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1.
Mikrobiyol Bul ; 54(3): 404-417, 2020 Jul.
Artigo em Turco | MEDLINE | ID: mdl-32755517

RESUMO

Gram-positive anaerobic cocci (GPAC), a large group of anaerobic bacteria, are the members of the normal microbiota that colonizes the skin and mucosal surfaces of the human body. However, in case of a wound or when the host becomes immunocompromised, GPAC can cause invasive and most frequently mixed infections. GPAC are the second most frequently isolated bacteria in anaerobic infections. Although the studies are limited, GPAC have been reported to develop resistance to antimicrobial drugs. The resistance of the pathogens to the antimicrobials and improper therapy can cause poor clinical outcomes. Therefore, monitoring of the resistance trends of regional clinically important anaerobic bacteria periodically is recommended. In our study, we aimed to determine the antimicrobial susceptibility profiles of clinically important GPAC. A total of 100 non-duplicated pathogenic GPAC isolates were collected from Marmara University Hospital between 2013 and 2015. The isolates were identified by using conventional methods, "matrix-assisted laser desorption ionization-time of flight mass spectrometry system (MALDI-TOF MS)" (VITEK MS; v3.0, bioMerieux, France) and 16S rRNA gene sequencing. Antimicrobial susceptibility test was carried out by the agar dilution method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The following antimicrobials were tested: penicillin, amoxicillin/ clavulanic acid (AMC), cefoxitin, meropenem, clindamycin, erythromycin, tetracycline, tigecycline, chloramphenicol, moxifloxacin and metronidazole. The minimum inhibitory concentration (MIC) results were interpreted according to the breakpoints described by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoints recommended by CLSI for cefoxitin, tetracycline and moxifloxacin, and breakpoint recommended by Food and Drug Administration (FDA) for tigecycline were used since there were no EUCAST breakpoints for these antimicrobials. MIC50 and MIC90 values were determined for erythromycin since the breakpoint was not described by EUCAST, CLSI or FDA guidelines. The identification results showed that the strains (n= 100) consisted of five different GPAC genus; Parvomonas (40%), Finegoldia (34%), Peptoniphilus (14%), Peptostreptococcus (10%) and Anaerococcus (1%). All of the organisms were susceptible to meropenem, tigecycline and metronidazole. The isolates were highly susceptible to penicillin, AMC, cefoxitin, and chloramphenicol, since the resistance rates against these antimicrobials were 5% or less. The resistance rates against clindamycin, tetracycline and moxifloxacin were 14%, 31% and 24%, respectively. In total, 11% of the isolates were multidrug resistant. Metronidazole and tigecycline displayed high in vitro activity against GPAC and both are appropriate antimicrobials for the selection of empiric therapy. The effectiveness of meropenem was also found high, but it was observed that this antimicrobial would be more appropriate to use in the treatment of severe mixed infections accompanied by other microorganisms with the resistance potential. Detection of penicillin and AMC resistant isolates, which are frequently used in the treatment of GPAC infection, requires periodic monitoring of the antimicrobial susceptibility patterns of GPAC. The high rates of resistance against clindamycin, tetracycline and moksifloxacin indicated that these antimicrobials should not be used for empirical treatment of infections without prior antimicrobial susceptibility testing. This study is one of the largest susceptibility studies specifically carried out on GPAC to date in Turkey. We believe that our results will provide good surveillance data both for our hospital and our country.


Assuntos
Antibacterianos , Farmacorresistência Bacteriana , Cocos Gram-Positivos , Anaerobiose , Antibacterianos/farmacologia , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/genética , Humanos , Testes de Sensibilidade Microbiana , RNA Ribossômico 16S/genética , Turquia
2.
BMC Infect Dis ; 20(1): 417, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546269

