RESUMEN
Increasing global travel and changes in the environment may escalate the frequency of contact with a natural host carrying an infection and, therefore, increase our chances of encountering microorganisms previously unknown to humans. During an emergency, the etiology of infection may be unknown at the time of patient treatment. The existing local or global Antimicrobial Stewardship Programs may not be fully prepared for emerging/re-emerging infectious disease outbreaks, especially if they are caused by an unknown organism, engineered bioterrorist attack, or rapidly evolving superbug. We demonstrate an antimicrobial efficacy profiling method that can be performed in hours directly from clinical urine specimens. The antimicrobial potency was determined by the level of microbial growth inhibition and compared to conventional antimicrobial susceptibility testing results. The oligonucleotide probe pairs on the sensors were designed to target Gram-negative bacteria, specifically Enterobacterales and Pseudomonas aeruginosa. A pilot study of 10 remnant clinical specimens from the Clinical Laboratory Improvement Amendments-certified labs of New York-Presbyterian Queens was conducted, and only one sample was not detected by the probes. The remaining nine samples agreed with reference AST methods (Vitek and broth microdilution), resulting in 100% categorical agreement. In a separate feasibility study, we evaluated a dual-kinetic response approach, in which we inoculated two antibiotic stripwells containing the same antimicrobial concentrations with clinical specimens at the original concentration (1x) and at a 10-fold dilution (0.1x) to cover a broader range of microbiological responses. The combined categorical susceptibility reporting of 12 contrived urine specimens was 100% for ciprofloxacin, gentamicin, and meropenem over a range of microbial loads from 105 to 108 CFU/mL.
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Antibacterianos/farmacología , Bacterias/crecimiento & desarrollo , Infecciones Bacterianas/diagnóstico , Pruebas de Sensibilidad Microbiana/métodos , ARN Bacteriano/genética , Bacterias/efectos de los fármacos , Bacterias/genética , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/orina , Humanos , Proyectos Piloto , ARN Bacteriano/orinaRESUMEN
OBJECTIVE: We sought to analyze the distribution and antibiotic sensitivity of pathogens in hospitalized patients and to provide a scientific reference for the rational application of antibiotics. METHODS: From January 2014 to December 2018, urine cultures from patients in our hospital were collected and analyzed retrospectively for the presence, distribution, and drug sensitivity of pathogens. RESULTS: A total of 42,854 midstream urine cultures were collected from which 11,891 (27.75%) pathogens were isolated, including 8101 (68.13%) strains of gram-negative bacteria, 2580 (21.69%) strains of gram-positive bacteria, and 1210 (10.18%) strains of fungi. Escherichia coli and Enterococci were the most common species of gram-negative and gram-positive bacteria, respectively. Drug sensitivity varied among different pathogens. Clear drug resistance was observed in bacteria, while fungus exhibited relatively lower resistance. CONCLUSION: Pathogens responsible for urinary tract infections in hospitalized patients are diversiform and display resistance to some antibiotics. Drug resistance monitoring should be enhanced to optimize antimicrobial therapy.
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Bacterias/patogenicidad , Infecciones Bacterianas/complicaciones , Farmacorresistencia Bacteriana , Farmacorresistencia Fúngica , Hongos/patogenicidad , Micosis/complicaciones , Preparaciones Farmacéuticas/administración & dosificación , Infecciones Urinarias/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/orina , Humanos , Micosis/microbiología , Micosis/orina , Estudios Retrospectivos , Factores de Tiempo , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/orinaRESUMEN
OBJECTIVE: To evaluate the impact of introducing the Step-by-Step approach on care quality in young febrile infants. DESIGN: Observational study including infants ≤90 days old with fever without source seen in a paediatric emergency department 5 years before (n=1222) and after (n=1151) its introduction. Quality of care was evaluated in terms of adherence to recommendations, resource use and safety. RESULTS: Adherence: percentages of infants undergoing both urine and blood tests and infants <15 days old receiving full sepsis evaluation increased (84.7% vs 91.0% and 23.9% vs 63.3%, respectively; p<0.01). Resource use: lumbar puncture and admission rates decreased (24.1% vs 18.7% and 43.6% vs 38.3%, respectively; p<0.01), while the rate of antibiotic therapy increased (30.2% vs 43.2%; p<0.01). SAFETY: the invasive bacterial infection rate among infants managed as outpatients was unchanged (0.7% vs 0.3%; p=0.24). CONCLUSION: The introduction of the Step-by-Step increased the quality of care provided to young febrile infants.
