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1.
BMC Infect Dis ; 19(1): 891, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651255

RESUMEN

BACKGROUND: Enterococcus hirae is rarely identified in humans and may be a commensal pathogen in psittacine birds. We present the fifth known case of E. hirae endocarditis. CASE PRESENTATION: A 64-year-old Caucasian female presented with fever, hypotension, atrial fibrillation with rapid ventricular response, and a two-week history of lightheadedness. Her previous medical history included COPD, recurrent DVT, atrial fibrillation (on warfarin), hypertension, hypothyroidism, and Hodgkin's lymphoma. Physical exam was notable for expiratory wheezes and a 2/6 systolic ejection murmur at the right sternal border. 2D echocardiogram revealed severe aortic stenosis. The patient underwent right and left heart catheterization, where she was found to have severe aortic stenosis and mild pulmonary hypertension. She subsequently underwent minimally invasive aortic valve replacement with a bovine pericardial valve, bilateral atrial cryoablation, and clipping of the left atrial appendage. Her aortic valve was found to have a bicuspid, thickened appearance with calcifications, multiple small vegetations, and a root abscess beneath the right coronary cusp. With a new suspicion of infective endocarditis, the patient was placed on broad-spectrum IV antibiotics. Intra-operative blood cultures were negative. A tissue culture from the aortic valve vegetations identified Enterococcus hirae susceptible to ampicillin through MALDI-TOF. Antibiotic treatment was then switched to IV ampicillin and ceftriaxone; she declined aminoglycoside treatment due to toxicity concerns. The patient had an uncomplicated postoperative course and was discharged with 6 weeks of antibiotics. To date, she continues to be followed with no signs of relapsing disease. CONCLUSIONS: To our knowledge, this case constitutes the fifth known case of E. hirae endocarditis, and the second case to have been identified with MALDI-TOF and treated with ampicillin and ceftriaxone. This case reinforces the efficacy of ampicillin and ceftriaxone for the treatment of E. hirae endocarditis.


Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis Bacteriana/terapia , Enterococcus hirae/patogenicidad , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/microbiología , Aminoglicósidos/uso terapéutico , Ampicilina/uso terapéutico , Animales , Bovinos , Ceftriaxona/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/etiología , Enterococcus hirae/efectos de los fármacos , Femenino , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Enfermedades de las Válvulas Cardíacas/terapia , Prótesis Valvulares Cardíacas , Humanos , Persona de Mediana Edad , Reemplazo de la Válvula Aórtica Transcatéter
2.
Medicine (Baltimore) ; 98(38): e17315, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31568018

RESUMEN

Early differential diagnosis of bloodstream infections (BSIs) caused by different sources and species of bacteria in hospitalized patients is crucial for the timely targeted interventions including appropriate use of antibiotics. The aim of this study was to identify 9 biomarkers for the early differentiation of gram-negative-bloodstream infection (GN-BSI), gram-positive (GP)-BSI, and fungal-BSI.A prospective study was conducted for a total of 390 inpatients who underwent blood culture in the Chinese PLA General Hospital from September 2015 to March 2018. Patients with positive culture of a single pathogen were divided into GN-BSI, GP-BSI, and Fungal-BSI groups, and a culture-negative disease control group was also established. The serum levels of macrophage inflammatory protein 1ß (MIP-1ß), tumor necrosis factor α (TNF-α), interleukin (IL)-3, interferon (IFN)-γ, IL-17A, IL-4, IL-12p70, and P-selectin were detected and the NLR was calculated from routine blood test. Receiver-operating characteristic analysis was used to determine the efficacy of various indicators in the differential diagnosis of BSIs. Prediction and validation experiments on clinical patient samples (263 cases) were also performed.The level of IL-3 in the GP-BSI group was significantly higher than those in the other 3 groups. The level of IFN-γ in the fungal-BSI group was significantly higher than those in the other 3 groups. NLR, MIP-1ß, TNF-α, IL-17A, and IL3 exhibited some efficacy when distinguishing between GN-BSI and GP-BSI and NLR had the largest area under curve (AUC) (0.728), followed by MIP-1ß with an AUC of 0.679. IFN-γ and IL-3 exhibited some value in differential diagnosis between GN-BSI and Fungal-BSI. IL-3, MIP-1ß, TNF-α, IFN-γ, NLR, IL-17A, and IL-4 exhibited some value in distinguishing fungal-BSI and GP-BSI, with IL-3 had the largest AUC (0.722), followed by MIP-1ß with an AUC of 0.703.NLR and MIP-1ß may be valuable in differentiating GN-BSI from GP-BSI in hospitalized patients. IFN-γ and IL-3 may be helpful in differential diagnosis GN-BSI and fungal-BSI. IL-3 and MIP-1ß exhibited some diagnostic efficacy in distinguishing fungal-BSI and GP-BSI. Additionally, IL-3 with high serum level may be a marker for GP-BSI and IFN-γ with high serum level may be a valuable marker for the prediction of Fungal-BSI. The utility of these biomarkers to predict BSIs owing to different pathogens in hospitalized patients needs to be assessed in further studies.


