a case-based approach, evidence and clinical judgement are meshed to highlight and justify the 5 core interventions that ought to be performed for all cases of S. aureus bacteremia: 1) appropriate anti-staphylococcal therapy, 2) screening echocardiography, 3) assessment for metastatic phenomena and source control, 4) decision on duration of antimicrobial therapy, and 5) Infectious Diseases consultation.

Antimicrobial peptide for bacterial infection imaging: first case reported in Brazil

ABSTRACT Molecular imaging markers can be used to differentiate between infection and aseptic inflammation, determine the severity of infection, and monitor treatment responses. One of these markers is ubiquicidin(29-41) (UBI), a cationic peptide fragment that binds to the bacterial membrane wall and is labeled with gallium-68 (68Ga), a positron emitter radioisotope. The use of UBI in positron emission tomography (PET)/computed tomography (CT) for improved detection of lesions has been receiving considerable attention recently. Herein, we report the first case of 68Ga-UBI PET/CT performed in Brazil. The patient was a 39-year-old woman referred for a scan to confirm a clinical suspicion of chronic osteomyelitis of her fractured left tibia. PET images revealed radiotracer uptake near the posterior contour of the tibial fracture focus and the fixation plate, in the soft tissue around the distal half of the tibia, and in the non-consolidated fracture of the left distal fibula. Surgery for local cleaning was performed, and culture of a specimen collected from the surgical site confirmed the presence of Staphylococcus aureus. In the present case, 68Ga-UBI PET/CT, a non-invasive imaging modality, identified the infection foci in vivo, indicating its potential for clinical use.

Actividad antimicrobiana de la peroxiadenosina en cultivos in vitro de Staphylococcus aureus resistente a meticilina / Antimicrobial activity of peroxyadenosine in vitro culture of resistant methicillin Staphylococcus aureus

RESUMEN Fundamento : las infecciones asociadas a la asistencia sanitaria y de la comunidad causadas por Staphylococcus aureus resistente a la meticilina, constituyen un problema de salud en el mundo. Esta situación se asocia al uso indiscriminado de antimicrobianos y a la mutagénesis bacteriana, por tanto, el desarrollo de nuevos productos con actividad antimicrobiana constituye una prioridad para Cuba. Objetivo : evaluar la actividad antimicrobiana de la peroxiadenosina en cultivo in vitro de Staphylococcus aureus resistente a la meticilina. Métodos : se realizó un estudio experimental de laboratorio en un modelo biológico (cultivo microbiano) en el Hospital Universitario Amalia Simoni de la provincia Camagüey, desde enero de 2016 hasta julio de 2020. La muestra se conformó con 60 cultivos biológicos de Staphylococcus aureus resistentes a la meticilina, mediante un muestreo aleatorio simple, distribuidos en dos grupos, cada uno con 30 cultivos. Un grupo correspondió a una cepa salvaje de Staphylococcus aureus resistentes a la meticilina, obtenida de la colección de cultivos del hospital y el otro a la cepa de referencia (ATCC 25923) de la American Type Culture Collection. Se estudiaron las variables: formación y concentración de la peroxiadenosina, preservación de la estructura aromática de la adenosina y el patrón de susceptibilidad a la meticilina. Resultados : la peroxiadenosina se formó a partir de la interacción del peróxido de hidrógeno con la adenosina. Los cultivos de Staphylococcus aureus resistentes a la meticilina se mostraron sensibles a las concentraciones de peroxiadenosina sin diluir y 1:2, demostrado por la presencia de halos de inhibición en el cultivo. Conclusiones : la inhibición del crecimiento de Staphylococcus aureus resistentes a la meticilina por la peroxiadenosina sugiere su evaluación como un nuevo producto antibacteriano eficaz contra este microorganismo.

