Brazilian Butt Lift Gone Wrong: A Case Series of Non-Tuberculous Mycobacterial Gluteal Infection After Brazilian Butt Lifts.

Cosmetic surgeries are very popular and glamorized by the mainstream media and celebrities. Many individuals perceive certain bodily features as appealing for physical attraction and will attempt to obtain these features by surgery. However, these surgeries are not without risk, and significant consequences can occur if not performed by qualified medical professionals under sterile procedures. The authors present novel cases of two healthy young female patients who underwent a Brazilian butt lift (BBL) procedure a week apart by the same plastic surgeon in Mexico and developed dark painful lesions secondary to Mycobacterium abscessus (M. abscessus), a multidrug-resistant non-tuberculous mycobacterium (NTM). The literature review shows a paucity of data concerning NTM infections via surgical procedures of this type. The first case was of a 31-year-old woman who underwent a BBL and presented with bilateral dark painful buttock lesions weeks later. The patient returned to the plastic surgeon, who drained some lesions and prescribed oral antibiotics. The patient's clinical status continued to deteriorate and presented to the hospital for further assessment. The patient was initially started on broad-spectrum antibiotic therapy. The patient was found to have an HIV infection with a relatively preserved CD4 lymphocyte count and was started on antiretroviral therapy (ART). Intraoperative excisional tissue sample cultures grew M. abscessus. The patient was started on empiric tigecycline, cefoxitin, and linezolid. Preliminary culture susceptibilities showed resistance to linezolid. Linezolid was discontinued, amikacin was started, and cefoxitin and tigecycline were continued. Tigecycline, cefoxitin, and amikacin were continued and final susceptibilities showed sensitivity to the current treatment. The patient received a total of four months of treatment with tigecycline, cefoxitin, and amikacin. The second case was of a 28-year-old woman who underwent a BBL a week after the first patient by the same surgeon and developed multiple gluteal and body abscesses. The patient underwent bilateral thigh and gluteal, right chest wall, and breast surgical debridements with intraoperative cultures at a different hospital facility, which grew M. abscessus. Susceptibilities were not performed there. The patient was transferred to our facility for further care. Intraoperative cultures remained negative, and the patient was treated with a six-month course of tigecycline, cefoxitin, and amikacin.

Theoretical and practical study of the cefoxitin-Escherichia coli PBP5 complex interaction by molecular dynamics to obtain computational prototype of antimicrobial susceptibility to Gram negative bacteria.

The penicillin-binding proteins (PBPs) are important biological target for new antibacterial drugs development. This study focused on molecular interaction between cefoxitin and the Escherichia coli PBP5 by molecular dynamics (MD) using hybrid quantum mechanics/molecular mechanics (QM/MM) simulations approach, searching to develop a computational simulations prototype method on antimicrobial susceptibility of gram-negative bacteria against antibiotics. Escherichia coliATCC 8739 strain susceptibility for the drugs used in the antimicrobial susceptibility testing and selection of bioactive molecules against resistant strain. The protonation revealed a deprotonate state for His146, His151, His216, and His320 residues. The complex was stabilized after 0.6 ns of MD simulation. The global interaction means for inhibition zone diameters of E. coliATCC8739 strain and cefoxitin were 24.33 mm no showing significant difference between computational and experimental methods. Our computational simulation method can reliably be performed as a molecular modeling prototype for gram-negative antimicrobial susceptibility testing bacteria.

Ceftaroline resistance in Staphylococcus pseudintermedius gene mecA carriers / Resistência à ceftarolina em Staphylococcus pseudintermedius portadores do gene mecA

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) being a constant concern, ceftaroline fosamil has been recently approved as a new cephalosporin, active against MRSA, for use in humans; only rare cases of resistance have been reported till date. There is no report of resistance to ceftaroline in Staphylococcus pseudintermedius, which is the main bacterium causing dermatitis and otitis in dogs. To evaluate staphylococcal resistance to ceftaroline, 35 isolates of methicillin-resistant S. pseudintermedius (MRSP), carrying the mecA gene, from 26 dogs with folliculitis and nine dogs with external otitis, underwent disk diffusion test with cefoxitin, oxacillin, and ceftaroline. Tests with cefoxitin and oxacillin showed > 90% sensitivity in methicillin resistance detection. In the disk diffusion test, 97.14% (34/35) were resistant to cefoxitin, 94.29% (33/35) to oxacillin, and 31.43% (11/35) to ceftaroline. Of the ceftaroline-resistant strains, 27.27% (3/11) were obtained from the ears of dogs while the rest (8/11) were from the skin. The current report is the first description of MRSP resistance to ceftaroline.(AU)

