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1.
Sci Rep ; 11(1): 12703, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135459

RESUMO

Secondary bacterial infections are a potentially fatal complication of influenza infection. We aimed to define the impact of secondary bacterial infections on the clinical course and mortality in coronavirus disease 2019 (COVID-19) patients by comparison with influenza patients. COVID-19 (n = 642) and influenza (n = 742) patients, admitted to a large tertiary center in Israel and for whom blood or sputum culture had been taken were selected for this study. Bacterial culture results, clinical parameters, and death rates were compared. COVID-19 patients had higher rates of bacterial infections than influenza patients (12.6% vs. 8.7%). Notably, the time from admission to bacterial growth was longer in COVID-19 compared to influenza patients (4 (1-8) vs. 1 (1-3) days). Late infections (> 48 h after admission) with gram-positive bacteria were more common in COVID-19 patients (28% vs. 9.5%). Secondary infection was associated with a higher risk of death in both patient groups 2.7-fold (1.22-5.83) for COVID-19, and 3.09-fold (1.11-7.38) for Influenza). The association with death remained significant upon adjustment to age and clinical parameters in COVID-19 but not in influenza infection. Secondary bacterial infection is a notable complication associated with worse outcomes in COVID-19 than influenza patients. Careful surveillance and prompt antibiotic treatment may benefit selected patients.


Assuntos
COVID-19/epidemiologia , COVID-19/mortalidade , Coinfecção/epidemiologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Vírus da Influenza A/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Pandemias , SARS-CoV-2/isolamento & purificação , Adulto , Idoso , COVID-19/virologia , Coinfecção/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Influenza Humana/virologia , Israel/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Estudos Retrospectivos
3.
BMC Infect Dis ; 21(1): 444, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001022

RESUMO

BACKGROUND: To investigate the trends and correlation between antibacterial consumption and carbapenem resistance in Gram-negative bacteria from 2012 to 2019 in a tertiary-care teaching hospital in southern China. METHODS: This retrospective study included data from hospital-wide inpatients collected between January 2012 and December 2019. Data on antibacterial consumption were expressed as defined daily doses (DDDs)/1000 patient-days. Antibacterials were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. The trends in antimicrobial usage and resistance were analyzed by linear regression, while Pearson correlation analysis was used for assessing correlations. RESULTS: An increasing trend in the annual consumption of tetracyclines, ß-lactam/ß-lactamase inhibitor (BL/BLI) combinations, and carbapenems was observed (P < 0.05). Carbapenem resistance in Acinetobacter baumannii (A. baumannii) significantly increased (P < 0.05) from 18% in 2012 to 60% in 2019. Moreover, significant positive correlations were found between resistance to carbapenems in A. baumannii (P < 0.05) and Escherichia coli (E. coli; P < 0.05) and consumption of carbapenems, while the resistance rate of A. baumannii to carbapenems was positively correlated with cephalosporin/ß-lactamase inhibitor (C/BLI) combinations (P < 0.01) and tetracyclines usage (P < 0.05). We also found that use of quinolones was positively correlated with the resistance rate of Burkholderia cepacia (B. cepacia) to carbapenems (P < 0.05), and increasing uses of carbapenems (P < 0.01) and penicillin/ß-Lactamase inhibitor (P/BLI) combinations (P < 0.01) were significantly correlated with reduced resistance of Enterobacter cloacae (E. cloacae) to carbapenems. CONCLUSION: These results revealed significant correlations between consumption of antibiotics and carbapenem resistance rates in Gram-negative bacteria. Implementing proper management strategies and reducing the unreasonable use of antibacterial drugs may be an effective measure to reduce the spread of carbapenem-resistant Gram-negative bacteria (CRGN), which should be confirmed by further studies.


Assuntos
Farmacorresistência Bacteriana , Bactérias Gram-Negativas/metabolismo , Infecções por Bactérias Gram-Negativas/diagnóstico , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Acinetobacter baumannii/metabolismo , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Burkholderia cepacia/efeitos dos fármacos , Burkholderia cepacia/isolamento & purificação , Burkholderia cepacia/metabolismo , Carbapenêmicos/farmacologia , Carbapenêmicos/uso terapêutico , Cefalosporinas/metabolismo , China , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Modelos Lineares , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Centros de Atenção Terciária , Tetraciclinas/metabolismo , Inibidores de beta-Lactamases/metabolismo
5.
BMC Infect Dis ; 21(1): 316, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33810788