ABSTRACT Background: infections associated with healthcare and the community caused by methicillin-resistant Staphylococcus aureus (MRSA) constitutes a health problem in the world. This situation is associated with the indiscriminate use of antimicrobials and bacterial mutagenesis, therefore, the development of new products with antimicrobial activity is a priority for Cuba. Objective: to evaluate the antimicrobial activity of peroxyadenosine in vitro culture of MRSA. Methods: an experimental laboratory study was carried out in a biological model (microbial culture) at the Amalia Simoni Hospital in Camagüey province, from January 2016 to July 2020. The sample consisted of 60 biological cultures through simple random sampling, distributed in two groups with 30 crops of each investigated layer. One group corresponded to a wild MRSA strain, obtained from the hospital culture collection and the other to the reference strain (ATCC 25923) from the American Type Culture Collection. The studied variables were: formation and concentration of peroxyadenosine, preservation of the aromatic structure of adenosine and the pattern of susceptibility to methicillin. Results: peroxyadenosine was formed from the interaction of hydrogen peroxide with adenosine. The MRSA cultures were sensitive to 1: 2 undiluted peroxyadenosine concentrations, demonstrated by the presence of inhibition halos in the culture. Conclusions: the inhibition of MRSA growth by peroxyadenosine suggests its evaluation as a new antibacterial product effective against this microorganism.

[Comparison of DRG revenues between fast and slow-track procedures for a two-stage replacement of prostheses for periprosthetic hip infections in the aG-DRG system 2020]. / Vergleich der DRG-Erlöse zwischen Fast- und Slow-Track-Verfahren beim zweizeitigen Prothesenwechsel bei periprothetischen Hüftinfektionen im aG-DRG-System 2020.

BACKGROUND: The treatment of periprosthetic hip infections is usually cost intensive, so it is generally not cost effective for hospitals. In chronic infections, a two-stage procedure is often indicated, which can be done as a fast-track procedure with a short prosthetic-free interim interval (2-4 weeks) or as a slow-track procedure with a long prosthetic-free interim interval (over 4 weeks). AIM: The aim of this study was to elucidate the revenue situation of both forms of treatment in the aG-DRG-System 2020, taking into account revenue-relevant influencing factors. METHODS: For fast-track and slow-track procedures with two-stage revision and detection of a staphylococcus aureus (MSSA), treatment cases were simulated using a grouper software (3M KODIP Suite) based on the diagnoses (ICD-10-GM) and procedures (OPS) and then grouped into DRGs. Revenue-relevant parameters, such as length of stay and secondary diagnoses (SD), were taken into account. In addition, two real treatment cases with fast-track and slow-track procedures were compared to each other. RESULTS: The total revenues for the slow-track procedure with a length of stay of 25 days (without SD) were 27,551 € and for a length of stay of 42 days (with SD) even 40,699 €, compared to 23,965 € with the fast-track procedure with a length of stay of 25 days (without SD) and 27,283 € for a length of stay of 42 days (with SD). The real treatment cases also showed a big difference in the total revenues of 12,244 € in favor of the slow-track procedure. DISCUSSION: Even in the aG-DRG-System 2020, the two-stage revision procedure with a long interim interval seems to be more interesting from a financial point of view and the hospital perspective compared to the fast-track procedure, especially with multimorbid patients. This creates a financial barrier to the treatment of such patients with a short interim interval.

Rapidly fatal tropical pyomyositis in an elderly diabetic woman.

Necrotizing soft tissue infection, with or without myositis, is classified among the most dangerous infectious emergencies in clinical practice. The authors report a case of an older diabetic woman who presented to the orthopedic service with right elbow pain after a small trauma with skin abrasion and released with an analgesic prescription. After 48h, she presented to the emergency room with a history of developing bullous and necrotic lesions in the upper right limb, hypotension, and numbness, with rapid and fatal evolution despite adequate clinical and surgical therapeutic support. Muscle biopsy showed necrotizing myositis. Blood culture was positive for Panton-Valentine leukocidin producing (PVL-positive) methicillin-resistant S. aureus. Although PVL has a strong epidemiologic association with Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, it can also be found in CA-MSSA in the context of necrotizing pneumonia and skin and soft tissue infections. Although infrequent, CA-MRSA or CA-MSSA PVL+ infections should always be suspected in high-risk patients because they can rapidly evolve with severe, sometimes fatal complications.

Microbiological profile in chronic granulomatous disease patients in a single Brazilian primary immunodeficiency center.

