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1.
BMC Infect Dis ; 19(1): 927, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31684875

RESUMEN

BACKGROUND: Capnocytophaga canimorsus is a gram-negative bacterium and an oral commensal in dogs and cats, but occasionally causes serious infections in humans. Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus infection is often difficult mainly because of its very slow growth. C. canimorsus infective endocarditis (IE) is rare and is poorly understood. Since quite a few strains produce ß-lactamase, antimicrobial susceptibility is pivotal information for adequate treatment. We herein report a case with C. canimorsus IE and the results of drug susceptibility test. CASE PRESENTATION: A 46-year-old man had a dog bite in his left hand 3 months previously. The patient was referred to our hospital for fever (body temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and we initially administered cefazolin and gentamycin assuming frequently encountered microorganisms and the patient underwent aortic valve replacement. C. canimorsus was detected in the aortic valve lesion and blood cultures. It was also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and continued because disk diffusion test revealed the isolate was negative for ß-lactamase and this case had cerebral symptoms. The patient successfully completed antibiotic treatment following surgery. CONCLUSIONS: We diagnosed C. canimorsus sepsis and IE by extended-period blood cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and successfully identified its drug susceptibility.


Asunto(s)
Mordeduras y Picaduras/complicaciones , Capnocytophaga/patogenicidad , Endocarditis Bacteriana/etiología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/etiología , Infecciones por Bacterias Gramnegativas/terapia , Animales , Antibacterianos/uso terapéutico , Cultivo de Sangre , Capnocytophaga/genética , Cefazolina/uso terapéutico , Ceftriaxona/uso terapéutico , Perros , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/terapia , Gentamicinas/uso terapéutico , Infecciones por Bacterias Gramnegativas/microbiología , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodos , Sepsis/tratamiento farmacológico , beta-Lactamasas
2.
BMC Infect Dis ; 19(1): 942, 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31699044

RESUMEN

BACKGROUND: Initiating early effective antimicrobial therapy is the most important intervention demonstrated to decrease mortality in patients with gram-negative bacteremia with sepsis. Rapid MIC-based susceptibility results make it possible to optimize antimicrobial use through both escalation and de-escalation. METHOD: We prospectively evaluated the performance of the Accelerate Pheno™ system (AXDX) for identification and susceptibility testing of gram-negative species and compared the time to result between AXDX and routine standard of care (SOC) using 82 patient samples and 18 challenge organisms with various confirmed resistance mechanisms. The potential impact of AXDX on time to antimicrobial optimization was investigated with various simulated antimicrobial stewardship (ASTEW) intervention models. RESULTS: The overall positive and negative percent agreement of AXDX for identification were 100 and 99.9%, respectively. Compared to VITEK® 2, the overall essential agreement was 96.1% and categorical agreement was 95.4%. No very major or major errors were detected. AXDX reduced the time to identification by an average of 11.8 h and time to susceptibility by an average of 36.7 h. In 27 patients evaluated for potential clinical impact of AXDX on antimicrobial optimization, 18 (67%) patients could potentially have had therapy optimized sooner with an average of 18.1 h reduction in time to optimal therapy. CONCLUSION: Utilization of AXDX coupled with simulated ASTEW intervention notification substantially shortened the time to potential antimicrobial optimization in this cohort of patients with gram-negative bacteremia. This improvement in time occurred when ASTEW support was limited to an 8-h coverage model.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos/métodos , Infecciones por Bacterias Gramnegativas/diagnóstico , Adulto , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Estudios Prospectivos , Juego de Reactivos para Diagnóstico
3.
BMC Infect Dis ; 19(1): 869, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640582

RESUMEN

BACKGROUND: Pandoraea species is a newly described genus, which is multidrug resistant and difficult to identify. Clinical isolates are mostly cultured from cystic fibrosis (CF) patients. CF is a rare disease in China, which makes Pandoraea a total stranger to Chinese physicians. Pandoraea genus is reported as an emerging pathogen in CF patients in most cases. However, there are few pieces of evidence that confirm Pandoraea can be more virulent in non-CF patients. The pathogenicity of Pandoraea genus is poorly understood, as well as its treatment. The incidence of Pandoraea induced infection in non-CF patients may be underestimated and it's important to identify and understand these organisms. CASE PRESENTATION: We report a 44-years-old man who suffered from pneumonia and died eventually. Before his condition deteriorated, a Gram-negative bacilli was cultured from his sputum and identified as Pandoraea Apista by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). CONCLUSION: Pandoraea spp. is an emerging opportunistic pathogen. The incidences of Pandoraea related infection in non-CF patients may be underestimated due to the difficulty of identification. All strains of Pandoraea show multi-drug resistance and highly variable susceptibility. To better treatment, species-level identification and antibiotic susceptibility test are necessary.