Infecções causadas por Staphylococcus aureus resistente à meticilina (MRSA) são uma preocupação médica constante. A ceftarolina fosamila é uma nova cefalosporina ativa contra Staphylococcus aureus resistente à meticilina recentemente aprovada para uso em humanos e raros casos de resistência relatados até agora. Não há relatos de resistência à ceftarolina em Staphylococcus pseudintermedius, principal bactéria causadora de dermatite e otite em cães. Com o objetivo de avaliar a resistência estafilocócica à ceftarolina, 35 amostras de S. pseudintermedius resistentes à meticilina (MRSP), portadoras do gene mecA, provenientes de 26 cães com foliculite e 9 com otite externa foram submetidos ao teste de disco-difusão com cefoxitina, oxacilina e ceftarolina. Os testes realizados com cefoxitina e oxacilina mostraram mais de 90% de sensibilidade na detecção da resistência à meticilina em ambas. No teste da disco-difusão, 97,14% (1/35) foram resistentes à cefoxitina, 94,29% (3/35) à oxacilina e 31,43% (11/35) à ceftarolina. Das cepas resistentes às ceftarolina, 27,27 (3/11) foram provenientes de ouvido de cães e as demais (8/11), provenientes da pele, sendo essa primeira descrição de resistência de MRSP à ceftarolina na literatura atual.(AU)

Ceftaroline resistance in Staphylococcus pseudintermedius gene mecA carriers / Resistência à ceftarolina em Staphylococcus pseudintermedius portadores do gene mecA

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) being a constant concern, ceftaroline fosamil has been recently approved as a new cephalosporin, active against MRSA, for use in humans; only rare cases of resistance have been reported till date. There is no report of resistance to ceftaroline in Staphylococcus pseudintermedius, which is the main bacterium causing dermatitis and otitis in dogs. To evaluate staphylococcal resistance to ceftaroline, 35 isolates of methicillin-resistant S. pseudintermedius (MRSP), carrying the mecA gene, from 26 dogs with folliculitis and nine dogs with external otitis, underwent disk diffusion test with cefoxitin, oxacillin, and ceftaroline. Tests with cefoxitin and oxacillin showed > 90% sensitivity in methicillin resistance detection. In the disk diffusion test, 97.14% (34/35) were resistant to cefoxitin, 94.29% (33/35) to oxacillin, and 31.43% (11/35) to ceftaroline. Of the ceftaroline-resistant strains, 27.27% (3/11) were obtained from the ears of dogs while the rest (8/11) were from the skin. The current report is the first description of MRSP resistance to ceftaroline.(AU)

Infecções causadas por Staphylococcus aureus resistente à meticilina (MRSA) são uma preocupação médica constante. A ceftarolina fosamila é uma nova cefalosporina ativa contra Staphylococcus aureus resistente à meticilina recentemente aprovada para uso em humanos e raros casos de resistência relatados até agora. Não há relatos de resistência à ceftarolina em Staphylococcus pseudintermedius, principal bactéria causadora de dermatite e otite em cães. Com o objetivo de avaliar a resistência estafilocócica à ceftarolina, 35 amostras de S. pseudintermedius resistentes à meticilina (MRSP), portadoras do gene mecA, provenientes de 26 cães com foliculite e 9 com otite externa foram submetidos ao teste de disco-difusão com cefoxitina, oxacilina e ceftarolina. Os testes realizados com cefoxitina e oxacilina mostraram mais de 90% de sensibilidade na detecção da resistência à meticilina em ambas. No teste da disco-difusão, 97,14% (1/35) foram resistentes à cefoxitina, 94,29% (3/35) à oxacilina e 31,43% (11/35) à ceftarolina. Das cepas resistentes às ceftarolina, 27,27 (3/11) foram provenientes de ouvido de cães e as demais (8/11), provenientes da pele, sendo essa primeira descrição de resistência de MRSP à ceftarolina na literatura atual.(AU)

Staphylococcus aureus y estafilococo coagulasa negativa resistentes a la meticilina / Staphylococcus aureus and negative coagulase staphylococcus resistant to methicillin