Asunto(s)
Bacteriemia/diagnóstico , Quimiocina CCL4/sangre , Infección Hospitalaria/diagnóstico , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Grampositivas/diagnóstico , Interferón gamma/sangre , Interleucina-12/sangre , Interleucina-17/sangre , Interleucina-3/sangre , Interleucina-4/sangre , Micosis/diagnóstico , Proteínas NLR/sangre , Selectina-P/sangre , Factor de Necrosis Tumoral alfa/sangre , Bacteriemia/sangre , Bacteriemia/microbiología , Biomarcadores/sangre , Infección Hospitalaria/sangre , Infección Hospitalaria/microbiología , Diagnóstico Diferencial , Femenino , Infecciones por Bacterias Gramnegativas/sangre , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Micosis/sangre , Micosis/microbiología , Estudios Prospectivos
3.
Rev Soc Bras Med Trop ; 52: e20190205, 2019 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-31508783

RESUMEN

INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS: A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS: Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS: MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.


Asunto(s)
Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Adolescente , Niño , Preescolar , Estudios Transversales , Monitoreo Epidemiológico , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Grampositivas/clasificación , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal
4.
Artículo en Inglés | MEDLINE | ID: mdl-31522664

RESUMEN

From 1 January to 31 December 2017, 36 institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2017 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the E. faecium isolates. Of the 1,137 unique episodes of bacteraemia investigated, 95.2% were caused by either E. faecalis (52.9%) or E. faecium (42.3%). Ampicillin resistance was not detected in E. faecalis but in 89.6% of E. faecium. Vancomycin non-susceptibility was reported in 0.3% and 47.0% of E. faecalis and E. faecium respectively. Overall 50.9% of E. faecium harboured vanA or vanB genes. For the vanA/B positive E. faecium isolates, 49.6% harboured vanB genes and 49.2% vanA genes; 1.2% harboured vanA and vanB genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is significantly higher than that seen in most European countries. E. faecium consisted of 76 multilocus sequence types (STs) of which 77% of isolates were classified into nine major STs containing ten or more isolates. All major STs belong to clonal cluster (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. Seven of the nine predominant STs (ST80, ST1421, ST17, ST296, ST555, ST203 and ST18) were found across most regions of Australia. The most predominant clone was ST17 which was identified in all regions except the Australian Capital Territory, the Northern Territory and Tasmania. Overall 60.7% of isolates belonging to the nine predominant STs harboured vanA or vanB genes. The AESOP 2017 has shown enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin resistant vanA or vanB E. faecium which have limited treatment options.


