Infecciones urinarias adquiridas en la comunidad: epidemiología a los antimicrobianos y opciones terapéuticas / Urinary infections acquired in community: epidemiology resistance to antibiotics and therapeutic options

Las infecciones del tracto urinario (ITU) constituyen uno de los principales motivos de consulta en el ámbito de atención primaria. En los últimos años se han producido cambios sustanciales en los patrones de sensibilidad de los principales patógenos urinarios, lo que ha condicionado cambios en el tratamiento empírico de éstas. El objetivo de este trabajo fue caracterizar las ITU en pacientes de la comunidad. La muestra estuvo conformada por 71 pacientes de ambos sexos mayores de 18 años. El género más afectado fue el femenino (80,28%). Los signos y síntomas más frecuentes fueron dolor lumbar, disuria y dolor abdominal. La presencia de cálculos renales fue el más importante factor predisponente (39,43%), seguido de la menopausia (23,94%). El 63,38% de los pacientes presentaron ITU previas. Escherichia coli fue el agente causal más frecuente (63,89%), seguido de Proteus mirabilis (6,94%). Las enterobacterias aisladas presentaron elevados niveles de resistencia a ampicilina, cefalotina y norfloxacina. El 51,52% de las enterobacterias presentaron resistencia a las fluoroquinolonas y en el 16,67% se demostró la producción de ß-lactamasas de espectro expandido (BLEE). La mayoría de los agentes causales fueron sensibles a la nitrofurantoína independientemente de la presencia de mecanismos de resistencia que afectan a otros grupos de antimicrobianos

Urinary tract infections (UTI) are one of the main reasons for consultation in primary care. In recent years, there have been substantial changes in susceptibility patterns for major urinary tract pathogens, which have conditioned changes in their empirical treatment. The aim of this study was to characterize UTI in patients from the community. The sample consisted of 71 patients of both sexes over 18 years of age. The most affected sex was the female (80.28%). The signs and symptoms were lumbar pain, dysuria and abdominal pain. The presence of kidney stones was the most important predisposing factor (39.43%), followed by menopause (23.94%); 63.38% of the patients had a previous UTI. Escherichia coli was the most common agent (63.89%), followed by Proteus mirabilis (6.94%). Isolates showed high levels of resistance to ampicillin, cephalothin and norfloxacin. 51.52% of the Enterobacteriaceae were resistant to fluoroquinolones and 16.67% showed production of extended spectrum ß-lactamases (ESBL). Most of the agents were susceptible to nitrofurantoin, regardless of the presence of resistance mechanisms affecting other antibiotic groups

Formação de biofilme cristalinode Proteus mirabilis em cateterurológico / Formation of crystalline biofilm of Proteus mirabilis in urological catheter

O cateter uretral de longa permanência tem papel de destaque para pacientes com retenção urinária, com obstrução debexiga, com danos neurológicos e outras doenças. A urina contém sais minerais, que em pH alcalino se precipitam,cristalizam-se e bloqueiam o cateter urológico. A cristalização dos componentes iônicos da urina ocorre em presença de urease, enzima produzida por Proteus mirabilis. Esta bactéria tem a capacidade de aderir a superfícies inanimadas e formar biofilme. O objetivo deste estudo foi observar a formação de biofilme cristalino na superfície luminal de cateter urológicode látex siliconizado, por meio de microscópio eletrônico de varredura, após a canalização de urina artificial infectada com Proteus mirabilis. O experimento foi realizado in vitro,em sistema de fluxo dinâmico. A urina artificial, composta de sais de cálcio, magnésio, fosfatos, uréia e albumina deovo, foi infectada com Proteus mirabilis ATCC 25933. O fluxo da urina canalizada foi interrompido após a cristalização dos componentes iônicos. A cristalização foi observada após a alcalinização da urina. A microscopia eletrônica de varredura demonstrou a presença de cristais e morfologiastípicas de bacilos embutidos em massa amorfa. O presente estudo mostrou que a incrustação pode limitar o uso decateter urológico de longa permanência.

