Bacteriemias por bacilos Gram negativos multirresistentes en neutropénicos febriles con enfermedades hematológicas / Bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematological diseases

Las infecciones por bacilos Gram negativos multiresistentes (BGN-MR) son frecuentes en nuestro hospital. Presentan limitadas opciones terapéuticas e importante impacto en la morbimortalidad y costos. Objetivo: analizar los factoes de riesgo y evolución de las bacteriemias por BGN-MR en pacientes neutropénicos febriles con patologías hematológicas. Materiales y métodos: estudio prospectivo, descriptivo y observacional de los factores de riesgo para BGN-MR en la población descripta. Se realizó análisis univariado y multivariado de variables clínicas, epidemiológicas, microbiológicas y evolutivas. Resultados: El 27 % de los episodios de neutropenia y fiebre cursaron con bacteriemias por BGN, 42 % de ellos fueron producidos por BGN-MR. En el análisis univariado, dichas bacteriemias se asociaron al uso previo de antibióticos; a las bacteriemias de brecha y neutropenias mayores a 7 días. En el análisis multivariado la bacteriemia de brecha mantuvo su significancia estadística (P<0,001; OR: 5,17; IC 95 % 2,1-12,7). Acinetobacter spp fue el BGN-MR más frecuentemente aislado incluso en los pacientes fallecidos. No se detectó el foco en el 45,9 % de los episodios. Los tratamientos inadecuados fueron significativamente más frecuentes en los pacientes con BGN-MR y la mortalidad tanto global como atribuible también se asoció significativamente al tratamiento inadecuado de las bacteriemias por BGN-MR (P<0,04;RR: 2,46;IC 95 % 1,03-5,9 y P< 0,014; RR: 3,02; IC 95 % 1,22-0,45 respectivamente). Conclusiones: Las bacteriemias por BGN-MR son frecuentes en la población estudiada en especial los que han recibido ATB previo y en las que surgen intratratamiento ATB. Recibieron con mayor frecuencia tratamiento empírico inadecuado, lo que se asoció a mayor mortalidad...

Bacterial infections by multiresistant Gram-negative bacilli (BGN-MR) are an increasing problem in our hospital with a major impact on morbidity, mortality and costs. Objective: to analize risk factors and outcome in bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematologic diseases. Material and Methods: We conducted a prospective, descriptive and observational study to describe the risk factors and outcome of BGN-MR bacteremia in these patients. Results: Twenty seven percent of neutropenia and fever episodes had Gram-negative bacilli bacteremia and 42 % of them were caused by BGN-MR. Previous use of antibioteics, breakthrough bacteremia and prolonged neutropenia (<7 days) were significant in univariate analysis. In multivariate analysis only breakthrough bacteremia was significant (P< 0.001; OR 5,17;IC 95 % 2.1-12.7). Acinetobactersppp was the most common BGN-MR isolated in blood-stream infections and in patients who died. The source of infections was unknown in 45,9 % of the episodes. Inadequate empirical therapy was most common in BGN-MR bacteremia and it was associated with increased overall and attributable mortality (P<0.04; RR: 2.46; IC 95 % 1.03-5.9 y P<0.014; RR: 3.02; IC 95 % 1.22-7.45). Conclusions: BGN-MR was frequent in neutropenic patients with hematological diseases specially in those exposed to antibiotics and in breakthroug bacteremia. Inappropiate antimicrobial therapy was common and is associated with adverse outcome...

Unilateral conjunctival ulcer due to Stenotrophomonas maltophilia infection.

We report a case of unilateral conjunctival ulcer due to Stenotrophomonas maltophilia infection in an immunocompetent individual. A 44-year-old male presented with complaints of pain and yellowish discharge in the right eye for one week. Patient underwent complete ophthalmic evaluation and relevant laboratory investigations. Anterior segment examination revealed localized conjunctival and episcleral congestion with conjunctival ulceration on the bulbar conjunctiva in the right eye. Gram's stain revealed gram-negative bacilli. Culture and sensitivity revealed S. maltophilia and responded well to topical moxifloxacin with systemic co-trimoxazole therapy.

Brevundimonas vesicularis bacteremia: A rare case report in a female infant.

Brevundimonas vesicularis has rarely been isolated from clinical specimens. We report here a case of B. vesicularis bacteremia in a female infant who presented with fever, vomiting and altered sensorium. USG abdomen showed mild hepatomegaly, moderate ascitis with bilateral mild basal pleural effusion. Blood culture was processed by BACTEC BD. Isolate was identified as B. vesicularis, by API ID 32 GN automated system. We have come across only one report of neonatal sepsis caused by B. vesicularis from India. To the best of our knowledge, this is one of the rare case reports of B. vesicularis bacteremia in a female infant.