RESUMO

BACKGROUND: Blood stream infection (BSI) and sepsis are serious clinical conditions and identification of the disease-causing pathogen is important for patient management. The RISE (Rapid Identification of SEpsis) study was carried out to collect a cohort allowing high-quality studies on different aspects of BSI and sepsis. The aim of this study was to identify patients at high risk for BSI who might benefit most from new, faster, etiological testing using neutrophil to lymphocyte count ratio (NLCR) and Shapiro score. METHODS: Adult patients (≥ 18 years) presenting at the emergency department (ED) with suspected BSI were prospectively included between 2014 and 2016 at Örebro University Hospital. Besides extra blood sampling, all study patients were treated according to ED routines. Electronic patient charts were retrospectively reviewed. A modified Shapiro score (MSS) and NLCR were extracted and compiled. Continuous score variables were analysed with area under receiver operator characteristics curves (AUC) to evaluate the ability of BSI prediction. RESULTS: The final cohort consisted of 484 patients where 84 (17%) had positive blood culture judged clinically significant. At optimal cut-offs, MSS (≥3 points) and NLCR (> 12) showed equal ability to predict BSI in the whole cohort (AUC 0.71/0.74; sensitivity 69%/67%; specificity 64%/68% respectively) and in a subgroup of 155 patients fulfilling Sepsis-3 criteria (AUC 0.71/0.66; sensitivity 81%/65%; specificity 46%/57% respectively). In BSI cases only predicted by NLCR> 12 the abundance of Gram-negative to Gram-positive pathogens (n = 13 to n = 4) differed significantly from those only predicted by MSS ≥3 p (n = 7 to n = 12 respectively) (p < 0.05). CONCLUSIONS: MSS and NLCR predicted BSI in the RISE cohort with similar cut-offs as shown in previous studies. Combining the MSS and NLCR did not increase the predictive performance. Differences in BSI prediction between MSS and NLCR regarding etiology need further evaluation.


Assuntos
Biomarcadores/sangue , Sepse/diagnóstico , Adulto , Idoso , Área Sob a Curva , Estudos de Coortes , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Linfócitos/citologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/citologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Sepse/microbiologia
6.
Int J Mol Sci ; 22(5)2021 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-33800916

RESUMO

Gut microbiota-derived metabolites, in particular short chain fatty acids (SCFAs) and their receptors, are linked to hypertension. Fructose and antibiotics are commonly used worldwide, and they have a negative impact on the gut microbiota. Our previous study revealed that maternal high-fructose (HF) diet-induced hypertension in adult offspring is relevant to altered gut microbiome and its metabolites. We, therefore, intended to examine whether minocycline administration during pregnancy and lactation may further affect blood pressure (BP) programmed by maternal HF intake via mediating gut microbiota and SCFAs. Pregnant Sprague-Dawley rats received a normal diet or diet containing 60% fructose throughout pregnancy and lactation periods. Additionally, pregnant dams received minocycline (50 mg/kg/day) via oral gavage or a vehicle during pregnancy and lactation periods. Four groups of male offspring were studied (n = 8 per group): normal diet (ND), high-fructose diet (HF), normal diet + minocycline (NDM), and HF + minocycline (HFM). Male offspring were killed at 12 weeks of age. We observed that the HF diet and minocycline administration, both individually and together, causes the elevation of BP in adult male offspring, while there is no synergistic effect between them. Four groups displayed distinct enterotypes. Minocycline treatment leads to an increase in the F/B ratio, but decreased abundance of genera Lactobacillus, Ruminococcus, and Odoribacter. Additionally, minocycline treatment decreases plasma acetic acid and butyric acid levels. Hypertension programmed by maternal HF diet plus minocycline exposure is related to the increased expression of several SCFA receptors. Moreover, minocycline- and HF-induced hypertension, individually or together, is associated with the aberrant activation of the renin-angiotensin system (RAS). Conclusively, our results provide a new insight into the support of gut microbiota and its metabolite SCAFs in the developmental programming of hypertension and cast new light on the role of RAS in this process, which will help prevent hypertension programmed by maternal high-fructose and antibiotic exposure.


Assuntos
Antibacterianos/toxicidade , Frutose/toxicidade , Microbioma Gastrointestinal/fisiologia , Hipertensão/microbiologia , Minociclina/toxicidade , Efeitos Tardios da Exposição Pré-Natal , Animais , Antibacterianos/administração & dosagem , Ácidos Graxos Voláteis/metabolismo , Feminino , Microbioma Gastrointestinal/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Negativas/metabolismo , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Bactérias Gram-Positivas/metabolismo , Hipertensão/etiologia , Rim/efeitos dos fármacos , Rim/metabolismo , Lactação , Masculino , Minociclina/administração & dosagem , Óxido Nítrico/metabolismo , Gravidez , Ratos , Ratos Sprague-Dawley , Receptores de Superfície Celular/biossíntese , Receptores de Superfície Celular/genética , Sistema Renina-Angiotensina/fisiologia
7.
Biomed Res Int ; 2021: 6614812, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33928150