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Infecciones Bacterianas/complicaciones , Fiebre de Origen Desconocido/diagnóstico , Adhesión a Directriz/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Sepsis/etiología , Antibacterianos/uso terapéutico , Infecciones Bacterianas/sangre , Infecciones Bacterianas/líquido cefalorraquídeo , Infecciones Bacterianas/orina , Femenino , Fiebre de Origen Desconocido/etiología , Adhesión a Directriz/ética , Directrices para la Planificación en Salud , Recursos en Salud/estadística & datos numéricos , Recursos en Salud/provisión & distribución , Humanos , Lactante , Recién Nacido , Masculino , Admisión del Paciente/estadística & datos numéricos , Medicina de Urgencia Pediátrica/estadística & datos numéricos , Estudios Prospectivos , Seguridad , Sepsis/diagnóstico , Punción Espinal/estadística & datos numéricosRESUMEN
INTRODUCTION: Urinary tract infections (UTI) are among the most common complications in persons with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI). As both asymptomatic bacteriuria and UTI are frequently treated with antibiotics, concerns about multidrug resistance arise. Therefore, we analyzed the bacterial spectrum in the urine and the resistance patterns of the strains over time in patients with NLUTD due to SCI. METHODS: In a systematic chart review, we identified all microbiologic urine test results including resistance patterns of persons with SCI in a tertiary referral hospital at 2 time periods (2010-2011 and 2017-2018). We assessed the frequency of the bacterial strains, the resistance patterns of the 5 most frequent bacteria, and the use of antibiotics for in- as well as for outpatients. RESULTS: From 2010 to 2011, 1,308 (outpatients) and 2,479 (inpatients) bacterial strains were detected in the urinalyses performed; these numbers rose to 3,162 and 6,112 during 2017-2018, respectively. The most frequently detected bacteria during both time periods were Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae/variicola, Streptococcus viridans, Pseudomonas aeruginosa, and coagulase negative Staphylococci. Fluoroquinolones were the most frequently used antibiotics during both time periods. Despite its frequent use, no relevant increase in resistance against fluoroquinolones was detected. The most prominent increase in resistance appeared in E. coli against amocixillin/clavulanic acid in inpatients (from 26.0 to 38.5%). DISCUSSION AND CONCLUSIONS: Although fluoroquinolones were used frequently, we did not observe an increased resistance against these antibiotics over time in the urine of patients with SCI.
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Antibacterianos/uso terapéutico , Infecciones Bacterianas/etiología , Infecciones Bacterianas/orina , Farmacorresistencia Bacteriana , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/orina , Traumatismos de la Médula Espinal/complicaciones , Infecciones Urinarias/etiología , Infecciones Urinarias/orina , Humanos , Síntomas del Sistema Urinario Inferior/microbiología , Estudios Retrospectivos , Factores de Tiempo , Infecciones Urinarias/microbiologíaRESUMEN
Urinary tract infection (UTI) is one of the most common infections, accounting for a substantial portion of outpatient hospital and clinic visits. Standard diagnosis of UTI by culture and sensitivity can take at least 48 h, and improper diagnosis can lead to an increase in antibiotic resistance following therapy. To address these shortcomings, rapid bioluminescence assays were developed and evaluated for the detection of UTI using intact, viable cells of Photobacterium mandapamensis USTCMS 1132 or previously lyophilized cells of Photobacterium leiognathi ATCC 33981™. Two platform technologies-tube bioluminescence extinction technology urine (TuBETUr) and cellphone-based UTI bioluminescence extinction technology (CUBET)-were developed and standardized using artificial urine to detect four commonly isolated UTI pathogens-namely, Escherichia coli, Proteus mirabilis, Staphylococcus aureus, and Candida albicans. Besides detection, these assays could also provide information regarding pathogen concentration/level, helping guide treatment decisions. These technologies were able to detect microbes associated with UTI at less than 105 CFU/mL, which is usually the lower cut-off limit for a positive UTI diagnosis. Among the 29 positive UTI samples yielding 105-106 CFU/mL pathogen concentrations, a total of 29 urine specimens were correctly detected by TuBETUr as UTI-positive based on an 1119 s detection window. Similarly, the rapid CUBET method was able to discriminate UTIs from normal samples with high confidence (p ≤ 0.0001), using single-pot conditions and cell phone-based monitoring. These technologies could potentially address the need for point-of-care UTI detection while reducing the possibility of antibiotic resistance associated with misdiagnosed cases of urinary tract infections, especially in low-resource environments.
