Spectroscopic Identification of Bacteria Resistance to Antibiotics by Means of Absorption of Specific Biochemical Groups and Special Machine Learning Algorithm.

FTIR (Fourier transform infrared spectroscopy) is one analytical technique of the absorption of infrared radiation. FTIR can also be used as a tool to characterize profiles of biomolecules in bacterial cells, which can be useful in differentiating different bacteria. Considering that different bacterial species have different molecular compositions, it will then result in unique FTIR spectra for each species and even bacterial strains. Having this important tool, here, we have developed a methodology aimed at refining the analysis and classification of the FTIR absorption spectra obtained from samples of Staphylococcus aureus, with the implementation of machine learning algorithms. In the first stage, the system conforming to four specified species groups, Control, Amoxicillin induced (AMO), Gentamicin induced (GEN), and Erythromycin induced (ERY), was analyzed. Then, in the second stage, five hidden samples were identified and correctly classified as with/without resistance to induced antibiotics. The total analyses were performed in three windows, Carbohydrates, Fatty Acids, and Proteins, of five hundred spectra. The protocol for acquiring the spectral data from the antibiotic-resistant bacteria via FTIR spectroscopy developed by Soares et al. was implemented here due to demonstrating high accuracy and sensitivity. The present study focuses on the prediction of antibiotic-induced samples through the implementation of the hierarchical cluster analysis (HCA), principal component analysis (PCA) algorithm, and calculation of confusion matrices (CMs) applied to the FTIR absorption spectra data. The data analysis process developed here has the main objective of obtaining knowledge about the intrinsic behavior of S. aureus samples within the analysis regions of the FTIR absorption spectra. The results yielded values with 0.7 to 1 accuracy and high values of sensitivity and specificity for the species identification in the CM calculations. Such results provide important information on antibiotic resistance in samples of S. aureus bacteria for potential application in the detection of antibiotic resistance in clinical use.

Macrolides at Clinically-Relevant Concentrations May Induce Biofilm Formation in Macrolide-Resistant Staphylococcus aureus.

Macrolides inhibit biofilm formation in several Gram-negative, intrinsically-resistant bacterial species. However, the effect of macrolides upon biofilm formation by susceptible Gram-positive bacteria has been much less explored as such concentrations also inhibit cell growth. To circumvent this problem, the effect of macrolides (erythromycin, clarithromycin and azithromycin) at 0.5-2 µg/mL, upon biofilm formation, was explored on macrolide-resistant Staphylococcus aureus isolates, using the crystal violet assay with 96-well plates. Early (4 h) biofilm formation by strains having constitutive target-modification resistance was consistently induced by all macrolides but not in azithromycin-treated cells in longer (8 and 12 h) incubation. In inducible-resistance isolates, early biofilm formation was enhanced by some macrolide treatments, compared to similar cell growth in the absence of antibiotics; but the typical decay of biofilms at longer incubation appeared prematurely in macrolide-treated cultures. Biofilm formation in an efflux-mediated resistant isolate was not affected by macrolides. These results indicate that macrolides induce the formation of biofilm by resistant S. aureus isolates, especially during the early stages. This suggests that the empirical use of macrolides against infections caused by resistant S. aureus strains could not only result in clinical failure but even in the enhancement of biofilms, making further treatment difficult.

The association of modified QuEChERS and DLLME to offer high analytical detectability to assess residual depletion profile of erythromycin in fish.

An analytical method for the determination of erythromycin A (ERY) residues in fish fillet was developed, optimized, and validated employing a modified QuEChERS procedure associated to DLLME technique as a preconcentration step. The obtained LOD and the LOQ were 0.1 µg kg-1 and 1 µg kg-1, respectively. The validated method provides linearity in the range of 1 to 20 µg kg-1, precision (CV < 6.3 %) and accuracy (recovery ranging from 103 to 110 %). The procedure was applied in an experimental study to evaluate the residual depletion profile of ERY in fish (Piaractus mesopotamicus) after oral administration. The treatment was carried out at a daily dose of 100 mg (kg BW)-1 of ERY, for 7 consecutive days and with an average water temperature of 30 °C. A withdrawal time of 240°-day was estimated for eliminating ERY residues at concentration levels below the maximum residue limit considered (MRL 100 µg kg-1).

Brazilian Butt Lift Gone Wrong: A Case Series of Non-Tuberculous Mycobacterial Gluteal Infection After Brazilian Butt Lifts.