RESUMO

Introduction: High mortality associated with carbapenemase-producing Gram-negative bacteria (CP-GNB) has evolved into a global health threat. Rapid and accurate detection as well as prompt treatment are of great significance in this case. Xpert Carba-R, a multiple qualitative analysis designed to detect five clinically relevant carbapenem-resistant gene families within one hour, is regarded as reliable, accurate, and easy-to-operate. This study is to present a systematic evaluation of the performance of Xpert Carba-R in detecting carbapenemase genes in GNB suspected for carbapenemase production. Methods: We searched and screened the literature on "Xpert Carba-R" in the database of PubMed, Web of Science, Embase, and Cochrane Library, employing two independent evaluators to collect data, respectively. Then, statistical analysis of the data obtained was performed by the Stata 12.0 software to measure the accuracy of Xpert Carba-R assay in detecting the carbapenemase genes in GNB. Results: We screened a total of 1767 Gram-negative bacillus isolates documented in 9 articles. The precision of the detection of OXA-48 carbapenemase genes was 100%; that of NDM = 100%; that of VIM = 100%. When it came to KPC, the precision rate was 100%; that of IMP = 99%. The overall accuracy of the detection of carbapenemase genes was 100%. Conclusions: Xpert Carba-R assay demonstrates a 100% precision in identifying carbapenemase genes in GNB. It can be seen that Xpert Carba-R method is an effective tool for early clinical detection, which is suitable for the detection of carbapenase gene in GNB.


Assuntos
Proteínas de Bactérias/genética , Ensaios Enzimáticos/métodos , Bactérias Gram-Negativas/enzimologia , Bactérias Gram-Negativas/genética , beta-Lactamases/genética , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Viés de Publicação , Especificidade da Espécie
8.
Tuberk Toraks ; 69(1): 9-20, 2021 Mar.
Artigo em Turco | MEDLINE | ID: mdl-33853301

RESUMO

Introduction: The patients in the intensive care unit have a higher risk of infections because of the poor general condition of these patients and the frequent application of invasive procedures with longer hospitalization length. Also, this group of patients tend to have resistant infections due to empirically widespread and uncontrolled use of broad-spectrum antibiotics. Hence, data are needed to determine appropriate empirical antibiotic therapy in intensive care patients. In this study, it was aimed to assess the distribution of microorganisms and antibiotic resistance profile from the samples taken from the patients in the intensive care unit. Materials and Methods: Patients who were hospitalized in Ankara University Faculty of Medicine Chest Diseases Intensive Care Unit for more than 24 hours between December 2016 and December 2017 were included in our study. Demographic characteristics, comorbid diseases, clinical findings, results of sputum, tracheal aspirate, blood, urine, gaita and pus culture samples and antibiotic susceptibility test results were recorded prospectively. Result: A total of 287 patients, 150 males and 137 females, were included in the study. The mean age of all patients was 69.96 ± 14.4 years. Two hundred twenty-three positive cultures were detected in 1053 samples taken from 287 patients. Gram-negative bacilli constituted 55.1% of the 223 positive cultures. The most common microorganisms were Acinetobacter (16.6%), Staphylococcus (14.8%) and Klebsiella (10.8%). Colistin resistance was found to be 8.3% in the Acinetobacter strains and resistance rates of 97-100% were observed to other antibiotic groups. Thirty-three staphylococcus were isolated, 17 were S. aureus and 16 were coagulase-negative Staphylococcus. While 29.4% of S. aureus were resistant to methicillin (MRSA), vancomycin resistance was not detected. Meanwhile, the MRSA ratio was 62.5%, there was no vancomycin resistance among the coagulase-negative Staphylococcus. Klebsiella was the third most common microorganism and beta-lactamase producing Klebsiella strain was 62.5%. Gentamycin was found to be the most susceptible antibiotic in Klebsiella strains with a resistance rate of 20.8%. Pseudomonas aeruginosa constituted 9.4% of the cultures. While the resistance to colistin was not detected, resistance to piperacillin/tazobactam 42.8%, tobramycin, imipenem and meropenem 50% and ceftazidime 61.9%. The duration of hospitalization in patients with Acinetobacter isolated (23 [10-34] days vs 12.5 [5-24] days, p= 0.011) and the mortality rate (62.5% vs 37.5%, p= 0.008) were significantly higher than those who were not Acinetobacter isolated. Conclusions: In conclusion, gram-negative bacilli constitute the majority of the patients in intensive care unit. Acinetobacter, the most common microorganism, has a high resistance rate and has been associated with prolonged hospitalization and mortality.