RESUMO

BACKGROUND: Most serious complications of infective endocarditis (IE) appear in the so-called "critical phase" of the disease, which represents the first days after diagnosis. The majority of patients overcoming the acute phase has a favorable outcome, yet they remain hospitalized for a long period of time mainly to complete antibiotic therapy. The major hypothesis of this trial is that in patients with clinically stable IE and adequate response to antibiotic treatment, without signs of persistent infection, periannular complications or metastatic foci, a shorter antibiotic time period would be as efficient and safe as the classic 4 to 6 weeks antibiotic regimen. METHODS: Multicenter, prospective, randomized, controlled open-label, phase IV clinical trial with a non-inferiority design to evaluate the efficacy of a short course (2 weeks) of parenteral antibiotic therapy compared with conventional antibiotic therapy (4-6 weeks). SAMPLE: patients with IE caused by gram-positive cocci, having received at least 10 days of conventional antibiotic treatment, and at least 7 days after surgery when indicated, without clinical, analytical, microbiological or echocardiographic signs of persistent infection. Estimated sample size: 298 patients. INTERVENTION: Control group: standard duration antibiotic therapy, (4 to 6 weeks) according to ESC guidelines recommendations. Experimental group: short-course antibiotic therapy for 2 weeks. The incidence of the primary composite endpoint of all-cause mortality, unplanned cardiac surgery, symptomatic embolisms and relapses within 6 months after the inclusion in the study will be prospectively registered and compared. CONCLUSIONS: SATIE will investigate whether a two weeks short-course of intravenous antibiotics in patients with IE caused by gram-positive cocci, without signs of persistent infection, is not inferior in safety and efficacy to conventional antibiotic treatment (4-6 weeks). TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04222257 (January 7, 2020). EudraCT 2019-003358-10.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/isolamento & purificação , Administração Intravenosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Protocolos Clínicos , Feminino , Seguimentos , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
3.
An Bras Dermatol ; 95(3): 298-306, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32303433

RESUMO

BACKGROUND: The increasingly frequent use of dermoscopy makes us think about the possibility of transfer of microorganisms, through the dermatoscope, between doctor and patients. OBJECTIVES: To identify the most frequent gram-positive cocci in dermatoscopes and smartphone adapters, as well as the resistance profile, and to evaluate the factors associated with a higher risk of bacterial contamination of the dermatoscopes. METHODS: A cross-sectional study was carried out with 118 dermatologists from Porto Alegre/Brazil between September 2017 and July 2018. Gram-positive cocci were identified by MALDI-TOF MS and habits of use of the dermatoscope were evaluated through an anonymous questionnaire. RESULTS: Of the dermatoscopes analysed, 46.6% had growth of gram-positive cocci on the lens and 37.3% on the on/off button. The microorganisms most frequently found were S. epidermidis, S. hominis and S. warneri. Attending a hospital, using the dermatoscope at the hospital, with inpatients and in the intensive care unit were significantly associated with colonisation by gram-positive cocci. The highest resistance rates were observed for penicillin, erythromycin and sulfamethoxazole-trimethoprim. STUDY LIMITATIONS: The non-search of gram-negative bacilli, fungi and viruses. Moreover, the small number of adapters did not make it possible to better define if the frequency differences were statistically significant. CONCLUSION: Coagulase-negative staphylococci were frequently identified. S. aureus was detected only on the lens.


Assuntos
Dermatologistas/estatística & dados numéricos , Dermoscopia/instrumentação , Infecções por Bactérias Gram-Positivas/epidemiologia , Cocos Gram-Positivos/isolamento & purificação , Smartphone , Adulto , Distribuição por Idade , Antibacterianos/farmacologia , Brasil/epidemiologia , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/crescimento & desenvolvimento , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Inquéritos e Questionários
4.
Georgian Med News ; (298): 75-79, 2020 Jan.
Artigo em Russo | MEDLINE | ID: mdl-32141854

