Fatal Cronobacter sakazakii Sequence Type 494 Meningitis in a Newborn, Brazil.

We describe a case of infection with Cronobacter sakazakii sequence type 494 causing bacteremia and meningitis in a hospitalized late premature infant in Brazil. We conducted microbiological analyses on samples of powdered infant formula from the same batch as formula ingested by the infant but could not identify the source of contamination.

Salmonella, Escherichia coli and Enterobacteriaceae in the peanut supply chain: From farm to table.

Due to recent foodborne outbreaks, peanuts have been considered a potential risk for Salmonella transmission. For this reason, the aim of this study was to determine the prevalence and contamination load of Salmonella, Escherichia coli and Enterobacteriaceae throughout the peanut supply chain in Brazil. Samples of peanuts and peanut-containing processed products from post-harvest (n=129), secondary processing (n=185) and retail market (n=100) were analyzed. The results showed high Enterobacteriaceae counts in the post-harvest samples. At the end of the secondary processing, 16% of the samples remained contaminated by this group of microorganisms. Six peanut samples from primary production and one sample of peanut butter were tested positive for E. coli while Salmonella was detected in nine samples (2.2%): six from post-harvest, two from the initial stage of the secondary processing and one from retail. The Salmonella counts ranged between 0.004 and 0.092MPN/g and five serotypes were identified (Muenster, Miami, Javiana, Oranienburg, Glostrup). The results demonstrated a high prevalence of Enterobacteriaceae and low prevalence of E. coli throughout the peanut supply chain. Furthermore, it was verified that peanuts may become contaminated by Salmonella during different stages of the supply chain, especially at post-harvest.

Occurrence and molecular characterization of different virulence-associated genes of Cronobacter sakazakii isolates from some foods and dust samples / Ocorrência e caracterização molecular de diferentes genes associados à virulência de Cronobacter sakazakiidetectados em alguns alimentos e amostras de poeira

Among the Cronobacter genus, Cronobacter sakazakii is the most common species posing a severe health risk for newborns, infants and children. Some infant formulas, cereal-based foods, and food production environments may be the potential reservoirs of C. sakazakii. This pathogen possesses different virulence factors encoded by different virulence genes. Therefore, characterizing these genes is important for distinguishing pathogenic strains from nonpathogenic ones. The objective of this study was to characterize some virulence genes [OmpA, OmpX, zpx, and Cpa] by real-time polymerase chain reaction (PCR) in C. sakazakii isolates from a total of 120 samples (20 each of milk powder, starch, rice flour, semolina, infant formula and dust samples from food production environments). Overall, 13 isolates (7 from milk powder, 2 rice flour, 1 semolina, and 3 dust) were cultured, identified by bioMérieux API® 20E test kit, and then subjected to real-time PCR application for screening the target virulence-associated genes. Our results showed that all of 13 isolates were positive for the virulence genes OmpA, OmpX, zpx, and Cpa. In summary, our study revealed that some of the analyzed foods and environmental samples were contaminated with pathogenic C. sakazakii with its virulence-associated markers, far above the allowable limit; and therefore, this level of contamination may pose a severe health threat for newborns, infants, and children.(AU)

Dentre o gênero Cronobacter, Cronobacter sakazakii é a espécie mais comum que representa um grave risco para a saúde dos recém-nascidos, bebês e crianças. Algumas formulas infantis para crianças, alimentos a base de cereais e locais de produção de alimentos, foram considerados como potenciais locais de contaminação de C. sakazakii. Este patógeno possui diferentes agentes de virulência codificados por diferentes genes de virulência. Portanto, a caracterização dos genes é importante para distinguir as cepas patogênicas das não patogênicas. O objetivo deste estudo foi caracterizar os diferentes genes de virulência [OmpA, OmpX, zpx, and Cpa] em C. sakazakii isolados em um total de 120 amostras (20 de cada uma delas - leite em pó, amido, farinha de arroz, sêmola, comida para bebês e amostras de poeira provenientes dos ambientes de produção de alimentos) por reação em cadeia da polimerase em tempo real (RT-PCR). No total, foram cultivadas 13 estirpes (7 de leite em pó, 2 de farinha de arroz, 1 de sêmola e 3 poeiras) e depois identificadas pelo kit de teste bio Mérieux API® 20E. As estirpes identificadas foram submetidas ao PCR em tempo real para caracterizar os genes alvo associados à virulência. Os resultados mostraram que todos os genes C. sakazakii isolados eram patogênicos e positivos às OmpA, OmpX, zpx e Cpa com um padrão de coexistência. Em resumo, o nosso estudo revelou que os alimentos e os ambientes de produção de alimentos analisados constituíam uma ameaça à saúde dos recém-nascidos, bebês e crianças devido à contaminação por C. sakazakii patogênico como marcadores associados à virulência.(AU)