Assuntos
Antibacterianos/uso terapêutico , Cuidados Críticos/organização & administração , Farmacorresistência Bacteriana/efeitos dos fármacos , Resistência Microbiana a Medicamentos , Idoso , Idoso de 80 Anos ou mais , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pseudomonas aeruginosa/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação
9.
Expert Rev Clin Pharmacol ; 14(4): 513-522, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33691556

RESUMO

Background: Currently, colistin-resistant pathogens emerged has become a global health concern. This study assessed the distribution of mcr-1 to mcr-5 variants with the phenotypic colistin-resistance in bacterial isolates from urinary tract infection (UTI) patients in Bangladesh.Methods: A cross-sectional study was conducted between April 2017 and March 2018 to enroll uncomplicated UTI patients, and 142 urine samples were analyzed. Uropathogens were identified using the API-20E biochemical panel and 16s rRNA gene sequencing. Polymerase chain reactions detected the mcr gene variants in the UTI isolates. The phenotypic colistin-susceptibility was determined by the Kirby-Bauer disc-diffusion method and the minimal inhibitory concentration (MIC) measurement.Results: The combined carriage of mcr-1 and mcr-2 genes in 11.4% (14/123) of urinary tract pathogens. The mcr-positive pathogens include five Escherichia coli, three Klebsiella pneumoniae, three Pseudomonas putida, two Enterobacter cloacae, and one Enterobacter hormaechei. The mcr-positive variant showed significantly higher phenotypic colistin resistance with MIC between >16 µg/mL and >128 µg/mL (p< 0.001). Over 85% of colistin-resistant isolates showed MDR phenomena.Conclusions: The emergence of the clinical MDR pathogens with resistance to a highly selective drug may lead to a lack of treatment options for the infectious diseases and spread of infection to the unaffected cohorts.


Assuntos
Antibacterianos/farmacologia , Colistina/farmacologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Adolescente , Adulto , Idoso , Proteínas de Bactérias/genética , Bangladesh/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Bacteriana/genética , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/genética , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/microbiologia , Adulto Jovem
10.
Nat Microbiol ; 6(4): 512-523, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33782558

RESUMO

Antimicrobial resistance in neonatal sepsis is rising, yet mechanisms of resistance that often spread between species via mobile genetic elements, ultimately limiting treatments in low- and middle-income countries (LMICs), are poorly characterized. The Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) network was initiated to characterize the cause and burden of antimicrobial resistance in neonatal sepsis for seven LMICs in Africa and South Asia. A total of 36,285 neonates were enrolled in the BARNARDS study between November 2015 and December 2017, of whom 2,483 were diagnosed with culture-confirmed sepsis. Klebsiella pneumoniae (n = 258) was the main cause of neonatal sepsis, with Serratia marcescens (n = 151), Klebsiella michiganensis (n = 117), Escherichia coli (n = 75) and Enterobacter cloacae complex (n = 57) also detected. We present whole-genome sequencing, antimicrobial susceptibility and clinical data for 916 out of 1,038 neonatal sepsis isolates (97 isolates were not recovered from initial isolation at local sites). Enterobacterales (K. pneumoniae, E. coli and E. cloacae) harboured multiple cephalosporin and carbapenem resistance genes. All isolated pathogens were resistant to multiple antibiotic classes, including those used to treat neonatal sepsis. Intraspecies diversity of K. pneumoniae and E. coli indicated that multiple antibiotic-resistant lineages cause neonatal sepsis. Our results will underpin research towards better treatments for neonatal sepsis in LMICs.


Assuntos
Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/patogenicidade , Infecções por Bactérias Gram-Negativas/microbiologia , Sepse Neonatal/microbiologia , África/epidemiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Ásia/epidemiologia , Proteínas de Bactérias/genética , Países em Desenvolvimento , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla/genética , Variação Genética , Genoma Bacteriano/genética , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/genética , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/mortalidade , Humanos , Recém-Nascido , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/mortalidade , Filogenia , Plasmídeos/genética , beta-Lactamases/genética
11.
Emerg Infect Dis ; 27(4): 1234-1237, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33565961
12.
BMC Infect Dis ; 21(1): 227, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639862

