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1.
Pan Afr Med J ; 39: 208, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603589

RESUMO

Acinetobacter ursingii is an anaerobic gram negative opportunistic coccobacillus, rarely isolated in bacteremic patients. It is mainly found in immunocompromised and severely ill patients with no identifiable source of infection. When isolated into the bloodstream, it usually displays resistance to at least two antimicrobial agents. To date only seven cases of bacteremia due to this microorganism have been reported in adults, of which, this accounts for the second one associated to renal replacement therapy and the first case of a documented catheter-related bloodstream infection (CRBSI) in a patient with a hemodialysis catheter. A 78-year-old male presented into the emergency department with acute kidney injury requiring hemodialysis, later developing bacteremia due to Acinetobacter ursingii.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter/isolamento & purificação , Bacteriemia/diagnóstico , Infecções Relacionadas a Cateter/diagnóstico , Infecções por Acinetobacter/microbiologia , Injúria Renal Aguda/terapia , Idoso , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Humanos , Masculino , Diálise Renal/efeitos adversos , Diálise Renal/métodos
2.
Ann Med ; 53(1): 1779-1786, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637370

RESUMO

BACKGROUND: An unexpected high prevalence of enterococcal bloodstream infection (BSI) has been observed in critically ill patients with COVID-19 in the intensive care unit (ICU). MATERIALS AND METHODS: The primary objective was to describe the characteristics of ICU-acquired enterococcal BSI in critically ill patients with COVID-19. A secondary objective was to exploratorily assess the predictors of 30-day mortality in critically ill COVID-19 patients with ICU-acquired enterococcal BSI. RESULTS: During the study period, 223 patients with COVID-19 were admitted to COVID-19-dedicated ICUs in our centre. Overall, 51 episodes of enterococcal BSI, occurring in 43 patients, were registered. 29 (56.9%) and 22 (43.1%) BSI were caused by Enterococcus faecalis and Enterococcus faecium, respectively. The cumulative incidence of ICU-acquired enterococcal BSI was of 229 episodes per 1000 ICU admissions (95% mid-p confidence interval [CI] 172-298). Most patients received an empirical therapy with at least one agent showing in vitro activity against the blood isolate (38/43, 88%). The crude 30-day mortality was 42% (18/43) and 57% (4/7) in the entire series and in patients with vancomycin-resistant E. faecium BSI, respectively. The sequential organ failure assessment (SOFA) score showed an independent association with increased mortality (odds ratio 1.32 per one-point increase, with 95% confidence interval 1.04-1.66, p = .021). CONCLUSIONS: The cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19. Our results suggest a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.KEY MESSAGESThe cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19.The crude 30-day mortality of enterococcal BSI in critically ill patients with COVID-19 may be higher than 40%.There could be a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.


Assuntos
Bacteriemia/epidemiologia , COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Enterococcus faecalis , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/epidemiologia , Mortalidade , Enterococos Resistentes à Vancomicina , Idoso , Bacteriemia/microbiologia , Estado Terminal , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Retrospectivos , SARS-CoV-2
3.
Medicine (Baltimore) ; 100(43): e27651, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34713857

RESUMO

ABSTRACT: To estimate the prevalence of the most frequent infections related to device utilization and their antimicrobial sensitivity panel, and to investigate the overall incidence of device associated infection rates per 1000 device days, at the pediatric intensive care unit of the Jordan University of Science and Technology.This is a retrospective study from a single pediatric intensive care unit. Data were collected in relation to bloodstream infections associated with central venous catheters, pneumonia associated with ventilator endotracheal tubes, and urinary tract infections associated with Foley catheters, between January 2013 and December 2018, according to the center of disease control and prevention protocols.During the 5-year study, 3195 patients were admitted to the pediatric intensive care unit for a total of 16,487 days. Forty-six patients (1.4%) developed 55 infections, with a median incidence rate of 7.4, 3.7, and 0.7 per 1000 days for central line associated infections, ventilator associated pneumonia, and catheter associated infections, respectively. The commonest isolated microorganisms were gram-negative bacteria in 89.1% of cases, and fungi in 10.9% of cases. Among the resistant bacterial isolates, 59.2% were multidrug resistant, and 32.6% were extended spectrum beta lactamase producers Klebsiella pneumoniae and Eschericia coli. High infection rates were related to Acinetobacter baumannii and K pneumoniae, associated with high resistance to cephalosporins. Susceptibility was highest to tigecycline and imipenem at 42.9% and 32.7% respectively.Microbial isolates are commonly associated with healthcare device insertions in pediatric intensive care unit, invasive bacterial infections associated with critical morbidity and mortality. Further studies on device associated infections are recommended for regional profiling purposes.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Infecções Urinárias/epidemiologia , Bacteriemia/etiologia , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Pré-Escolar , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Humanos , Lactente , Jordânia/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Estudos Retrospectivos , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia
4.
PLoS One ; 16(10): e0258592, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669727

