Prevalence, genetic characteristics, and antimicrobial resistance of staphylococcal isolates from oral cavity and skin surface of healthy individuals in northern Japan.

BACKGROUND: Oral cavity is an ecological niche for colonization of staphylococci, which are a major bacterial species causing community-acquired infections in humans. In this study, prevalence, and characteristics of staphylococci in oral cavity and skin of healthy individuals were investigated in northern Japan. METHODS: Saliva from oral cavity and swab from skin surface of hand were collected and cultured on selective media. Species of the isolates were identified genetically, and ST was determined for S. aureus and S. argenteus. Genes associated with antimicrobial resistance were detected by PCR. RESULTS: Among 166 participants, a total of 75 S. aureus isolates were obtained from 61 individuals (37 %), and recovered more frequently in oral cavity (n = 48) than skin (n = 27). Among 23 STs identified in S. aureus isolates, ST8 (CC8), ST15 (CC15), and ST188 (CC1) were the most common (10 isolates each), with STs of CC1 being dominant (17 isolates). Methicillin-resistant S. aureus (MRSA) was isolated in the skin of two individuals and belonged to ST1 and ST6. Resistance to erythromycin and gentamicin associated with erm(A) and aac(6')-Ie-aph(2")-Ia, respectively, was more commonly found in ST5 and ST8 isolates. One S. argenteus isolate (ST2250, mecA-negative) was recovered from oral cavity of a participant (0.6 %). A total of 186 isolates of coagulase-negative staphylococci (CoNS) were recovered from 102 participants and identified into 14 species, with S. warneri being the most common (n = 52), followed by S. capitis (n = 42), S. saprophyticus (n = 20) and S. haemolyticus (n = 19). mecA was detected in S. saprophyticus, S. haemolyticus, and S. caprae, while arginine-catabolic mobile element (ACME) in only S. capitis and S. epidermidis. CONCLUSION: S. aureus was more prevalent in oral cavity than skin surface, belonging to three major STs, with CC1 being a dominant lineage. The prevalence of antimicrobial resistance was distinct depending on CoNS species.

The Prevalence, Risk Factors, and Antimicrobial Resistance Determinants of Helicobacter pylori Detected in Dyspeptic Patients in North-Central Bangladesh.

Chronic infection of Helicobacter pylori represents a key factor in the etiology of gastrointestinal diseases, with high endemicity in South Asia. The present study aimed to determine the prevalence of H. pylori among dyspeptic patients in north-central Bangladesh (Mymensingh) and analyze risk factors of infection and antimicrobial resistance (AMR) determinants in the pathogen. Endoscopic gastrointestinal biopsy samples were collected from dyspeptic patients for a one-year period from March 2022 and were checked for the presence of H. pylori via the rapid urease test and PCR and further analyzed for the status of virulence factors vacA/cagA and genetic determinants related to AMR via PCR with direct sequencing or RFLP. Among a total of 221 samples collected, 80 (36%) were positive for H. pylori, with the vacA+/cagA+ genotype being detected in almost half of them. H. pylori was most prevalent in the age group of 41-50-year-olds, with it being more common in males and rural residents with a lower economic status and using nonfiltered water, though the rates of these factors were not significantly different from those of the H. pylori-negative group. Relatively higher frequency was noted for the A2147G mutation in 23S rRNA, related to clarithromycin resistance (18%, 7/39). Amino acid substitutions in PBP-1A (T556S) and GyrA (N87K and D91N) and a 200 bp deletion in rdxA were detected in samples from some patients with recurrence after treatment with amoxicillin, levofloxacin, and metronidazole, respectively. The present study describes the epidemiological features of H. pylori infection in the area outside the capital in Bangladesh, revealing the spread of AMR-associated mutations.

Genetic characterization of methicillin-resistant / susceptible Staphylococcus aureus (MRSA/MSSA) and Staphylococcus argenteus clinical isolates in Bangladesh: Dominance of ST6-MRSA-IV/t304 and detection of cfr/fexA in ST8-MSSA/t008.