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Infecciones Bacterianas/orina , Técnicas Biosensibles/métodos , Candidiasis/orina , Mediciones Luminiscentes/métodos , Photobacterium , Infecciones Urinarias/orina , Infecciones Bacterianas/microbiología , Técnicas Biosensibles/economía , Candida albicans/aislamiento & purificación , Candidiasis/microbiología , Escherichia coli/aislamiento & purificación , Humanos , Límite de Detección , Luminiscencia , Mediciones Luminiscentes/economía , Photobacterium/citología , Photobacterium/aislamiento & purificación , Proteus mirabilis/aislamiento & purificación , Staphylococcus aureus/aislamiento & purificación , Factores de Tiempo , Infecciones Urinarias/microbiologíaRESUMEN
Objectives In this study, the possibilities of Fourier-transformed infrared spectroscopy (FTIR) for analysis of urine sediments and for detection of bacteria causing urinary tract infections (UTIs) were investigated. Methods Dried urine specimens of control subjects and patients presenting with various nephrological and urological conditions were analysed using mid-infrared spectroscopy (4,000-400 cm-1). Urine samples from patients with a UTI were inoculated on a blood agar plate. After drying of the pure bacterial colonies, FTIR was applied and compared with the results obtained by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Chemometric data analysis was used to classify the different species. Results Due to the typical molecular assignments of lipids, proteins, nucleic acids and carbohydrates, FTIR was able to identify bacteria and showed promising results in the detection of proteins, lipids, white and red blood cells, as well as in the identification of crystals. Principal component analysis (PCA) allowed to differentiate between Gram-negative and Gram-positive species and soft independent modelling of class analogy (SIMCA) revealed promising classification ratios between the different pathogens. Conclusions FTIR can be considered as a supplementary method for urine sediment examination and for detection of pathogenic bacteria in UTI.
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Bacterias/aislamiento & purificación , Infecciones Bacterianas/orina , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Infecciones Urinarias/orina , Orina/química , Orina/microbiología , Bacterias/clasificación , Infecciones Bacterianas/microbiología , Humanos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Urinálisis , Infecciones Urinarias/microbiologíaRESUMEN
PURPOSE: The burden of urinary tract infections (UTIs) and risk factors for developing infections with multidrug resistant organisms (MDROs) post-kidney transplantation (KT) are poorly understood. METHODS: Single-center retrospective cohort study (January 2015-December 2017) evaluating first and recurrent episodes of bacteriuria and subsequent analysis of episodes caused by MDROs up to 6 months post-KT. Donor and recipient variables were reviewed. RESULTS: A total of 743 adults underwent single KT during the study period, and 106 patients were hospitalized with bacteriuria. 45% were asymptomatic in their first episode. 73.6% had a single episode, and 26.4% had 2 or more episodes. A total of 28 patients had recurrent episodes; 64.3% had an MDRO on the first episode and 78.6% on the second episode. Escherichia coli was the most common organism isolated, 88.5% were resistant to trimethoprim-sulfamethoxazole (TMP-SMX), 9.3% were extended-spectrum beta-lactamase (ESBL) producers, and 38.1% were MDROs. Body mass index ≥30 was significantly associated with the presence of MDROs in both univariate and multivariate analyses (RR 1.37, 95% CI 1.01-1.88; OR 3.26, CI 1.29-8.25). A total of 12 donors had bacteremia or bacteriuria and 6 (50%) with E coli. A total of 10 KT recipients received antibiotic prophylaxis to prevent donor-derived infections. CONCLUSIONS: Our results suggest that a significant proportion of patients develop recurrent bacteriuria post-transplantation; of those, more than half caused by MDROs. There is a possible association between obesity and MDROs in KT recipients that merits further investigation. With the global crisis in antimicrobial resistance, innovative strategies are needed to prevent and treat UTIs in KT patients.