RESUMO

The article presents the results of a multicenter study of the etiology, antibiotic sensitivity and pharmacoepidemiology of infective endocarditis in the Russian Federation. The purpose of this study is to analyze the current practice of management of patients with infective endocarditis in conditions of low frequency of etiologically significant pathogens in the Russian Federation. The study included patients of both sexes of all age groups with definite and probable infective endocarditis. 406 cases of infectious endocarditis (240 in retrospect and 166 in the prospective part) were analyzed. Etiologically significant pathogen was isolated in 144 cases (35.5%). The structure of pathogens was dominated by gram (+) cocci (90.3%), most often - Staphylococcus aureus (46.5% of all isolated pathogens). Aminoglycosides (22.8%), parenteral cephalosporins of the III generation (22.1%) and glycopeptides (14.5%) were most frequently used in the course of starting antimicrobial therapy. When changing the mode of antimicrobial therapy, glycopeptides (18.6%), aminoglycosides (15.3%), fluoroquinolones (11.2%) and parenteral cephalosporins of generation III (9.5%) were most often prescribed.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Cocos Gram-Positivos/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Cefalosporinas , Resistência a Medicamentos , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Feminino , Cocos Gram-Positivos/patogenicidade , Humanos , Masculino , Testes de Sensibilidade Microbiana , Farmacoepidemiologia , Estudos Prospectivos , Federação Russa/epidemiologia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade
5.
J Med Microbiol ; 69(2): 249-255, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32003712

RESUMO

Introduction. Among the causative agents of bloodstream infections (BSIs), methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) are the key causative pathogens. Their rapid detection directly from Gram-positive cocci-positive blood culture specimens will promote timely treatment and help to implement effective infection control measures.Aim. We aim to develop a PCR-dipstick technique for the rapid detection of MRSA and VRE directly from positive blood culture specimens.Methodology. PCR-dipstick is a PCR-based multiplex detection technique where DNA-DNA hybridization is employed, and the results are interpreted with the naked eye. It was designed to target three drug resistance genes: mecA in MRSA and vanA/vanB in VRE from positive blood culture specimens. A total of 120 clinical isolates were used to evaluate the sensitivity and specificity of PCR-dipstick. Then, PCR-dipstick was examined for MRSA and VRE detection directly from positive blood cultures.Results. PCR-dipstick showed 100 % sensitivity and specificity in detecting mecA, vanA and vanB genes directly from bacterial colonies in comparison with multiplex PCR for genomic DNA followed by agarose gel electrophoresis. Further, it could differentially detect multiple resistant genes in pooled bacterial colonies (n=10). Ultimately, PCR-dipstick could detect MRSA and VRE in positive blood cultures in ~3 h.Conclusion. The results of the current study substantiate that PCR-dipstick can be used as an efficient detection system for MRSA and VRE directly from Gram-positive cocci-positive blood cultures. Its affordability and rapidity indicate that PCR-dipstick can be an effective tool for controlling nosocomial pathogens.


Assuntos
Proteínas de Bactérias/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/genética , Reação em Cadeia da Polimerase Multiplex/métodos , Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Sangue/microbiologia , Hemocultura , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/diagnóstico , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/isolamento & purificação , Humanos , Reação em Cadeia da Polimerase Multiplex/instrumentação
6.
PLoS One ; 15(1): e0227006, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978071

RESUMO

Diabetic foot ulcers (DFUs) lead to nearly 100,000 lower limb amputations annually in the United States. DFUs are colonized by complex microbial communities, and infection is one of the most common reasons for diabetes-related hospitalizations and amputations. In this study, we examined how DFU microbiomes respond to initial sharp debridement and offloading and how the initial composition associates with 4 week healing outcomes. We employed 16S rRNA next generation sequencing to perform microbial profiling on 50 samples collected from 10 patients with vascularized neuropathic DFUs. Debrided wound samples were obtained at initial visit and after one week from two DFU locations, wound bed and wound edge. Samples of the foot skin outside of the wounds were also collected for comparison. We showed that DFU wound beds are colonized by a greater number of distinct bacterial phylotypes compared to the wound edge or skin outside the wound. However, no significant microbiome diversity changes occurred at the wound sites after one week of standard care. Finally, increased initial abundance of Gram-positive anaerobic cocci (GPAC), especially Peptoniphilus (p < 0.05; n = 5 subjects), was associated with impaired healing; thus, GPAC's abundance could be a predictor of the wound-healing outcome.