BACKGROUND: Chronic granulomatous disease (CGD) is a rare primary immunodeficiency. Infections of lung, skin, lymph nodes, and liver are the hallmark of CGD and frequently the initial manifestation of the disease. The aim of the present paper is to describe the sites of infections and their causative agents in 38 pediatric patients with CGD. METHODS: This retrospective, single-center cohort study included CGD patients followed at the allergy and immunology unit of a tertiary hospital in São Paulo, Brazil over the last 40 years. Sites of infections and their causative agents were described. RESULTS: Thirty-eight patients were included (36 males). The median age of onset of symptoms was 45 days (ranging from 7 days-7 years), and the median age at diagnosis was 23 months (ranging from 1 month-12 years). In all, 31.6% of the patients reported a family history of child deaths and 21% (eight cases) had another male family member with CGD. The most common infections were pneumonia (81.6%), skin infections (50.0%), adenitis (42.1%), and liver abscess (23.7%); 188 cultures were positive (85.6% bacteria; 14.4% fungi). The most prevalent bacterial agents were Staphylococcus sp. (12.4%), Staphylococcus aureus (11.2%), and Klebsiella pneumoniae (9.3%). Aspergillus sp. and Candida sp. were 56% and 22.2% of the isolated fungi, respectively. Mycobacterium tuberculosis was isolated in 5.6% and Mycobacterium bovis in one patient (0.9%). CONCLUSION: Staphylococcus sp., Staphylococcus aureus, and Aspergillus sp. were the most frequent agents found in this cohort. M. tuberculosis should be considered in endemic area. Detection of infectious agents drives to the adequate treatment and benefits the evolution of patients with CGD.

Outcomes of patients with acute prosthetic aortic valve endocarditis.

BACKGROUND: Prosthetic valve endocarditis is burdened by high mortality and morbidity. We reviewed our experience in the management of patients with acute prosthetic aortic valve infection and studied the implications and outcomes associated with surgical treatment and medical therapy. METHODS: Data of 118 consecutive patients admitted during the period 2008-2018 with definite acute prosthetic aortic valve endocarditis, and presenting a surgical indication, were retrieved from the hospital database. Univariate and multivariate analysis were undertaken to study the association of preoperative characteristics with hospital mortality and the probability of undergoing a reoperation. Survival was assessed with Kaplan-Meier analysis. RESULTS: In the overall population, prosthesis dehiscence was independently associated with the possibility of undergoing surgical reoperation, while presentation with embolic stroke was associated with medical treatment. Hospital mortality was 24%, medical treatment was found to be independently associated with early death. One hundred (85%) patients underwent redo procedures; aortic valve replacement was performed in 53 and full root replacement in 47. Postoperative hospital mortality was 17%. Survival at 1-, 5-, and 8-years was 78%, 74%, and 66%, respectively. Freedom from reoperation and recurrent endocarditis was 95% at 8-year follow-up.Hospital mortality in patients who did not receive a redo operation was 61% with a survival rate of 17% at 1-year follow-up. CONCLUSIONS: Surgical mortality after reoperation for prosthetic aortic valve endocarditis is still high but mid-term outcomes are satisfactory. Failure to undertake surgery when indicated is an independent risk factor for early death.

Prevalence of central venous catheter salvage in newborn with staphylococcal bloodstream infection / Prevalencia del rescate del catéter venoso central en recién nacidos con infección del torrente sanguíneo estafilocócica / Prevalência de salvamento de cateter venoso central em recém-nascidos com infecção de corrente sanguínea estafilocócica

ABSTRACT Objectives: to establish the prevalence of salvage of central venous catheters in newborns with bloodstream infection caused by coagulase-negative staphylococci. Methods: retrospective cross-sectional study with 136 newborns admitted to the Neonatal Intensive Care Unit between 2011 and 2017. The total of 143 infection events undergoing antibiotic therapy were evaluated. Results: among the 143 infection events, 39 catheters in which antibiotic therapy was used were saved and in 69 cases, the device was removed. Positive central blood culture and single lumen catheter were factors associated with salvage failure. The probability of salvage decreased with infections diagnosed from 15 days of using the catheter. Negative blood culture raised the chance of salvage by fourfold. Conclusions: the use of antibiotic therapy in the treatment of infections resulted in a low prevalence of salvage of the central venous catheter. The probability of salvage was associated with variables of the device.