Cosmetic surgeries are very popular and glamorized by the mainstream media and celebrities. Many individuals perceive certain bodily features as appealing for physical attraction and will attempt to obtain these features by surgery. However, these surgeries are not without risk, and significant consequences can occur if not performed by qualified medical professionals under sterile procedures. The authors present novel cases of two healthy young female patients who underwent a Brazilian butt lift (BBL) procedure a week apart by the same plastic surgeon in Mexico and developed dark painful lesions secondary to Mycobacterium abscessus (M. abscessus), a multidrug-resistant non-tuberculous mycobacterium (NTM). The literature review shows a paucity of data concerning NTM infections via surgical procedures of this type. The first case was of a 31-year-old woman who underwent a BBL and presented with bilateral dark painful buttock lesions weeks later. The patient returned to the plastic surgeon, who drained some lesions and prescribed oral antibiotics. The patient's clinical status continued to deteriorate and presented to the hospital for further assessment. The patient was initially started on broad-spectrum antibiotic therapy. The patient was found to have an HIV infection with a relatively preserved CD4 lymphocyte count and was started on antiretroviral therapy (ART). Intraoperative excisional tissue sample cultures grew M. abscessus. The patient was started on empiric tigecycline, cefoxitin, and linezolid. Preliminary culture susceptibilities showed resistance to linezolid. Linezolid was discontinued, amikacin was started, and cefoxitin and tigecycline were continued. Tigecycline, cefoxitin, and amikacin were continued and final susceptibilities showed sensitivity to the current treatment. The patient received a total of four months of treatment with tigecycline, cefoxitin, and amikacin. The second case was of a 28-year-old woman who underwent a BBL a week after the first patient by the same surgeon and developed multiple gluteal and body abscesses. The patient underwent bilateral thigh and gluteal, right chest wall, and breast surgical debridements with intraoperative cultures at a different hospital facility, which grew M. abscessus. Susceptibilities were not performed there. The patient was transferred to our facility for further care. Intraoperative cultures remained negative, and the patient was treated with a six-month course of tigecycline, cefoxitin, and amikacin.

In vitro synergistic interaction between Melaleuca armillaris essential oil and erythromycin against Staphylococcus aureus isolated from dairy cows.

Staphylococcus aureus frequently causes subclinical mastitis around the world with a high impact on the milk industry and public health. Essential oils (EO) are recognized antimicrobials that can be synergistic with antibiotics. The main objective of this study was to evaluate the essential oil (EO) of Melaleuca armillaris as an adjuvant of erythromycin (ERY) for the alternative treatment of bovine mastitis caused by S. aureus. The Minimum Inhibitory and Bactericidal Concentrations (MIC and MBC) of EO, ERY, and its combinations were established against S. aureus at different pHs (7.4, 6.5 and 5.0), emulating extra and intracellular conditions. Sensitive (N = 3) and resistant (N = 3) strains to ERY and S. aureus ATCC 29213 as control were used. Math models were applied to describe the antibacterial activity of EO and combinations EO-ERY. The EO was bactericidal against all the strains independently of the pH with a slight improvement in acid conditions. The synergism between EO and ERY was estimated by the Fractional Inhibitory Concentration Index (FIC) and by mathematical modeling of the bacterial killing data. Synergism was observed with ERY, where combinations had bactericidal activity also even with pH modification. M. armillaris EO is an interesting adjuvant for ERY, being a promissory option for further analysis of intracellular efficacy against S. aureus.

The Role of H2O2-Scavenging Enzymes (Ascorbate Peroxidase and Catalase) in the Tolerance of Lemna minor to Antibiotics: Implications for Phytoremediation.

We investigated the individual and combined contributions of two distinct heme proteins namely, ascorbate peroxidase (APX) and catalase (CAT) on the tolerance of Lemna minor plants to antibiotics. For our investigation, we used specific inhibitors of these two H2O2-scavenging enzymes (p-aminophenol, 3-amino,1,2,4-triazole, and salicylic acid). APX activity was central for the tolerance of this aquatic plant to amoxicillin (AMX), whereas CAT activity was important for avoiding oxidative damage when exposed to ciprofloxacin (CIP). Both monitored enzymes had important roles in the tolerance of Lemna minor to erythromycin (ERY). The use of molecular kinetic approaches to detect and increase APX and/or CAT scavenging activities could enhance tolerance, and, therefore, improve the use of L. minor plants to reclaim antibiotics from water bodies.

Uso de eritromicina como procinético para cesárea con cuatro horas de ayuno / Use of erythromycin as a prokinetic for cesarean section with four hours of fasting

Resumen: El ayuno preoperatorio es fundamental como requisito previo a la mayoría de cirugías tanto para las electivas como para las urgencias relativas. Sin embargo, no siempre se cumplen las condiciones idóneas al momento de abordar a un paciente y la falta de ayuno es una condición que puede poner en riesgo la vida del mismo, siendo un factor de riesgo mayúsculo para la broncoaspiración del contenido gástrico. Hasta el momento se cuenta con un reducido arsenal farmacológico de medicamentos que con distinta función e intensidad aceleran el vaciamiento gástrico; la eritromicina no se encuentra en esta lista de manera oficial. A pesar de que ya ha sido utilizada ampliamente con este fin en el ámbito de los procedimientos endoscópicos, no existen aún suficientes reportes en los que se haya puesto a prueba su eficacia procinética en cirugía de urgencia, específicamente una cesárea. Este artículo, además de ofrecer un breve sumario de dicho macrólido, presenta el caso de una paciente embarazada con ingesta alimenticia reciente, en la cual se obtuvieron las condiciones idóneas para cirugía tan sólo cuatro horas después de la administración de la eritromicina.