Objectives: Coagulase-positive staphylococcus (CoPS), represented by Staphylococcus aureus, is a major cause of infections in humans. This study aimed to investigate molecular epidemiological characteristics, antimicrobial resistance, and their trends of CoPS in Bangladesh. Methods: Clinical isolates of CoPS were collected from two medical institutions in Bangladesh for a 2-year period and analyzed for their species, genotypes, virulence factors, antimicrobial susceptibility, and resistance determinants. Results: 172 CoPS isolates collected were identified as S. aureus or S. argenteus (170 and two, respectively). Methicillin-resistant S. aureus (MRSA) accounted for 36% (n = 61), having Staphylococcal cassette chromosome mec (SCCmec)-IV (82%) or V (18%). Panton-Valentine leukocidin (PVL) genes were detected at higher rate in methicillin-susceptible S. aureus (MSSA) (62%) than MRSA (26%). MRSA comprised 11 STs, including a dominant type ST6 (46%) associated with mostly SCCmec-IVa/spa-t304, and one isolate had genetic features of the USA300 clone (ST8/SCCmec-IVa/coa-IIIa/spa-t008/ACME-I/ΦSa2USA). STs of CC1, CC88, and CC398 were common in MSSA, with CC88 showing the highest PVL-positive rate. One MSSA isolate (ST8/spa-t008) harbored fexA and cfr showing susceptibility to linezolid. S. argenteus was methicillin-susceptible and belonged to ST2250/coa-XId. Conclusions: Genetic characteristics of current MRSA/MSSA in Bangladesh were revealed, with first identification of S. argenteus at low prevalence.

Molecular Epidemiological Characterization of Methicillin-Resistant Staphylococcus aureus from Bloodstream Infections in Northern Japan: Increasing Trend of CC1 and Identification of ST8-SCCmec IVa USA300-Like Isolate Lacking Arginine Catabolic Mobile Element.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major infectious disease pathogen, and its molecular epidemiological profile has been changing. In this study, a total of 279 MRSA isolates were collected from patients with bloodstream infection (BSI) in Hokkaido, northern main island of Japan, for a 2-year period from August 2019 to July 2021. CC5 (ST5/ST764)-MRSA-IIa (SCCmec-IIa) (47%, n = 132) and CC1 (ST1/ST2725/ST2764)-MRSA-IVa (42%, n = 116) were found to be major lineages, with CC8-MRSA-IVa being lower prevalence (5%, n = 13). CC1-MRSA-IVa showed a relatively increased proportion compared with our previous study (22%, 2017-2019). Seven isolates with SCCmec IVa (2.5%) were positive for Panton-Valentine leukocidin genes on ΦSa2usa and belonged to ST8/spa-t008/agr-I/coa-IIIa, showing genetic features of the USA300 clone. Among these isolates, six isolates harbored arginine catabolic mobile element (ACME) type I typical to the USA300 clone, while it was not detected in an isolate (strain R3-8). Whole genomic analysis of strain R3-8 revealed that its chromosome was highly similar to the USA300 strain TCH1516, but lacked ACME, carrying a plasmid genetically close to that of USA300 strains. The present study revealed increasing trend of CC1-MRSA-IV and occurrence of a novel variant of the USA300 clone among MRSA from BSI in northern Japan.

Escherichia coli extraintestinal, resistencia antimicrobiana y producción de betalactamasas en aislados cubanos / Extraintestinal Escherichia coli, antimicrobial resistance and betalactamase production in Cuban isolates

Introducción: Escherichia coli extraintestinal constituye uno de los principales patógenos causantes de infecciones asociadas a la asistencia sanitaria con un alto impacto en la salud por su morbilidad y mortalidad. Objetivo: Describir el comportamiento clínico de E. coli extraintestinal en hospitales cubanos, así como determinar la resistencia antimicrobiana y la producción de betalactamasas. Métodos: Se realizó un estudio descriptivo de corte transversal, durante el período de mayo 2017 a junio 2018, en el Laboratorio Nacional de Referencia de Microbiología del Instituto de Medicina Tropical Pedro Kourí que incluyó 119 aislados de Escherichia coli causantes de infecciones extraintestinales en 30 hospitales de diferentes áreas geográficas del país. Se llevó a cabo la identificación mediante el sistema API 20E y la determinación de la susceptibilidad in vitro a 16 antimicrobianos por el sistema automatizado VITEK-2 y el método de difusión por disco, excepto para la colistina que se empleó el método de elución de disco. Se realizó, además, la detección fenotípica de betalactamasa de espectro extendido, de tipo AmpC y metalobetalactamasa. Resultados: E. coli extraintestinal causó con mayor frecuencia infección de herida quirúrgica (23,5 por ciento), infección del torrente sanguíneo (20,7 por ciento), infecciones respiratorias (17,6 por ciento), infecciones de piel (16,8 por ciento) e infección del tracto urinario (12,6 por ciento). Predominó la resistencia a betalactámicos que osciló entre 61,3 por ciento y 89,1 por ciento, mientras que 79,8 por ciento y 80,5 por ciento de los aislados fueron resistentes a trimetoprim/sulfametoxazol y tetraciclina, respectivamente. La amikacina, la fosfomicina, la colistina y los carbapenémicos mostraron mayor actividad in vitro. El 43,7 por ciento produjo betalactamasas de espectro extendido, 7,6 por ciento AmpC plasmídica y 0,8 por ciento metalobetalactamasa. Conclusiones: La escasa sensibilidad en los aislados de E. coli extraintestinal a los antimicrobianos de primera línea, así como la detección de un aislado productor de metalobetalactamasa evidencia la necesidad de mantener un monitoreo continuo de este patógeno para el cual las alternativas de tratamiento son cada vez más restringidas(AU)