RESUMO

BACKGROUND: Past respiratory viral epidemics suggest that bacterial infections impact clinical outcomes. There is minimal information on potential co-pathogens in patients with coronavirus disease-2019 (COVID-19) in the US. We analyzed pathogens, antimicrobial use, and healthcare utilization in hospitalized US patients with and without severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). METHODS: This multicenter retrospective study included patients with > 1 day of inpatient admission and discharge/death between March 1 and May 31, 2020 at 241 US acute care hospitals in the BD Insights Research Database. We assessed microbiological testing data, antimicrobial utilization in admitted patients with ≥24 h of antimicrobial therapy, and length of stay (LOS). RESULTS: A total of 141,621 patients were tested for SARS-CoV-2 (17,003 [12.0%] positive) and 449,339 patients were not tested. Most (> 90%) patients tested for SARS-CoV-2 had additional microbiologic testing performed compared with 41.9% of SARS-CoV-2-untested patients. Non-SARS-CoV-2 pathogen rates were 20.9% for SARS-CoV-2-positive patients compared with 21.3 and 27.9% for SARS-CoV-2-negative and -untested patients, respectively. Gram-negative bacteria were the most common pathogens (45.5, 44.1, and 43.5% for SARS-CoV-2-positive, -negative, and -untested patients). SARS-CoV-2-positive patients had higher rates of hospital-onset (versus admission-onset) non-SARS-CoV-2 pathogens compared with SARS-CoV-2-negative or -untested patients (42.4, 22.2, and 19.5%, respectively), more antimicrobial usage (68.0, 45.2, and 25.1% of patients), and longer hospital LOS (mean [standard deviation (SD)] of 8.6 [11.4], 5.1 [8.9], and 4.2 [8.0] days) and intensive care unit (ICU) LOS (mean [SD] of 7.8 [8.5], 3.6 [6.2], and 3.6 [5.9] days). For all groups, the presence of a non-SARS-CoV-2 pathogen was associated with increased hospital LOS (mean [SD] days for patients with versus without a non-SARS-CoV-2 pathogen: 13.7 [15.7] vs 7.3 [9.6] days for SARS-CoV-2-positive patients, 8.2 [11.5] vs 4.3 [7.9] days for SARS-CoV-2-negative patients, and 7.1 [11.0] vs 3.9 [7.4] days for SARS-CoV-2-untested patients). CONCLUSIONS: Despite similar rates of non-SARS-CoV-2 pathogens in SARS-CoV-2-positive, -negative, and -untested patients, SARS-CoV-2 was associated with higher rates of hospital-onset infections, greater antimicrobial usage, and extended hospital and ICU LOS. This finding highlights the heavy burden of the COVID-19 pandemic on healthcare systems and suggests possible opportunities for diagnostic and antimicrobial stewardship.


Assuntos
Anti-Infecciosos/uso terapêutico , COVID-19/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , SARS-CoV-2/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecção Hospitalar/microbiologia , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
J Hosp Infect ; 110: 165-171, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33561503

RESUMO

BACKGROUND: We investigated the clinical characteristics and risk factors for the isolation of multi-drug-resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients. METHODS: We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), with those with no MDR GNB isolates (controls). RESULTS: Seventy-eight cases were identified (4.5 per 1000 intensive care unit (ICU) days, 95% confidence interval (CI) 3.6-5.7). Of 98 MDR GNB isolates, the most frequent species were Stenotrophomonas maltophilia (24, 24.5%), and Klebsiella pneumoniae (23, 23.5%). Two (8.7%) K. pneumoniae, and six (85.7%) Pseudomonas aeruginosa isolates were carbapenem resistant. A total of 24 (24.5%) isolates were not considered to be associated with active infection. Those with active infection received appropriate antimicrobial agents within a median of one day. The case group had significantly longer median central venous line days, mechanical ventilation days, and hospital length of stay (P<0.001 for each). All-cause mortality at 28 days was not significantly different between the two groups (P=0.19). Mechanical ventilation days (adjusted odds ratio 1.062, 95% CI 1.012-1.114; P=0.015), but not receipt of corticosteroids or tocilizumab, was independently associated with the isolation of MDR GNB. There was no association between MDR GNB and 28-day all-cause mortality (adjusted odds ratio 2.426, 95% CI 0.833-7.069; P= 0.104). CONCLUSION: In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimizing the use of invasive devices, and to remove them as soon as their presence is no longer necessary.