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Infecciones Bacterianas/orina , Farmacorresistencia Bacteriana , Hospitalización/estadística & datos numéricos , Trasplante de Riñón/efectos adversos , Infecciones Urinarias/microbiología , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Infecciones Bacterianas/microbiología , Quimioprevención , Infecciones por Escherichia coli/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Receptores de Trasplantes/estadística & datos numéricos , Infecciones Urinarias/tratamiento farmacológico , Adulto JovenRESUMEN
Suspected bacterial urinary tract infections (UTI) are a common cause of overuse and misuse of antimicrobials. A bedside diagnostic test that could accurately predict urine culture results would prevent antimicrobial overuse, but accurate biomarkers have not yet been identified in veterinary medicine. The objective of this study was to evaluate urine myeloperoxidase (uMPO) as a rapidly available, accurate marker to predict urine culture results. We hypothesized that uMPO would be higher in dogs with a positive urine culture than in dogs with a negative urine culture, and that uMPO could be used to aid in the accurate diagnosis of significant bacteriuria. Urine samples were collected from a veterinary university clinical pathology lab. uMPO concentration was measured using a commercially available canine myeloperoxidase (MPO) enzyme-linked immunosorbent assay (ELISA). Following validation, samples from 98 dogs that had a urinalysis and urine culture performed as part of their diagnostic investigation were included. Forty-seven dogs had a negative urine culture and fifty-one dogs had a positive urine culture. uMPO levels were significantly higher in samples that had a positive culture (median 2.13 ng/ml; IQR 0.98-7.07) versus samples that had a negative culture (median 1.07 ng/ml; IQR 0.52-1.84)(p < 0.005). Based on receiver-operator characteristic, a cutoff of 0.55 ng/ml was chosen to maximize sensitivity and specificity. Using a cutoff of 0.55 ng/ml, uMPO had a sensitivity of 70% and specificity of 69% to determine the presence of a positive culture. However, the degree of overlap between groups may preclude the use of this test as a surrogate for urine culture in a clinical setting.
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Infecciones Bacterianas , Bacteriuria , Biomarcadores/orina , Enfermedades de los Perros , Peroxidasa/orina , Animales , Bacterias/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/orina , Infecciones Bacterianas/veterinaria , Bacteriuria/diagnóstico , Bacteriuria/orina , Bacteriuria/veterinaria , Enfermedades de los Perros/diagnóstico , Enfermedades de los Perros/orina , Perros , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , MasculinoRESUMEN
Antimicrobial resistance (AMR) is an increasing problem. The prevalence of antimicrobial resistance in general practice patients is expected to be relatively high in Rotterdam, the Dutch city with the largest proportion non-Western immigrants. The aim of this study was to assess the prevalence of antibiotic-resistant uropathogens (Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis) in general practices in Rotterdam, and to find a possible association between the prevalence of antibiotic-resistant E. coli and age, gender, and socioeconomic status (SES). A retrospective analysis was performed of urine samples from general practice patients in 2016. The prevalence of AMR in uropathogens was compared with national resistance data, as was the prevalence of highly and multidrug resistant and extended spectrum ß-lactamase (ESBL) producing E. coli and K. pneumoniae. Univariate logistic regression was used to study associations between antibiotic-resistant E. coli and age, gender, and SES area score. No clinically relevant differences were observed in the prevalence of antibiotic-resistant uropathogens in Rotterdam compared with the national prevalence. For E. coli and K. pneumoniae, the prevalence was 3.6% for ESBL production (both pathogens together), while the prevalence ranged between 4.2%-5.0% for high resistance and between 1.2%-3.3% for multidrug resistance. Ciprofloxacin-resistant E. coli was significantly associated with higher age. Although Rotterdam has a high percentage of non-western immigrants and a low SES, AMR is low among general practice patients. This indicates that adherence to national guidelines in general practice enables maintenance of low AMR, even in high-risk populations.
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Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Farmacorresistencia Bacteriana Múltiple , Emigrantes e Inmigrantes/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/patogenicidad , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/orina , Ciudades/epidemiología , Femenino , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/patogenicidad , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Países Bajos/epidemiología , Prevalencia , Proteus mirabilis/efectos de los fármacos , Proteus mirabilis/patogenicidad , Estudios Retrospectivos , Factores Socioeconómicos , Escherichia coli Uropatógena/efectos de los fármacos , Escherichia coli Uropatógena/patogenicidad , Adulto JovenRESUMEN
OBJECTIVE: To evaluate whether multiplex PCR-based molecular testing is noninferior to urine culture for detection of bacterial infections in symptomatic patients. METHODS: Retrospective record review of 582 consecutive elderly patients presenting with symptoms of lower urinary tract infection (UTI) was conducted. All patients had traditional urine cultures and PCR molecular testing run in parallel. RESULTS: A total of 582 patients (mean age 77; range 60-95) with symptoms of lower UTI had both urine cultures and diagnostic PCR between March and July 2018. PCR detected uropathogens in 326 patients (56%, 326/582), while urine culture detected pathogens in 217 patients (37%, 217/582). PCR and culture agreed in 74% of cases (431/582): both were positive in 34% of cases (196/582) and both were negative in 40% of cases (235/582). However, PCR and culture disagreed in 26% of cases (151/582): PCR was positive while culture was negative in 22% of cases (130/582), and culture was positive while PCR was negative in 4% of cases (21/582). Polymicrobial infections were reported in 175 patients (30%, 175/582), with PCR reporting 166 and culture reporting 39. Further, polymicrobial infections were identified in 67 patients (12%, 67/582) in which culture results were negative. Agreement between PCR and urine culture for positive cultures was 90%, exceeding the noninferiority threshold of 85% (95% conflict of interest 85.7%-93.6%). CONCLUSION: Multiplex PCR is noninferior to urine culture for detection and identification of bacteria. Further investigation may show that the accuracy and speed of PCR to diagnose UTI can significantly improve patient outcomes.