Assuntos
Desbridamento/métodos , Pé Diabético/complicações , Úlcera do Pé/microbiologia , Cocos Gram-Positivos/isolamento & purificação , Microbiota , Cicatrização , Idoso , Bactérias Anaeróbias , Pé Diabético/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento
7.
Artigo em Japonês | MEDLINE | ID: mdl-31856572

RESUMO

Identification of bacteria by using MALDI Biotyper is relevant at the species category if Score Value (SV) is not less than 2.000. However, in practical examination, the analysis by MALDI Biotyper frequently produces the multiple candidate bacterial species with SV ≥2.000. In this study, we analyzed the ratio of multiple results among 10,081 specimens and identified the species of bacteria with high frequency of multiple results. Our analysis indicated that 8,129 strains out of 10,081 strains examined from July 2015 to July 2017, showed multiple identification results with MALDI Biotyper, and that multiple result was obtained in 4.9% of gram positive cocci analysis, 5.8% of gram positive rods, 25.4% of gram negative cocci, 16% of gram negative rod, none of fungus. In particular, MALDI Biotyper analysis of Enterobacter spp. (E. cloacae, E. asburiae, E. kobei, etc.), Acinetobacter spp. (A. baumannii, A. nosocomialis, A. pittii etc.), Neisseria spp. (N. flavescens, N. perflava etc.) had high ratios of multiple results. Our data suggests that genetic homology among bacteria results in multiple results of bacteria identification. The mass spectrometer method is the rapid test for bacteria identification. However, for obtaining higher specificity, it is required to combine with other methods. Furthermore, systematic annotation of bacteria is highly recommended.


Assuntos
Bactérias Gram-Negativas , Cocos Gram-Positivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Bacilos Gram-Positivos , Reprodutibilidade dos Testes
8.
Tokai J Exp Clin Med ; 44(4): 113-117, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31769001

RESUMO

A 5-year-old girl was referred to our institution with complaints of right hip pain and fever (39.0°C); blood tests and magnetic resonance imaging (MRI) were performed. Blood biochemical results revealed a high inflammatory reaction. MRI results revealed inflammation in the hip joint. She was diagnosed with pediatric septic arthritis of the hip, which required arthrotomy and lavage drainage. Treatment with intravenous vancomycin was initiated on the assumption that the causative bacterial species was Staphylococcus aureus. However, Group A Streptococcus pyogenes (GAS) was subsequently isolated from an intraoperative sample, and the antimicrobial agent was switched to aminobenzylpenicillin (ABPC). Clindamycin (CLDM) was added to the treatment regimen 14 days after surgery as MRI indicated the development and spread of osteomyelitis. Three months post-surgery, MRI findings indicated that the osteomyelitis had resolved and antimicrobial therapy was discontinued. To prevent the spread of osteomyelitis, a combination of CLDM and ABPC should be considered at an early stage, particularly in pediatric patients with GAS-induced septic arthritis.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Clindamicina/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Quadril/microbiologia , Osteomielite/tratamento farmacológico , Antibacterianos/administração & dosagem , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/cirurgia , Pré-Escolar , Clindamicina/administração & dosagem , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/cirurgia , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/isolamento & purificação , Quadril/diagnóstico por imagem , Quadril/cirurgia , Humanos , Imagem por Ressonância Magnética , Osteomielite/diagnóstico , Osteomielite/cirurgia
9.
Diagn Microbiol Infect Dis ; 95(4): 114881, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31477408

RESUMO

A total of 368 Gram-positive cocci from ABSSI were included in the study. S. aureus and S. pyogenes were susceptible to dalbavancin with MIC50 0.016 mg/L and MIC90 0.032 mg/L for MSSA and MIC50 0.032 mg/L and MIC90 0.047 mg/L for MRSA; MICs for S. pyogenes were ≤0.002-0.008 mg/L; for E. faecalis and E. faecium, ranging 0.016-0.12 mg/L and 0.012-≥32 mg/L, respectively; MICs for VRE were 0.032-0.125 mg/L.