Asunto(s)
Antiinfecciosos/farmacología , Bacteriemia/epidemiología , Farmacorresistencia Bacteriana Múltiple , Enterococcus/efectos de los fármacos , Infecciones por Bacterias Grampositivas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Bacteriemia/microbiología , Niño , Preescolar , Enterococcus/clasificación , Enterococcus/genética , Enterococcus faecalis/clasificación , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/genética , Enterococcus faecium/clasificación , Enterococcus faecium/efectos de los fármacos , Enterococcus faecium/genética , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Adulto Joven
5.
Invest Ophthalmol Vis Sci ; 60(12): 3727-3739, 2019 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-31479113

RESUMEN

Purpose: Bacillus causes a sight-threating infection of the posterior segment of the eye. The robust intraocular inflammatory response in this disease is likely activated via host innate receptor interactions with components of the Bacillus cell envelope. S-layer proteins (SLPs) of some Gram-positive pathogens contribute to the pathogenesis of certain infections. The potential contributions of SLPs in eye infection pathogenesis have not been considered. Here, we explored the role of a Bacillus SLP (SlpA) in endophthalmitis pathogenesis. Methods: The phenotypes and infectivity of wild-type (WT) and S-layer deficient (ΔslpA) Bacillus thuringiensis were compared. Experimental endophthalmitis was induced in C57BL/6J mice by intravitreally injecting 100-CFU WT or ΔslpA B. thuringiensis. Infected eyes were analyzed by bacterial counts, retinal function analysis, histology, and inflammatory cell influx. SLP-induced inflammation was also analyzed in vitro. Muller cells (MIO-M1) were treated with purified SLP. Nuclear factor-κB (NF-κB) DNA binding was measured by ELISA and expression of proinflammatory mediators from Muller cells was measured by RT-qPCR. Results: Tested phenotypes of WT and ΔslpA B. thuringiensis were similar, with the exception of absence of the S-layer in the ΔslpA mutant. Intraocular growth of WT and ΔslpA B. thuringiensis was also similar. However, eyes infected with the ΔslpA mutant had significantly reduced inflammatory cell influx, less inflammatory damage to the eyes, and significant retention of retinal function compared with WT-infected eyes. SLP was also a potent stimulator of the NF-κB pathway and induced the expression of proinflammatory mediators (IL6, TNFα, CCL2, and CXCL-1) in human retinal Muller cells. Conclusions: Taken together, our results suggest that SlpA contributes to the pathogenesis of Bacillus endophthalmitis, potentially by triggering innate inflammatory pathways in the retina.


Asunto(s)
Bacillus thuringiensis/patogenicidad , Proteínas Bacterianas/fisiología , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Glicoproteínas de Membrana/fisiología , Animales , Recuento de Colonia Microbiana , Citocinas/metabolismo , Electrorretinografía , Endoftalmitis/metabolismo , Endoftalmitis/patología , Ensayo de Inmunoadsorción Enzimática , Células Ependimogliales/microbiología , Infecciones Bacterianas del Ojo/metabolismo , Infecciones Bacterianas del Ojo/patología , Infecciones por Bacterias Grampositivas/metabolismo , Infecciones por Bacterias Grampositivas/patología , Ratones , Ratones Endogámicos C57BL , Microscopía Electrónica de Transmisión , Modelos Animales , FN-kappa B/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Retina/microbiología , Retina/fisiopatología , Virulencia/fisiología
6.
Transplant Proc ; 51(8): 2766-2770, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31493916

