[Clinical and microbiological study of catheter-associated urinary tract infections in internal medicine services of a Venezuelan university hospital]. / Estudio clínico y microbiológico de la infección urinaria asociada a catéter, en los servicios de medicina interna de un hospital universitario venezolano.

OBJECTIVES: To determine the clinical and microbiological characteristics of catheter-associated urinary tract infections (CA-UTI) in patients admitted to the Internal Medicine services of the Hospital Universitario de Los Andes (HULA), Mérida, Venezuela and to establish the clonal distribution of multi-resistant Enterobacteriaceae that produce this infection. MATERIALS AND METHODS: Seventy-three adult patients with bladder catheterization were studied between January and July 2015. The microbiological processing of the urine samples was performed using conventional and automatized methods. Extended- spectrum beta-lactamase (ESBL) and carbapenemase were detected phenotypically. Clonal classification was determined using repetitive element sequence-based PCR. RESULTS: A total of 53.4% of the patients were male, and the average age was 50.6 years. The average time the catheter remained in the patient was 10.9 ± 6.5 days and 54.8% of patients had positive urine cultures. Yeasts were the main etiological agent (44.7%), followed by enterobacteria (29.8%). Enterobacteria, Pseudomonas aeruginosa, and Acinetobacter baumannii produced ESBL and carbapenemase associated with other resistance markers. Two clonal groups were identified in multi-resistant Escherichia coli and Klebsiella pneumoniae strains that circulated in the shock trauma unit in the adult emergency department. CONCLUSIONS: The findings in this study show the need to adopt strict criteria justifying the use of bladder catheterization and its duration, as well as the implementation of programs to prevent and control the spread of multi-resistant bacterial clones in patients with CA-UTI in the HULA Internal Medicine department.

Estudio clínico y microbiológico de la infección urinaria asociada a catéter, en los servicios de medicina interna de un hospital universitario venezolano / Clinical and microbiological study of catheter-associated urinary tract infections in internal medicine services of a Venezuelan university hospital

RESUMEN Objetivos Determinar las características clínicas y microbiológicas de las infecciones del tracto urinario asociadas a catéter (ITUAC) en pacientes hospitalizados en los servicios de Medicina Interna del Hospital Universitario de Los Andes (HULA), Mérida, Venezuela y establecer la distribución clonal de Enterobacteriaceae multirresistentes productoras de esta infección. Materiales y métodos Se estudiaron 73 pacientes adultos con cateterismo vesical, durante enero a julio de 2015. El procesamiento microbiológico de las muestras de orina se realizó por métodos convencionales y automatizados. Las β-lactamasas de espectro extendido (BLEE) y carbapenemasas fueron detectadas fenotípicamente. La tipificación clonal se determinó por la amplificación de secuencias repetitivas por PCR. Resultados El 53,4% de los pacientes eran varones, con una edad media de 50,6 años. El promedio de permanencia del catéter fue de 10,9 + 6,5 días/paciente. El 54,8% de los pacientes tuvo urocultivos positivos. Las levaduras fueron el principal agente etiológico (44,7%), seguido por las enterobacterias (29,8%). Las enterobacterias, Pseudomonas aeruginosa y Acinetobacter baumannii produjeron BLEE y carbapenemasas asociadas a otros marcadores de resistencia. Dos grupos clonales fueron identificados en cepas de E. coli y K. pneumoniae multirresistentes, los cuales circularon en la unidad de trauma shock de la emergencia de adulto. Conclusiones Los hallazgos de este estudio permiten evidenciar la necesidad de adoptar estrictos criterios que justifiquen el uso del catéter vesical y la duración del mismo, así como el implementar programas para prevenir y controlar la diseminación de clonas bacterianas multirresistentes en pacientes con ITUAC en los servicios de medicina interna del HULA.

ABSTRACT Objectives To determine the clinical and microbiological characteristics of catheter-associated urinary tract infections (CA-UTI) in patients admitted to the Internal Medicine services of the Hospital Universitario de Los Andes (HULA), Mérida, Venezuela and to establish the clonal distribution of multi-resistant Enterobacteriaceae that produce this infection. Materials and Methods Seventy-three adult patients with bladder catheterization were studied between January and July 2015. The microbiological processing of the urine samples was performed using conventional and automatized methods. Extended- spectrum beta-lactamase (ESBL) and carbapenemase were detected phenotypically. Clonal classification was determined using repetitive element sequence-based PCR. Results A total of 53.4% of the patients were male, and the average age was 50.6 years. The average time the catheter remained in the patient was 10.9 ± 6.5 days and 54.8% of patients had positive urine cultures. Yeasts were the main etiological agent (44.7%), followed by enterobacteria (29.8%). Enterobacteria, Pseudomonas aeruginosa, and Acinetobacter baumannii produced ESBL and carbapenemase associated with other resistance markers. Two clonal groups were identified in multi-resistant Escherichia coli and Klebsiella pneumoniae strains that circulated in the shock trauma unit in the adult emergency department. Conclusions The findings in this study show the need to adopt strict criteria justifying the use of bladder catheterization and its duration, as well as the implementation of programs to prevent and control the spread of multi-resistant bacterial clones in patients with CA-UTI in the HULA Internal Medicine department.