Asunto(s)
Burkholderiaceae/patogenicidad , Infecciones por Bacterias Gramnegativas/microbiología , Hemorragia Intracraneal Traumática/complicaciones , Neumonía Bacteriana/microbiología , Adulto , Burkholderiaceae/aislamiento & purificación , China , Fibrosis Quística/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico por imagen , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Hemorragia Intracraneal Traumática/etiología , Masculino , Neumonía Bacteriana/diagnóstico por imagen , Neumonía Bacteriana/tratamiento farmacológico , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Esputo/microbiología
4.
Biocontrol Sci ; 24(3): 145-154, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31527345

RESUMEN

Atypical Aeromonas salmonicida ( i.e. subsp. achromogenes and subsp. masoucida) are one of the major opportunistic pathogens that cause ulcer diseases in a variety of fishes, in which this pathogen has become a worldwide economic threat in sectors that handle of particular high-priced ornamental fishes like varicolored carp and goldfish due to appearance damages. Here we reported that the kuma bamboo grass (Sasa veitchii) extracts (KBGE) that contained a variety of fatty acids, exhibited antibacterial activity against nine Aeromonas strains including 5 atypical A. salmonicida strains. Experimental challenges with four atypical A. salmonicida strains revealed that supplementation with 375 to 750 µg/ml of the KBGE restored the survival of goldfish in coincidence of inhibition of both bacterial replication and superoxide dismutase (SOD) activity upon infection, compared with those of untreated control. Together, our data demonstrating the antibacterial effects of the plant extracts proposes its possible implication for prevention of Aeromonas infection in the ornamental fish.


Asunto(s)
Aeromonas salmonicida/efectos de los fármacos , Antibacterianos/farmacología , Enfermedades de los Peces/prevención & control , Infecciones por Bacterias Gramnegativas/veterinaria , Extractos Vegetales/farmacología , Sasa/química , Animales , Antibacterianos/aislamiento & purificación , Enfermedades de los Peces/tratamiento farmacológico , Carpa Dorada , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/prevención & control , Extractos Vegetales/aislamiento & purificación , Análisis de Supervivencia , Resultado del Tratamiento
5.
Aust Vet J ; 97(11): 452-464, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31529470

RESUMEN

BACKGROUND: Swine dysentery (SD) caused by Brachyspira hyodysenteriae is an important disease in Australia. AIM: The aim of this study is to evaluate the macrolide antibiotic kitasamycin for use in SD control. METHODS: The minimum inhibitory concentrations (MICs) of kitasamycin, tylosin and lincomycin for 32 Australian isolates of B. hyodysenteriae were evaluated. Mutations in the 23S rRNA gene were examined. Isolate '13' with a low kitasamycin MIC was used to challenge weaner pigs. Sixty pigs were housed in 20 pens each containing three pigs: pigs in four pens received 2 kg/tonne of a product containing kitasamycin (3.1% active) prophylactically in their food starting 4 days before B. hyodysenteriae challenge (group 1); pigs in four pens were challenged and received the same dose therapeutically once one pig in a pen showed diarrhoea (group 2); four pens were challenged and received 4 kg/tonne of the product therapeutically (group 3); four pens were challenged but not medicated (group 4); two pens were unmedicated and unchallenged (group 5) and two pens received 2 kg/tonne and were unchallenged (group 6). Pigs were monitored for B. hyodysenteriae excretion and disease. RESULTS: Macrolide resistance was widespread, and mutations in the 23S rRNA gene were identified in 23 isolates. Four isolates with kitasamycin MICs < 5 µg/mL were considered susceptible. Following experimental challenge, 10 of 12 unmedicated pigs developed SD. No pigs receiving kitasamycin prophylactical or therapeutically developed SD. Medicated pigs shed low numbers of B. hyodysenteriae in their faeces. CONCLUSIONS: Kitasamycin can help control SD in pigs infected with susceptible isolates of B. hyodysenteriae.