Introduction: Extraintestinal Escherichia coli is one of the main pathogens causing infections associated to health care, with a high impact on health, due to its morbidity and mortality. Objective: Describe the clinical behavior of extraintestinal E. coli in Cuban hospitals, and determine antimicrobial resistance and betalactamase production. Methods: A descriptive cross-sectional study was conducted at the Microbiology National Reference Laboratory of Pedro Kourí Tropical Medicine Institute from May 2017 to June 2018. The study included 119 Escherichia coli isolates causing extraintestinal infections in 30 hospitals from various geographic areas in the country. Identification was based on the API 20E system, and determination of in vitro susceptibility to 16 antimicrobials on the automated system VITEK-2 and the disk diffusion method, except for colistin, for which the disk elution method was used. Phenotypical detection was also performed of AmpC extended-spectrum betalactamase and metallobetalactamase. Results: The most common disorders caused by extraintestinal E. coli were surgical wound infection (23.5 percent), bloodstream infection (20.7 percent), respiratory infections (17.6 percent), skin infections (16.8 percent) and urinary tract infection (12.6 percent). A predominance was found of resistance to betalactams, which ranged between 61.3 percent y 89.1 percent, whereas 79.8 percent and 80.5 percent of the isolates were resistant to trimethoprim / sulfamethoxazole and tetracycline, respectively. Amikacin, fosfomycin, colistin and carbapenemics displayed greater in vitro activity. 43.7 percent produced extended spectrum betalactamases, 7.6 percent plasmid AmpC and 0.8 percent metallobetalactamase. Conclusions: The low sensitivity of extraintestinal E. coli isolates to first-line antimicrobials and the detection of a metallobetalactamase producing isolate are evidence of the need to maintain continuous surveillance of this pathogen, for which the treatment options are ever more restricted.

Resistencia antimicrobiana en aislamientos clínicos de Klebsiella spp. y producción de B-lactamasas de espectro extendido en hospitales de Cuba / Antimicrobial resistance observed in clinical Klebsiella spp isolates and extended spectrum B lactamases in Cuban hospitals

Introducción: el género Klebsiella causa brotes hospitalarios, por cepas multidrogorresistentes en diferentes continentes y conlleva a un aumento en la morbimortalidad. Objetivos: identificar las especies de Klebsiella causantes de infecciones en hospitales cubanos, determinar la procedencia de los aislamientos según el servicio, y la susceptibilidad antimicrobiana, conocer la prevalencia de aislamientos productores de ß-lactamasas de espectro extendido (BLEE), y tipos, así como la susceptibilidad de los mismos a diferentes antimicrobianos de interés terapéutico. Métodos: se realizó un estudio descriptivo en 448 aislamientos de Klebsiella spp. recibidos en el Laboratorio Nacional de Referencia de Microbiología del IPK (LRNM/IPK) procedentes de 40 hospitales de 12 provincias del país durante el período de 2010 a 2012. La identificación de las especies se realizó mediante pruebas bioquímicas convencionales y por la técnica de Espectrometría de masas MS MALDI-TOF. Se determinó la susceptibilidad a 15 antimicrobianos mediante el método E-test y la producción de BLEE mediante el método de discos combinados según las recomendaciones del Instituto de Estándares Clínicos y de Laboratorio. Los genes blaESBL se determinaron mediante la reacción en cadena de la polimerasa según protocolo descrito previamente. Resultados: la especie prevalente fue Klebsiella pneumoniae (95,1 por ciento), seguida por K. oxytoca (4,5 por ciento) y K. ozaenae (0,4 por ciento). Los aislamientos procedieron, principalmente, de los servicios de Unidades de Cuidados Intensivos (26,3 por ciento), cirugía (22 por ciento) y neonatología (13 por ciento). La mayor resistencia se observó para las cefalosporinas (48-52 por ciento), trimetoprim-sulfametoxazol (49 por ciento), gentamicina (43 por ciento), ácido nalidíxico (38 por ciento) y tetraciclina (34 por ciento). El 52 por ciento de los aislamientos fueron productores de BLEE y prevaleció la enzima CTX-M (82 por ciento) y la TEM (70 por ciento)...