Se realizó un estudio prospectivo de 47 cepas de estafilococo procedentes de muestras biológicas del Laboratorio de Microbiología del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, desde febrero hasta abril de 2017, con vistas a determinar la frecuencia de estafilococos resistentes a la meticilina. En la serie, el mayor número de los aislamientos correspondió a las muestras de secreciones y catéter; asimismo, los servicios con mayores aislamientos notificados fueron Ortopedia y Cirugía. Se observó una frecuencia elevada de cepas de Staphylococcus aureus y estafilococo coagulasa negativa, resistentes a meticilina

A prospective study of 47 staphylococcus stumps coming from biological samples of the Microbiology Laboratory in Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from February to April, 2017, aimed at determining the frequency of staphylococcus resistant to methicillin. In the series, the highest number of isolations corresponded to the samples of secretions and catheter; also, the services with more notified isolations were Orthopedics and Surgery. A high frequency of Staphylococcus aureus stumps and negative coagulase staphylococcus resistant to methicillin was observed

Tipificación SARM en trabajadores asistenciales de las unidades de cuidados intensivos en una institución hospitalari / MRSA Typing in health care workers from intensive care units of a Hospital Institution

Objetivo. Caracterizar microbiológicamente SARM en trabajadores asistenciales de las Unidades de Cuidados Intensivos en una institución hospitalaria de la ciudad de Montería. Materiales y métodos. Se realizó un estudio descriptivo longitudinal, en 52 trabajadores de dos unidades de cuidado intensivo; se tomaron hisopados nasales y faríngeos a cada individuo, con una periodicidad de 15 días/cinco meses. Mediante pruebas convencionales como fermentación de manitol, catalasa y coagulasa se realizó la identificación de S. aureus, con el disco de cefoxitín por Kirby- Bauer se evaluó la resistencia a Meticilina mediada por el gen mecA; antibióticos como Vancomicina, Eritromicina y Clindamicina fueron evaluados por esta prueba y confirmados por MicroScan ®. Resultados. se obtuvieron 88 aislamientos de S. aureus y 21 aislamientos SARM, una prevalencia de portación de SARM del 25%. El 90,5 % de las cepas de SARM fueron recuperadas de la faringe, en mayor proporción (50%) en el personal de enfermería. Conclusiones. La evidencia de su circulación de SARM en el personal asistencial dentro de una institución hospital, genera una alerta que le permite a la misma establecer políticas de contención para evitar la diseminación de estas cepas y evitar la aparición de brotes o infecciones hospitalarias asociadas a este patógeno.

Objective. To characterize microbiologically MRSA in health care workers of the Intensive Care Units at a hospital institution in the city of Montería. Materials and methods. A longitudinal descriptive study was carried out in 52 workers from two intensive care units; nasal and pharyngeal swabs were taken from each individual, with a periodicity of 15 days / five months. Examined through microbiological methods such as fermentation of mannitol, catalase and coagulase the identification of S. aureus was performed, with the cefoxitin disc by Kirby-Bauer disc-diffusion method the methicillin resistance mediated by the mecA gene was evaluated; antibiotics such as Vancomycin, Erythromycin and Clindamycin were evaluated by this test and confirmed by MicroScan ®. Results. we obtained 88 isolates of Staphylococcus aureus and 21 MRSA, a prevalence of MRSA of 25%. 90.5% of strains Of SARM were recovered from the pharynx, in a greater proportion (50%) in nursing staff. Conclusions. Evidence of MRSA circulation in care staff within a hospital institution generates an alert that allows it to establish containment policies to avoid the dissemination of these strains and to avoid the appearance of outbreaks or hospital infections associated with this pathogen.

Study of variables involved in hospital-acquired urinary tract infections at a university hospital / Estudo de variáveis envolvidas em infecção do trato urinário nosocomiais em um hospital universitário

OBJECTIVE: Analyze bacteria involved in urinary tract nosocomial infections (UTIs), their sensitivity profile, and other correlated clinical variables. METHODS: This was a retrospective study, based on the analysis of positive urine culture reports (from100,000CFU/ml) for nosocomial infection covering the years 2009, 2010 and 2011, and on medical records. Statistical analysis was performed through SPSS 19.0 software, using chi-square tests with Yates correction and Pearson's correlation coefficient. p<0.05 was considered statistically significant. RESULTS: The sample consisted of 74 positive urine cultures, 64.9% of which from females, and 58.1% of which from patients above 50 years of age. Medical conditions accounted for 87.8% of cases, and nervous and gastrointestinal problems were the most prevalent. Hospital stay ranged from 56.7±35.7 days; 51.4% of the patients used indwelling urinary catheter, 54% of whom over a 30 day period. Klebsielle pneumoniae and Escherichia coli together accounted for 60.8% of cases. Amikacin, Gentamicin, Cefoxitin, Piperacillin-tazobactam, Imipem, Meropenem and Ertapenem showed ≥50% sensitivity. There were correlations between symptoms associated to UTI and antibiotic use after urine culture (p=0.02), and catheter use and duration of hospital stay (p=0.04). CONCLUSIONS: Female patients over 50 years of age with underlying clinical conditions originated in the nervous system or the gastrointestinal apparatus making use of indwelling urinary catheters for over 30 days and a hospital stay period of 56.7±35.7 days are more likely to develop nosocomial UTIs. Amikacin, Gentamycin and Cefoxitin are feasible options for empirical antibiotic therapy against the two most prevalent bacteria.