Assuntos
Antibacterianos/farmacologia , Cocos Gram-Positivos/efeitos dos fármacos , Infecções dos Tecidos Moles/microbiologia , Teicoplanina/análogos & derivados , Monitoramento Epidemiológico , Cocos Gram-Positivos/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Polônia/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Teicoplanina/farmacologia
11.
Rev Esp Quimioter ; 32(4): 365-369, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31293114

RESUMO

OBJECTIVE: Matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry (MALDI-TOF MS) is widely used for fast identification of bacteria from blood cultures (BC). We compared the performance of two procedures, one including a pre-enrichment step in brain heart infusion and the other a direct method using vacutainer separator gel tubes (DI), for identification of bacteria from blood cultures by MALDI-TOF MS. METHODS: We first prepared a training set of 20 simulated bacteremia specimens, including 10 Gram-negative and 10 Gram-positive species. A total of 145 non-consecutive BCs flagged as positive (68 Gram-negative rods, and 77 Gram-positive cocci) were prospectively analyzed (validation set). RESULTS: A total of 82% and 49% of isolates were correctly identified to the species level by the respective methods. CONCLUSIONS: The pre-enrichment method outperformed the DI method for identification of virtually all bacterial species included in the panels.


Assuntos
Bacteriemia/microbiologia , Hemocultura/métodos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Técnicas de Tipagem Bacteriana/métodos , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/isolamento & purificação , Humanos , Estudos Prospectivos
12.
BMC Pulm Med ; 19(1): 132, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319825

RESUMO

BACKGROUND: Culturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia. However, the sensitivity is low, especially in patients pre-treated with anti-infective agents. The early detection of a pathogen is crucial for the outcome of respiratory tract infections. For bloodstream infections, a multiplex polymerase chain reaction (PCR) assay (SeptiFast®, SF) is available for improved pathogen detection from blood. OBJECTIVE: The aim of the present study was to determine whether the SF assay is applicable to the BAL of children with pulmonary infections and whether the frequency of pathogen detection is enhanced by the use of this multiplex PCR method. METHODS: We investigated 70 BAL samples of 70 children simultaneously by culture and multiplex PCR. The frequency of pathogen detection was compared. RESULTS: Pathogens were detected more frequently by SF than by culture (83% vs. 31%; p < 0.001). This advantage was shown for immunocompetent patients (p = 0.001) as well as for immunocompromised patients (p = 0.003). The majority (38/44; 86%) of the Gram positive cocci were only detected by SF. Fungal organisms were detected in 7/70 patients (10%) by SF and in 2/70 (3%) by culture (p = 0.125). CONCLUSION: Compared to conventional culture, the use of the SF assay on the BAL of children with pneumonia increases pathogen detection rates and therefore adds important information to guide anti-infective therapy.


Assuntos
Infecções Bacterianas/diagnóstico , Líquido da Lavagem Broncoalveolar/microbiologia , Micoses/diagnóstico , Adolescente , Adulto , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Feminino , Fungos/isolamento & purificação , Fungos/patogenicidade , Cocos Gram-Positivos/isolamento & purificação , Cocos Gram-Positivos/patogenicidade , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Masculino , Reação em Cadeia da Polimerase Multiplex , Micoses/microbiologia , Pneumonia/diagnóstico , Pneumonia/microbiologia , Sensibilidade e Especificidade , Adulto Jovem
13.
Clin Nephrol ; 92(1): 44-51, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31131821