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Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/orina , Reacción en Cadena de la Polimerasa Multiplex , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/orina , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Urinálisis/métodos , Orina/microbiologíaRESUMEN
Simple tests using sniff analysis that have the ability of diagnosing and rapidly distinguishing between infections due to different bacteria are urgently required by medical community worldwide. Professionals interested in this topic wish for these tests to be simultaneously cheap, fast, easily applicable, non-invasive, robust, reliable, and sensitive. Current analytical instrumentation has already the ability for performing real time (minutes or a few dozens of minutes) analysis of volatile bacterial biomarkers (the VOCs emitted by bacteria). Although many articles are available, a review displaying an objective evaluation of the current status in the field is still needed. This review tries to present an overview regarding the bacterial biomarkers released from in vitro cultivation of various bacterial strains and also from different biological matrices investigated, over the last 10 years. We have described results of relevant studies, which used modern analytical techniques to evaluate specific biomarker profiles associated with bacterial infections. Our purpose was to present a comprehensive view of available possibilities for detection of emitted bacterial VOCs from different matrices. We intend that this review to be of general interest for both medical doctors and for all researchers preoccupied with bacterial infectious diseases and their rapid diagnosis using analytical instrumentation.
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Infecciones Bacterianas/diagnóstico , Compuestos Orgánicos Volátiles/metabolismo , Animales , Bacterias/metabolismo , Infecciones Bacterianas/orina , Biomarcadores/metabolismo , Biomarcadores/orina , Heces/química , Heces/microbiología , Humanos , Compuestos Orgánicos Volátiles/orinaRESUMEN
We determined the impact of reducing incubation times for urine cultures incubated in BD Kiestra ReadA Compact incubators. Urine samples (n = 348) were inoculated to solid media, incubated in the ReadA Compacts and processed at 12, 15, and 18 h. Colony size and identification by MALDI-TOF, growth, semi-quantitation, Vitek and disk diffusion susceptibilities from cultures incubated at 12 and 15 h were compared to 18 h. There was no impact on MALDI-TOF performed after 12 and 15 versus 18 h of incubation. Interpretation for 99% of urine cultures was identical at 15 and 18 h. There was no major or very major error for VitekII or disk diffusion testing with >94% and >92% overall agreement for Gram-negative and positives organisms, respectively. Therefore, reducing the maximum incubation times of primary cultures incubated in the ReadA Compacts from 18 h to 15 h did not impact outcomes.
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Bacterias/crecimiento & desarrollo , Pruebas de Sensibilidad Microbiana/normas , Urinálisis/normas , Antibacterianos/farmacología , Automatización de Laboratorios , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/orina , Recuento de Colonia Microbiana , Humanos , Factores de Tiempo , Urinálisis/métodosRESUMEN
Multidrug-resistant bacteria are increasingly isolated from the urinary tract of pets, particularly those that suffer from concurrent conditions, have been hospitalised, or were treated with antimicrobials in the recent past. Many of the multidrug-resistant bacteria encountered are resistant to all commonly used oral antibiotics. This poses both a therapeutic dilemma in the individual pet and a threat to public health. This article begins with an overview of multidrug resistance in organisms that are commonly isolated from the urinary tract of pets. This is followed by a proposed clinical approach to managing multidrug-resistant urinary bacteria, which summarises current knowledge regarding appropriate sampling and analysis, reviews the current guidelines regarding appropriate antimicrobial use and discusses treatment options that might be considered. The article highlights several shortcomings of the current knowledge to be considered when planning future clinical research and developing policies.