OBJETIVO: Analisar as bactérias envolvidas nas infecções do trato urinário (ITUs) nosocomiais, perfil de sensibilidade, e outras variáveis clínicas correlacionadas. MÉTODOS: Estudo retrospectivo, com base na análise dos laudos de urocultura positiva (a partir de 100 mil UFC/ml) para infecção nosocomial abrangendo os anos 2009, 2010 e 2011, em prontuários médicos. A análise estatística foi realizada no SPSS 19.0, utilizando os testes do qui-quadrado com correção de Yates e coeficiente de correlação de Pearson. Considerou-se estatisticamente significativo p<0,05. RESULTADOS: A amostra constitui-se de 74 uroculturas positivas, sendo 64,9% do sexo feminino, com 58,1% acima de 50 anos. As patologias clínicas corresponderam a 87,8% dos casos, sendo sistema nervoso e gastrointestinal os de maiores prevalências. Tempo de permanência hospitalar foi de 56,7±35,7 dias, 51,4% fizeram uso de SVD, sendo 54% destes com uso acima de 30 dias. As bactérias Klebsielle pneumoniae e Escherichia coli representaram juntas 60,8% dos casos. Os antibióticos Amicacina, Gentamicina, Cefoxitina, Piperaciclina-tazobactam, Imipem, Meropenem e Ertapenem apresentaram sensibilidade ≥50%. Houve correlação entre sintomas associados à ITU e uso de antibiótico após urocultura (p=0,02); tempo de uso de sonda e tempo de permanência hospitalar (p=0,04). CONCLUSÕES: Pacientes femininos com mais de 50 anos e doença de base clínica, de origem no sistema nervoso ou gastrointestinal, em uso de SVD por mais de 30 dias e tempo de permanência hospitalar de 56,7±35,7 dias, estão entre as mais propensas a desenvolverem ITU nosocomial. A Amicacina, Gentamicina e Cefoxitina apresentaram opções factíveis para a antibioticoterapia empírica as duas bactérias mais prevalentes.

Frecuencia de aislamiento de Staphylococcus aureus resistente a meticillina en el Hospital Manuel Fajardo Rivero / Frequency of isolation of methicillin resistant Staphylococcus aureus in Manuel Fajardo Rivero hospital

Introducción: el Staphylococcus aureus constituye uno de los gérmenes patógenos más importantes desde el punto de vista clínico, tanto por el amplio espectro de infecciones que produce, como por la gran resistencia antimicrobiana que ha desarrollado, en especial las cepas resistentes a meticillina (MRSA), que además de portar resistencia a todos los betalactámicos, tienen genes de resistencia múltiples a otros antimicrobianos. Objetivo: caracterización epidemiológica de los aislamientos de MRSA realizados en pacientes ingresados en el Hospital Manuel Fajardo. Material y Métodos: se realizó un estudio retrospectivo en pacientes ingresados en el Hospital Comandante Manuel Fajardo, en el período comprendido entre el 1ro de junio y el 31 de diciembre de 2012. Resultados: a pesar de que en casi un cuarto de los aislamientos de S. aureus no se empleó el disco de cefoxitina como marcador de resistencia, se pudo comprobar una alta incidencia de MRSA en el tiempo estudiado. La gran mayoría de los aislamientos provino de heridas o abscesos, seguida a gran distancia por los hemocultivos. En correspondencia con esto, los servicios que mayores aislamientos reportaron fueron Dermatología y Angiología. Además de la vancomicina, los antimicrobianos a los que se halló mayor sensibilidad fueron amikacina, cloranfenicol, tetraciclina y ciprofloxacino. Conclusiones: las cepas MRSA son un problema internacional y una realidad en nuestro hospital, que deben ser identificadas para realizar un adecuado diagnóstico y tratamiento(AU)