Introduction: the Klebsiella genus gives rise to many hospital outbreaks due to multi-drug-resistant strains on different continents and leads to increased morbidity and mortality. Objectives: to identify the Klebsiella species causing infections in Cuban hospitals, to determine the origin of isolates per service, their antimicrobial susceptibility and, to determine the production and type of extended-spectrum ß-lactamases (ESBLs) and the susceptibility of these isolations to several antimicrobials of therapeutic interest. Methods: a descriptive study was conducted on 448 Klebsiella spp. Isolates that were received in the national reference microbiology laboratory of Pedro Kouri Institute of Tropical Medicine from 40 hospitals located in 12 Cuban provinces during the 2010-2012 period. Species identification was based on conventional biochemical tests and mass spectrometry technique called MS MALDI-TOF. The susceptibility to 15 antimicrobials and the extended spectrum ß-lactamase production were determined by the E-test method and by the combined disks method, respectively, according to recommendations of the Institute of Clinical and Laboratory Standards. The polymerase chain reaction made it possible the detection of BlaESBL genes as indicated in the previously described protocol. Results: Klebsiella pneumoniae (95.4 por ciento) was the prevalent species, followed by K. oxytoca (4.1por ciento), and K. ozaenae (0.5 por ciento). The isolates were mainly from the intensive care units (26.3 por ciento), surgery (22 por ciento), and neonatology (13 por ciento) services. The highest resistance rate was observed for cephalosporins (48-52 por ciento), trimethoprim-sulfamethoxazole (49 por ciento), gentamicin (43 por ciento), nalidixic acid (38 por ciento), and tetracycline (34 por ciento). Fifty-two percent of the isolates were extended spectrum ß-lactamase producers, with CTX-M (82 por ciento) and TEM (70 por ciento) enzymes prevailing...

Infecciones por los géneros Klebsiella y Acinetobacter en hospitales pediátricos cubanos y resistencia antibiótica / Infections caused by Klebsiella y Acinetobacter genuses in Cuban pediatric hospitals and antimicrobial resistance

Introducción: Klebsiella pneumoniae y el complejo Acinetobacter baumannii-calcoaceticus constituyen importantes patógenos nosocomiales a nivel mundial siendo más susceptibles los pacientes ingresados en neonatología y unidades de cuidados intensivos. Objetivos: caracterizar, desde el punto de vista clínico-microbiológico los aislamientos de los géneros Klebsiella y Acinetobacter causantes de infecciones en hospitales pediátricos cubanos. Métodos: se realizó un estudio descriptivo-longitudinal durante el período de Junio 2011-Septiembre 2012 que incluyó 152 aislamientos clínicos (102 de Klebsiella spp. y 50 de Acinetobacter spp) causantes de infecciones nosocomiales en niños y que fueron remitidos al Laboratorio Nacional de Referencia de Microbiología del Instituto Pedro KourÝ. La identificación de esta especie se realizó mediante pruebas bioquímicas. Se determinó la susceptibilidad a 18 antimicrobianos, la producción de β-lactamasas de espectro extendido (BLEE) y la de metalo-β-lactamasas (MBLs) según las normas del Instituto de Estandarización de Laboratorio Clínico (CLSI, por sus siglas en inglés). Resultados: las muestras más frecuentes de recuperación de Acinetobacter y Klebsiella fueron sangre, secreción endotraqueal y lesiones de piel. Klebsiella pneumoniae (96 por ciento) y el complejo Acinetobacter baumannii-calcoaceticus (90 por ciento) fueron las especies más prevalentes y se aislaron con mayor frecuencia en servicios de terapias, neonatología y quemado. Ambos patógenos mostraron elevada resistencia a las cefalosporinas con 57 por ciento de producción de BLEE para el género Klebsiella spp. La resistencia a carbapenémicos solo se detectó en Acinetobacter spp (61 por ciento) mediada por la producción de metalo-β-lactamasas en un 2 por ciento de los aislamientos...