Assuntos
COVID-19/epidemiologia , COVID-19/microbiologia , COVID-19/fisiopatologia , Estado Terminal , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Catar/epidemiologia , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
14.
Chem Biodivers ; 18(4): e2100046, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33636028

RESUMO

From arid, high desert soil samples collected near Bend, Oregon, 19 unique bacteria were isolated. Each strain was identified by 16S rRNA gene sequencing, and their organic extracts were tested for antibacterial and antiproliferative activities. Noteworthy, six extracts (30 %) exhibited strong inhibition resulting in less than 50 % cell proliferation in more than one cancer cell model, tested at 10 µg/mL. Principal component analysis (PCA) of LC/MS data revealed drastic differences in the metabolic profiles found in the organic extracts of these soil bacteria. In total, fourteen potent antibacterial and/or cytotoxic metabolites were isolated via bioactivity-guided fractionation, including two new natural products: a pyrazinone containing tetrapeptide and 7-methoxy-2,3-dimethyl-4H-chromen-4-one, as well as twelve known compounds: furanonaphthoquinone I, bafilomycin C1 and D, FD-594, oligomycin A, chloramphenicol, MY12-62A, rac-sclerone, isosclerone, tunicamycin VII, tunicamycin VIII, and (6S,16S)-anthrabenzoxocinone 1.264-C.


Assuntos
Antibacterianos/farmacologia , Antineoplásicos/farmacologia , Produtos Biológicos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Solo/química , Antibacterianos/química , Antibacterianos/metabolismo , Antineoplásicos/química , Antineoplásicos/metabolismo , Produtos Biológicos/química , Produtos Biológicos/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Bactérias Gram-Negativas/química , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/química , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Estrutura Molecular , Análise de Componente Principal , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Microbiologia do Solo
15.
Zhonghua Wai Ke Za Zhi ; 59(1): 24-31, 2021 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-33412630

RESUMO

Objective: To investigate the pathogens' distribution and antimicrobial resistance in the bile of acute biliary tract infection patients. Methods: The data of bile bacterial culture and drug sensitivity test of 223 acute biliary tract infection patients who underwent gallbladder puncture or endoscopic retrograde cholangiopancreatography drainage from July 2009 to July 2019 were analyzed retrospectively at Department of General Surgery,Xinhua Hospital,Affiliated to Shanghai Jiao Tong University School of Medicine.There were 141 males and 82 females with age of 67.3 years(range:28 to 93 years).Three to five milliliter of bile was extracted from each patient and sent to the laboratory for bacterial culture,identification and drug sensitivity test.The patients were divided into two groups according to the visiting time: the former group (n=124) was admitted from July 2009 to July 2014,and the latter group(n=99) was admitted from August 2014 to July 2019.The distribution of pathogenic bacteria and the changing trend of drug resistance rate of common bacteria in the two groups were compared.The results of drug sensitivity test were analyzed by WHONET software provided by WHO bacterial surveillance network.The drug resistance rates in different time periods were compared by χ2 test. Results: In this study,there were 147 cases of acute cholangitis and 76 cases of acute cholecystitis.A total of 376 strains of pathogenic bacteria were cultured.Among them,98 strains(26.1%) were gram-positive bacteria,269 strains(71.5%) were gram-negative bacteria and 9 strains(2.4%) were fungi.The top three gram-positive bacteria were Enterococcus faecium (49.0%,48/98),Enterococcus faecalis(20.4%,20/98),and Enterococcus luteus(7.1%,7/98).The top 5 gram-negative bacteria were Escherichia coli(33.5%,90/269),Klebsiella pneumoniae(13.8%,37/269),Pseudomonas aeruginosa(13.0%,35/269),Acinetobacter baumannii (12.6%,34/269),and Enterobacter cloacae(4.8%,13/269).From 2009 to 2019,there was no significant change in the proportion of gram-positive bacteria (former group vs. latter group: 25.3% vs. 28.2%) and gram-negative bacteria(former group vs.latter group: 74.7% vs. 71.8%) in the bile of patients with acute biliary tract infection.Gram-positive bacteria were mainly Enterococci(85.7%,84/98) and gram-negative bacteria were Escherichia coli(33.5%,90/269).Acinetobacter baumannii accounted for 7.8%(11/142) of gram-negative bacteria in the former group and 18.1%(23/127) in the latter group,an increase of 10.3% over previous five years.Pseudomonas aeruginosa had a downward trend,16.9% in the former group(24/142) and 8.7% in the latter group (11/127),the proportion decreased by 8.2%,and the other changes were not significant.The drug resistance rates of common gram-positive bacteria were relatively stable,and the drug resistance rates of Enterococcus faecium to many antibiotics were higher than those of Enterococcus faecalis.The resistance rates of gram-negative bacteria to most antibiotics showed an upward trend,among which Klebsiella pneumoniae showed an upward trend to most of antibiotics(former group: 0/15-4/13, latter group: 55.0%-70.0%; χ2=3.996-16.942, P=0.000-0.046).The drug resistance rates of Acinetobacter baumannii was generally higher,but there were no significant changes in the drug resistance rates of Acinetobacter baumannii between the two groups.The drug resistance rates of Pseudomonas aeruginosa to most antibiotics increased,and the overall drug resistance rates of Escherichia coli were stable and showed a slight upward trend. Conclusions: The main pathogens in bile of patients with acute biliary tract infection are gram-negative bacteria.The constituent ratio of various gram-negative bacteria had no significant change from 2009 to 2019,but the drug resistance rates shows an upward trend.Among the gram-negative bacteria, Escherichia coli is the most important pathogen,and the proportion has no significant change.The proportion of Acinetobacter baumannii in the former group was significantly higher than that in the former group.And the proportion of Pseudomonas aeruginosa has a decreased trend.