Estudos estruturais e de interações proteína-proteína envolvendo componentes de um sistema de secreção do tipo IV de Xanthomonas axonopodis pv. citri / Structural and protein-protein interaction studies of type IV secretion system components from Xanthomonas axonopodis pv. citri

Xanthomonas axonopodis pv. citri (Xac) é o causador do cancro de plantas cítricas. Entre os potenciais fatores de virulência codificados por Xac, está o Sistema de Secreção do Tipo IV (T4SS), um grande complexo multiprotéico que atravessa o periplasma e as membranas interna e externa de bactérias Gram-negativas. O T4SS está envolvido com secreção de proteínas e/ou DNA para o meio extracelular ou diretamente no interior da célula do hospedeiro. Este Sistema requer tipicamente 12 proteínas para realizar suas funções: VirB1-VirB11 e VirD4. O T4SS codificado pelo cromossomo de Xac está aparentemente incompleto, devido a não codificar nenhuma proteína com similaridade de seqüência a VirB7. Os objetivos deste trabalho são estudar a estrutura, função e interações das proteínas do T4SS de Xanthomonas. Foram clonados 23 genes que codificam proteínas ou domínios relacionados ao T4SS, e os polipeptídeos foram produzidos de forma recombinante em E. coli. Treze deles foram purificados e submetidos a estudos estruturais, espectroscópicos e de interações proteína-proteína. A estrutura em solução de Xac262224-139 foi resolvida, apresentando uma região N-terminal desenovelada de aproximadamente 30 resíduos e um domínio globular. Este polipeptídeo oligomeriza em troca química rápida na escala de tempo de RMN e o seu N-terminal desenovelado reconhece o domínio C-terminal de VirB9 (VirB9154-255) em troca lenta. Análise de RMN demonstrou que VirB9154-255 possui uma estrutura flexível em solução, sofrendo uma marcante mudança conformacional na presença de Xac262224-139. Ambas proteínas se tornam rígidas após a interação. Xac2622 é o equivalente a VirB7 em Xanthomonas, baseado na localização do seu gene no lócus do T4SS, localização subcelular predita do polipeptídeo codificado e sua interação com VirB9...

Xanthomonas axonopodis pv. citri (Xac) is a gram-negative bacterial phytopathogen that infects citrus. One possible virulence determinant is a chromosomally encoded Type IV Secretion System (T4SS), a multiprotein complex that spans the bacterial periplasm and both inner and outer membranes. The T4SS is used by some bacteria to secrete proteins and/or DNA to the extracellular milieu or the host interior. The model T4SS from Agrobacterium tumefaciens is made up of twelve structural proteins: VirB1-VirB11 and VirD4. The Xanthomonas T4SS is apparently incomplete because of the lack of a polypeptide with sequence similarity to VirB7. The aim of this project is the study of structure-function relationships in the Xanthomonas T4SS. Twenty-three T4SS protein-coding genes, including full-length proteins or domains, were cloned and the proteins were produced in different E. coli strains. Thirteen polypeptides were purified and some of them were submitted to structural, spectroscopic and protein-protein interaction studies. We used NMR to solve the solution structure of Xac262224-139 which consists of an unfolded N-terminal segment of ~30 residues followed by a globular domain. Xac262224-139 oligomerizes in fast exchange at the NMR time scale and interacts via its unfolded N-terminus with the VirB9 C-terminus (VirB9154-255) in slow exchange. NMR analysis showed that VirB9154-255 has a flexible structure in solution. However, this polypeptide undergoes a significant conformational modification in the presence of Xac2622,24-139 and both proteins become rigid upon interaction. Xac2622 is the Xanthomonas VirB7, based on the chromosomal localization of its gene, predicted subcellular localization and protein interaction analysis. But surprisingly, unlike other VirB7 proteins, Xac2622 has an extra C-terminal folded domain whose topology and structure are strikingly similar to that of periplasmic domains found in outer membrane proteins of many bacterial Secretion Systems...