Introduction: Staphylococcus aureus is one of the most important pathogens in the clinical setting, both for the broad spectrum of infections it causes and the increasing antibiotic resistance. Special attention is regarded to methicillin-resistant clones (MRSA), which provide not only resistance to all beta-lactamic agents, but carry multiple resistance genes. Objective: to characterize epidemiologically MRSA isolations in patients hospitalized in Comandante Manuel Fajardo hospital in the time period between the 1st of June and December 31st, 2012. Material and Methods: a retrospective study was performed between the 1st of June and December 31st, 2012, which included patients admitted in the hospital during that time in which at least 1 isolation of MRSA was made. Methillicin resistance was determined by using 30 µg cefoxitin discs. Results: although it was not possible to use cefoxitin discs as resistance marker in about a quarter of total S. aureus isolations, a high incidence of MRSA was found (64,2 percent). The vast majority of isolations came from skin and soft tissues infection. Angiology and Dermatology services had 60,0 percent of isolations. The greatest antimicrobial sensitivity was for vancomycin, amikacin, chloramphenicol, tetracycline and ciprofloxacin. Conclusions: MRSA clones are both an international problem and a reality in our hospital; they must be properly identified in order to start the right treatment(AU)

Comparison of cefoxitin disk diffusion test and mecA gene PCR results for methicillin resistance detection in Staphylococcus intermedius group isolates from canine origin in Brazil.

The study evaluated cefoxitin disk diffusion tests breakpoints and their correlation to mecA gene PCR results for detecting Methicillin-resistant Staphylococcus intermedius Group (MRSP) isolates from dogs in Brazil. Agreement using proposed breakpoint (resistant ≤ 30 mm) was encouraging. The current study reinforces that an epidemiological breakpoint can be established to predict presence of MRSP.

Comparison of cefoxitin disk diffusion test and mecA gene PCR results for methicillin resistance detection in Staphylococcus intermedius group isolates from canine origin in Brazil

The study evaluated cefoxitin disk diffusion tests breakpoints and their correlation to mecA gene PCR results for detecting Methicillin-resistant Staphylococcus intermedius Group (MRSP) isolates from dogs in Brazil. Agreement using proposed breakpoint (resistant < 30 mm) was encouraging. The current study reinforces that an epidemiological breakpoint can be established to predict presence of MRSP.(AU)

Comparison of cefoxitin disk diffusion test and mecA gene PCR results for methicillin resistance detection in Staphylococcus intermedius group isolates from canine origin in Brazil

The study evaluated cefoxitin disk diffusion tests breakpoints and their correlation to mecA gene PCR results for detecting Methicillin-resistant Staphylococcus intermedius Group (MRSP) isolates from dogs in Brazil. Agreement using proposed breakpoint (resistant < 30 mm) was encouraging. The current study reinforces that an epidemiological breakpoint can be established to predict presence of MRSP.

Comparison of five methods for oxacillin susceptibility testing of Staphylococcus aureus isolates from cystic fibrosis patients / Comparação entre cinco métodos para avaliação de susceptibilidade à oxacilina em cepas de Staphylococcus aureus isoladas de pacientes com fibrose cística

Methicillin-resistant Staphylococcus aureus (MRSA) are now a worldwide problem. Cystic fibrosis (CF) patients are commonly colonized and infected by MRSA. Accurate oxacillin susceptibility testing is mandatory for the adequate management of these patients. We performed a comparison of the accuracy of different tests in CF isolates, including methicillin-susceptible S. aureus and MRSA with different SCCmec types, and using the mecA gene as the gold-standard. The sensitivity and specificity of oxacillin disc, Etest, and oxacillin agar screening plate were 100%. Sensitivity of the cefoxitin disc was 85% and specificity was 100%. For clinically relevant isolates, laboratories may consider the use of a combination of two phenotypic methods.

Staphylococcus aureus resistentes à oxacilina (MRSA) são, atualmente, um problema global. Pacientes com fibrose cística (FC) são frequentemente colonizados e infectados por MRSA. A realização de testes de susceptibilidade acurados é extremamente importante para o manejo da terapia antimicrobiana nesses indivíduos. Nesse estudo, realizamos comparação entre as acurácias de diversos testes de susceptibilidade à oxacilina, em cepas de S. aureus isoladas de pacientes com fibrose cística, tanto sensíveis como resistentes à oxacilina, com diferentes tipos de SCCmec, e utilizando a detecção do gene mecA como método padrão. A sensibilidade e a especificidade do disco de oxacilina, do Etest, e da placa de agar screening com oxacilina foram de 100%. A sensibilidade do disco de cefoxitina foi 85%, com especificidade de 100%. Em cepas clinicamente relevantes, a utilização combinada de mais de um método deveria ser considerada.