Asunto(s)
Antibacterianos/farmacología , Brachyspira hyodysenteriae/efectos de los fármacos , Disentería Bacilar/veterinaria , Infecciones por Bacterias Gramnegativas/veterinaria , Kitasamicina/farmacología , Enfermedades de los Porcinos/tratamiento farmacológico , Animales , Autopsia/veterinaria , Modelos Animales de Enfermedad , Disentería Bacilar/tratamiento farmacológico , Disentería Bacilar/microbiología , Disentería Bacilar/patología , Genes de ARNr/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/patología , Masculino , Pruebas de Sensibilidad Microbiana , Análisis de Secuencia de ARN , Porcinos , Enfermedades de los Porcinos/patología , Australia Occidental
6.
Expert Opin Pharmacother ; 20(17): 2169-2184, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31500471

RESUMEN

Introduction: Antimicrobial resistance in Gram-negative pathogens is a significant threat to global health. ß-Lactams (BL) are one of the safest and most-prescribed classes of antibiotics on the market today. The acquisition of ß-lactamases, especially those which hydrolyze carbapenems, is eroding the efficacy of BLs for the treatment of serious infections. During the past decade, significant advances were made in the development of novel BL-ß-lactamase inhibitor (BLI) combinations to target ß-lactamase-mediated resistant Gram-negatives.Areas covered: The latest progress in 20 different approved, developing, and preclinical BL-BLI combinations to target serine ß-lactamases produced by Gram-negatives are reviewed based on primary literature, conference abstracts (when available), and US clinical trial searches within the last 5 years. The majority of the compounds that are discussed are being evaluated as part of a BL-BLI combination.Expert opinion: The current trajectory in BLI development is promising; however, a significant challenge resides in the selection of an appropriate BL partner as well as the development of resistance linked to the BL partner. In addition, dosing regimens for these BL-BLI combinations need to be critically evaluated. A revolution in bacterial diagnostics is essential to aid clinicians in the appropriate selection of novel BL-BLI combinations for the treatment of serious infections.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Inhibidores de beta-Lactamasas/uso terapéutico , Ácidos Borónicos/química , Ácidos Borónicos/uso terapéutico , Cefalosporinas/química , Cefalosporinas/uso terapéutico , Ensayos Clínicos como Asunto , Combinación de Medicamentos , Compuestos Heterocíclicos con 1 Anillo/química , Compuestos Heterocíclicos con 1 Anillo/uso terapéutico , Humanos , Meropenem/química , Meropenem/uso terapéutico , Tazobactam/química , Tazobactam/uso terapéutico
7.
Molecules ; 24(17)2019 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-31470632

RESUMEN

Antimicrobial resistance in bacteria is frightening, especially resistance in Gram-negative Bacteria (GNB). In 2017, the World Health Organization (WHO) published a list of 12 bacteria that represent a threat to human health, and among these, a majority of GNB. Antibiotic resistance is a complex and relatively old phenomenon that is the consequence of several factors. The first factor is the vertiginous drop in research and development of new antibacterials. In fact, many companies simply stop this R&D activity. The finding is simple: there are enough antibiotics to treat the different types of infection that clinicians face. The second factor is the appearance and spread of resistant or even multidrug-resistant bacteria. For a long time, this situation remained rather confidential, almost anecdotal. It was not until the end of the 1980s that awareness emerged. It was the time of Vancomycin-Resistance Enterococci (VRE), and the threat of Vancomycin-Resistant MRSA (Methicillin-Resistant Staphylococcus aureus). After this, there has been renewed interest but only in anti-Gram positive antibacterials. Today, the threat is GNB, and we have no new molecules with innovative mechanism of action to fight effectively against these bugs. However, the war against antimicrobial resistance is not lost. We must continue the fight, which requires a better knowledge of the mechanisms of action of anti-infectious agents and concomitantly the mechanisms of resistance of infectious agents.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Drogas en Investigación/uso terapéutico , Enterobacteriaceae/efectos de los fármacos , Salud Global/tendencias , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/patogenicidad , Acinetobacter baumannii/fisiología , Aminoglicósidos/síntesis química , Aminoglicósidos/economía , Aminoglicósidos/uso terapéutico , Antibacterianos/síntesis química , Antibacterianos/economía , Aprobación de Drogas/organización & administración , Drogas en Investigación/síntesis química , Drogas en Investigación/economía , Enterobacteriaceae/patogenicidad , Enterobacteriaceae/fisiología , Fluoroquinolonas/síntesis química , Fluoroquinolonas/economía , Fluoroquinolonas/uso terapéutico , Salud Global/economía , Glicopéptidos/síntesis química , Glicopéptidos/economía , Glicopéptidos/uso terapéutico , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/patogenicidad , Bacterias Gramnegativas/fisiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/patología , Humanos , Macrólidos/síntesis química , Macrólidos/economía , Macrólidos/uso terapéutico , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/patogenicidad , Pseudomonas aeruginosa/fisiología , beta-Lactamas/síntesis química , beta-Lactamas/economía , beta-Lactamas/uso terapéutico
8.
Med. infant ; 26(3): 276-284, sept. 2019. Tab, ilus
Artículo en Español | LILACS | ID: biblio-1024913