Introduction: Klebsiella pneumoniae and the Acinetobacter baumannii-calcoaceticus complex represent important nosocomial pathogens worldwide. The patients admitted to the neonatology and the intensive care unit services suffer infections very frequently. Objectives: to characterize clinically and microbiologically Klebsiella and Acinetobacter isolates causing infections in Cuban pediatric hospitals. Methods: a descriptive longitudinal study of 152 clinical isolates (102 Klebsiella spp and 50 Acinetobacter spp), which caused nosocomial infections in children and were sent to the national reference laboratory of microbiology in Pedro Kouri Institute. The study was conducted from June 2011 to September 2012. The species were identified by biochemical tests. The susceptibility to 18 antimicrobials, the production of extended spectrum ?-lactamase (ESBL) and metallo-?-lactamases were determined according to the Clinical and Laboratory Standards Institute. Results: the most frequent infections in infants and children by Acinetobacter and Klebsiella were found in blood, endotracheal secretion and skin lesions.. Klebsiella pneumoniae (96 %) and Acinetobacter baumannii-calcoaceticus complexes (90 percent) were the most prevalent species and were frequently isolated in intensive care, neonatology and burned patient wards. Both pathogens showed high resistance to cephalosporins with 57 percent of extended-spectrum betalactamase production in Klebsiella spp. Resistance to carbapenems was only detected in Acinetobacter (61 percent) with 2 percent of metallobetalactamse production...

Infecciones por los géneros Klebsiella y Acinetobacter en hospitales pediátricos cubanos y resistencia antibiótica / Infections caused by Klebsiella y Acinetobacter genuses in Cuban pediatric hospitals and antimicrobial resistance

Introducción: Klebsiella pneumoniae y el complejo Acinetobacter baumannii-calcoaceticus constituyen importantes patógenos nosocomiales a nivel mundial siendo más susceptibles los pacientes ingresados en neonatología y unidades de cuidados intensivos. Objetivos: caracterizar, desde el punto de vista clínico-microbiológico los aislamientos de los géneros Klebsiella y Acinetobacter causantes de infecciones en hospitales pediátricos cubanos. Métodos: se realizó un estudio descriptivo-longitudinal durante el período de Junio 2011-Septiembre 2012 que incluyó 152 aislamientos clínicos (102 de Klebsiella spp. y 50 de Acinetobacter spp) causantes de infecciones nosocomiales en niños y que fueron remitidos al Laboratorio Nacional de Referencia de Microbiología del Instituto Pedro Kourí. La identificación de esta especie se realizó mediante pruebas bioquímicas. Se determinó la susceptibilidad a 18 antimicrobianos, la producción de ß;-lactamasas de espectro extendido (BLEE) y la de metalo-ß;-lactamasas (MBLs) según las normas del Instituto de Estandarización de Laboratorio Clínico (CLSI, por sus siglas en inglés). Resultados: las muestras más frecuentes de recuperación de Acinetobacter y Klebsiella fueron sangre, secreción endotraqueal y lesiones de piel. Klebsiella pneumoniae (96 por ciento) y el complejo Acinetobacter baumannii-calcoaceticus (90 por ciento) fueron las especies más prevalentes y se aislaron con mayor frecuencia en servicios de terapias, neonatología y quemado. Ambos patógenos mostraron elevada resistencia a las cefalosporinas con 57 por ciento de producción de BLEE para el género Klebsiella spp. La resistencia a carbapenémicos solo se detectó en Acinetobacter spp (61 por ciento) mediada por la producción de metalo-&-lactamasas en un 2 por ciento de los aislamientos. La mayor susceptibilidad de este género se encontró para las tetraciclinas, mientras que el género Klebsiella spp. fue más susceptible a la ciprofloxacina. En ambos se observó resistencia elevada para los aminoglucósidos (66 por ciento-75 por ciento) y el trimetoprim-sulfametoxazol (45 por ciento-60 por ciento). Conclusiones: Klebsiella pneumoniae y el Complejo Acinetobacter baumannii-calcoaceticus constituyen un peligro potencial en servicios pediátricos con escasas opciones terapéuticas quedando como únicas alternativas los carbapenémicos para las infecciones por Klebsiella spp multidrogorresistentes y la colistina para las infecciones por Acinetobacter spp con extrema drogorresistencia(AU)