Staphylococcus lugdunensis: um olhar diferenciado no laboratório clínico / Staphylococcus lugdunensis: a different view in the clinical laboratory

Os estafilococos coagulase negativos (ECNs) são cocos Gram-positivos usualmente considerados contaminantes em laboratórios de microbiologia clínica. Apesar de pertencer a este grupo, Staphylococcus lugdunensis pode causar infecções complicadas, como endocardites, infecções de pele e tecidos moles, osteomielites, entre outras. Além da formação de biofilmes, apresenta patogenicidade similar ao Staphylococcus aureus. É um dos principais agentes causadores de endocardites, com taxa de mortalidade de até 70 por cento. Pode ser confundido com S. aureus quando se utilizam testes rápidos para sua identificação, como a pesquisa de clumping factor, no caso de teste de coagulase em lâmina, ou em testes de aglutinação direta em látex. Pode ser facilmente identificado por meio de provas bioquímicas acessíveis, como a presença de atividade da ornitina descarboxilase e pirrolidonil arilamidase (PYR). Apresenta sensibilidade à maioria dos agentes antimicrobianos, devendo ser pesquisada rotineiramente a presença de betalactamases e do gene mecA por meio de testes com cefalosporina cromogênica e suscetibilidade à cefoxitina, respectivamente. Convém salientar que os critérios interpretativos utilizados para avaliar a sensibilidade à cefoxitina são os mesmos preconizados para S. aureus e diferentes dos utilizados para os outros ECNs. Apesar de incomum, o S. lugdunensis é um patógeno com acentuada virulência que deve ser corretamente identificado, pois raramente poderá ser considerado contaminante quando isolado de sítios estéreis.

Coagulase-negatives staphylococci (CNS) are Gram-positives cocci commonly regarded as contaminants in clinical microbiology laboratories. Despite belonging to this group, Staphylococcus lugdunensis may cause complicated infections such as endocarditis, skin infections and soft tissue, osteomyelitis, among others. Apart from the formation of biofilms, it has pathogenic features similar to Staphylococcus aureus. It may be mistakenly identified as S. aureus when using rapid identification tests, such as clumping factor in slide coagulase or in agglutination latex tests. It is easily identified through available biochemical tests, such as the presence of ornithine decarboxylase and pyrrolidonyl arylamidase (PYR). It presents sensitivity to most antimicrobial agents. Furthermore, the presence of beta-lactamase and mecA gene should be routinely investigated by testing with chromogenic cephalosporin and cefoxitin susceptibility, respectively. It is convenient to highlight that the interpretative criteria used to evaluate cefoxitin sensitivity are the same recommended for S. aureus and different from those used for other CNS. Despite the fact it is atypical, S. lugdunensis is a virulent pathogen, which must be accurately identified insofar as it will rarely be deemed as a contaminant when isolated from sterile sites.

Bacteremias por Staphylococcus coagulase negativos oxacilina resistentes em um hospital escola na cidade de Santa Maria, Estado do Rio Grande do Sul / Oxacillin-resistant coagulase-negative Staphylococci bacteremia at a teaching hospital in Santa Maria, State of Rio Grande do Sul, Brazil

INTRODUÇÃO: Neste estudo, objetivou-se caracterizar a prevalência e o perfil de suscetibilidade de cepas de Staphylococcus coagulase negatives resistentes à oxacilina isoladas de culturas de sangue, em um hospital escola, localizado na Cidade de Santa Maria. Além disso, buscou-se comparar ao teste genotípico de referência, diferentes metodologias fenotípicas para a caracterização da resistência mediada pelo gene mecA. MÉTODOS: Após identificação (MicroScan® - Siemens), os isolados foram submetidos a testes de sensibilidade antimicrobiana a partir da difusão do disco e automação (MicroScan® - Siemens). A presença do gene mecA foi evidenciada através da técnica molecular de reação em cadeia da polimerase. RESULTADOS: A espécie prevalente foi Staphylococcus epidermidis (67 por cento). O gene mecA foi detectado em 90 por cento das cepas e conforme análise dos perfis de sensibilidade, observou-se um índice elevado de resistência a várias classes de antimicrobianos. Contudo, todos os isolados mostraram-se uniformemente sensíveis à vancomicina e tigeciclina. O disco de cefoxitina foi a metodologia fenotípica que melhor correlacionou-se com o padrão ouro. CONCLUSÕES: A análise da significância clínica de SCN isolados de hemoculturas e a detecção precisa da resistência à oxacilina representam fatores decisivos para a instituição correta da antibioticoterapia. Apesar da vancomicina constituir o tratamento usual na maioria dos hospitais brasileiros, tem a redução de seu emprego recomendada.