The indwelling urethral catheter has an important role for patients with urinary retention, bladder obstruction, neurological damage and other diseases. Urine contains minerals which precipitate in alkaline pH, crystallize and block the urological catheter. Thecrystallization of the ionic components of urine occurs in the presence of urease, an enzyme produced by Proteus mirabilis. This bacterium adheres to inanimate surfaces and forms biofilms. The aim of this study was to investigate the formation of crystalline biofilm on the luminal surface of siliconized latex catheters by means of scanning electron microscope, after channeling artificialurine infected with Proteus mirabilis. The experiment was performed in vitro using a dynamic flow system. The artificial urine compounds were salts of calcium, magnesium, phosphates, urea and egg albumin, and it was infected with Proteus mirabilis ATCC 25933. The urine flow was stopped after crystallization of the ionic components. Crystallization was observed afteralkalinization of urine. Scanning electron microscopy showed the presence of crystals and morphologies typical of bacilli embedded in an amorphous mass on the internal lumen of the catheter. Thepresent study showed that catheter encrustation may limit the use of long-term indwelling catheter.

Attachment of Proteus mirabilis to human urinary sediment epithelial cells in vitro

In vitro attachment of 335 Proteus mirabilis strains from various human sources to human urinary tract epithelial in adhesive capacity was found between Proteus mirabilis strains were isolated from the blood of 30 patients with Bacteria, Burns swabs 59 infected skin, the stool of 36 healthy subjects and 56 patients with diarrhea and the urine of 62 adults and 92 children with bacteremia. High mean adhesion values were observed in all groups. The Proteus mirabilis strains attached only to squamous cells and not to transitional epithelial cells. The attachment of Proteus mirabilis to sequamous epithelial cells was high about day 15 of the menstrual cycle of the epithelial cell donor, but low at the beginning and the end of the cycle

Development of an operational substrate for ZapA, a metalloprotease secreted by the bacterium Proteus mirabilis

The protease ZapA, secreted by Proteus mirabilis, has been considered to be a virulence factor of this opportunistic bacterium. The control of its expression requires the use of an appropriate methodology, which until now has not been developed. The present study focused on the replacement of azocasein with fluorogenic substrates, and on the definition of enzyme specificity. Eight fluorogenic substrates were tested, and the peptide Abz-Ala-Phe-Arg-Ser-Ala-Ala-Gln-EDDnp was found to be the most convenient for use as an operational substrate for ZapA. A single peptide bond (Arg-Ser) was cleaved with a Km of 4.6 µM, a k cat of 1.73 s-1, and a catalytic efficiency of 376 (mM s)-1. Another good substrate for ZapA was peptide 6 (Abz-Arg-Pro-Pro-Gly-Phe-Ser-Pro-Phe-Arg-Gln-EDDnp) which was cleaved at a single bond (Phe-Ser) with a Km of 13.6 µM, a k cat of 3.96 s-1 and a catalytic efficiency of 291 (mM s)-1. The properties of the amino acids flanking the scissile bonds were also evaluated, and no clear requirement for the amino acid residue at P1 was found, although the enzyme seems to have a preference for a hydrophobic residue at P2.

Absceso esplénico: una complicación poco frecuente en el paciente diabético / Splenic abscess: an infrequent complication in the diabetic patient

Objetivo: Informar un caso de absceso explénico tratado con drenaje externo y antimicrobianos adecuados con buen resultado. Sede: Hospital General de Zona No. 1 "Gabriel Mancera" IMSS, México, D.F. Diseño: Estudio Informativo. Paciente: Presentamos el caso de una paciente diabética de 45 años de edad, que preentó un absceso esplénico. Fue tratada con drenaje externo mediante laparotomía exploradora, metronidazol y gentamicina, con resultados satisfactorios. Revisamos las manifestaciones clínicas, los métodos diagnósticos y el tratamiento de esta entidad

Microbiología de la otitis media crónica y su sensibilidad antimicrobiana / Microbiology of the chronic medial otitis and it antimicrobial sensibility

Se estudiaron tres grupos de pacientes con otitis media crónica (tímpano perforado). Dieciocho con mucosa ótica normal, 15 con mucosa hiperplásica y 16 con mucosa supurada. Se comprobó que los dos grupos con mucosa alterada estaban infectados, encontrándose Pseudomonas aeruginosa y Proteus mirabilis como agentes más frecuentes (42%). Amikacina y gentamicina fueron los antimicrobianos más activos, frente a las 36 bacterias aisladas