Abstract: Preoperative fasting is essential as a prerequisite for most surgeries, either elective procedures or relative emergencies. However, the ideal conditions for surgery are not always fulfilled at the time of approaching a patient, and the lack of fasting is a factor that could endanger patient's life, being a major risk factor for bronchoaspiration of gastric content. Until now there is a small pharmacological list of medications that with different function and intensity accelerate gastric emptying, erythromycin is not officially on this list. Despite the fact that it has already been widely used for this purpose in the field of endoscopic procedures, there are not enough reports about its efficacy in emergency surgery, specifically C-section. This article, in addition to offering a brief summary of this macrolide, presents a case in which after erythromycin administration to a pregnant patient with a recent food intake, the ideal conditions for surgery were obtained only four hours later.

Erythromycin in the aquatic environment: deleterious effects on the initial development of zebrafish.

Due to the large volume of erythromycin continuously reaching waterbodies and its high persistence, this antibiotic drug has been detected in the aquatic environment at elevated concentrations. Although the problem of the presence of erythromycin in the environment is evident due to its influence in development of antimicrobial resistance, the toxicological consequences on non-target organisms remain to be determined. There are no apparent data on the impact of environmentally relevant concentrations of erythromycin on developing fish. Data on toxic effects during development are essential for evaluation of environmental risk to organisms. Therefore, the aim of this study was to investigate the effects of exposure to erythromycin on certain parameters including hatchability, survival rate, heart rate, and behavior in developing zebrafish. Zebrafish were exposed to a range of environmentally relevant concentrations of antibiotic (0.001, 0.01, 0.1, 1 µg/L) and one concentration 10-fold higher (10 µg/L). Exposure to erythromycin at 0.1 µg/L delayed hatching and decreased survival rate. Exposure to all tested concentrations increased heart rate. Further, exposure to erythromycin at 1 or 10 µg/L enhanced swimming activity. Our results indicated that erythromycin present in the aquatic environment might lead to disabling consequences in developing fish organisms and subsequently may result in ecological imbalance in the natural environment.

Resistencia a antibióticos ß-lactámicos y eritromicina en bacterias de la cavidad oral / Resistance to ß-lactam Antibiotics and Erythromycin in Bacteria of the Oral Cavity

Resumen Introducción. La microbiota humana como fuente de bacterias y genes de resistencia constituyen un problema de salud pública. En este estudio se investigó la prevalencia de bacilos entéricos Gram negativos resistentes a β-lactámicos y de los Streptococcus del grupo viridans (EGV) con resistencia a eritromicina en la cavidad oral. Métodos. Se realizó un estudio descriptivo de corte transversal con 193 aislamientos de la cavidad oral sana de 178 adultos que asistieron a una Clínica Odontológica de la ciudad de Cali durante el 2018. La evaluación de la sensibilidad antimicrobiana se realizó en 59 bacilos entéricos y 134 EGV y se identificó por PCR los genes que confieren resistencia a β-lactámicos y eritromicina. El análisis estadístico se realizó mediante el empleo del paquete SPSS vs 23. Resultados. El 84,7% de los bacilos entéricos fueron multirresistentes y presentaron genes bla, siendo blaTEM-1 (49,2%) y blaVIM-2 (30,5%,) los más prevalentes. Los EGV fueron resistentes a eritromicina (38,8%) y clindamicina (28,4%). El 18,7% presentaron el fenotipo cMLSβ, 4,5% el iMLSβ y el 14,9% fueron M. El gen ermB se detectó en los cMLSβ, (13,4%) y el gen mef en los M (9,7%). Conclusión. En este estudio se demostró la presencia de EGV y bacilos entéricos resistentes a los antibióticos y portadores de genes de resistencia a eritromicina y genes bla en la cavidad oral sana. La presencia de estas bacterias representa un riesgo para la salud de los individuos portadores y contribuyen a la creciente epidemia de resistencia bacteriana.