RESUMO

BACKGROUND: Peritoneal dialysis-associated peritonitis (PDAP) is one of the major causes of peritoneal dialysis (PD) failure and death. Therefore, it is important to determine how to effectively treat patients with PDAP. MATERIALS AND METHODS: We analyzed the pathogen spectrum and bacterial resistance in 203 PDAP cases that were enrolled in this study from January 1, 2015 to December 31, 2017. All patients were infected with peritonitis and had been treated with antibiotics while at our center. Bacterial culture results of PD fluid and pathogen drug resistance were collected and analyzed. A total of 159 cases (78.3%) had a positive bacterial culture of PD fluid. RESULTS: A total of 47 pathogens were identified, including 19 (40.4%) Gram-positive cocci strains (the most common was Staphylococcus spp.), 15 (31.9%) Gram-negative bacilli strains (the most common was Escherichia coli, 4 fungal strains, and 9 other strains. The drug sensitivity test showed that Gram-positive cocci were sensitive to vancomycin (94.9%), but had a high resistance to cefazolin (67.7%). Gram-negative bacilli were sensitive to imipenem (96.2%), but had a high resistance to ceftriaxone (60.0%). Voriconazole and itraconazole were sensitive in fungal infections. A total of 162 cases were cured, 37 cases were unresponsive to antibiotic treatment and converted to hemodialysis after Tenckhoff catheter removal, and 4 cases resulted in death. CONCLUSION: Gram-positive cocci are still the primary pathogen of PDAP cases in our center, but demonstrate a high resistance to first-generation cephalosporin, which is the suggested treatment per International Society for Peritoneal Dialysis 2016 Peritonitis Recommendations. Therefore, an individualized treatment based on the distribution of pathogens and drug resistance in different centers is more conducive to improve the cure rate of PDAP.


Assuntos
Antibacterianos/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/efeitos dos fármacos , Diálise Peritoneal/efeitos adversos , Peritonite/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antifúngicos/uso terapêutico , Infecções Bacterianas , Cefazolina/uso terapêutico , Ceftriaxona/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Imipenem/uso terapêutico , Itraconazol/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Peritonite/etiologia , Vancomicina/farmacologia , Voriconazol/uso terapêutico , Adulto Jovem
14.
Eur J Clin Microbiol Infect Dis ; 38(8): 1471-1479, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31079314

RESUMO

For patients with a single-positive blood culture growing gram-positive cocci, organism identification can provide supportive information for differentiating contamination from infection. We investigated the effect of a rapid blood culture identification panel (BCID) on vancomycin-prescribing patterns and patient outcomes for single positive blood culture (PBC) growing gram-positive cocci. Adult patients with single-positive blood culture growing gram-positive cocci with conventional organism identification (pre-BCID) were compared with organism identification by BCID (post-BCID). Antimicrobial Stewardship Program (ASP) review of PBC was performed in both study groups. Vancomycin prescribing patterns were studied. Secondary endpoints were the incidence of nephrotoxicity, length of stay (LOS), readmission rate, mortality, and hospital costs. A total of 188 patients (86 pre-BCID, 102 post-BCID) were included. Organism identification was known 21 h sooner in the post-BCID group (P < 0.001). Coagulase-negative staphylococci were the most commonly isolated organisms (73%). In patients where vancomycin was deemed unnecessary (n = 133), vancomycin use (51% pre-BCID vs 36% post-BCID; P = 0.09) and time from culture positivity to vancomycin discontinuation (1.5 vs. 1.7 days; P = 0.92) did not differ between groups. We found no differences in the development of nephrotoxicity, LOS, readmission, mortality, or hospital costs. Earlier identification of single positive blood culture growing gram-positive cocci did not significantly influence prescribing patterns of vancomycin. However, baseline antimicrobial stewardship review of single positive blood culture growing gram-positive cocci may have lessened the opportunity for detectable differences. Larger studies, accounting for the impact of ASP intervention, should be performed to determine the value of each individual component.


Assuntos
Bacteriemia/diagnóstico , Hemocultura , Cocos Gram-Positivos/genética , Cocos Gram-Positivos/isolamento & purificação , Reação em Cadeia da Polimerase , Adulto , Idoso , Gestão de Antimicrobianos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Padrões de Prática Médica , Staphylococcus/isolamento & purificação , Fatores de Tempo , Estados Unidos , Vancomicina/uso terapêutico
15.
Artigo em Inglês | MEDLINE | ID: mdl-30718254