A Model-Based Strategy to Control the Spread of Carbapenem-Resistant Enterobacteriaceae: Simulate and Implement.

OBJECTIVE To reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model. DESIGN Before-after trial with a 44-week baseline period and 24-week intervention period. SETTING Medical intensive care unit of a tertiary care teaching hospital. PARTICIPANTS All patients admitted to the unit. METHODS We developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted. RESULTS The goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0-2.1). CONCLUSIONS The simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention. Infect Control Hosp Epidemiol 2016;1-8.

Antimicrobial resistance among Enterobacteriaceae in South America: history, current dissemination status and associated socioeconomic factors.

South America exhibits some of the higher rates of antimicrobial resistance in Enterobactericeae worldwide. This continent includes 12 independent countries with huge socioeconomic differences, where the ample access to antimicrobials, including counterfeit ones, coexists with ineffective health systems and sanitation problems, favoring the emergence and dissemination of resistant strains. This work presents a literature review concerning the evolution and current status of antimicrobial resistance threats found among Enterobacteriaceae in South America. Resistance to ß-lactams, fluoroquinolones and aminoglycosides was emphasized along with description of key epidemiological studies that highlight the success of specific resistance determinants in different parts of the continent. In addition, a discussion regarding political and socioeconomic factors possibly related to the dissemination of antimicrobial resistant strains in clinical settings and at the community is presented. Finally, in order to assess the possible sources of resistant bacteria, we compile the current knowledge about the occurrence of antimicrobial resistance in isolates in South American' food, food-producing animals and off-hospitals environments. By addressing that intensive intercontinental commerce and tourism neutralizes the protective effect of geographic barriers, we provide arguments reinforcing that globally integrated efforts are needed to decelerate the emergence and dissemination of antimicrobial resistant strains.

Detecção de bactérias enteropatogênicas e enteroparasitas em pacientes com diarreia aguda em Juruti, Pará, Brasil / Detection of enteropathogenic bacteria and enteroparasites in patients with acute diarrhea in Juruti, Pará, Brazil

Com o intuito de determinar a frequência de bactérias enteropatogênicas e enteroparasitas em pacientes com diarreia aguda no Município de Juruti, Pará, o qual passa por intenso processo imigratório face o grande projeto de exploração mineral, avaliaram-se 263 casos de diarreia aguda, dos quais 19 por cento foram atribuídos a bactérias enteropatogênicas, destacando-se a Shigella spp, que representou 13,7 por cento. Salmonella spp, Aeromonas spp e Plesiomonas shigelloides também foram detectados. Os sorotipos de Shigella mais frequentemente encontrados foram S. flexneri (61,1 por cento) e S. sonnei (38,9 por cento). Entre as Salmonella, identificaram-se os seguintes sorotipos: S. Panama (2), S. Newport (2), S. Bredeney, S. Saintpaul e S. Gaminara. A infecção pelos protozoários alcançou 85,3 por cento tendo como principais responsáveis, por ordem de frequência, Blastocystis hominis (37,3 por cento), Entamoeba histolytica/E. dispar (22,8 por cento), Endolimax nana (16,7 por cento), Entamoeba coli (9,5 por cento) e Giardia lamblia (8,4 por cento). Esses resultados fornecem valiosos subsídios à vigilância epidemiológica e ambiental, demonstrando as condições insatisfatórias de saneamento básico em que vive a população do Município.