INTRODUCTION: This study aimed to characterize the prevalence and susceptibility profile to oxacillin-resistant Coagulase-negative Staphylococci strains isolated from blood cultures in a teaching hospital, located in Santa Maria, RS. In addition, different methodologies for phenotypic characterization of mecA-mediated oxacillin resistance were compared with genotypic reference testing. METHODS: After identification (MicroScan® - Siemens), the isolates were tested for antimicrobial sensitivity using disk diffusion and automation (MicroScan® - Siemens). The presence of mecA gene was identified by the polymerase chain reaction molecular technique. RESULTS: The most common species was Staphylococcus epidermidis (n=40, 67 percent). The mecA gene was detected in 54 (90 percent) strains, while analysis of the sensitivity profiles revealed a high rate of resistance to multiple classes of antimicrobial drugs. However, all isolates were uniformly sensitive to vancomycin and tigecycline. The cefoxitin disk was the phenotypic method that best correlated with the gold standard. CONCLUSIONS: Analysis of the clinical significance of CoNS isolated from hemocultures and the precise detection of oxacillin resistance represent decisive factors for the correct choice of antibiotic therapy. Although vancomycin constitutes the normal treatment in most Brazilian hospitals, reduction in its use is recommended.

Desenvolvimento e Caracterização de Nanopartículas de D, L-PLA contendo Cefoxitina / Development and Characterization of Cefoxitin Loaded D, L-PLA Nanoparticles

As nanopartículas de D, L-PLA (PLA) contendo cefoxitina (CEF) foram preparadas pelo método de emulsão múltipla / evaporação do solvente. As partículas foram avaliadas em relação à morfologia, à eficiência de encapsulação, às interações polímero-fármaco, bem como à cinética de liberação do fármaco in vitro . As nanopartículas são esféricas e isoladas, com um diâmetro médio de cerca de 600 nm. O comportamento térmico (DSC) das nanopartículas contendo CEF sugeriu que o fármaco está disperso em um nível molecular dentro do sistema. A eficiência de encapsulação do fármaco no sistema quando a concentração de CEF é 30 mg / mL foi de 5,5%, determinada após a extração de fármaco, através de um método de HPLC validado. Esta baixa eficiência de encapsulação é compreensível, uma vez que a CEF é altamente hidrofílica. Os ensaios in vitro mostraram um perfil de liberação do fármaco a partir das nanopartículas fortemente sustentado e com uma cinética de difusão Fickiana pura.

Nanoparticles containing cefoxitin (CEF) made of D,L-PLA (PLA) were designed by a multiple emulsion/solvent evaporation method. The particles were extensively evaluated in relation to morphology, encapsulation efficiency, drug-polymer interactions as well as in vitro drug release kinetics. Nanoparticles were spherical in shape and isolated, with a mean diameter of about 600 nm. The thermal behaviour (DSC) of CEF-containing nanoparticles suggested that the drug was dispersed at a molecular level within the system. The drug encapsulation efficiency in the system for a CEF concentration of 30 mg/mL was 5.5%, as assessed after the drug extraction, by a validated HPLC method. This low encapsulation efficiency is understandable, since CEF is highly hydrophilic. The in vitro assays showed a strong sustained drug release profile from the nanoparticles with kinetics following pure Fickian diffusion.

Avaliação de métodos comumente usados em laboratórios para a determinação da suscetibilidade à oxacilina entre amostras de Staphylococcus sp, isoladas de um hospital de Vitória, Estado do Espírito Santo / Evaluation of methods commonly used in laboratories to determine the susceptibility to oxacillin among Staphylococcus sp samples isolated from a hospital in Vitória, State of Espírito Santo