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Infecciones Bacterianas/veterinaria , Bacteriuria/veterinaria , Enfermedades de los Gatos/microbiología , Enfermedades de los Perros/microbiología , Infecciones Urinarias/veterinaria , Animales , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/orina , Bacteriuria/microbiología , Gatos , Perros , Farmacorresistencia Bacteriana Múltiple , Infecciones Urinarias/microbiologíaRESUMEN
Periodic monitoring of antibiotic susceptibility patterns in clinical settings is vital to ascertain the potency as well as re-establishing empirical therapy. This retrospective study aimed to evaluate the antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Ndola Teaching Hospital. A retrospective study was conducted on routine specimens received between May 2016 and July 2018. Specimens were cultured on standard media and Kirby-Bauer disc diffusion method was used for susceptibility testing in accordance with the Clinical and Laboratory Standard Institute's recommendations. A total of 693 specimens were analyzed, of which 65.9% (457) specimens came from inpatient departments and 49.1% (340) came from female patients. The commonest specimens were urine (58.6%), blood (12.7%) and wound swabs (8.5%), and the most common microorganisms were coliform (29.3%), Staphylococcus aureus (15.4%), coagulase negative Staphylococci (CoNS, 13.4%), and Escherichia coli (13%). The highest percentage of resistance to any particular antibiotic was co-trimoxazole (91.7%, 33) followed by nalidixic acid (75.2%, 279), norfloxacin (69.0%, 100), ceftazidime (55.7%, 185), nitrofurantoin (46.6%, 191), chloramphenicol (43%, 111) and ciprofloxacin (8.6%, 271). Furthermore, patient location had resistance effect on coliform (p = 0.014), CoNS (p = 0.031), Streptococcus species (p = 0.024) and Klebsiella species (p = 0.004) to nitrofurantoin, ceftazidime, nitrofurantoin and chloramphenicol, respectively. Besides coliform, resistance of Enterobacter species to ceftazidime and Proteus species to nalidixic acid were more from female patients. Generally, the most effective antibiotics were chloramphenicol and nitrofurantoin with addition of ceftazidime on blood pathogens and ciprofloxacin on wound swab pathogens. The common isolates were coliform, S. aureus, coagulase negative Staphylococci and Escherichia coli. The resistance of most bacteria to ceftazidime and nitrofurantoin were influenced by both gender and location. Our study presents a broad overview of the resistance profiles of bacterial isolates. However, more nosocomial prevalence and antibiogram studies on individual routine specimens are required to provide a more detailed picture of resistance patterns.
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Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Infecciones Bacterianas/tratamiento farmacológico , Farmacorresistencia Bacteriana , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Bacterias/aislamiento & purificación , Infecciones Bacterianas/sangre , Infecciones Bacterianas/orina , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: To study the outcomes and experiences of using metallic stents in treating patients with malignant ureteral obstruction (MUO), we examined the effects of metallic ureteral stenting using the Cook Resonance® stent in the treatment of MUO. METHODS: All patients who had a Resonance metallic stent inserted between April 2015 and March 2018 at one of multiple facilities were prospectively observed with a 1-year follow-up. The primary outcome was the patency rate of the metallic ureteral stent. The secondary outcomes included the complications (e.g., infection and fever). RESULTS: Although stent insertion was attempted in 50 patients, the stent could not be inserted as a ureteral stent in three patients due to severe ureteral stricture, and one ureteral cancer patient was excluded from the analysis. The remaining 46 patients' median age was 67 years (range 28-85 years) (16 males, 30 females). Twenty-four patients died during the study; their median survival time was 226 days. The median follow-up period for the censored patients was 355 days (range 16-372 days), and just seven patients were still alive without Resonance failure > 1 year later. The women's IPSS scores tended to be lower than those of the men. Regarding the OABSS score, although the women's total score tended to be low, the difference between the men's and women's scores was nonsignificant. The bacteria detected from urine culture after stent insertion were more gram-positive than gram-negative. CONCLUSION: Metallic ureteric stenting using the Resonance stent is safe and effective for treating MUO. Subjective symptoms were relatively less in the female patients.