RESUMEN Objetivos: establecer la prevalencia de rescate de catéteres venosos centrales en recién nacidos con infección del torrente sanguíneo causada por estafilococos coagulasa negativos. Métodos: estudio transversal retrospectivo con 136 recién nacidos ingresados en la Unidad de Cuidados Intensivos Neonatales, entre 2011 y 2017. Se evaluaron 143 eventos de infección sometidos a terapia antibiótica. Resultados: de los 143 eventos de infección, se rescataron 39 catéteres en los que se utilizó antibioticoterapia y en 69 casos se retiró el dispositivo. El hemocultivo central positivo y el catéter de un lumen fueron factores asociados con el fracaso del rescate. La probabilidad de rescate disminuyó con las infecciones diagnosticadas a partir de los 15 días de uso del catéter. Los hemocultivos negativos multiplicaron por cuatro la posibilidad de recuperación. Conclusiones: el uso de terapia antibiótica en el tratamiento de infecciones resultó en una baja prevalencia de rescate del catéter venoso central. La probabilidad de rescate se asoció con las variables del dispositivo.

RESUMO Objetivos: estabelecer a prevalência de salvamento de cateteres venosos centrais em recém-nascidos com infecção de corrente sanguínea ocasionada por estafilococos coagulase-negativa. Métodos: estudo transversal, retrospectivo com 136 recém-nascidos internados em Unidade de Terapia Intensiva Neonatal, entre 2011 a 2017. Foram avaliados 143 eventos de infecção submetidos à antibioticoterapia. Resultados: entre os 143 eventos de infecção, 39 cateteres nos quais se usou antibioticoterapia foram salvos e em 69 casos, o dispositivo foi removido. Hemocultura central positiva e cateter mono lúmen foram fatores associados à falha de salvamento. A probabilidade de salvamento diminuiu com infecções diagnosticadas a partir de 15 dias de uso do cateter. Hemocultura negativa elevou a chance de salvamento em quatro vezes. Conclusões: o uso da antibioticoterapia no tratamento das infecções resultou em baixa prevalência de salvamento do cateter venoso central. A probabilidade de salvamento mostrou-se associada às variáveis do dispositivo.

Perfil epidemiológico de Staphylococcus spp. isolados de hemoculturas de pacientes internados em um hospital de atenção terciária da rede pública do Ceará / Epidemiological profile of Staphylococcus spp. isolated from hemocultures of interned patients in a tertiary attention hospital of the Ceará public network

Staphylococcus spp. vem ganhando destaque em infecções na corrente sanguínea (ICS), apresentando alta prevalência, multirresistência e considerável poder de letalidade. O presente estudo teve como objetivo analisar a prevalência e traçar o perfil de sensibilidade das espécies de Staphylococcus spp. isoladas de amostras de hemoculturas positivas obtidas de um hospital de atenção terciária da rede pública do Ceará, no período de janeiro de 2015 a dezembro de 2018. Dos 3292 exames de hemocultura realizados, apenas 15,88% tiveram resultado positivo, dos quais 24,85% eram cocos Gram positivos. S. aureus representou 1,53% das hemoculturas positivas com 50% das cepas resistentes à oxacilina. Os isolados de Staphylococcus sp. coagulase negativo obtiveram prevalência de 10,89%, representados por: S. epidermidis (n=23), S. haemolyticus (n=17), S. hominis (n=13), S. saprophyticus (n=2) e S. warneri (n=2). Verificou-se multirresistência em diversos isolados analisados, apresentando variações intra e interespécies. Portanto, nossos achados melhoram o entendimento da epidemiologia das ICS causadas por Staphylococcus spp., na instituição de estudo, bem como seu perfil de sensibilidade. A identificação precoce do agente infeccioso auxilia na escolha adequada do tratamento, aumentando as chances de cura e reduzindo o tempo de internação do paciente. (AU)