RESUMEN

Chromobacterium violaceum es una bacteria gram negativa anaerobia facultativa, que se encuentra ampliamente distribuida en el agua y el suelo en regiones tropicales y subtropicales, que se asocia con infecciones respiratorias, gastrointestinales, abscesos hepáticos, meningitis, endocarditis, síndrome hemofagocítico y sepsis fulminante. Se presentan 2 casos en niños: el primero es un varón de 8 años con lesiones en piel, fiebre y adenitis inguinal, que ingresó con un cuadro de sepsis severa, síndrome de distrés respiratorio agudo (SDRA) y falleció a las 3 h del ingreso. De los hemocultivos se aisló Chromobacterium violaceum. El segundo caso, es una niña de 12 años con antecedente de fiebre y adenopatía inguinal secundaria a herida cortopunzante en el pie homolateral, que ingresó con un cuadro de sepsis, con desarrollo de abscesos múltiples profundos. De la colección obtenida de piel y partes blandas y de un aspirado traqueal se aisló Chromobacterium violaceum. Recibió tratamiento antibiótico adecuado y posteriormente fue dada de alta. Se realizó una revisión bibliográfica de esta infección en niños y se encontraron 44 casos en todo el mundo. Algunos de éstos, se relacionaron con inmunodeficiencia de base, como la enfermedad granulomatosa crónica. La infección por esta bacteria es rara y se presenta como un cuadro grave que no responde a antibióticos habituales de uso empírico y tiene una alta tasa de mortalidad (AU)


Chromobacterium violaceum is a facultative anaerobic Gramnegative bacillus, widely distributed in water and soil in tropical and subtropical regions and associated with respiratory and gastrointestinal infections, liver abscesses, meningitis, endocarditis, hemophagocytic syndrome, and fulminant sepsis. Here two pediatric cases are presented: The first was an 8-year-old boy with skin lesions, fever, and inguinal adenitis, who was admitted with severe sepsis, acute respiratory distress syndrome (ARDS) and died three hours after. Chromobacterium violaceum was isolated from blood cultures. The second case was a 12-year-old girl with a history of fever and inguinal adenopathy secondary to a wound in the homolateral foot, who was admitted because of sepsis and multiple deep abscesses. From samples collected from the skin and soft tissues as well as tracheal aspirate Chromobacterium violaceum was isolated. Adequate antibiotic treatment was started and the patient was subsequently discharged. In a review of the literature, 44 cases worldwide were identified. Some of these cases were related to underlying immunodeficiency, such as chronic granulomatous disease. Infection with this bacterium is rare and presents with severe manifestations that do not respond to the common empirical antibiotics and are associated with a high mortality rate (AU)


Asunto(s)
Humanos , Niño , Chromobacterium/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/microbiología , Sepsis/microbiología , Antibacterianos/uso terapéutico , Mortalidad , Resultado del Tratamiento , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico
9.
BMC Infect Dis ; 19(1): 718, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31412809

RESUMEN

BACKGROUND: We developed a clinical bedside tool to simultaneously estimate the probabilities of third-generation cephalosporin-resistant Enterobacteriaceae (3GC-R), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant Pseudomonas aeruginosa (MDRP) among hospitalized adult patients with Gram-negative infections. METHODS: Data were obtained from a retrospective observational study of the Premier Hospital that included hospitalized adult patients with a complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP), or bloodstream infection (BSI) due to Gram-negative bacteria between 2011 and 2015. Risk factors for 3GC-R, CRE, and MDRP were ascertained by multivariate logistic regression, and separate models were developed for patients with community-acquired versus hospital-acquired infections for each resistance phenotype (N = 6). Models were converted to a singular user-friendly interface to estimate the probabilities of a patient having an infection due to 3GC-R, CRE, or MDRP when ≥ 1 risk factor was present. RESULTS: Overall, 124,068 patients contributed to the dataset. Percentages of patients admitted for cUTI, cIAI, HAP/VAP, and BSI were 61.6, 4.6, 16.5, and 26.4%, respectively (some patients contributed > 1 infection type). Resistant infection rates were 1.90% for CRE, 12.09% for 3GC-R, and 3.91% for MDRP. A greater percentage of the resistant infections were community-acquired relative to hospital-acquired (CRE, 1.30% vs 0.62% of 1.90%; 3GC-R, 9.27% vs 3.42% of 12.09%; MDRP, 2.39% vs 1.59% of 3.91%). The most important predictors of having an 3GC-R, CRE or MDRP infection were prior number of antibiotics; infection site; infection during the previous 3 months; and hospital prevalence of 3GC-R, CRE, or MDRP. To enable application of the six predictive multivariate logistic regression models to real-world clinical practice, we developed a user-friendly interface that estimates the risk of 3GC-R, CRE, and MDRP simultaneously in a given patient with a Gram-negative infection based on their risk (Additional file 1). CONCLUSIONS: We developed a clinical prediction tool to estimate the probabilities of 3GC-R, CRE, and MDRP among hospitalized adult patients with confirmed community- and hospital-acquired Gram-negative infections. Our predictive model has been implemented as a user-friendly bedside tool for use by clinicians/healthcare professionals to predict the probability of resistant infections in individual patients, to guide early appropriate therapy.


Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/microbiología , Toma de Decisiones Asistida por Computador , Farmacorresistencia Bacteriana/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/microbiología , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Bacteriemia/microbiología , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Enterobacteriaceae Resistentes a los Carbapenémicos/patogenicidad , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/epidemiología , Hospitales/estadística & datos numéricos , Humanos , Neumonía Asociada al Ventilador/tratamiento farmacológico , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/microbiología , Sistemas de Atención de Punto , Prevalencia , Probabilidad , Estudios Retrospectivos , Estados Unidos/epidemiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , Interfaz Usuario-Computador
10.
Indian J Med Microbiol ; 37(1): 91-94, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31424015

RESUMEN

Tigecycline is a reserve antibiotic increasingly used for the treatment of multidrug-resistant bacteria, especially Klebsiella pneumoniae and Acinetobacter baumannii. At present, there are concerns regarding the testing and interpretation of tigecycline susceptibility to bugs such as K. pneumoniae and A. baumannii, which limit clinicians in appropriate usage. Use of appropriate method for testing such as broth microdilution is essential. In addition, tigecycline susceptibility testing is a challenge due to inconsistent results from various antimicrobial susceptibility testing automated platforms. There is a great need to define a suitable methodology along with interpretive criteria, especially for K. pneumoniae and A. baumannii. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Food and Drug Administration (FDA) breakpoints show wide variation and are defined for different set of organisms. Non-species-related pharmacokinetic/pharmacodynamic (PK/PD) breakpoints defined by the EUCAST can be used for organisms such as K. pneumoniae and A. baumannii.


Asunto(s)
Acinetobacter baumannii/efectos de los fármacos , Antibacterianos/farmacología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Klebsiella pneumoniae/efectos de los fármacos , Tigeciclina/farmacología , Acinetobacter baumannii/genética , Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Klebsiella pneumoniae/genética , Pruebas de Sensibilidad Microbiana
11.
Artículo en Inglés | MEDLINE | ID: mdl-31426735

RESUMEN

The Australian Group on Antimicrobial Resistance (AGAR) performs regular period-prevalence studies to monitor changes in antimicrobial resistance in selected enteric Gram-negative pathogens. The 2017 survey was the fifth year to focus on blood stream infections, and included Enterobacterales, Pseudomonas aeruginosa and Acinetobacter species. Seven thousand nine hundred and ten isolates, comprising Enterobacterales (7,100, 89.8%), P. aeruginosa (697, 8.8%) and Acinetobacter species (113, 1.4%), were tested using commercial automated methods. The results were analysed using Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints (January 2018). Of the key resistances, non-susceptibility to the third-generation cephalosporin, ceftriaxone, was found in 11.3%/11.3% of Escherichia coli (CLSI/EUCAST criteria), 8.8%/8.8% of Klebsiella pneumoniae, and 5.7%/5.7% of K. oxytoca. Non-susceptibility rates to ciprofloxacin were 12.1%/18.0% for E. coli, 4.4%/11.2% for K. pneumoniae, 1.3%/3.5% for K. oxytoca, 3.0%/8.5% for Enterobacter cloacae complex, and 5.1%/9.8% for P. aeruginosa. Resistance rates to piperacillin-tazobactam were 2.8%/5.9%, 3.7%/7.3%, 9.6%/11.0%, 22.5%/27.6%, and 6.4%/13.2% for the same five species respectively. Twenty-seven isolates from 25 patients were shown to harbour a carbapenemase gene: 12 blaIMP (11 patients), five blaOXA-181 (four patients), three blaOXA-23, two blaNDM, two blaKPC, two blaVIM, and one blaGES.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Sepsis/tratamiento farmacológico , Sepsis/epidemiología , Sepsis/microbiología , Informes Anuales como Asunto , Australia/epidemiología , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Infección Hospitalaria/tratamiento farmacológico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Escherichia coli/efectos de los fármacos , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Tipificación Molecular , Evaluación del Resultado de la Atención al Paciente , Pseudomonas aeruginosa/efectos de los fármacos , beta-Lactamasas/genética , beta-Lactamasas/metabolismo
12.
J Craniofac Surg ; 30(7): 2214-2216, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31369500