Abstract Introduction. The human microbiota as a source of bacteria and resistance genes is a public health problem. This study researched the prevalence of Gram-negative enteric bacilli resistant to β-lactams and erythromycin resistance in the oral cavity. Methods. A descriptive cross-sectional study was carried out with 193 isolates obtained from the oral cavity of 178 healthy adults who were treated at a Dental Clinic in the city of Cali during 2018. The evaluation of antimicrobial sensitivity was performed in 59 enteric bacilli and 134 EGV and the genes that confer resistance to β-lactam and erythromycin were identified by PCR. Statistical analysis was performed using the SPSS statistical package vs. 25.0. Results. 84.7% of the enteric bacilli presented the MDR phenotype and all presented the bla genes, blaTEM-1 (49.2%) and blaVIM-2 (30.5%) being the most prevalent. EGVs were resistant to erythromycin (38.8%) and clindamycin (28.4%). 18.7% presented the cMLSβ phenotype, 4.5% the iMLSβ and 14.9% were M. The ermB gene was detected more frequently in the cMLSβ, (13.4%) and the mef gene in the M (9.7%). Conclusion. This study demonstrated the presence of antibiotics and Gram-negative enteric bacilli resistant to antibiotics and carriers of erythromycin resistance genes and bla genes, respectively in the healthy oral cavity. The presence of these bacteria represents a risk to the health of carrier individuals and contributes to the growing epidemic of bacterial resistance.

Azithromycin vs erythromycin for the management of preterm premature rupture of membranes.

BACKGROUND: Preterm premature rupture of membranes complicates 2-3% of pregnancies. Many institutions have advocated for the use of azithromycin instead of erythromycin. This is secondary to national shortages of erythromycin, ease of administration, better side effect profile, and decreased cost of azithromycin as compared with erythromycin. OBJECTIVE: The objective of the study was to evaluate whether there are differences in the latency from preterm premature rupture of membranes to delivery in patients treated with different dosing regimens of azithromycin vs erythromycin. STUDY DESIGN: This is a multicenter, retrospective cohort of women with singleton pregnancies with confirmed rupture of membranes between 230 and 336 weeks from January 2010 to June 2015. Patients were excluded if there was a contraindication to expectant management of preterm premature rupture of membranes. Patients received 1 of 4 antibiotic regimens: (1) azithromycin 1000 mg per os once (azithromycin 1 day group); (2) azithromycin 500 mg per os once, followed by azithromycin 250 mg per os daily for 4 days (azithromycin 5 day group); (3) azithromycin 500 mg intravenously for 2 days, followed by azithromycin 500 mg per os daily for 5 days (azithromycin 7 day group); or (4) erythromycin intravenously for 2 days followed by erythromycin per os for 5 days (erythromycin group). The choice of macrolide was based on institutional policy and/or availability of antibiotics at the time of admission. In addition, all patients received ampicillin intravenously for 2 days followed by amoxicillin per os for 5 days. Primary outcome was latency from diagnosis of rupture of membranes to delivery. Secondary outcomes included clinical and histopathological chorioamnionitis and neonatal outcomes. RESULTS: Four hundred fifty-three patients who met inclusion criteria were identified. Seventy-eight patients received azithromycin for 1 day, 191 patients received azithromycin for 5 days, 52 patients received azithromycin for 7 days, and 132 patients received erythromycin. Women who received the 5 day regimen were younger and less likely to be non-African American, have hypertension, have sexually transmitted infection, or experienced substance abuse. There was no statistical difference in median latency time of azithromycin 1 day (4.9 days, 95% confidence interval, 3.3-6.4), azithromycin 5 days (5.0, 95% confidence interval, 3.9-6.1), or azithromycin 7 days (4.9 days, 95% confidence interval, 2.8-7.0) when compared with erythromycin (5.1 days, 95% confidence interval, 3.9-6.4) after adjusting for demographic variables (P = .99). Clinical chorioamnionitis was not different between groups in the adjusted model. Respiratory distress syndrome was increased in the azithromycin 5 day group vs azithromycin 1 day vs erythromycin (44% vs. 29% and 29%, P = .005, respectively). CONCLUSION: There was no difference in latency to delivery, incidence of chorioamnionitis, or neonatal outcomes when comparing different dosing regimens of the azithromycin with erythromycin, with the exception of respiratory distress syndrome being more common in the 5 day azithromycin group. Azithromycin could be considered as an alternative to erythromycin in the expectant management of preterm premature rupture of membranes if erythromycin is unavailable or contraindicated. There appears to be no additional benefit to an extended course of azithromycin beyond the single-day dosing, but final recommendations on dosing strategies should rely on clinical trials.