Staphylococcus spp. has been highlighted among bloodstream infections (BI), presenting high prevalence, multidrug resistance and considerable lethality. The present study aimed to analyze the prevalence and the susceptibility profile of Staphylococcus spp. isolated from positive blood cultures from a tertiary care public hospital of Ceará, from January 2015 to December 2018. Of the 3292 blood cultures performed during this period, only 15.88% were positive, of which 24.85% were Gram positive cocci. S. aureus represented 1.53% of positive blood cultures, of which 50% were oxacilin resistant. Isolates of coagulase-negative Staphylococcus spp. showed a prevalence of 10.89%, represented by: S. epidermidis (n = 23), S. haemolyticus (n = 17), S. hominis (n = 13), S. saprophyticus (n = 2) and S. warneri (n = 2). Multiresistance occurrence was verified in several of the analyzed isolates, presenting intra and inters species variations. Therefore, our findings improve the understanding of the epidemiology of BI caused by Staphylococcus spp. in the studied institution, as well as its susceptibility profile. Early identification of the infectious agent might aid in the appropriate choice of treatment, increasing the chance of cure and reducing the patient length stay in hospital. (AU)

Effects of staphylococcal infection and aseptic inflammation on bone mass and biomechanical properties in a rabbit model.

BACKGROUND/OBJECTIVE: Orthopaedic implants are important devices aimed at relieving pain and improving mobility. Staphylococcal infection and aseptic loosening are two common events associated with inflammatory osteolysis that lead to implant failures. Bone mass and biomechanical properties are important indicators that could influence patient outcomes after revision surgery. However, the dynamics of bacterial infections and their influence on bone mass and biomechanical properties remain unclear. Hence, in this study, we developed rabbit aseptic inflammation and staphylococcal infection models to determine the effects of coagulase-positive and coagulase-negative bacterial infection, as well as aseptic inflammation, on the mass and biomechanical properties of the bone. METHODS: Sixty New Zealand white rabbits were randomly assigned to 6 groups, and each group had 10 rabbits. The medullary cavities in rabbits of each group were injected with phosphate-buffered saline (100 â€‹µL), titanium (Ti)-wear particles (300 µg/100 â€‹µL), a low concentration of Staphylococcus epidermidis (105/100 â€‹µL), a high concentration of S. epidermidis (108/100 â€‹µL), a low concentration of Staphylococcus aureus (105/100 â€‹µL), and a high concentration of S. aureus (108/100 â€‹µL), respectively. At four and eight weeks after surgery, the rabbits were sacrificed, and the tibias on the surgical side were analysed via histopathology, microcomputed tomography, and nanoindentation testing. RESULTS: Histopathological analysis demonstrated that inflammatory responses and bacterial loads caused by high concentrations of staphylococcal infections, particularly coagulase-positive staphylococci, are more detrimental than low concentrations of bacterial infection and Ti-wear particles. Meanwhile, microcomputed tomography and nanoindentation testing showed that high concentrations of S. aureus caused the highest loss in bone mass and most biomechanical function impairment in rabbits experiencing aseptic inflammation and staphylococcal infections. CONCLUSIONS: Inflammatory osteolysis caused by a high concentration of coagulase-positive staphylococci is significantly associated with low bone mass and impaired biomechanical properties. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: It is necessary to obtain an overall assessment of the bone mass and biomechanical properties before revision surgery, especially when S. aureus infection is involved. In addition, a better understanding of these two parameters might help develop a reasonable treatment regimen and reduce the risk of adverse events after revision surgery.

Modifying the lipophilic part of phenylthiazole antibiotics to control their drug-likeness.

Compounds with high lipophilic properties are often associated with bad physicochemical properties, triggering many off-targets, and less likely to pass clinical trials. Two metabolically stable phenylthiazole antibiotic scaffolds having notable high lipophilic characters, one with alkoxy side chain and the other one with alkynyl moiety, were derivatized by inserting a cyclic amine at the lipophilic tail with the objective of improving physicochemical properties and the overall pharmacokinetic behavior. Only alkynyl derivatives with 4- or 5-membered rings showed remarkable antibacterial activity. The azetidine-containing compound 8 was the most effective and it revealed a potent antibacterial effect against 15 multi-drug resistant (MDR)-Gram positive pathogens including Staphylococcus aureus, Streptococcus pneumoniae, Staphylococcus epidermidis and enterococci. Compound 8 was also highly effective in clearing 99.7% of the intracellular methicillin-resistant S. aureus (MRSA) harbored inside macrophages. In addition to the remarkable enhancement in aqueous solubility, the in vivo pharmacokinetic study in rats indicated that compound 8 can penetrate gut cells and reach plasma at a therapeutic concentration within 15 min and maintain effective plasma concentration for around 12 h. Interestingly, the main potential metabolite (compound 9) was also active as an antibacterial agent with potent antibiofilm activity.