RESUMEN

BACKGROUND: Enterococcus species are a common cause of bacteremia in liver transplant recipients. Vancomycin-resistant enterococci (VRE) have become an important cause of nosocomial infection. In this study, we analyzed the incidence, antibiotic resistance, and outcomes of enterococcal bacteremia in living donor liver transplant recipients and the risk factors for VRE. PATIENTS AND METHODS: This single-center, retrospective review included 536 patients who underwent liver transplant between January 2008 and December 2017. RESULTS: Among 536 patients, 42 (7.8%) experienced a total of 58 enterococcal bacteremic episodes (37 Enterococcus faecium, 17 Enterococcus faecalis, 2 Enterococcus casseliflavus, 1 Enterococcus. avium, and 1 Enterococcus raffinosus). Most cases of enterococcal bacteremia (46/58, 79.3%) occurred within 6 months after transplant; among the 26 cases of VRE bacteremia, 50% occurred within 1 month after transplant. E. faecium isolates had the highest rate of vancomycin resistance (25/37, 67.5%), whereas all E. faecalis isolates were susceptible to vancomycin. According to multivariate analysis, post-transplant dialysis (odds ratio, 3.95; 95% CI, 1.51-10.34; P = .005) and length of post-transplant hospital stay (odds ratio, 1.03; 95% CI, 1.009-1.04; P = .004) were significantly associated with VRE bacteremia. One-year mortality was 31% (13/42) among recipients with enterococcal bacteremia, 5.0% (20/384) among nonbacteremic patients, and 11.1% (10/90) among patients with nonenterococcal bacteremia (P < .001). CONCLUSION: In this study, enterococcal bacteremia showed high incidence in liver transplant recipients, especially with vancomycin resistance, occurred in early period after transplant, and was associated with increased mortality. High rates of resistance to vancomycin warrant further efforts to manage enterococcal infection in liver transplant recipients at our center.


Asunto(s)
Bacteriemia/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/inmunología , Trasplante de Hígado , Complicaciones Posoperatorias/epidemiología , Resistencia a la Vancomicina , Adulto , Antibacterianos/uso terapéutico , Bacteriemia/inmunología , Bacteriemia/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/inmunología , Enterococcus faecalis , Enterococcus faecium/efectos de los fármacos , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Huésped Inmunocomprometido , Incidencia , Donadores Vivos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/microbiología , Estudios Retrospectivos , Factores de Riesgo , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/inmunología
7.
BMC Infect Dis ; 19(1): 711, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31409282

RESUMEN

BACKGROUND: Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [1] identify risk factors for VRE amongst cirrhotic patients before liver transplantation, and [2] evaluate risk of morbidity and mortality at 30-days and one-year after VRE infection. METHODS: Chart review of 533 cirrhotic patients hospitalized at a tertiary medical center was performed. Patients infected with VRE (n = 65) were separately compared to patients infected with gram-negative organisms (n = 80) and uninfected patients (n = 306). RESULTS: In multivariable logistic regression analyses, female gender (OR 3.73(95% CI1.64,8.49)), severity of liver disease measured by higher Child Pugh scores (OR 0.37(95%CI 0.16,0.84)), presence of ascites (OR 9.43(95% CI 3.22,27.65) and any type of dialysis (OR 3.31,95% CI (1.21,9.04), oral antibiotic prophylaxis for spontaneous bacterial peritonitis and rifaximin use were statistically significantly associated with VRE infection (OR 2.37 (95%CI 1.27, 4.42)). VRE-infected patients had significantly longer mean ICU and total hospital stays (both p < 0.0001), with increased one-year mortality compared to cirrhotic patients without VRE infection, adjusted for age, sex, Hispanic ethnicity, and disease severity. CONCLUSIONS: It is unclear whether VRE infection serves as an independent risk factor for increased mortality or an indicator for patients with more severe illnesses and thus a higher risk for death.


Asunto(s)
Infecciones por Bacterias Grampositivas/microbiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Adulto , Anciano , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Niño , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Cirrosis Hepática/microbiología , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Peritonitis/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Resistencia a la Vancomicina
8.
BMC Infect Dis ; 19(1): 744, 2019 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-31455296