Identificación de microorganismos vaginales en pacientes en trabajo de parto pretérmino / Identification of vaginal microorganisms of patients in preterm labor

Resumen OBJETIVO: Identificar los microorganismos vaginales más frecuentes en pacientes en trabajo de parto pretérmino, mediante el A.F. Genital System-Liofilchem®. MATERIALES Y MÉTODOS: Estudio descriptivo, prospectivo y transversal llevado a cabo en pacientes en trabajo de parto pretérmino atendidas en el servicio de Ginecología y Obstetricia de la Fundación Hospital Infantil Universitario de San José de Bogotá, entre julio de 2015 y febrero de 2016 de quienes se obtuvieron muestras de flujo del introito vaginal y se sembraron en el panel del A.F. Genital System-Liofilchem®, de acuerdo con las instrucciones del fabricante. Para el análisis de los datos se utilizó el programa estadístico Stata versión 13 (StataCorp®) y se implementó la prueba no paramétrica de Wilcoxon. RESULTADOS: Los microorganismos aislados con mayor frecuencia fueron: Staphylococcus aureus (89.1%), Ureaplasma urealyticum (43.4%) y Mycoplasma hominis (19.5%). De las muestras positivas para especies de micoplasma, 52.2% tuvo concentración mayor de 105 UFC/mL. De los agentes aislados, Ureaplasma urealyticum y Mycoplasma hominis mostraron resistencia de 100% para clindamicina y eritromicina, respectivamente. CONCLUSIONES: Los microorganismos vaginales representan un factor de riesgo de parto pretérmino. Ureaplasma urealyticum y Mycoplasma hominis muestran resistencia total a clindamicina y eritromicina.

Abstract OBJECTIVE: Determine the frequency of microorganisms present in the vagina of women in preterm labor. MATERIALS AND METHODS: Descriptive, prospective, cross-sectional study of a series of cases of 46 patients treated at the Fundación Hospital Infantil Universitario de San José de Bogotá for preterm labor, who were sampled from the vaginal introitus and planted on the A.F. Genital System-Liofilchem® panel. Genital System by Liofilchem®, according to the manufacturer's instructions. The statistical package Stata version 13 (StataCorp®) was used. The statistical analysis was descriptive, the nonparametric Wilcoxon test was run. RESULTS: The most isolated microorganism was Staphylococcus aureus with a frequency of 89.13%. Ureaplasma urealyticum was detected in 43.48% and Mycoplasma hominis in 19.57 Of the positive samples for genital Mycoplasmas, 52.2% showed a concentration >105 CFU/mL. Ureaplasma urealyticum isolates showed 100% resistance to clindamycin and 100% Mycoplasma hominis for erythromycin. CONCLUSIONS: Microorganisms that have been identified as risk factors for preterm delivery were identified in 93.5% of the vaginal discharge samples. For Ureaplasma urealyticum and Mycoplasma hominis, 100% resistance for clindamycin and erythromycin is identified.

Development and optimization of erythromycin-loaded lipid-based gel by Taguchi design: In vitro characterization and antimicrobial evaluation

The foremost aim of the current research was to prolong and sustain the release of erythromycin (ERY) by preparing a solid lipid nanoparticles (SLNs)-based gel formulation for the safe and effective treatment of acne. ERY-loaded SLNs were developed, and various process variables were optimized with respect to particle size, zeta potential, and entrapment efficiency using the Taguchi model. The average particle size, PDI, zeta potential, drug entrapment efficiency, and drug loading of optimized SLN (F4) were found to be 176.2±1.82 nm, 0.275±0.011, -34.0±0.84, 73.56%, and 69.74% respectively. The optimized SLN (F4) was successfully incorporated into the carbopol-based hydrogel. The in vitro release of ERY from the SLN gel and plain gel were compared and found to be 90.94% and 87.94% respectively. In vitro study of ERY-loaded SLN gel showed sustained delivery of drug from formulation thus enhancing the antimicrobial activity after 30 hours when compared to ERY plain gel.

Epidemiología de la faringitis aguda bacteriana en un hospital general de agudos / Epidemiology of acute bacterial pharyngitis in a general acute care hospital / Epidemiologia da faringite bacteriana aguda em um hospital geral de cuidados agudos

La faringitis aguda bacteriana (FAB) representa entre un 20 a 30% de las faringitis. El principal agente causal es Streptococcus pyogenes. Se revisó retrospectivamente la información microbiológica disponible entre 2010 y 2016, para analizar la incidencia de la FAB, sus agentes causales, la incidencia de casos según el período estacional y rango etario. Se determinó el porcentaje de resistencia (R) de S. pyogenes a eritromicina y el fenotipo predominante. Se diagnosticó FAB en 21,5% de 3.246 cultivos, donde 89% fueron causados por S. pyogenes. El 35,3% de las FAB se presentó en niños de 7 a 10 años, seguido por el grupo de mayores de 15 años (31,3%). Se evidenció un aumento de faringitis por Streptococcus dysgalactiae subsp. equisimilis en 2011 y 2014; 56,2% de los casos se diagnosticaron en mayores de 15 años. Hubo 3 casos de FAB por Arcanobacterium haemolyticum. El 36,1% de las faringitis se presentaron en primavera, con un aumento significativo durante las correspondientes a 2010 y 2016. La R global a eritromicina en S. pyogenes fue del 16,6% con predominio del fenotipo M. El valor de R encontrado fue superior al ser comparado con otras estadísticas similares, lo que demostró la importancia de monitorear este dato, dado que es el antibiótico alternativo en pacientes alérgicos a penicilina.