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Stents , Obstrucción Ureteral/terapia , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/orina , Creatinina/sangre , Femenino , Estudios de Seguimiento , Neoplasias Gastrointestinales/complicaciones , Neoplasias de los Genitales Femeninos/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Metales , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Implantación de Prótesis/métodos , Factores Sexuales , Stents/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Obstrucción Ureteral/etiología , Obstrucción Ureteral/mortalidadRESUMEN
BACKGROUND: The objective is to compare the prevalence of serious bacterial infection (SBI) and invasive bacterial infection (IBI) in febrile infants <60 days of age and in those between 61 and 90 days. METHODS: Prospective registry-based cohort study including all the infants ≤90 days with fever without a source evaluated in a pediatric emergency department between 2003 and 2017. We compared the prevalence of SBI and IBI in febrile infants <60 days of age and those between 61 and 90 days. RESULTS: We included 3,301 infants. Overall, 605 (18.3%) had a SBI (mainly urinary tract infection), of these 81 (2.5%) had an IBI (bacteremia 60, meningitis 12, sepsis 9). The prevalence of SBI in infants >60 days old was 18.5% (95% CI: 16.4-20.7) versus 16.6% (95% CI: 14.7-18.7; n.s.) in those between 29 and 60 days and versus 21.5% (95% CI: 18.6-24.7; n.s.) in those <28 days of age. The prevalence of IBI among infants >60 days old was 1.1% (95% CI: 0.6-2.2) versus 2.3% (95% CI: 1.6-3.3; P < 0.05) in those between 29 and 60 days and 5.1% (95% CI: 3.7-7.0; P < 0.05) in those <28 days of age. The prevalence of IBI in well appearing >60 days was 1.0% (versus 4.5% in those <28 days old, P < 0.01; and 2.0% in those between 29 and 60 days, P = 0.06). All bacterial meningitis, except one, were diagnosed in infants <28 days. CONCLUSIONS: The prevalence of IBI in febrile infants between 61 and 90 days of age is high enough to support the recommendation for obtaining urine and blood tests in this population.
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Infecciones Bacterianas/epidemiología , Fiebre/microbiología , Sistema de Registros , Factores de Edad , Bacteriemia/epidemiología , Infecciones Bacterianas/orina , Servicio de Urgencia en Hospital , Fiebre/epidemiología , Humanos , Lactante , Recién Nacido , Meningitis Bacterianas/epidemiología , Prevalencia , Estudios Prospectivos , Sepsis/epidemiología , Sepsis/microbiología , España/epidemiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiologíaRESUMEN
Urinary tract infections (UTI) occur commonly in dogs, and gram-negative enteric bacteria are the most prevalent pathogens. Clinical parameters, urinalysis, and urine culture and sensitivity results were retrieved from the medical records of 208 dogs with positive urine cultures over a 3 yr period at the Louisiana State University Veterinary Teaching Hospital. Several groups were defined including dogs presented for primary care versus referred cases; simple UTI, complicated UTI, and pyelonephritis; dogs pretreated with antimicrobials; and dogs having an indwelling catheter in place prior to sampling. Nearly 80% of dogs had complicated UTI. Of all dogs, 70% had no documented clinical signs of lower urinary tract disease (LUTD), with 68% of them showing hematuria and/or pyuria. Based on clinical signs or urinalysis, 19% of all dogs had no evidence of lower UTI. In dogs without LUTD signs the most common comorbidities were immunosuppressive treatment and severely restricted mobility (23%). Chronic recurring UTI were present in 19% of dogs with LUTD signs. Distribution of bacterial species was comparable with the existing literature and not significantly different between clinical subgroups. Isolates from dogs pretreated with antimicrobials showed decreased susceptibility to enrofloxacin. The prevalence of multidrug-resistant Escherichia coli and Staphylococcus spp. was moderate (29%).
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Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Infecciones Bacterianas/veterinaria , Enfermedades de los Perros/microbiología , Infecciones Urinarias/veterinaria , Orina/microbiología , Animales , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/orina , Enfermedades de los Perros/orina , Perros , Femenino , Masculino , Estudios Retrospectivos , Factores de Riesgo , Infecciones Urinarias/microbiologíaRESUMEN
Relebactam is a small-molecule ß-lactamase inhibitor developed as a fixed-dose combination with imipenem/cilastatin. The pharmacokinetics of relebactam and imipenem across 10 clinical studies were analyzed using data from adult healthy volunteers and patients with bacterial infections. Renal function estimated by creatinine clearance significantly affected the clearance of both compounds, whereas weight and health status were of less clinical significance. Simulations were used to calculate probability of joint target attainment (ratio of free drug area under the curve from 0 to 24 hours to minimum inhibitory concentration (MIC) for relebactam and percentage of time the free drug concentration exceeded the MIC for imipenem) for the proposed imipenem/relebactam dose of 500/250 mg, with adjustments for patients with renal impairment, administered as a 30-minute intravenous infusion four times daily. These dosing regimens provide sufficient antibacterial coverage (MIC ≤ 4 µg/mL) for all renal groups.