RESUMEN

BACKGROUND: Multidrug resistant (MDR) enterococci are important nosocomial pathogens causing serious problem in hospitalized patients. The aim of present study was to investigate the frequency of high-level aminoglycoside-resistant and vancomycin-resistant enterococci (VRE) and virulence encoding genes in enterococci isolated from hospitalized patients. METHODS: A total of 100 enterococci isolated from urine samples of hospitalized patients with symptomatic urinary tract infections were investigated for antimicrobial susceptibility, the frequency of aminoglycoside and vancomycin resistance genes (including aac (6')-Ie-aph (2")-Ia, aph (3')-IIIa, ant (4')-Ia, aph (2")-Ic, aph (2")-Ib, aph (2")-Id, ant (3″)-III, ant (6')-Ia, vanA, vanB and vanC) and virulence encoding genes (including gelE, PAI, esp, ace, cyl, hyl and sprE). RESULTS: Enterococcus faecalis species was identified as predominant enterococci (69%), followed by "other" Enterococcus species (21%) and E. faecium (10%). Ninety three percent of isolates were resistant to one or more antimicrobial agents, with the most frequent resistance found against tetracycline (86%), ciprofloxacin (73%) and quinupristin-dalfopristin (53%). Gentamicin and streptomycin resistance were detected in 50 and 34% of isolates, respectively. The most prevalent aminoglycoside resistance genes were ant (3″)-III (78%) and aph (3')-IIIa (67%). Vancomycin resistance was detected in 21% of isolates. All E. faecium isolates carried vanA gene, whereas, the vanB gene was not detected in Enterococcus species. The most frequent virulence gene was ace (88.6%), followed by esp (67.1%), PAI (45.5%) and sprE (41.7%). CONCLUSION: Our study revealed the high frequency of gentamycin resistance and VRE in E. faecium isolates, with a high prevalence and heterogeneity of virulence and resistance genes. Due to high frequency of MDR enterococci, it seems that the appropriate surveillance and control measures are essential to prevent the emergence and transmission of these isolates in hospitals.


Asunto(s)
Farmacorresistencia Bacteriana/genética , Enterococcus/patogenicidad , Infecciones por Bacterias Grampositivas/microbiología , Infecciones Urinarias/microbiología , Factores de Virulencia/genética , Adulto , Aminoglicósidos/farmacología , Antibacterianos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Enterococcus/efectos de los fármacos , Enterococcus/genética , Gentamicinas/farmacología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Hospitalización , Humanos , Incidencia , Irán , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Resistencia a la Vancomicina/efectos de los fármacos , Resistencia a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/patogenicidad
10.
BMC Infect Dis ; 19(1): 730, 2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31429713

RESUMEN

BACKGROUND: Solobacterium moorei, the only species in the genus Solobacterium, is a Gram-positive, non-spore-forming, strict anaerobic, short to long bacillus. It has rarely been documented to cause blood stream infections. Here we report the first case of bacteremia caused by S.moorei in China. CASE PRESENTATION: A 61-year-old male presented to Peking Union Medical College Hospital (Beijing) with thrombotic thrombocytopenic purpura (TTP) and several other underlying diseases. He also had persistent coma accompanied by intermittent convulsions, halitosis, and intermittent fever. Blood cultures taken when the patient had a high fever were positive, with the anaerobic bottle yielding an organism identified as S.moorei by 16S rRNA gene sequencing, whilst the aerobic bottle grew Streptococcus mitis. After replacement of venous pipeline, and empirical use of vancomycin and meropenem, the patient's body temperature and white blood cell count returned to normal. Unfortunately, the patient died of severe TTP. CONCLUSION: This is the first case report of S. moorei isolation from blood stream in China. 16S rRNA gene sequencing is the only method that can identify S. moorei. Blood cultures must be taken before administration of antibiotics, and anaerobic culture should be considered for such rare pathogens in patients with oral diseases and immune deficiency.