Acute bacterial pharyngitis (ABP) accounts for 20 to 30% of acute pharyngitis. The most common bacterial agent is Streptococcus pyogenes. A retrospective, record-based study was carried out based on the microbiological records from 2010 to 2016, analyzing ABP's incidence, its causal agents and its incidence according to the season and age range. Erythromycin resistance and the main resistance phenotype were determined in S. pyogenes. Acute bacterial pharyngitis was diagnosed in 21.5% out of 3.246 cultures, 89% were due to S. pyogenes, 36.3% of patients were children between 7 to 10 years old and 31.3% were older than 15 years of age. There was a significant increase in pharyngitis due to Streptococcus dysgalactiae subsp. equisimilis since 2010 (p<0.05), 52.5% were detected in patients older than 15 years of age. There were only three cases of ABP produced by Arcanobacterium haemolyticum. A total of 36.1% of pharyngitis occurred during spring, with a significant increase during 2010 and 2016 springs. Global erythromycin resistance in S. pyogenes was 16.6% with predominance of the M phenotype. This resistance rate is higher than that described in other similar series, demonstrating the importance of continuously monitoring of macrolide R in S. pyogenes, since they are the antibiotics of choice to treat pharyngitis in patients allergic to penicillin.

A faringite bacteriana aguda (FAB) representa entre 20 e 30% das faringites. O principal agente causador é Streptococcus pyogenes. Foi revista retrospectivamente a informação microbiológica disponível entre 2010 e 2016, para analisar a incidência da FAB, seus agentes causadores, a incidência de casos de acordo com o período sazonal e a faixa etária. A percentagem de resistência (R) de S. pyogenes à eritromicina e ao fenótipo predominante foram determinadas. Foi diagnosticado FAB em 21,5% de 3,246 culturas, 89% das quais foram causadas por S. pyogenes. 35,3% das FAB se apresentou em crianças de 7 a 10 anos, seguidas pelo grupo de mais de 15 anos (31,3%). Houve aumento de faringite por Streptococcus dysgalactiae subsp. equisimilis em 2011 e 2014; 56,2% dos casos foram diagnosticados em jovens de mais de 15 anos. Houve 3 casos de FAB por Arcanobacterium haemolyticum. 36,1% das faringites ocorreu na primavera, com um aumento significativo em 2010 e 2016. A R global a eritromicina em S. pyogenes foi de 16,6% com prevalência do fenótipo M. O valor de R encontrado foi superior em comparação com outras estatísticas semelhantes, demonstrando a importância de monitorar esse dado, pois é o antibiótico alternativo em pacientes alérgicos à penicilina.

Susceptibility of Streptococcus agalactiae to erythromycin and clindamycin in pregnant women in the prenatal screening

Introduction: Group B streptococcus (GBS), or Streptococcus agalactiae, is a bacterium found in normal human microbiota. However, it may cause neonatal pneumonia, sepsis, and meningitis. Genital colonization in pregnant women is associated with a higher risk of preterm birth. The treatment of choice is antibiotic therapy with beta-lactams, but in the case of multidrug-resistance, erythromycin and clindamycin can be used. Methods: This study evaluated bacterial cultures in the period from 2014 to 2015 from a group of 29,875 pregnant women. GBS colonization and resistance to erythromycin and clindamycin were investigated. Results: Positive cultures were found in 26.8% and 26.1% of the samples in 2014 and 2015, respectively. Levels of resistance to erythromycin and clindamycin were, respectively, 2.4% and 5.5% in 2014 and 3.2% and 6.5% in 2015. Conclusion: The investigation of GBS colonization and the evaluation of GBS resistance to erythromycin and clindamycin are of extreme relevance, given the increasing incidence of bacterial resistance, risks of preterm birth. (AU)

Resistencia a oxacilina, eritromicina y gentamicina en cepas de Staphylococcus coagulasa negativa aisladas de hemocultivos / Resistance to oxacillin, erythromycin and gentamycin in coagulase negative Staphylococcus strains isolated from blood cultures