Assuntos
Bile/microbiologia , Sistema Biliar , Colangite , Colecistite Aguda/microbiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bile/efeitos dos fármacos , Sistema Biliar/microbiologia , China , Colangite/tratamento farmacológico , Colangite/microbiologia , Colangite/cirurgia , Colecistite Aguda/tratamento farmacológico , Colecistite Aguda/cirurgia , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/fisiologia , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Paracentese , Estudos Retrospectivos
16.
BMC Infect Dis ; 21(1): 66, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441088

RESUMO

BACKGROUND: Early detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis (a potentially fatal condition caused by the body's response to an infection), may benefit a patient's outcome, since the mortality rate increases by 5-10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on bacterial culture, which is time consuming. Therefore, an economic and effective GNB (defined as a positive blood, sputum, or urine culture) infection detection tool in the emergency department (ED) is warranted. METHODS: We conducted a retrospective cohort study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) bacterial culture from blood, sputum, or urine ordered and obtained in the ED. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via univariate logistic regression and receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The odds ratios of patients with body temperature ≥ 38.5 °C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, in predicting GNB infection were found to be 2.3, 1.4, 1.9, and 1.6, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively. CONCLUSION: The four physiological parameters were rapid and reliable independent predictors for detection of GNB infection.


Assuntos
Temperatura Corporal , Serviço Hospitalar de Emergência , Escala de Coma de Glasgow , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Frequência Cardíaca , Taxa Respiratória , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/microbiologia
17.
J Infect Public Health ; 14(2): 206-213, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33486377

RESUMO

AIMS: The emerging biliary colonization of microorganisms in patients with biliary diseases may be devastating. Recent evidence suggests that age and gender may influence changes in the microbial composition of gut microbiota. To study the relationship between these parameters on bile microbiota, we retrospectively reviewed positive bile cultures following an endoscopic retrograde cholangiopancreatography (ERCP) in a QA-certified academic surgical unit of a single institution. METHODS: 449 positive bile cultures from 172 Italian patients with diseases of the biliopancreatic system hospitalized from 2006 through 2017 were investigated for aerobic, anaerobic, and fungal organisms. The patients were stratified into four age intervals (22-66, 67-74, 75-81, and 82-93 years) and followed up for five years. RESULTS: Gram-positive bacteria (GPB) was negatively associated with age only in multivariate analysis (Rpartial = -0.114, p = 0.017), with younger patients prone to harbor GPB and older patients likely to have Gram-negative bacteria (GNB). There was a definite link with the male gender using both univariate and multivariate analysis (p < 0.001). Enterococcus spp. was the most common strain identified in patients with GPB except for patients aged 67-74 years for male (95.2%) and female (80.9%) patients. Escherichia coli and Klebsiella spp. were most frequent than others in every group analyzed. Analogous results were found for bacteria Non-fermenting Gram-negative bacilli (NFGNB), such as Pseudomonas spp. and Stenotrophomonas spp. apart of the 2nd quartile. CONCLUSIONS: Our study strengthens the bond of age and gender with bile microbiota composition and suggests that further investigations may be required in targeting the aging microbiome. Other studies should also focus on Mediterranean epidemiological characteristics and antibiotic resistance surveillance system strategies.


Assuntos
Bile/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Pacientes Internados/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Colangiopancreatografia Retrógrada Endoscópica , Estudos Transversais , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
18.
Arch Microbiol ; 203(4): 1471-1475, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33398401