RESUMO

Bacterial keratitis is an aggressive infectious corneal disease. With the continuing rise in antibiotic resistance and a decline in the discovery of new antibiotics, new antimicrobial drugs are now required. In the present study, we determined the antibacterial activity of diacerein, an anti-inflammatory drug, against 76 Gram-positive cocci isolated from bacterial keratitis patients in vitro and anti-Staphylococcus aureus activity in a mouse bacterial keratitis model in vivo The MICs of diacerein were tested using the broth microdilution method in vitro A BALB/c Staphylococcus aureus keratitis animal model was selected and the corneal clinical observation, viable bacteria, and hematoxylin-eosin and Gram staining of infected corneas were measured to evaluate the antibacterial efficacy of diacerein eye drops in vivo An in vivo eye irritation study was carried out by a modified Draize test in rabbits. Our in vitro results showed that diacerein possesses satisfactory antibacterial activity against the majority of Gram-positive cocci (60/76), including all 57 tested Staphylococcus spp. and 3 Enterococcus spp. The in vivo experiment showed that diacerein eye drops reduced bacterial load and improved ocular clinical scores after topical administration of diacerein drops on infected corneas. The ocular irritation test revealed that diacerein eye drop had excellent ocular tolerance. These results indicated that diacerein possesses in vivo anti-Staphylococcus aureus activity. We suggest that diacerein is a possible topically administered drug for Staphylococcus aureus-infected patients, especially those with ocular surface inflammatory disorders.


Assuntos
Antraquinonas/farmacologia , Antibacterianos/farmacologia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/efeitos dos fármacos , Ceratite/microbiologia , Animais , Antraquinonas/metabolismo , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/patologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/isolamento & purificação , Humanos , Ceratite/tratamento farmacológico , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Soluções Oftálmicas , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade
16.
Clin Microbiol Infect ; 25(6): 760.e1-760.e6, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30217761

RESUMO

OBJECTIVES: Gram-positive, anaerobic cocci (GPAC) can cause infections in humans. Only a few cases of bacteraemia with GPAC have been reported. We describe the clinical and microbiological characteristics of GPAC bacteraemia. METHODS: A retrospective population-based study of GPAC bacteraemia 2012-2016 in southern Sweden was performed. GPAC were identified using matrix-associated laser desorption ionization time-of-flight mass spectrometry or 16S rRNA gene sequencing. Etests were used to determine antibiotic susceptibilities. Data on patient and infection characteristics, treatment, and outcome were collected from the medical records. RESULTS: A total of 226 episodes of GPAC bacteraemia in adults were studied; this corresponds to an annual incidence of 3.4 cases per 100,000 persons per year. The bacteria identified were Anaerococcus spp. (n = 43), Atopobium spp. (n = 7), Blautia spp. (n = 1), Finegoldia spp. (n = 15), Parvimonas spp. (n = 100), Peptoniphilus spp. (n = 52), Peptostreptococcus spp. (n = 2), and Ruminococcus spp. (n = 9) of which 200 isolates were identified to the species level. Resistance to imipenem and piperacillin was not identified, whereas resistance among the 229 isolates to penicillin was detected in four, to metronidazole in six, and clindamycin in 16 isolates. The median age of patients was 73 years (55-83, IQR), 57% were male and comorbidities were common. Fifty-one per cent of infections were polymicrobial. In 60% of cases a focus of infection was identified. Forty per cent of patients had either organ dysfunction or shock. The 30-day mortality was 11%, and nosocomial infections were over-represented among the deceased. CONCLUSIONS: GPAC bacteraemia is much more common than previously reported. GPAC-bacteraemia is a condition with significant mortality mainly affecting elderly persons with comorbidities.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bactérias Anaeróbias/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Bacteriemia/patologia , Bactérias Anaeróbias/classificação , Bactérias Anaeróbias/efeitos dos fármacos , Bactérias Anaeróbias/genética , Criança , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Feminino , Infecções por Bactérias Gram-Positivas/patologia , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/genética , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico 16S/genética , Estudos Retrospectivos , Análise de Sequência de DNA , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Suécia/epidemiologia , Adulto Jovem
17.
Enferm Infecc Microbiol Clin ; 37(1): 4-10, 2019 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29907368