Introduction: Klebsiella pneumoniae and the Acinetobacter baumannii-calcoaceticus complex represent important nosocomial pathogens worldwide. The patients admitted to the neonatology and the intensive care unit services suffer infections very frequently. Objectives: to characterize clinically and microbiologically Klebsiella and Acinetobacter isolates causing infections in Cuban pediatric hospitals. Methods: a descriptive longitudinal study of 152 clinical isolates (102 Klebsiella spp and 50 Acinetobacter spp), which caused nosocomial infections in children and were sent to the national reference laboratory of microbiology in Pedro Kouri Institute. The study was conducted from June 2011 to September 2012. The species were identified by biochemical tests. The susceptibility to 18 antimicrobials, the production of extended spectrum ß-lactamase (ESBL) and metallo-ß-lactamases were determined according to the Clinical and Laboratory Standards Institute. Results: the most frequent infections in infants and children by Acinetobacter and Klebsiella were found in blood, endotracheal secretion and skin lesions.. Klebsiella pneumoniae (96 percent) and Acinetobacter baumannii-calcoaceticus complexes (90 percent) were the most prevalent species and were frequently isolated in intensive care, neonatology and burned patient wards. Both pathogens showed high resistance to cephalosporins with 57 percent of extended-spectrum betalactamase production in Klebsiella spp. Resistance to carbapenems was only detected in Acinetobacter (61 percent) with 2 percent of metallobetalactamse production. Acinetobacter spp. was more susceptible to tetracyclines and cholistin where Klebsiella spp was more susceptible to ciprofloxacin. In both pathogens, a high resistance to aminoglycosides (66 percent -75 percent) and trimethoprim-sulfamethoxazole (45 percent-60 percent) was observed. Conclusions: Klebsiella pneumoniae and Acinetobacter baumannii-calcoaceticus complex represent a potential threat in pediatric services with few therapeutic options. The carbapenems remain the only alternative to severe infections caused by multidrug resistant Klebsiella spp and cholistin is the only choice to treat extreme multidrug resistant Acinetobacter spp infections(AU)

Resistencia antimicrobiana en aislamientos clínicos de Klebsiella spp. y producción de B-lactamasas de espectro extendido en hospitales de Cuba / Antimicrobial resistance observed in clinical Klebsiella spp isolates and extended spectrum B lactamases in Cuban hospitals

Introducción: el género Klebsiella causa brotes hospitalarios, por cepas multidrogorresistentes en diferentes continentes y conlleva a un aumento en la morbimortalidad. Objetivos: identificar las especies de Klebsiella causantes de infecciones en hospitales cubanos, determinar la procedencia de los aislamientos según el servicio, y la susceptibilidad antimicrobiana, conocer la prevalencia de aislamientos productores de ß-lactamasas de espectro extendido (BLEE), y tipos, así como la susceptibilidad de los mismos a diferentes antimicrobianos de interés terapéutico. Métodos: se realizó un estudio descriptivo en 448 aislamientos de Klebsiella spp. recibidos en el Laboratorio Nacional de Referencia de Microbiología del IPK (LRNM/IPK) procedentes de 40 hospitales de 12 provincias del país durante el período de 2010 a 2012. La identificación de las especies se realizó mediante pruebas bioquímicas convencionales y por la técnica de Espectrometría de masas MS MALDI-TOF. Se determinó la susceptibilidad a 15 antimicrobianos mediante el método E-test y la producción de BLEE mediante el método de discos combinados según las recomendaciones del Instituto de Estándares Clínicos y de Laboratorio. Los genes blaESBL se determinaron mediante la reacción en cadena de la polimerasa según protocolo descrito previamente. Resultados: la especie prevalente fue Klebsiella pneumoniae (95,1 %), seguida por K. oxytoca (4,5 %) y K. ozaenae (0,4 %). Los aislamientos procedieron, principalmente, de los servicios de Unidades de Cuidados Intensivos (26,3 %), cirugía (22 %) y neonatología (13 %). La mayor resistencia se observó para las cefalosporinas (48-52 %), trimetoprim-sulfametoxazol (49 %), gentamicina (43 %), ácido nalidíxico (38 %) y tetraciclina (34 %). El 52 % de los aislamientos fueron productores de BLEE y prevaleció la enzima CTX-M (82 %) y la TEM (70 %). Conclusiones: se evidencia la repercusión clínica de Klebsiella spp. en hospitales cubanos con elevada resistencia a diferentes antimicrobianos. La producción de BLEE es un mecanismo de resistencia importante en esta bacteria en las que los carbapenémicos, la piperacilina-tazobactam, la colistina, y la tigeciclina juegan un rol terapéutico importante.