RESUMEN

PURPOSE: To define the microbiological features of dacryocystitis in childhood. METHODS: Patients with dacryocystitis secondary to CNLDO between 2017 and 2019 in Izmir, Turkey were included in the study. Inclusion criteria of the study were: mucopurulent secretion, being under 4 years old and not having received prior antibiotic treatment. Samples from secretion were cultivated in sheep blood agar, eosin methylene blue, and chocolate agar. Reproduction was checked intermittently. Clinically significant growths were reported. RESULTS: Seventy patients with dacryocystitis secondary to CNLDO were included in the study. Sixty percent of patients were female (n = 42) and 40% (n = 28) percent of patients were male. The average age of participants was 2.09 ±â€Š0.68 (1-3) years old. Positive bacterial proliferation results were noted in 20 patients (28.6%). Eighty percent (n = 16) of culture-positive bacterias were gram-negative bacterias and 20% (4) were gram-positive bacterias. Twenty percent of culture-positive bacterias were aerobic and 80% were facultative bacterias. The most common bacteria seen in culture specimen was Haemophilus 40% (Haemophilus haemolyticus [20%] and Haemophilus influenzae [20%]). CONCLUSIONS: Gram-negative organisms especially Haemophilus were most prevalent. These findings could be helpful for antibiotic selection.


Asunto(s)
Infecciones por Bacterias Gramnegativas , Infecciones por Bacterias Grampositivas , Aparato Lagrimal/microbiología , Obstrucción del Conducto Lagrimal/etiología , Conducto Nasolagrimal/microbiología , Antibacterianos/uso terapéutico , Preescolar , Dacriocistitis/tratamiento farmacológico , Dacriocistitis/microbiología , Femenino , Bacterias Gramnegativas , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Bacterias Grampositivas , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Lactante , Obstrucción del Conducto Lagrimal/congénito , Masculino
13.
BMC Res Notes ; 12(1): 464, 2019 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-31362783

RESUMEN

OBJECTIVE: The aim of this study was to determine the predominant bacterial species causing bacteremia among febrile cancer patients, and their antibacterial resistance profiles at the Uganda Cancer Institute. RESULTS: We enrolled in-patients with a documented fever (≥ 37.5 °C). Bacteria from positive blood cultures were identified using standard methods biochemically. Antibacterial susceptibility testing was performed with the Kirby-Bauer disc diffusion method. From a total of 170 febrile episodes, positive blood cultures were obtained from 24 (14.1%). A positive culture was more likely to be obtained from a patient with neutropenia (P = 0.017). Of 22 (66.7%) Gram-negative bacteria isolated, half were E. coli (n = 11). Gram-negative compared to Gram-positive bacteria were most likely to be isolated from patients with a hematologic malignancy (P = 0.02) or patients with neutropenia (P = 0.006). Of the isolated Enterobacteriaceae 85% (n = 20) were resistant to three or more classes of antibiotic and 41% (n = 7) had extended spectrum beta-lactamases. Of the 11 Gram-positive bacteria isolated, the S. aureus isolate was methicillin resistant but susceptible to vancomycin. Multidrug resistant Gram-negative bacteria are the main cause of bacteremia in febrile cancer patients at the Uganda Cancer Institute. There is need for ongoing microbial surveillance, infection prevention and control, and antibiotic stewardship programs.


Asunto(s)
Bacteriemia/microbiología , Fiebre/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Neoplasias/microbiología , Neutropenia/microbiología , Adulto , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Bacteriemia/patología , Cultivo de Sangre , Niño , Estudios Transversales , Farmacorresistencia Bacteriana Múltiple/genética , Femenino , Fiebre/complicaciones , Fiebre/tratamiento farmacológico , Fiebre/patología , Expresión Génica , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/enzimología , Bacterias Gramnegativas/genética , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/patología , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/enzimología , Bacterias Grampositivas/genética , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/patología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Neoplasias/patología , Neutropenia/complicaciones , Neutropenia/tratamiento farmacológico , Neutropenia/patología , Uganda , beta-Lactamasas/genética , beta-Lactamasas/metabolismo
14.
BMC Infect Dis ; 19(1): 690, 2019 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-31382913