RESUMO

Gram-negative bacteria are worrisome because they are becoming resistant to many antibiotic available options, mainly in hospital environment. Several studies have noted the presence of bacteria producing extended-spectrum beta-lactamase, with the presence of antibiotic-resistance genes in fresh vegetables and fruits. This study aimed to detect the presence of phenotypic and genotypic resistance in eight samples of fresh fruit juices served to patients admitted to a hospital in Rio de Janeiro. The growth of microorganisms on MacConkey and XLD agar was carried out to obtain a "pool" of Gram-negative bacteria. The disk diffusion test and the polymerase chain reaction were performed to detect the phenotypic and genotypic resistance of Gram-negative bacteria to the tested antibiotics. The multidrug resistance was detected in all samples and the shv, tem, ctx, tetA, tetB and oxa- 48 genes were found in the samples, including the presence of class 2 and 3 integrons. We can conclude that the selection methodology allows the detection of a greater number of genes and this found warns about the risk of making these foods available to patients in hospitals.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Sucos de Frutas e Vegetais/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Proteínas de Bactérias/genética , Brasil , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Frutas/microbiologia , Genótipo , Bactérias Gram-Negativas/genética , Bactérias Gram-Negativas/isolamento & purificação , Hospitais Públicos , Humanos , Testes de Sensibilidade Microbiana , beta-Lactamases/genética
19.
Ann R Coll Surg Engl ; 103(1): 35-40, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32829649

RESUMO

INTRODUCTION: Necrotising fasciitis with sepsis is a life threatening disease. The aim of this study was to analyse the association between international normalised ratio (INR) and mortality in sepsis patients with necrotising fasciitis. METHODS: A retrospective review was undertaken of 106 patients suffering from necrotising fasciitis with sepsis between November 2007 and December 2016. Data on comorbidities, clinical manifestations, laboratory findings, causative microbiological organisms, APACHE II (Acute Physiology and Chronic Health Evaluation II) score and outcomes were extracted. Logistic regression was carried out to examine the factors affecting mortality. RESULTS: Forty patients (37.7%) died. There was no significant difference in the white blood count (WBC) for the survivor and non-survivor groups. Non-survivors had a lower mean oxygenation index (OI) (288.7mmHg vs 329.4mmHg, p=0.032) and platelet count (PC) (139.5 vs 214.8 x 109/l, p=0.028), and a higher mean INR (1.9 vs 1.3, p=0.000), activated partial thromboplastin time (APTT) (54.6 vs 44.2 seconds, p=0.005) and serum creatinine (2.3mg/dl vs 1.4mg/dl, p=0.007). Mortality in patients with INR >1.5 was significantly higher than in those with INR <1.5 when all risk factors (WBC, PC, OI, INR, APTT, creatinine) were considered (odds ratio: 4.414, 95% confidence interval: 1.263-15.428, p=0.020). Even after adjusting for age, sex, bacteraemia, diabetes and hepatic disorders, the data still exhibited elevated mortality for patients with INR >1.5 (odds ratio: 5.600, 95% confidence interval: 1.415-22.166, p=0.014). CONCLUSIONS: INR is a significant independent predictor of mortality in sepsis patients diagnosed with necrotising fasciitis.


Assuntos
Fasciite Necrosante/mortalidade , Bactérias Gram-Negativas/isolamento & purificação , Coeficiente Internacional Normatizado , Sepse/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Fasciite Necrosante/sangue , Fasciite Necrosante/complicações , Fasciite Necrosante/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Sepse/sangue , Sepse/microbiologia , Sepse/cirurgia , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
20.
J Sci Food Agric ; 101(5): 2072-2077, 2021 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32974924

RESUMO

BACKGROUND: Stingless bee honey has great therapeutic potential, especially as an antimicrobial agent. In the present study, we evaluated the in vitro antibacterial potential of honey from Melipona spp. with occurrence in Rio Branco-AC and Xapuri-AC from the Amazonian region. Samples were collected from the species Melipona eburnea, Melipona grandis, Melipona flavolineata and Melipona seminigra. The antibacterial activity of the honey samples was tested against standard Gram-positive and Gram-negative bacteria and two strains isolated from bovine mastitis. RESULTS: In the agar diffusion assay, we observed antibacterial activity for the four honeys against the tested strains. The honey from M. flavolineata showed a minimmum inhibitory concentration (MIC) lower than 3.12% (v/v). The minimum bactericidal concentration values were larger than the MIC for most of the microorganisms tested. Scanning electron microscopy (SEM) showed the damaging effect of the honey of M. flavolineata on Staphylococcus aureus cells, as well as its inhibitory effect on cell division. CONCLUSION: The results of the present study demonstrate that the honey from stingless bees possesses in vitro antimicrobial activity against pathogenic bacteria. The effects observed by SEM show that honey from the Amazonian stingless bee M. flavolineata has promising therapeutic potential as a future antimicrobial agent. © 2020 Society of Chemical Industry.


Assuntos
Antibacterianos/farmacologia , Mel/análise , Animais , Antibacterianos/análise , Abelhas , Bovinos , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/crescimento & desenvolvimento , Bactérias Gram-Positivas/isolamento & purificação , Mastite Bovina/microbiologia , Testes de Sensibilidade Microbiana
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