Nosocomial outbreak of extended-spectrum ß-lactamase-producing Enterobacter ludwigii co-harbouring CTX-M-8, SHV-12 and TEM-15 in a neonatal intensive care unit in Venezuela.

Enterobacter spp. have emerged as an important group of pathogens linked to outbreaks in neonatal intensive care units (NICUs), usually involving strains expressing extended-spectrum ß-lactamases (ESBLs). The aim of this study was to describe the first nosocomial bloodstream infection outbreak caused by Enterobacter ludwigii co-harbouring CTX-M-8, SHV-12 and TEM-15 in a NICU in a Venezuelan hospital. Initial bacterial identification was achieved by VITEK®2 system and matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (VITEK® MS) and was subsequently confirmed by nucleotide sequencing of the 16S rDNA gene and hsp60 genotyping. Antimicrobial susceptibility testing was determined by AST-GN-299 VITEK®2 system cards and Etest strips. Isolates were typed by repetitive element sequence-based PCR (rep-PCR). Detection of blaESBL genes was carried out by molecular methods. Plasmid analysis included Southern blot and restriction pattern analysis, with transferability of resistance genes being assessed by conjugation. ESBL-producing E. ludwigii isolates were recovered from three neonates with bloodstream infection from the NICU in a 21-day period. rep-PCR fingerprints were indistinguishable among all of the isolates, strongly suggesting spread of a clonal strain. All isolates carried an ca. 56kb conjugative plasmid harbouring the blaCTX-M-8, blaSHV-12 and blaTEM-15 genes. Considering that isolation of ESBL-producing E. ludwigii remains an unusual phenomenon, not previously reported in Venezuela, the results of this study reveal the potential role of E. ludwigii as an emerging pathogen and highlight the importance of microbiological surveillance and judicious antibiotic use as measures to curb the emergence and spread of ESBL-producing bacteria.

Investigación de blastocystis sp. en agua de consumo humano en una población escolar de la zona rural del estado Mérida, Venezuela / Blastocystis sp. in drinking water at a rural school in Mérida, Venezuela

Para detectar la presencia de Blastocystis sp. en el agua de consumo de una escuela rural del estado Mérida, se recolectaron 36 muestras provenientes de la fuente natural que surte el tanque de distribución, del tanque y de los grifos, durante los meses de Septiembre 2008, Febrero y Diciembre del 2009 y Mayo 2010. El procesamiento de las muestras se realizó siguiendo la técnica propuesta por Suresh y col. (2005). Los resultados sugieren que el agua de consumo estaba exenta de Blastocystis o que la cantidad de quistes viables presentes en las muestras fue muy baja, lo que no permitió lograr la recuperación del parásito en el cultivo. Por ello se requiere el uso de técnicas más sensibles que permitan detectar cantidades bajas del microorganismo en aguas de consumo humano. El estudio de los hábitos de consumo de agua de la población estudiantil de la escuela rural, mostró que más de la mitad de la población consume agua hervida, esto probablemente se deba a que están conscientes que el agua a la cual tienen acceso proviene de una fuente natural no tratada

In order to determine the presence of Blastocystis sp. in drinking water at a rural school in Merida, 36 water samples were collected from natural sources that feed the distribution tank and faucets during the months of September, 2008, February and December, 2009, and May, 2010. Samples were processed using the technique proposed by Suresh et al. (2005). All samples were negative. These results suggest that the water was exempt from Blastocystis or that the quantity of viable cysts present in the samples was very low, not permitting reproduction in the culture. This report suggests the importance of using more sensitive techniques to detect low amounts of the organismin drinking water. The study of student water consumption habits at the rural school showed that more than half the population consume boiled water; probably, they are aware that the water source has not been treated for drinking

Campilobacterias termotolerantes como causa de enfermedad diarreica aguda (EDA) en niños merideños / Thermophilic compilobacters as cause of acute diarrheal disease (ADD) in merideños childrens

Con la finalidad de conocer algunas características epidemiológicas, clínicas y microbiológicas de las campilobacterias termotolerantes asociados a la EDA, en niños menores de 5 años, se analizaron 397 muestras de heces de niños con diarrea y 121 de niños asintomáticos como grupo control, procedentes del Instituto Autónomo Hospital Universitario de Los Andes, Mérida, Venezuela, entre junio de 1993 y diciembre de 1994. Campylobacter se aisló en el medio sin sangre Preston modificado, con cefoperazona (32 mg/Lt), la identificación se realizó por métodos descritos. Compylobacter se encontró en 47 casos de diarrea (11.83 por ciento) y 10 controles (8.26 por ciento). En 53.19 por ciento de los casos de diarrea se aisló como patógeno único, y el mayor porcentaje de asociación fue con ratavirus (23.40 por ciento). En los casos con diarrea el 51.29 por ciento correspondió a C. jejuni subsp. jejuni, 33.33 por ciento a C. coli y 15.38 por ciento C. lari. Campylobacter se aisló con mayor frecuencia a partir de las heces de los niños con diarrea y edades comprendidas entre 0-24 meses. La distribución según el sexo fue similar en los niños con campylobacter como patógeno único. El mayor número de casos en ambos grupos de estudio se registró en el período de lluvia (abril-octubre). Campylobacter es un importante agente productor de diarrea en niños menores de 5 años, que debe ser investigado de forma rutinaria en el coprocultivo