RESUMEN

BACKGROUND: In most developing countries, puerperal sepsis is treated empirically with broad spectrum antibiotics due to lack of resources for culture and antibiotics susceptibility testing. However, empirical treatment does not guarantee treatment success and may promote antimicrobial resistance. We set to determine etiological agents and susceptibility pattern to commonly prescribed antimicrobial agents, among women suspected of puerperal sepsis, and admitted at Muhimbili National Hospital. METHODS: Hospital based cross-sectional study conducted at tertiary hospital from December 2017 to April 2018. The study recruited post-delivery women suspected with puerperal sepsis. Socio- demographic, clinical and obstetric information were collected using structured questionnaire. Blood and endocervical swab samples were collected for aerobic culture. Blood culture bottles were incubated in BACTEC FX40 (Becton-Dickinson, Sparks, MD, USA). Positive blood cultures and cervical swabs were inoculated onto sheep blood agar, MacConkey agar, chocolate agar and Sabouraud's dextrose agar, incubated aerobically at 37 °C for 18-24 h. Antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method. RESULTS: A total of 197women were recruited, of whom 50.3% had spontaneous vaginal delivery, while 49.2% had caesarean section. Bacteraemia was detected in 22 (11.2%) women, along with 86 (43.6%) isolated from endocervical swabs. Gram-negative bacilli were the predominant isolates detected in 92(46.7%) cases. Majority of the isolates were E. coli 68(61.8%) followed by Klebsiella spp. 22(20.0%). E. coli were highly susceptible to meropenem (97.0%), while resistance to ceftriaxone, ampicillin and ceftazidime was 64.7, 67.6 and 63.2%, respectively. Klebsiella spp. were susceptible to meropenem (86.4%) and resistant to ceftriaxone (77.3%), gentamicin (86.4%), ampicillin (81.8%) and ceftazidime (86.4%). Staphylococcus aureus isolates were 100% susceptible to clindamycin. The proportion of extended spectrum beta lactamase producers among gram-negative bacilli was 64(69.6%) and 53.8% of S. aureus isolates were resistant to methicillin. CONCLUSION: In this study puerperal sepsis was mostly caused by E. coli and Klebsiella spp. Causative agents exhibited very high levels of resistance to most antibiotics used in empiric treatment calling for review of treatment guidelines and strict infection control procedures.


Asunto(s)
Antibacterianos/uso terapéutico , Trastornos Puerperales/microbiología , Sepsis/microbiología , Adulto , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Cesárea/efectos adversos , Estudios Transversales , Pruebas Antimicrobianas de Difusión por Disco , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Femenino , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Embarazo , Trastornos Puerperales/tratamiento farmacológico , Sepsis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Tanzanía , Centros de Atención Terciaria
15.
Internist (Berl) ; 60(10): 1111-1117, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31444523

RESUMEN

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.


Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Micosis/tratamiento farmacológico , Adulto , Comorbilidad , Endocarditis/diagnóstico , Endocarditis/epidemiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/epidemiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Incidencia , Micosis/diagnóstico , Micosis/epidemiología
16.
BMC Infect Dis ; 19(1): 754, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31462215

RESUMEN

BACKGROUND: Stenotrophomonas maltophilia is an important nosocomial pathogen. This pathogen has intrinsic or acquired resistance to a number of antibiotics classes. Furthermore, Stenotrophomonas infections have been associated with high mortality, mainly in immunocompromised patients. Accordingly, we conducted a retrospective cohort study on the clinical data, microbiological characteristics, and outcomes of patients with S. maltophilia (SM) bacteremia. METHODS: A retrospective cohort study was conducted at two tertiary care referral hospitals in Seoul, South Korea. Data were collected between January 2006 and December 2015 from electric medical records. Our analysis aimed to identify the risk factors associated with crude mortality, as well as the predictive factors of quinolone-resistant strains in SM bacteremia patients. RESULTS: A total of 126 bacteremia patients were enrolled in the study. The mortality rate was 65.1%. On multivariable analysis, hypoalbuminemia (odds ratio [OR], 5.090; 95% confidence interval [CI], 1.321-19.621; P = 0.018), hematologic malignancy (OR, 35.567; 95% CI, 2.517-502.515; P = 0.008) and quinolone-resistant strains (OR, 7.785; 95% CI, 1.278-47.432; P = 0.026) were independent risk factors for mortality. Alternatively, usage of an empirical regimen with quinolone (OR, 0.172; 95% CI, 0.034-0.875; P = 0.034) was an independent protective factor for mortality. The multivariable analysis of predictive factors revealed that high Charlson comorbidity index (OR, 1.190; 95% CI, 1.040-1.361; P = 0.011) and indwelling of a central venous catheter (CVC) (OR, 3.303; 95% CI, 1.194-9.139; P = 0.021) were independent predisposing factors associated with quinolone-resistant strains in SM bacteremia patients. CONCLUSIONS: Our findings suggest that a high Charlson comorbidity score and indwelling of a CVC were significantly independent predictors of quinolone-resistant strains in SM bacteremia patients. Therefore, we need to carefully consider the antibiotic use in SM bacteremia patients with these predictive factors.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/mortalidad , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/mortalidad , Quinolonas/uso terapéutico , Stenotrophomonas maltophilia/inmunología , Anciano , Bacteriemia/microbiología , Estudios de Cohortes , Farmacorresistencia Bacteriana/efectos de los fármacos , Femenino , Infecciones por Bacterias Gramnegativas/microbiología , Neoplasias Hematológicas/microbiología , Neoplasias Hematológicas/mortalidad , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Seúl/epidemiología , Stenotrophomonas maltophilia/efectos de los fármacos , Centros de Atención Terciaria/estadística & datos numéricos , Resultado del Tratamiento
17.
Adv Exp Med Biol ; 1145: 1-8, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31364067