Introduction: the Klebsiella genus gives rise to many hospital outbreaks due to multi-drug-resistant strains on different continents and leads to increased morbidity and mortality. Objectives: to identify the Klebsiella species causing infections in Cuban hospitals, to determine the origin of isolates per service, their antimicrobial susceptibility and, to determine the production and type of extended-spectrum ß-lactamases (ESBLs) and the susceptibility of these isolations to several antimicrobials of therapeutic interest. Methods: a descriptive study was conducted on 448 Klebsiella spp. Isolates that were received in the national reference microbiology laboratory of "Pedro Kouri" Institute of Tropical Medicine from 40 hospitals located in 12 Cuban provinces during the 2010-2012 period. Species identification was based on conventional biochemical tests and mass spectrometry technique called MS MALDI-TOF. The susceptibility to 15 antimicrobials and the extended spectrum ß-lactamase production were determined by the E-test method and by the combined disks method, respectively, according to recommendations of the Institute of Clinical and Laboratory Standards. The polymerase chain reaction made it possible the detection of BlaESBL genes as indicated in the previously described protocol. Results: Klebsiella pneumoniae (95.4 %) was the prevalent species, followed by K. oxytoca (4.1%), and K. ozaenae (0.5 %). The isolates were mainly from the intensive care units (26.3 %), surgery (22 %), and neonatology (13%) services. The highest resistance rate was observed for cephalosporins (48-52 %), trimethoprim-sulfamethoxazole (49 %), gentamicin (43 %), nalidixic acid (38 %), and tetracycline (34 %). Fifty-two percent of the isolates were extended spectrum ß-lactamase producers, with CTX-M (82 %) and TEM (70 %) enzymes prevailing. Conclusions: This study shows the clinical impact of Klebsiella spp in Cuban hospitals, which is highly resistant to different antimicrobials. The production of extended spectrum ß-lactamases provides a significant resistance mechanism in Klebsiella in which carbapenems, piperacillin-tazobactam, cholistin and tigecycline play an important therapeutic role.

Susceptibilidad antimicrobiana y factores de virulencia en especies de Enterococcus causantes de infecciones pediátricas en Cuba / Antimicrobial susceptibility and virulence factors found in Enterococcus species causing pediatric infections

Objetivos: conocer la prevalencia de especies de enterococos causantes de infecciones en niño, su virulencia, susceptibilidad antimicrobiana e infecciones más frecuentes. Métodos: se estudiaron 156 aislamientos de enterococos causantes de infecciones en niños ingresados en el Hospital Octavio de la Concepción y La Pedraja, Holguín. Se llevó a cabo la identificación de especies y detección de factores de virulencia por métodos fenotípicos. Se determinó la concentración inhibitoria mínima para vancomicina, ciprofloxacina, ampicilina, gentamicina, estreptomicina, cloranfenicol, nitrofurantoína, eritromicina, tetraciclina, levofloxacina y norfloxacina, según las normas del Clinical Laboratory Standard Institute. Resultados: las cepas se aislaron de sangre, orina, heridas quirúrgicas, piel y tejido blando, oído medio, vulva, punta de catéter, líquido peritoneal, vagina, esperma, líquido cefalorraquídeo, y otras fuentes. La especie prevalente fue Enterococcus faecalis, seguido por Enterococcus faecium, Enterococcus gallinarum y Enterococcus raffinossus, Enterococcus casseliflavus y Enterococcus avium. La producción de proteasa y hemolisina se detectó solo en E. faecalis. E. faecium mostró porcentajes más altos de resistencia a ampicilina, ciprofloxacina, norfloxacina, levofloxacina, mientras que E. faecalis mostró más resistencia a eritromicina, cloranfenicol y tetraciclina. De E. faecalis 58 aislamientos y 12 de E. faecium presentaron altos niveles de resistencia a gentamicina, así como 45 y 32,3 por ciento mostraron altos niveles de resistencia para estreptomicina, respectivamente. Se detectó una cepa de E. faecium resistente a vancomicina. Conclusiones: la circulación de cepas de enterococos virulentas y resistentes a diferentes antibióticos indica la necesidad del control de la infección enterocócica...

Objectives: to find out the prevalence of Enterococcus species causing child infections, their virulence, antimicrobial susceptibility and most frequent infections. Methods: One hundred and fifty six isolations from Enterococcus causing infections in children, admitted to Octavio de la Concepción y La Pedraja hospital in Holguin, were studied. The phenotypical methods allowed identifying species and detecting virulence factors. Following Clinical Laboratory Standard Institute requirements, minimal inhibitory concentration was determined for vancomycin, ciprofloxacin, ampicilline, gentamycin, streptomycin, chloranphenicol, nitrofurantoine, erythromycin, tetracycline, levofloxacin and norfloxacine. Results: Strains were isolated from the blood, the urine, surgical wounds, the skin and the soft tissue, the middle ear, the vulva, catheter point, peritoneal fluid, vagina, sperm, cerebrospinal fluid, and from other sources. The prevailing species was Enterococcus faecalis followed by Enterococcus faecium, Enterococcus gallinarum y Enterococcus raffinossus, Enterococcus casseliflavus y Enterococcus avium. Protease and hemolysin was only detected in E. faecalis. E. faecium accounted for the highest percentage of resistance to ampicillin, ciprofloxacine, norfloxacin, levofloxacin whereas E. faecalis was more resistant to erythromycin, chloranphenicol and tetracycline. Fifty eight E. faecalis isolates and 12 E. faecium isolates exhibited the highest levels of resistance to gentamycin, as well as 45 percent and 32.3 percent of samples had high levels of resistance to streptomycin respectively. A vancomycin-resistent E. faecium strain was detected. Conclusions: The circulation of virulent and multiple resistant Enterococcus strains indicates that Enterococcus infection need to be controlled and the importance of monitoring antimicrobial susceptibility...