La resistencia a los antimicrobianos en bacterias Gram positivas como Staphylococcus coagulasa negativa constituye una amenaza mundial emergente. El propósito de la presente investigación fue identificar los genes de resistencia a oxacilina (mecA), eritromicina (erm y msrA), y gentamicina aac(6´)/aph(2´´), en cepas de Staphylococcus coagulasa negativa aisladas de hemocultivos de pacientes atendidos en el Hospital Universitario de Maracaibo. La detección fenotípica se realizó mediante métodos automatizados. Se utilizó la reacción en cadena de la polimerasa para detectar la presencia de genes de resistencia a los antimicrobianos. Se estudiaron 34 cepas cuya distribución por especie fue: S. haemolyticus (38,23%), S. epidermidis (29,42%), S. hominis (26,47%), S. xylosus y S. capitis (5,88% cada uno). Todas las cepas fueron resistentes a oxacilina. La resistencia a gentamicina varió entre 38,46% y 100%; mientras que la resistencia a eritromicina osciló entre 77,78% y 100%. Los análisis mostraron la presencia de los genes mecA (100%), ermA (35,2%), ermC (41,17%), msrA (17,64%), y aac(6´)/aph(2´´) (61,76%). En conclusión, se encontró una alta frecuencia de genes de resistencia a estos antibióticos y la Unidad de Cuidados Intensivos fue el servicio médico donde se aisló el mayor porcentaje de cepas portadoras de estos genes.

Resistance to antimicrobials in Gram-positive bacteria such as coagulase negative Staphylococcus is an emerging global threat. The purpose of this research was to identify the genes for resistance to oxacillin (mecA), erythromycin (erm and msrA), and gentamicin aac(6´)/aph(2´´), in Staphylococcus coagulase negative strains isolated from blood cultures from patients attended at the University Hospital in Maracaibo. Phenotypic detection was performed using automated methods. Polymerase chain reaction was used for the detection of antimicrobial resistance genes. Be studied 34 strains whose distribution by species was: S. haemolyticus (38.23%), S. epidermidis (29.42%), S. hominis (26.47%), S. xylosus and S. capitis (5.88% each one). All strains were resistant to oxacillin. Gentamicin resistance varied between 38.46% and 100%; while the erythromycin resistance ranged between 77.78% and 100%. The analyses showed the presence of genes mecA (100%), ermA (35.2%), ermC (41.17%), msrA (17.64%), and aac(6´)/aph (2´´) (61,76%). In conclusion, is found a high frequency of genes for resistance to these antibiotics and the intensive care unit was the health service where the highest percentage of isolated strains carriers of these genes.

Erythromycin Seromadesis in Orthopedic Surgery.

INTRODUCTION: The presence of postoperative seromadesis is common, corresponding to the presence of serum in the subcutaneous tissue post a surgical event. Erythromycin has been reported as sclerosing, although not in orthopedic surgery. We report a case of erythromycin seromadesis in orthopedic surgery. CASE PRESENTATION: We present a case of a 63-year-old woman having undergone femoral prosthesis surgery and total hip replacement with a subfacial seroma without findings of infection, refractory to standard treatment of compression bandages, massage and cleaning surgery in two oportunities. A literature review was undertaken to obtain the therapeutic alternatives where erythromycin seromadesis is chosen with excellent response. CONCLUSION: Erythromycin sclerotherapy should be considered as an effective and safe option in the treatment of seroma in general surgery and traumatology. More studies are necessary to get a better evidence. We believe that this is the first study of use of erythromycin as sclerotherapy in a traumatology case.

Frecuencia y susceptibilidad antiparasitaria in vitro de Blastocystis hominis en pacientes admitidos en el Hospital Regional Lambayeque, Perú

Objetivo. Describir la frecuencia y susceptibilidad antiparasitaria in vitro de Blastocystis hominis en pacientes admitidos en el Hospital Regional Lambayeque, Perú. Material y métodos. Se realizó un estudio transversal entre enero y agosto del 2015 en 313 pacientes de todas las edades. La detección de B. hominis se realizó en muestras seriadas de heces mediante examen microscópico directo y microcultivo en solución de Locke modificada. La prueba de susceptibilidad in vitro frente a los fármacos metronidazol, nitazoxanida, trimetoprim-sulfametoxazol y eritromicina, se realizó en 24 cepas de B. hominis, a los cuales se los cultivó (método del microcultivo), en 10 concentraciones dobles de cada antimicrobiano (desde 256 ug/ mL hasta 0,5 ug/mL), además de un control. Resultados. El 46,3% (145/313) de la muestra tuvo B. hominis, además se observó que, la edad entre 12 a 17 años y más de 60 años estuvo asociado con la mayor frecuencia del parásito (OR: 2,93 y 2,62 respectivamente). La concentración inhibitoria mínima (CIM) 90 del metronidazol y nitazoxanida fue de 3,19 ug/mL y 11,19 ug/mL respectivamente, mientras que el CIM-90 del trimetoprim-sulfametoxazol y eritromicina fueron superiores a 256 ug/mL. Conclusiones. B. hominis se presenta en alta frecuencia en pacientes admitidos en el Hospital Regional de Lambayeque, mostrando ser importante y un problema de salud pública en la región. Asimismo, los B. hominis aislados de estos pacientes mostraron ser susceptibles in vitro a bajas concentraciones de metronidazol y nitazoxanida por lo que podrían ser de elección para el tratamiento de este parásito.