Asunto(s)
Bacteriemia/microbiología , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/patogenicidad , Infecciones por Bacterias Grampositivas/microbiología , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , China , Bacterias Grampositivas/genética , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Halitosis/etiología , Halitosis/microbiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Púrpura Trombocitopénica Trombótica/complicaciones , ARN Ribosómico 16S/genética
11.
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
12.
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
13.
Int J Hyperthermia ; 36(1): 886-896, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31464154

RESUMEN

Purpose: The objective of this study was to investigate the bactericidal effects of high intensity focused ultrasound (HIFU) on Bacillus Calmette-Guerin (BCG, a substitute for Mycobacterium tuberculosis) in vitro and in vivo, and to explore the underlying mechanisms. Materials and methods: HIFU, at a fixed frequency of 1 MHz, was applied to both BCG culture suspensions and subcutaneous BCG abscesses in rats. Results: HIFU irradiation significantly reduced the bacterial survival rate and caused temperature elevations both in vitro and in vivo. Furthermore, BCG suspensions irradiated for 15 s at 3185 and 6369 W/cm2 had increased cell wall damage, which resulted in morphological changes compared to the untreated control group. Additionally, we observed histological changes in the rat subcutaneous abscesses after HIFU ablation at 6369 W/cm2. H&E staining of infected lesions showed coagulative necrosis with central nucleus dissolution and increased infiltration of inflammatory cells, as well as nuclear pyknosis and nuclear fragmentation in the periphery. The volumes of the subcutaneous abscesses in the HIFU-treated group were significantly lower than those in the sham-treated group. Conclusion: HIFU has the therapeutic potential to treat BCG-infected tissues in rats. We theorize that a combination of mechanical, cavitation, and thermal effects most efficiently inactivate BCG bacteria via HIFU. This study is expected to provide a bio-plausible basis for a noninvasive and effective treatment for tuberculosis.


Asunto(s)
Bacillus , Infecciones por Bacterias Grampositivas/terapia , Ultrasonido Enfocado de Alta Intensidad de Ablación , Animales , Carga Bacteriana , Infecciones por Bacterias Grampositivas/microbiología , Ratas Sprague-Dawley
14.
Biosens Bioelectron ; 142: 111541, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31382097

RESUMEN

Some of microorganisms are potential pathogens that can be infectious agents under some circumstances, and development of new detection methods of the pathogens is of high interest. In the present study, an Enterococcus faecalis (E. faecalis) DNA biosensor (ef-biosensor) was fabricated to quantify the bacterium genome. A specific E. faecalis DNA probe was selected from 16S rRNA sequence of E. faecalis and immobilized on a gold electrode surface in an optimized time to fabricate the ef-biosensor. The ef-biosensor detected a synthetic target of the probe with a detection limit of 3.3 amol L-1 and with a nice selectivity to resolve from one-, two- and three-base mismatched sequences. In addition, the bacterium genomic DNA was quantified with a detection limit of 7.1 × 10-9 ng mL-1 in a concentration range of 1.1 × 10-7 to 1.1 ng mL-1. The ef-biosensor had a long time stability, good fabrication reproducibility and good regeneration ability. The ef-biosensor was successfully applied for E. faecalis detection in human samples.


Asunto(s)
Técnicas Biosensibles/métodos , Sondas de ADN/química , ADN Bacteriano/análisis , Enterococcus faecalis/aislamiento & purificación , Infecciones por Bacterias Grampositivas/microbiología , ARN Ribosómico 16S/química , Secuencia de Bases , Sondas de ADN/genética , ADN Bacteriano/genética , Técnicas Electroquímicas/métodos , Enterococcus faecalis/genética , Infecciones por Bacterias Grampositivas/diagnóstico , Humanos , Límite de Detección , ARN Ribosómico 16S/genética , Reproducibilidad de los Resultados
15.
Rev Soc Bras Med Trop ; 52: e20190081, 2019 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-31340368

RESUMEN

Eggerthella lenta is a gram-positive anaerobic bacillus that has been associated with life-threatening infections. Bacteremia is always clinically significant and is mostly but not always associated with gastrointestinal disease. We present a unique case of abrupt deterioration and rapid development of septic shock secondary to periurethral abscess caused by E. lenta infection. This case highlights the atypical clinical presentation, risk factors, uncommon source of infection, challenges in therapy, and outcome of this infrequent infection. There is still a gap in the understanding of E. lenta pathogenicity, and more literature is needed to establish clear management recommendations.


