RESUMO
An outbreak of extended-spectrum ß-lactamase-producing Enterobacter cloacae (ESBL-ECL) occurred in our intensive care unit (ICU) and involved 18 patients (8 infected and 10 colonized). The mean age of patients was 69 years, and all infected patients had underlying medical conditions. Within hours' recognition of the spread of ESBL-ECL, the infection control team requested for staff education, reinforcement of infection control measures, and environmental screening. New transmissions were observed in the institution after weeks of enhanced infection control measures. Microbial swabbing revealed bacterial contamination of some mattresses and syphons with epidemiologic links between environmental, screening, and clinical isolates. This outbreak resulted in the temporary closure of the ICU for complete biocleaning.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Enterobacter cloacae/enzimologia , Infecções por Enterobacteriaceae/epidemiologia , Microbiologia Ambiental , beta-Lactamases/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/microbiologia , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-IdadeAssuntos
Abscesso/microbiologia , Nocardiose/microbiologia , Nocardia/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Infecção dos Ferimentos/microbiologia , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana/métodos , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Joelho , Lincomicina/farmacologia , Pessoa de Meia-Idade , Nocardia/efeitos dos fármacos , Nocardiose/tratamento farmacológico , Nocardiose/epidemiologia , Pristinamicina/farmacologia , Reunião , Tela Subcutânea , Viagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecção dos Ferimentos/tratamento farmacológicoRESUMO
In a study performed in Cambodia, a higher number of tuberculosis (TB) strains with mutations in the pncA gene associated with pyrazinamide resistance (PZA-R) was found in fluoroquinolone-resistant (FQ-R) multidrug-resistant (MDR) strains (93%), compared with 47% in MDR and 3% in non-MDR strains. This emphasises the need for easy and rapid tests for identification of PZA-R for efficient treatment of MDR-TB.
Assuntos
Amidoidrolases/genética , DNA Bacteriano/genética , Fluoroquinolonas/uso terapêutico , Mutação , Mycobacterium tuberculosis/genética , Pirazinamida/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Antituberculosos/uso terapêutico , Camboja/epidemiologia , Genótipo , Humanos , Incidência , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
UNLABELLED: The monitoring of infection by glycopeptide-resistant enterococci (GRE) is one of the main elements of hospital hygiene policy. It involves systematic rectal swabs in clinics at risk (asymptomatic carriage). AIM: We compare two GRE screening methods and evaluate a new kit associating multiplex PCR and hybridization (Génotype(®) Enterococcus, Hain Lifescience) on a panel of 448 samples collected over a 4-month period. PATIENTS AND METHODS: The first method is based on direct inoculation of the sample; the second one involves a preliminary enrichment phase followed by molecular diagnosis allowing the identification of species of enterococci as well as glycopeptide resistance genes. RESULTS: All the resistant strains were isolated using the enrichment technique. The incidence of GRE (VanA) carriage was 0,55% (two out of 362 patients, two out of 448 isolates) with two Enterococcus faecium VanA. Six Enterococcus gallinarum VanC1 and two Enterococcus casseliflavus VanC2/C3 were also isolated and identified. The main clinics concerned are intensive care and hematology. The two patients with E. faecium VanA had been previously given glycopeptides for 10 days. For three strains, the molecular method allowed to correct prior erroneous results based on rapid identification (RapidID32Strep V2.0). CONCLUSION: The method using direct samples inoculation underestimates real incidence of GRE carriage. The performances of Génotype(®) Enterococcus molecular method, evaluated for other parameters using reference strains and DNA sequencing, offer new possibilities applicable to routine laboratory.
Assuntos
Antibacterianos/farmacologia , Técnicas Bacteriológicas , Portador Sadio/microbiologia , Farmacorresistência Bacteriana Múltipla , Enterococcus/isolamento & purificação , Glicopeptídeos/farmacologia , Infecções por Bactérias Gram-Positivas/microbiologia , Programas de Rastreamento/métodos , Kit de Reagentes para Diagnóstico , Idoso , Proteínas de Bactérias/genética , Carbono-Oxigênio Ligases/genética , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Enterococcus/classificação , Enterococcus/efeitos dos fármacos , Enterococcus/genética , Enterococcus/crescimento & desenvolvimento , Fezes/microbiologia , Feminino , França , Infecções por Bactérias Gram-Positivas/diagnóstico , Unidades Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Sintases/genética , Reto/microbiologia , Especificidade da Espécie , Vancomicina/farmacologia , Resistência a Vancomicina/genética , Adulto JovemRESUMO
Cellular morphology has a predominant place in diagnosis of hematological malignancies in spite of flow cytometry, cytogenetic and molecular biology progresses. CellaVisionDM8/96TM is automated microscope and image analysis software which are able to characterize white and red blood cells morphology and to perform platelets counts in peripheral blood smears. Validity of results is always submitted to the cytologist agreement. We routinely analyzed 99 peripheral blood smears, included 9 therapeutic cytopenias, stained with May-Grünwald-Giemsa. DM8/96TM is highly efficient in the cellular identification with great security of identity management and timesaving (30% faster than manual microscopy). Major innovations are the complete slides recording, efficiency on cytopenias processing, education functionalities and the networking ability.