RESUMEN

Antibiotic resistance has become the most significant threat to human health across the globe. Polymyxins are often used as the only available therapeutic option against Gram-negative 'superbugs', namely Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. The limited pharmacological and clinical knowledge on the polymyxins in the old literature substantially limited optimizing their clinical use. The current chapter provides a general introduction to this first-ever polymyxin book which comprehensively reviews the significant progress over the last two decades in the chemistry, microbiology, pharmacology, clinical use and drug discovery of polymyxins. In particular, recent pharmacological results have led to the first scientifically-based dosing recommendations and facilitated the discovery of new-generation polymyxins. Future challenges in polymyxin research are highlighted, aiming at improving the clinical utility of this last-line defence.


Asunto(s)
Antibacterianos/farmacología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Polimixinas/farmacología , Acinetobacter baumannii/efectos de los fármacos , Humanos , Pseudomonas aeruginosa/efectos de los fármacos
18.
Adv Exp Med Biol ; 1145: 9-13, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31364068

RESUMEN

Antibiotic resistance has presented a major health challenge in the world and many isolates of Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa become resistant to almost all current antibiotics. This chapter provides an overview on the mechanisms of antibiotic resistance in these Gram-negative pathogens and outlines the formidable problem of the genetics of bacterial resistance. Prevalent multidrug-resistance in Gram-negative bacteria underscores the need for optimizing the clinical use of the last-line polymyxins.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Polimixinas/farmacología , Acinetobacter baumannii/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Humanos , Pseudomonas aeruginosa/efectos de los fármacos
19.
Adv Exp Med Biol ; 1145: 15-36, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31364069

RESUMEN

Polymyxins are naturally occurring cyclic lipopeptides that were discovered more than 60 years ago. They have a narrow antibacterial spectrum, which is mainly against Gram-negative pathogens. The dry antibiotic pipeline, together with the increasing incidence of bacterial resistance in the clinic, has been dubbed 'the perfect storm'. This has forced a re-evaluation of 'old' antibiotics, in particular the polymyxins, which retain activity against many multidrug-resistant (MDR) Gram-negative organisms. As a consequence, polymyxin B and colistin (polymyxin E) are now used as the last therapeutic option for infections caused by 'superbugs' such as Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. This chapter covers the history, chemistry and antibacterial spectrum of these very important last-line lipopeptide antibiotics.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Polimixinas/farmacología , Colistina/farmacología , Humanos , Polimixina B/farmacología
20.
Adv Exp Med Biol ; 1145: 143-153, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31364077

RESUMEN

In this chapter, we systematically reviewed studies that assessed polymyxin's effectiveness and summarized results through meta-analysis. The outcomes addressed were all-cause mortality, assuming that for patients with severe multidrug-resistant infections survival is the most important outcome, and resistance development, important for future patients. Most clinical data on polymyxins in the literature are from retrospective, observational studies at high risk of bias. The majority of clinical studies were unpowered to examine mortality controlling for other risk factors. The studies had no control of dosage regimens and treatment modifications. We identified several areas of missing data, in particular randomized controlled trials (RCTs) examining treatment options for carbapenem-resistant Gram-negative bacteria, different dosage regimens, polymyxins versus alternative antibiotics (e.g. aminoglycosides, tigecycline), and monotherapy versus specific combination therapies. Ideally, mortality and development of resistance should be examined in RCTs, with further longitudinal studies required for the latter.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Polimixinas/uso terapéutico , Carbapenémicos , Farmacorresistencia Bacteriana , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos
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