Asunto(s)
Absceso/diagnóstico por imagen , Actinobacteria/aislamiento & purificación , Bacteriemia/microbiología , Enfermedades Uretrales/diagnóstico por imagen , Absceso/tratamiento farmacológico , Absceso/microbiología , Actinobacteria/clasificación , Antibacterianos/uso terapéutico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Infección Pélvica/diagnóstico , Infección Pélvica/microbiología , Factores de Riesgo , Tomografía Computarizada por Rayos X , Enfermedades Uretrales/tratamiento farmacológico
16.
Chemosphere ; 236: 124349, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31326753

RESUMEN

Heavy metal Pb is a common toxic pollutant present in our environment adversely affecting health of the living organisms. Recent studies suggest positive correlation between heavy metal exposure and immune dysfunction and present work utilizes Drosophila to address this issue in relation to Pb exposure. In-vivo Pb toxicity was established by dietary intake where essential parameters like development and life span were found to be hampered and augmented upon metallothionein B (mtnB) downregulation hinting towards potential role of mtnB in Pb detoxification. Further response of Drosophila to B. subtilis bacterial infection was monitored by carrying out oral infections. Pb fed flies showed increased susceptibility to infection as compared to their controls. Since Drosophila hemocytes play dual role as immune cells, we checked for the total hemocyte count and found significant decrease in hemocyte numbers in Pb fed larvae. Both crystal cells and plasmatocytes, the two major hemocytes in third instar larval hemolymph were reduced. However we did not find any visible morphological changes in Giemsa stained hemocytes. Crystal cells are crucial for synthesis and release of phenoloxidase (PO), an enzyme required for melanin clot synthesis and deposition. PO activity assessed from total hemolymph protein isolates was found to be substantially decreased in Pb raised animals. Results were also confirmed by spot test and native gel activity assay of PO. Overall our results suggest immunotoxic effect of Pb through decrease in hemocyte count including crystal cell which in turn leads to decreased PO activity and increased susceptibility to B. subtilis.


Asunto(s)
Drosophila melanogaster/inmunología , Contaminantes Ambientales/toxicidad , Infecciones por Bacterias Grampositivas/inducido químicamente , Hemocitos/citología , Plomo/toxicidad , Animales , Bacillus subtilis , Drosophila melanogaster/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Hemocitos/metabolismo , Hemolinfa/metabolismo , Larva/efectos de los fármacos , Metalotioneína/metabolismo , Monofenol Monooxigenasa/metabolismo
17.
Microb Genom ; 5(7)2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31329096

RESUMEN

Vancomycin-resistant Enterococcus faecium (VREfm) is a globally significant public health threat and was listed on the World Health Organization's 2017 list of high-priority pathogens for which new treatments are urgently needed. Treatment options for invasive VREfm infections are very limited, and outcomes are often poor. Whole-genome sequencing is providing important new insights into VREfm evolution, drug resistance and hospital adaptation, and is increasingly being used to track VREfm transmission within hospitals to detect outbreaks and inform infection control practices. This mini-review provides an overview of recent data on the use of genomics to understand and respond to the global problem of VREfm.


Asunto(s)
Brotes de Enfermedades , Enterococcus faecium/efectos de los fármacos , Enterococcus faecium/genética , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Resistencia a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/genética , Genoma Bacteriano/genética , Genómica , Humanos , Filogenia , Secuenciación Completa del Genoma/métodos
18.
Int J Mol Sci ; 20(14)2019 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-31319552