Objective. To describe the frequency and antiparasitic in vitro susceptibility of Blastocystis hominis in patients admitted to the Hospital Regional Lambayeque, Peru. Material and methods. A cross-sectional study was conducted from January to August 2015 at 313 patients of all ages. B. hominis detection was performed on serial fecal samples by direct microscopic examination and microculture in modified Locke solution. The in vitro susceptibility testing against the drug metronidazole, nitazoxanide, trimethoprim-sulfamethoxazole and erythromycin was performed in 24 strains of B. hominis, which grew up (microculture method) in 10 double concentrations of each antimicrobial (from 256 ug/ml to 0.5 ug/mL) plus a control. Results. 46.3% (145/313) of the sample had B. hominis, also the age between 12 to 17 years and 60 years was associated with higher frequency of parasites (OR: 2.93 and 2.62). The minimum inhibitory concentration (MIC) 90 of metronidazole and nitazoxanide was 3.19 ug/mL and 11.19 ug/ml, respectively, whereas the MIC 90 of trimethoprim-sulfamethoxazole and erythromycin were above 256 ug/mL. Conclusions. B. hominis occurs in high frequency in patients admitted to the Hospital Regional in Lambayeque, proving to be an important problem of public health in the region. Also B. hominis isolated from these patients were shown to be susceptible in vitro to low concentrations of metronidazole and nitazoxanide so they could be chosen for treatment of this parasite.

Effects of penicillin and erythromycin on adherence of invasive and noninvasive isolates of Streptococcus pyogenes to laminin

This study investigated the possible relationship between the invasiveness of group A Streptococcus (GAS) strains and their abilities to adhere to laminin and assessed the effects of subinhibitory concentrations of penicillin and erythromycin on the ability of GAS to adhere to laminin. The adherence of noninvasive and highly invasive isolates of GAS to laminin was significantly higher than the adherence displayed by isolates of low invasiveness. Antibiotic treatment caused significant reductions in adherence to laminin in all three groups of strains. Penicillin was more successful in reducing the adherence abilities of the tested GAS strains than erythromycin.

Resistencia a la clindamicina inducida por eritromicina en cepas de Staphylococcus aureus de origen clínico / Clindamycin Resistance Induced by Erythromycin in Strains of Staphylococcus Aureus of Clinical Origin

Staphylococcus aureus es un importante patógeno involucrado en una serie de infecciones cuyo impacto se incrementa por sus múltiples factores de virulencia y su resistencia a los antimicrobianos. La resistencia a clindamicina inducida por eritromicina constituye un problema creciente en diversas partes del mundo. Este estudio fue de tipo retrospectivo y se analizó el comportamiento frente a los antimicrobianos de 4307 cepas de Staphylococcus aureus aisladas en un hospital de la ciudad de Maracaibo entre enero 2006 y diciembre de 2013. Se determinó la frecuencia de resistencia a clindamicina inducida por eritromicina, su asociación con la resistencia a oxacilina y el origen biológico de las muestras a partir de las cuales se aisló el microorganismo. La susceptibilidad a oxacilina se comprobó mediante el método de difusión con discos en agar y la resistencia inducida a clindamicina usando la prueba D-test. Se detectaron 60 cepas D-Test positivo (1,39%), de las cuales 38(63,33%) fueron sensibles a meticilina y 22 cepas fueron resistentes (36,67%). La resistencia total a clindamicina (constitutiva e inducida) representó el 31,43% (1354) del total de cepas evaluadas. La frecuencia de resistencia inducida a clindamicina en cepas de Staphylococcus aureus en la localidad es aún baja tanto en cepas sensibles como resistentes a meticilina.

Staphylococcus aureus is an important pathogen involved in a series of infections whose impact is increased by its multiple factors of virulence and antimicrobial resistance. Erythromycin-induced clindamycin resistance is a growing problem in various parts of the world. This study was retrospective and analyzed the behavior in response to antimicrobials of 4307 strains of Staphylococcus aureus isolated in a hospital in the city of Maracaibo between January 2006 and December 2013. The frequency of erythromycin-induced clindamycin resistance, its association with resistance to oxacillin and the biological origin of the samples from which the microorganism was isolated were determined. Susceptibility to oxacillin was checked by diffusion method with disk agar and the induced clindamycin resistance was evaluated using the D-test. 60 D-Test positive strains were detected (1.39%), of which 38 (63.33%) were sensitive to methicillin and 22 strains were resistant (36.67%. The total resistance to clindamycin (constitutive and induced) represented 31.43% (1354) of the total number of strains tested. The frequency of induced resistance to clindamycin in Staphylococcus aureus strains in the locality is still low for both methicillin sensitive and resistant strains.