Comportamiento de acinobacter en los procesos infecciosos de los pacientes ingresados al HEALF de enero 2004 a diciembre de 2005 / Acinobacter behavior in the infectious processes of the patients entered the HEALF of January 2004 to December of 2005

El trabajo comportamiento de acinetobacter en los procesos infecciosos de pacientes ingresados al HEALF de enero de 2004- diciembre de 2005, se realizó con el objetivo de conocer el comportamiento de esta bacteria en nuestro medio ya que el acinetobacter ha surgido como un importante microorganismo a nivel intrahospitalario y uno de los mayores problemas de la infecciones producidas por esta bacteria es su tratamiento, por su amplia multiresistencia y por las pocas alternativas terapéuticas disponibles en la actualidad. Dicho estudio es descriptivo, de serie de casos. Para alcanzar este objetivo se estudiaron 452 pacientes a los que se aisló 528 Acinetobacter. Los procesos infewcciosos más frecuentes fueron: Sepsis de Herida Quirúrgica, Neumonías y Traqueóbronquitis. Los servicios más afectados fueron: Medicina Interna y de esta, la sala de UCI (Unidad de cuidados intensivos), Neurocirugía, principalmente lka sala de Neurocirugía Intermedios y cirugía plástica principalmente la sala de quemados. Según los resultados de Antibiogrma se encontró un alto grado de resistencia de la bacteria a los antibióticos disponibles en la Lista Básica de Medicamentos como son: Ceftriazona, Ampicilina, Amikacina, Ceftazidima y en menor grado de resistencia a los Carbapemenes (Imipenem, Meropenem)...>

Hepatic abscesses at the University Hospital of the West Indies. A 24-year autopsy review

A retrospective review of all hepatic abscesses identified at autopsy over the 24-year period 1977-2000 at the University Hospital of the West Indies (UHWI), Kingston, Jamaica, was conducted. Post mortem and microbiology records were reviewed. Data collected included age, gender, predisposing factors, organisms isolated, number of abscesses and associated conditions, such as diabetes mellitus. Data for the adults was analyzed separately. Thirty-nine cases of pyogenic abscesses were identified from 7480 post-mortems. Thirty-three occurred in adults of mean age 59.5 years. Sixty per cent of the abscesses were solitary. Biliary tract disease was the predisposing factor in 33 of cases. Six per cent were cryptogenic: 11/33 patients were diabetic and these were significantly older than non-diabetics (p < 0.014) Klebsiella pneumoniae was the most common organism isolated from diabetics (6.9). Only 2/33 abscesses were diagnosed ante-mortem. The abscesses in children were more frequently multiple and associated with extra-abdominal infection. Gram positive cocci were the commonly isolated organisms in children. There were no cases of amoebic abscess. The prevalence of hepatic abscess was low. Diabetes mellitus was a significant contributing factor. A high index of clinical suspicion is therefore warranted particularly in elderly diabetics

Enterotoxicity, haemolytic activity and antibiotic susceptibility of Aeromonas eucrenophila strains isolated from water and infected fish.

Strains of A. eucrenophila isolated from fresh water (2 strains) and infected fish (4 strains) were tested for haemolytic activity and enterotoxicity and any correlation between them. Also, the resistance patterns of A. eucrenophila were tested especially in relation to ampicillin. None of the A. eucrenophila strains caused fluid accumulation in the initial tests, however, they did so only after one to four sequential passages through the gut of a susceptible host. All the strains of A. eucrenophila showed beta-haemolytic activities. Production of beta-haemolysin could be correlated with enterotoxicity. Since all the strains of A. eucrenophila were resistant to ampicillin, media containing this antibiotic may be used for their isolation from diverse sources.

Estudio clínico de eficacia y tolerancia con sultamicilina fipexiam en procesos infecciosos de tratamiento ambulatorio / Clinic study of efficacy and toleration with sultamicilina fipeham in infectious process of ambulatory treatment

Se realizó un estudio abierto, multicéntrico, no comparativo donde se avaluó la eficacia y tolerancia de la combinación Ampicilina/Sulbatam por vía oral-Sultamicilina-(Fipexiam), en adultos y niños con infecciones del tracto respiratorio superior e inferior y con infeciones de piel y partes blandas, y adultos con Enfermedad Inflamatoria Pélvica (EIP). El estudio reunió los investigadores de 73 Centros. Se trataron un total de 195 pacientes obteniéndose una efectividad global de 93.3 por ciento. De estos pacientes 84 presentaron Otitis media aguda, resultando curas clínicas en el 89.2 por ciento, 67 presentaron procesos orofaríngeos con curación en el 94 por ciento; en los casos con infecciones de piel y partes blandas, así como en las mujeres tratadas con (EIP) la curación clínica fue de 100 por ciento. Se reportaron efectos adversos en 10.9 por ciento, siendo las molestias gastrointestinales más resaltantes con 8.7 por ciento de los casos reportados, siendo menores a lo reportado por la literatura médica