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Antibacterianos/farmacología , Compuestos de Azabiciclo/farmacocinética , Infecciones Bacterianas/tratamiento farmacológico , Imipenem/farmacocinética , Administración Intravenosa , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Compuestos de Azabiciclo/administración & dosificación , Infecciones Bacterianas/orina , Estudios de Casos y Controles , Ensayos Clínicos como Asunto , Creatinina/orina , Combinación de Medicamentos , Femenino , Humanos , Imipenem/administración & dosificación , Masculino , Persona de Mediana Edad , Modelos Biológicos , Eliminación Renal , Adulto JovenRESUMEN
Nursing home residents are at a greater risk of developing pressure injuries that develop into an open wound, which can become colonized with bacteria. Understanding the factors that influence microbial colonization of open wounds can lead to the prevention of infections. The relationship between bacteria found in urine and those in open wounds is currently unknown. To determine if bacterial species colonizing open wounds are also found in the urine, we conducted a pilot study with nursing home residents, comparing bacterial species present in the urine with those present in wounds between the umbilicus and mid-thigh. To identify microbial species that were present in both urine and open wound at one time point in one patient, standard clinical bacteriologic culture techniques followed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) were used, as well as 16S rRNA-encoding gene amplicon sequencing. We found some bacterial species detected in urine were also detected in open wounds in one individual at one time point, using both culture-dependent and -independent techniques. Bacterial species that were more often detected, using culture-dependent and -independent methods, at both sites included Enterococcus faecalis, Proteus mirabilis, Escherichia coli, and Providencia stuartii This pilot study provides evidence that bacterial species identified within the urine can also be identified in open wounds in the same patient at one point in time. Further studies are needed to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of open wounds below the umbilicus.IMPORTANCE Older adults, specifically those in nursing facilities, are more susceptible to developing chronic open nonhealing wounds. Chronic open nonhealing wounds severely impact an individual's quality of life and can lead to other comorbidities, such as infection. Recent evidence suggests that the open wound bacterial community can influence wound healing and repair. It is important to understand all sources of open wound contamination to improve preventative infection measures and treatment protocols. In this pilot study, we investigated if bacterial species isolated from urine can also be isolated from open wounds located between the levels of the umbilicus and mid-thigh in the same patient at the same point in time. A growing body of evidence suggests that urine can harbor a microbial community, even in asymptomatic individuals, and older adults are more prone to urinary incontinence. This is the first study to investigate bacterial species concordance between these two anatomical sites. We found, using both culture-dependent and -independent methods, that the same bacterial species can colonize both the urine and wound in one patient at one point in time. Further studies are needed to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of these types of open wounds.
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Bacterias/aislamiento & purificación , Infecciones Bacterianas/orina , Microbiota , Casas de Salud/estadística & datos numéricos , Heridas y Lesiones/microbiología , Anciano , Bacterias/clasificación , Infecciones Bacterianas/microbiología , Técnicas Bacteriológicas , Humanos , Masculino , Proyectos Piloto , Calidad de Vida , ARN Ribosómico 16S/genética , Células MadreRESUMEN
High-throughput metagenomic sequencing offers an unbiased approach to identify pathogens in clinical samples. Conventional metagenomic sequencing, however, does not integrate information about the host, which is often critical to distinguish infection from infectious disease, and to assess the severity of disease. Here, we explore the utility of high-throughput sequencing of cell-free DNA (cfDNA) after bisulfite conversion to map the tissue and cell types of origin of host-derived cfDNA, and to profile the bacterial and viral metagenome. We applied this assay to 51 urinary cfDNA isolates collected from a cohort of kidney transplant recipients with and without bacterial and viral infection of the urinary tract. We find that the cell and tissue types of origin of urinary cfDNA can be derived from its genome-wide profile of methylation marks, and strongly depend on infection status. We find evidence of kidney and bladder tissue damage due to viral and bacterial infection, respectively, and of the recruitment of neutrophils to the urinary tract during infection. Through direct comparison to conventional metagenomic sequencing as well as clinical tests of infection, we find this assay accurately captures the bacterial and viral composition of the sample. The assay presented here is straightforward to implement, offers a systems view into bacterial and viral infections of the urinary tract, and can find future use as a tool for the differential diagnosis of infection.