Post-mortem findings in Staphylococcus aureus acute infective endocarditis

Infective endocarditis (IE) is a microbial infection of the heart valves or the mural endocardium that leads to the formation of vegetations composed of thrombotic debris and microorganisms often associated with the destruction of the cardiac tissues. Most of the infections are bacterial (bacterial endocarditis), although fungi and other microorganisms can be etiological agents. Causative organisms differ among the major high-risk groups. Virulent microorganisms like Staphylococcus aureus, commonly found on the skin, can infect normal or deformed valves and are responsible for 20-30% of all IE cases. Staphylococcus aureus is the major offender in IE among intravenous drug abusers. Acute infective endocarditis is typically caused by infection of a previously normal heart valve by a highly virulent organism (e.g., Staphylococcus aureus) that rapidly produces necrotizing and destructive lesions. These infections may be difficult to cure with antibiotics, and despite appropriate treatment, death can ensue within days to weeks. Here we present autopsy findings of a 31-year-old male patient who died of acute infective endocarditis caused by Staphylococcus aureus as the causative organism.

Caracterización clínico epidemiológica de los pacientes con infecciones por estafilococo dorado / Clinical-epidemiological characterization of patients with Staphylococcus aureus infections

RESUMEN Introducción: El estafilococo dorado es una causa importante de morbilidad y mortalidad en el mundo. En Cuba, es un germen a tener en cuenta como causa de infección intrahospitalaria. Objetivo: Caracterizar, clínica y epidemiológicamente, una muestra de pacientes con infecciones causadas por estafilococo dorado. Métodos: Se realizó un estudio observacional, descriptivo y transversal en el Hospital Militar "Dr. Mario Muñoz Monroy" de Matanzas, durante el período de enero a diciembre del año 2014. La población estuvo constituida por la totalidad de los pacientes hospitalizados con el diagnóstico de infección por estafilococo dorado (120 casos), identificados por el departamento de Microbiología; luego se revisaron las historias clínicas de las cuales se obtuvo la información. Resultados: Existió un predominio del sexo masculino (64,2 por ciento), los mayores de 60 años fueron los más afectados (36,7 por ciento). La diabetes mellitus fue la enfermedad asociada más frecuente (40,8 por ciento) y la mayoría de las infecciones fueron de origen comunitario (67,5 por ciento). Los aislamientos predominaron en las muestras tomadas de las lesiones en piel y los hemocultivos con un 50,8 por ciento y 19,2 por ciento, respectivamente. Se evidenció baja sensibilidad a la vancomicina (49,2 por ciento) y al cotrimoxazol (38,3 por ciento). Conclusiones: Las infecciones por estafilococo dorado fueron más frecuentes en pacientes masculinos geriátricos de su origen extrahospitalario. El germen presentó alta resistencia a los antibióticos y de estos, los aminoglucósidos mostraron la mayor sensibilidad antimicrobiana(AU)

Introduction: Staphylococcus aureus is an important cause of morbidity and mortality in the world. In Cuba, it is a germ to be taken into account as a cause of nosocomial infection. Objective: To characterize, clinically and epidemiologically, a sample of patients with infections caused by Staphylococcus aureus. Methods: An observational, descriptive and cross-sectional study was conducted at the Military Hospital "Dr. Mario Muñoz Monroy "of Matanzas, during the period from January to December of the year 2014. The population was constituted by all the patients hospitalized with the diagnosis of infection by Staphylococcus aureus (120 cases), identified by the department of Microbiology; then the medical records from which the information was obtained were reviewed. Results: There was a predominance of males (64.2 percent) those over 60 were the most affected (36.7 percent). Diabetes mellitus was the most frequent associated disease (40.8 percent) and the majority of infections were of community origin (67.5 percent). Positivity predominated in samples taken from skin lesions and blood cultures with 50.8 percent and 19.2 percent, respectively. Low sensitivity to vancomycin (49.2 percent) and cotrimoxazole (38.3 percent) was evidenced. Conclusions: Staphylococcus aureus infections were more frequent in geriatric male patients of out-of-hospital origin. The germ showed high resistance to antibiotics and of these, the aminoglycosides showed the highest antimicrobial sensitivity(AU)