Susceptibilidad antimicrobiana y factores de virulencia en especies de Enterococcus causantes de infecciones pediátricas en Cuba / Antimicrobial susceptibility and virulence factors found in Enterococcus species causing pediatric infections

Objetivos: conocer la prevalencia de especies de enterococos causantes de infecciones en niño, su virulencia, susceptibilidad antimicrobiana e infecciones más frecuentes. Métodos: se estudiaron 156 aislamientos de enterococos causantes de infecciones en niños ingresados en el Hospital Octavio de la Concepción y La Pedraja, Holguín. Se llevó a cabo la identificación de especies y detección de factores de virulencia por métodos fenotípicos. Se determinó la concentración inhibitoria mínima para vancomicina, ciprofloxacina, ampicilina, gentamicina, estreptomicina, cloranfenicol, nitrofurantoína, eritromicina, tetraciclina, levofloxacina y norfloxacina, según las normas del Clinical Laboratory Standard Institute. Resultados: las cepas se aislaron de sangre, orina, heridas quirúrgicas, piel y tejido blando, oído medio, vulva, punta de catéter, líquido peritoneal, vagina, esperma, líquido cefalorraquídeo, y otras fuentes. La especie prevalente fue Enterococcus faecalis, seguido por Enterococcus faecium, Enterococcus gallinarum y Enterococcus raffinossus, Enterococcus casseliflavus y Enterococcus avium. La producción de proteasa y hemolisina se detectó solo en E. faecalis. E. faecium mostró porcentajes más altos de resistencia a ampicilina, ciprofloxacina, norfloxacina, levofloxacina, mientras que E. faecalis mostró más resistencia a eritromicina, cloranfenicol y tetraciclina. De E. faecalis 58 aislamientos y 12 de E. faecium presentaron altos niveles de resistencia a gentamicina, así como 45 y 32,3 por ciento mostraron altos niveles de resistencia para estreptomicina, respectivamente. Se detectó una cepa de E. faecium resistente a vancomicina. Conclusiones: la circulación de cepas de enterococos virulentas y resistentes a diferentes antibióticos indica la necesidad del control de la infección enterocócica..........(AU)

Objectives: to find out the prevalence of Enterococcus species causing child infections, their virulence, antimicrobial susceptibility and most frequent infections. Methods: One hundred and fifty six isolations from Enterococcus causing infections in children, admitted to Octavio de la Concepción y La Pedraja hospital in Holguin, were studied. The phenotypical methods allowed identifying species and detecting virulence factors. Following Clinical Laboratory Standard Institute requirements, minimal inhibitory concentration was determined for vancomycin, ciprofloxacin, ampicilline, gentamycin, streptomycin, chloranphenicol, nitrofurantoine, erythromycin, tetracycline, levofloxacin and norfloxacine. Results: Strains were isolated from the blood, the urine, surgical wounds, the skin and the soft tissue, the middle ear, the vulva, catheter point, peritoneal fluid, vagina, sperm, cerebrospinal fluid, and from other sources. The prevailing species was Enterococcus faecalis followed by Enterococcus faecium, Enterococcus gallinarum y Enterococcus raffinossus, Enterococcus casseliflavus y Enterococcus avium. Protease and hemolysin was only detected in E. faecalis. E. faecium accounted for the highest percentage of resistance to ampicillin, ciprofloxacine, norfloxacin, levofloxacin whereas E. faecalis was more resistant to erythromycin, chloranphenicol and tetracycline. Fifty eight E. faecalis isolates and 12 E. faecium isolates exhibited the highest levels of resistance to gentamycin, as well as 45 percent and 32.3 percent of samples had high levels of resistance to streptomycin respectively. A vancomycin-resistent E. faecium strain was detected. Conclusions: The circulation of virulent and multiple resistant Enterococcus strains indicates that Enterococcus infection need to be controlled and the importance of monitoring antimicrobial susceptibility ....................(AU)