With the aim of determining the frequency rate of enteropathogenic bacteria and enteroparasites in patients with acute diarrhea in the Municipality of Juruti, Pará State, which has been facing an intense migratory process due to a great mining project, we analyzed 263 cases of acute diarrhea. A total of 19 percent of those cases were related to enteropathogenic bacteria, particularly Shigella spp. that accounted for 13.7 percent of the cases. Salmonella spp, Aeromonas spp and Plesiomonas shigeloide were also detected. The most frequent Shigella serotypes found were S. flexneri (61.1 percent) and S. sonnei (38.9 percent). Among the Salmonella, we could observe the following serotypes: S. Panama (2), S. Newport (2), S. Bredeney, S. Saintpaul and S. Gaminara. The infection caused by protozoa reached 85.3 percent, mostly due to Blastocystis hominis (37.3 percent), Entamoeba histolytica/E. dispar (22.8 percent), Endolimax nana (16.7 percent), Entamoeba coli (9.5 percent) and Giardia lamblia (8.4 percent). These results provide valuable data to epidemiological and environmental surveillance because it presents the unsatisfactory basic sanitary conditions of the local population.

[Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. Report of one case]. / Sepsis neonatal precoz causada por transmisión vertical de Morganella morganii, en un embarazo de término.

We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother's lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the membranes.

Sepsis neonatal precoz causada por transmisión vertical de Morganella morganii, en un embarazo de término / Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. Report of one case

We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother's lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the membranes (RevMéd Chile 2009; 137: 1201-4).

[Morganella morganii and early-onset neonatal infection]. / Morganella morganii et infection maternofoetale.

UNLABELLED: Morganella morganii is an opportunistic gram-negative bacterium, resistant to ampicillin, and scarcely involved in early-onset neonatal sepsis. CASE REPORT: After a premature rupture of the membranes, a pregnant patient received prophylactic amoxicillin per os. She developed chorioamnionitis. Her infant was diagnosed with early-onset sepsis. Maternal and baby's blood cultures grew M. morganii. Both the mother and the infant were successfully treated with a third-generation cephalosporin and an aminoglycoside. DISCUSSION: The influence of a prior antibiotherapy on the emergence of M. morganii vertical infections is discussed.

Phenotyping and genotyping methods applied to investigate the relatedness of Brazilian isolates of Enterobacter cloacae

In order to evaluate the resolving power of several typing methods to identify relatedness among Brazilian strains of Enterobacter cloacae, we selected twenty isolates from different patients on three wards of a University Hospital (Orthopedics, Nephrology, and Hematology). Traditional phenotyping methods applied to isolates included biotyping, antibiotic sensitivity, phage-typing, and O-serotyping. Plasmid profile analysis, ribotyping, and macrorestriction analysis by pulsed-field gel electrophoresis (PFGE) were used as genotyping methods. Sero- and phage-typing were not useful since the majority of isolates could not be subtyped by these methods. Biotyping, antibiogram and plasmid profile permitted us to classify the samples into different groups depending on the method used, and consequently were not reliable. Ribotyping and PFGE were significantly correlated with the clinical epidemiological analysis. PFGE did not type strains containing nonspecific DNase. Ribotyping was the most discriminative method for typing Brazilian isolates of E. cloacae

Phenotyping and genotyping methods applied to investigate the relatedness of Brazilian isolates of Enterobacter cloacae.

In order to evaluate the resolving power of several typing methods to identify relatedness among Brazilian strains of Enterobacter cloacae, we selected twenty isolates from different patients on three wards of a University Hospital (Orthopedics, Nephrology, and Hematology). Traditional phenotyping methods applied to isolates included biotyping, antibiotic sensitivity, phage-typing, and O-serotyping. Plasmid profile analysis, ribotyping, and macrorestriction analysis by pulsed-field gel electrophoresis (PFGE) were used as genotyping methods. Sero- and phage-typing were not useful since the majority of isolates could not be subtyped by these methods. Biotyping, antibiogram and plasmid profile permitted us to classify the samples into different groups depending on the method used, and consequently were not reliable. Ribotyping and PFGE were significantly correlated with the clinical epidemiological analysis. PFGE did not type strains containing nonspecific DNase. Ribotyping was the most discriminative method for typing Brazilian isolates of E. cloacae.

Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial.

OBJECTIVE: To identify risk factors for polymicrobial bloodstream infections (BSIs) in neonatal intensive care unit (NICU) patients during an outbreak of BSIs. DESIGN: During an outbreak of BSIs, we conducted a retrospective cohort study, assessed NICU infection control practices and patient exposure to NICU healthcare workers (HCWs), and obtained cultures of the environment and HCW hands. PATIENTS: During the period May 3 to 7, 1996, 5 infants contracted BSIs caused by both Enterobacter cloacae and Pseudomonas aeruginosa, and one infant contracted a BSI caused by E cloacae only. For each pathogen, all isolates were identical on DNA typing. RESULTS: Infants exposed to the following were more likely than nonexposed infants to have BSI: umbilical venous catheters (6/14 vs 0/7, P = .05), total parenteral nutrition given simultaneously with a dextrose/electrolyte solution (6/12 vs 0/9, P = .02), or one HCW (5/7 vs 1/13, P = .007). Neither environmental nor HCW hand cultures yielded the outbreak pathogens. Quality control cultures of intravenous solution bags were negative. CONCLUSIONS: We speculate that a dextrose multidose vial became contaminated during manipulation or needle puncture and that successive use of this contaminated vial for multiple patients may have been responsible for BSIs. Aseptic techniques must be employed when multidose vial medications are used. Single-dose vials should be used for parenteral additives whenever possible to reduce the risk of extrinsic contamination and subsequent transmission of nosocomial pathogens.

Circulation flow of enteropathogenia bacteria in institutionalized children. I. An epidemiologic study

Durante o período de um ano (maio de 1982 - abril de 1983) avaliou-se a circulaçäo e manutençäo de bactérias enteropatogênicas, em populaçäo de menor institucionalizada e funcionários adultos contactantes, na cidade do Rio de Janeiro, Brasil. Foram constituídos três grupos: A e B incluíram, respectivamente, 104 e 46 crianças, portadoras de quadro diarréico, diferenciando-se pelo período de ingresso na instituiçäo, anterior (B) e durante (A) o período do estudo; o grupo C era composto de 82 adultos contactantes. Fontes de infecçäo parcialmente expressas pela positividade de coproculturas: 35,2% no grupo A, 39,1% no B e 19,7% nos adultos sadios, sugerem a potencialidade de outras vias de transmissäo representadas pelo ambiente com 30% de contaminaçäo fecal. Maior taxa de isolamento combinada a elevados títulos de anticorpos indicaram Escherichia coli (EPEC) como o agente prevalente, enquanto que na hemaglutinacäo passiva, Shigella predominou. Admite-se que a instituiçäo deve desempenhar um papel importante na epidemiologia e transmissäo de infecçöes entéricas para a comunidade

A nursery outbreak caused by Serratia marcescens--scalp-vein needles as a portal of entry.

Serratia marcescens rarely causes infections in newborn infants. We recently studied an epidemic caused by a multiply-resistant, serotype 014:H12 Serratia marcescens that involved 42 infants. Cutaneous abscesses at previous intravenous infusion sites occurred nine times, usually required surgical drainage, and were the most striking infections during the outbreak. Six infants developed Serratia bacteremia and two died with Serratia meningitis; 34 patients were colonized with Serratia but remained uninfected. An epidemiologic investigation of the 83 infants at risk in the nursery assessed factors predisposing them to colonization or infection with the epidemic organism. Colonization of the throat, umbilicus, gastrointestinal tract, or skin was frequent among infants as was carriage of Serratia on nursey employees' hands. Infected and colonized infants were the most important reservoir for Serratia in the nursery and cross-infection between infants readily occurred. Scalp-vein needles appeared to provide a portal of entry of Serratia in colonized infants, predisposing them to abscess formation and bacteremia.