INTRODUÇÃO: O gênero Staphylococcus é de grande importância devido a sua alta prevalência em infecções hospitalares e por apresentar taxas elevadas de resistência a oxacilina e a outros antimicrobianos. Assim, a avaliação da acurácia dos métodos fenotípicos usados para determinação do perfil de suscetibilidade a antimicrobianos é essencial para garantir a escolha da terapia mais adequada. MÉTODOS: Foram usadas 114 amostras de Staphylococcus sp (53 S. aureus e 61 SCN) na avaliação da acurácia dos métodos de difusão de disco, microdiluição em agar, ágar triagem oxacilina e sistema automatizado em comparação com a PCR para verificação da resistência a oxacilina. RESULTADOS: O gene mecA foi detectado em 48 (42,1 por cento) amostras e 27 (23,7 por cento) amostras apresentaram discrepância de resultados em pelo menos um dos métodos (74,1 por cento SCN, 25,9 por cento S. aureus). Para S. aureus, com exceção do Microscan Walkaway, todos os métodos apresentaram 100 por cento de especificidade e sensibilidade. Já para os SCN, o sistema automatizado e o disco de cefoxitina apresentaram menor acurácia. CONCLUSÕES: O uso de dois métodos deve ser a melhor opção para a melhora da acurácia, principalmente quando o laboratório de diagnóstico utiliza somente sistema automatizado ou teste de difusão do disco de oxacilina. A associação destes métodos com outros apresentaram praticamente 100 por cento de sensibilidade e especificidade em nosso estudo.

INTRODUCTION: The genus Staphylococcus is of great importance because of its high prevalence in hospital infections and because it presents high rates of resistance to oxacillin and other antimicrobials. Thus, evaluation of the accuracy of the phenotypic methods that are used to determine the profile of antimicrobial resistance is essential to ensure that the most appropriate therapy is chosen. METHODS: One hundred and fourteen strains of Staphylococcus sp (53 S. aureus and 61 CNS) were used to evaluate the accuracy of the methods of disk diffusion, agar microdilution, oxacillin screening agar and automated systems, in comparison with PCR for investigating resistance to oxacillin. RESULTS: The mecA gene was detected in 48 strains (42.1 percent), and 27 strains (23.7 percent) showed discrepant results in at least one of the methods (74.1 percent of CNS, 25.9 percent of S. aureus). For S. aureus, with the exception of the Microscan Walkaway, all the methods showed 100 percent specificity and sensitivity. In relation to CNS, the automated system and cefoxitin disk had lower accuracy. CONCLUSIONS: Use of two methods should be the best option for improved accuracy, especially when the diagnostic laboratory only uses an automated system or oxacillin disk diffusion test. Combination of these methods with others presented almost 100 percent sensitivity and specificity in our study.

Evaluation of different methods for detecting methicillin resistance in staphylococcus aureus isolates in a university hospital located in the northeast of Brazil

Many methods have been described for the detection of methicillin-resistant Staphylococcus aureus (MRSA), but the heterogeneous expression of methicillin resistance affects the reliability of these methods. The aim of the present study was to evaluate some methods for detecting methicillin resistance in Staphylococcus aureus isolates in a university hospital located in the Northeast of Brazil. Among the isolates, 15 were methicillin-susceptible and 45 were methicillin-resistant, including low-level heterogeneous resistance strains. Both the 30 µg-cefoxitin disk and PBP2a test had 100 percent sensibility/specificity and appear to be good options for the detection of MRSA in the clinical laboratory.

Evaluation of different methods for detecting methicillin resistance in Staphylococcus aureus isolates in a university hospital located in the Northeast of Brazil.

Many methods have been described for the detection of methicillin-resistant Staphylococcus aureus (MRSA), but the heterogeneous expression of methicillin resistance affects the reliability of these methods. The aim of the present study was to evaluate some methods for detecting methicillin resistance in Staphylococcus aureus isolates in a university hospital located in the Northeast of Brazil. Among the isolates, 15 were methicillin-susceptible and 45 were methicillin-resistant, including low-level heterogeneous resistance strains. Both the 30 ηg-cefoxitin disk and PBP2a test had 100% sensibility/specificity and appear to be good options for the detection of MRSA in the clinical laboratory.

Evaluation of different methods for detecting methicillin resistance in Staphylococcus aureus isolates in a university hospital located in the Northeast of Brazil

Many methods have been described for the detection of methicillin-resistant Staphylococcus aureus (MRSA), but the heterogeneous expression of methicillin resistance affects the reliability of these methods. The aim of the present study was to evaluate some methods for detecting methicillin resistance in Staphylococcus aureus isolates in a university hospital located in the Northeast of Brazil. Among the isolates, 15 were methicillin-susceptible and 45 were methicillin-resistant, including low-level heterogeneous resistance strains. Both the 30 µg-cefoxitin disk and PBP2a test had 100% sensibility/specificity and appear to be good options for the detection of MRSA in the clinical laboratory.