RESUMO

INTRODUCTION: Over recent years we have witnessed an increase in the resistance of microorganisms to the available antimicrobials and a decrease in the number of new antimicrobials. Fosfomycin is a safe and cheap broad-spectrum antibiotic which has shown very promising results in combination therapy, mainly against gram-negative microorganisms. Little is known, however, about its clinical efficacy against gram-positive microorganisms. METHODS: We performed a retrospective review of all patients with severe gram-positive infections who received fosfomycin as part of their treatment from 2011 to 2017. We also performed in vitro time-kill assays to study the behaviour of fosfomycin with different antimicrobials against two strains of methicillin-resistant Staphylococcus aureus (MRSA) and two strains of methicillin-susceptible S. aureus (MSSA). RESULTS: Seventy-five patients were treated with different fosfomycin combinations. Among them, 61 (81%) were successfully treated. Daptomycin plus fosfomycin was the most effective combination. Overall, the treatment with fosfomycin was safe, and side effects were minor. There was only one major side effect that resolved after discontinuation of therapy. Time-kill studies demonstrated increased activity of fosfomycin combinations, with daptomycin-fosfomycin being the most active combination against both MRSA and MSSA strains. CONCLUSIONS: Our results suggest that antimicrobial combinations including fosfomycin are an alternative and effective approach for gram-positive infections.


Assuntos
Antibacterianos/administração & dosagem , Fosfomicina/administração & dosagem , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos , Antibacterianos/farmacologia , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Fosfomicina/farmacologia , Cocos Gram-Positivos/efeitos dos fármacos , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Resultado do Tratamento
18.
Enferm Infecc Microbiol Clin ; 37(2): 140-141, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29631929
19.
BMC Infect Dis ; 18(1): 490, 2018 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-30268097

RESUMO

BACKGROUND: Staphylococcus aureus bacteraemia is a common and significant infection, associated with high rates of mortality. Therefore, early identification is important for the initiation of appropriate treatment. The objective of this study was to evaluate the accuracy of blood culture Gram staining along with the finding of an 'oozing sign' to diagnose either Staphylococcus aureus or coagulase-negative staphylococci. METHODS: This single-centre, prospective observational study was performed from May 2017 to November 2017. We used routine blood culture bottles (BacT/ALERT FA and BacT/ALERT SN; bioMérieux, Inc., Durham, NC). Bacterial species were identified and the minimum inhibitory concentration was determined by using the MicroScan WalkAway 96 SI system (Beckman Coulter, Tokyo, Japan). Bottles showing growth were removed, and Gram staining was performed. RESULTS: A total of 118 samples, including 55 aerobic and 63 anaerobic bottle samples, were analysed. The overall sensitivity of Gram staining was 78.7% (95% CI: 65.8-94.3%), and the specificity was 95.0% (95% CI: 84.7-98.4%). CONCLUSION: The 'oozing sign' observed in Gram staining may be useful for the rapid prediction of S. aureus in BacT/ALERT blood culture bottles.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Cocos Gram-Positivos/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Antibacterianos/farmacologia , Bacteriemia/microbiologia , Violeta Genciana/química , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/crescimento & desenvolvimento , Humanos , Testes de Sensibilidade Microbiana , Fenazinas/química , Estudos Prospectivos , Sensibilidade e Especificidade , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento
20.
Artigo em Inglês | MEDLINE | ID: mdl-30150472

RESUMO

In community hospitals, antimicrobial stewardship team notification of rapid diagnostic testing (RDT) results may not be feasible. A retrospective quasi-experimental study was conducted evaluating 252 adult inpatients with blood cultures positive for Gram-positive cocci in clusters (pre-RDT, n = 143; post-RDT, n = 109). The median time to appropriate therapy was significantly shorter in the post-RDT group (15 versus 0 h, P < 0.001), and the mean length of stay for patients with coagulase-negative staphylococcus was significantly shorter (10.5 versus 7.7 days; P = 0.015).


Assuntos
Infecções por Bactérias Gram-Positivas/diagnóstico , Cocos Gram-Positivos/isolamento & purificação , Adulto , Gestão de Antimicrobianos/métodos , Bacteriemia/sangue , Bacteriemia/diagnóstico , Bacteriemia/metabolismo , Bacteriemia/microbiologia , Hemocultura/métodos , Coagulase/metabolismo , Feminino , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/metabolismo , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais Comunitários/métodos , Hospitais de Ensino/métodos , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação
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