RESUMEN

Acne is an inflammatory skin disorder in puberty with symptoms including papules, folliculitis, and nodules. Propionibacterium acnes (P. acnes) is the main anaerobic bacteria that cause acne. It is known to proliferate within sebum-blocked skin hair follicles. P. acnes activates monocytic cell immune responses to induce the expression of proinflammatory cytokines. Although the anti-inflammatory function of the Laurus nobilis (L. nobilis) extract (LNE) on several immunological disorders have been reported, the effect of LNE in P. acnes-mediated skin inflammation has not yet been explored. In the present study, we examined the ability of the LNE to modulate the P. acnes-induced inflammatory signaling pathway, and evaluated its mechanism. LNE significantly suppressed the expression of P. acnes-mediated proinflammatory cytokines, such as IL-1ß, IL-6, and NLRP3. We also found that LNE inhibited the inflammatory transcription factor NF-κB in response to P. acnes. In addition, eucalyptol, which is the main constituent of LNE, consistently inhibited P. acnes-induced inflammatory signaling pathways. Moreover, LNE significantly ameliorated P. acnes-induced inflammation in a mouse model of acne. We suggest for the first time that LNE hold therapeutic value for the improvement of P. acnes-induced skin inflammation.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Antiinflamatorios/farmacología , Eucaliptol/farmacología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Laurus/química , Extractos Vegetales/farmacología , Propionibacterium acnes/crecimiento & desarrollo , Acné Vulgar/metabolismo , Acné Vulgar/microbiología , Acné Vulgar/patología , Animales , Antiinflamatorios/química , Línea Celular , Eucaliptol/química , Infecciones por Bacterias Grampositivas/metabolismo , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/patología , Inflamación/tratamiento farmacológico , Inflamación/metabolismo , Inflamación/microbiología , Inflamación/patología , Ratones , Extractos Vegetales/química
20.
J Hosp Infect ; 103(2): 115-120, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31279758

RESUMEN

BACKGROUND: Detection of faecal carriers of carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant Enterococci (VRE) has become a routine medical practice in many countries. In an outbreak setting, several public health organizations recommend three-weekly rectal screenings to rule-out acquisition in contact patients. This strategy, associated with bed closures and reduction of medical activity for a relatively long time, seems costly. AIM: The objective of this study was to test the positive and negative predictive values of reverse transcription polymerase chain reaction (RT-PCR; GeneXpert®) carried-out at Day 0, compared with conventional three-weekly culture-based rectal screenings, in identifying, among contact patients, those who acquired CPE/VRE. METHODS: A multicentre retrospective study was conducted from January2015 to October2018. All contact patients (CPs) were included identified from index patients (IPs) colonized or infected with CPE/VRE, incidentally discovered. Each CP was investigated at Day 0 by PCR (GeneXpert®), and by the recommended three-weekly screenings. FINDINGS: Twenty-two IPs and 159 CPs were included. An average of 0.77 secondary cases per patient was noted, with a mean duration of contact of 10 days (range 1-64). Among the 159 CPs, 16 (10%) had a CPE/VRE-positive culture during the monitoring period. Rectal screenings were positive at Day 0 (10 patients), Day 7 (two patients), Day 14 (four patients). Thirteen of 16 patients with positive culture had a positive PCR at Day 0. Overall, a concordance of 97.5% (155/159) was observed between the three-weekly screenings and Day 0 PCR results. When performed on CPs at Day 0 of the identification of an IP, PCR (GeneXpert®) allowed the reduction in turnaround time by five to 27 days, compared to three-weekly screenings. Positive predictive value and negative predictive value were 100% and 98%, respectively. CONCLUSIONS: The use of RT-PCR (GeneXpert®) can avoid the three-weekly rectal samplings needed to rule-out acquisition of CPE/VRE.


Asunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , Infecciones por Enterobacteriaceae/diagnóstico , Monitoreo Epidemiológico , Infecciones por Bacterias Grampositivas/diagnóstico , Clausura de las Instituciones de Salud/estadística & datos numéricos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Enterobacteriaceae/microbiología , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Hospitales , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Técnicas de Diagnóstico Molecular/métodos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Adulto Joven
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