RESUMO

Understating how antibiotic tolerance impacts subsequent resistance development in the clinical setting is important to identifying effective therapeutic interventions and prevention measures. This study describes a patient case of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia which rapidly developed resistance to three primary MRSA therapies and identifies genetic and metabolic changes selected in vivo that are associated with rapid resistance evolution. Index blood cultures displayed susceptibility to all (non-beta-lactam) antibiotics with the exception of trimethoprim/ sulfamethoxazole. One month after initial presentation, during the same encounter, blood cultures were again positive for MRSA, now displaying intermediate resistance to vancomycin and ceftaroline and resistance to daptomycin. Two weeks later, blood cultures were positive for a third time, still intermediate resistant to vancomycin and ceftaroline and resistant to daptomycin. Mutations in mprF and vraT were common to all multidrug resistant isolates whereas mutations in tagH, agrB and saeR and secondary mprF mutation emerged sequentially and transiently resulting in distinct in vitro phenotypes. The baseline mutation rate of the patient isolates was unremarkable ruling out the hypermutator phenotype as a contributor to the rapid emergence of resistance. However, the index isolate demonstrated pronounced tolerance to the antibiotic daptomycin, a phenotype that facilitates the subsequent development of resistance during antibiotic exposure. This study exemplifies the capacity of antibiotic-tolerant pathogens to rapidly develop both stable and transient genetic and phenotypic changes, over the course of a single patient encounter.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana Múltipla , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Infecções Estafilocócicas/microbiologia , Idoso , Aminoaciltransferases/genética , Antibacterianos/classificação , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Evolução Molecular , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Viabilidade Microbiana/efeitos dos fármacos , Mutação , Infecções Estafilocócicas/tratamento farmacológico , Fatores de Transcrição/genética
5.
PLoS One ; 16(10): e0258114, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618858

RESUMO

BACKGROUND: Enterobacter species are an important cause of healthcare-associated bloodstream infections (BSI) in children. Up to 19% of adult patients with Enterobacter BSI have recurrence of infection resistant to third-generation cephalosporins (3GCs) while on therapy with a 3GC. Data are lacking regarding the incidence of and risk factors for recurrence of infection in children with Enterobacter BSI. METHODS: We conducted a retrospective case-control study of patients aged ≤21 years old admitted to Texas Children's Hospital from January 2012 through December 2018 with Enterobacter BSI. The primary outcome was microbiologic failure from 72 hours to 30 days after the initial BSI (cases). The secondary outcome was isolation of a 3GC non-susceptible Enterobacter sp. from a patient with an initial 3GC-susceptible isolate. RESULTS: Twelve patients (6.7%) had microbiologic failure compared to 167 controls without microbiologic failure. Of the 138 patients (77.1%) with an Enterobacter sp. isolate that was initially susceptible to 3GCs, 3 (2.2%) developed a subsequent infection with a non-susceptible isolate. Predictors of microbiologic failure were having an alternative primary site of infection besides bacteremia without a focus or an urinary tract infection (OR, 9.64; 95% CI, 1.77-52.31; P < 0.01) and inadequate source control (OR, 22.16; 95% CI, 5.26-93.36; P < 0.001). CONCLUSIONS: Source of infection and adequacy of source control are important considerations in preventing microbiologic failure. In-vitro susceptibilities can be used to select an antibiotic regimen for the treatment of Enterobacter BSI in children.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Enterobacter/patogenicidade , Infecções por Enterobacteriaceae/tratamento farmacológico , Sepse/tratamento farmacológico , Adolescente , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Enterobacter/genética , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Sepse/epidemiologia , Sepse/microbiologia , Adulto Jovem
6.
Elife ; 102021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34636322

RESUMO

The dissemination of pathogens through blood and their establishment within organs lead to severe clinical outcomes. However, the within-host dynamics that underlie pathogen spread to and clearance from systemic organs remain largely uncharacterized. In animal models of infection, the observed pathogen population results from the combined contributions of bacterial replication, persistence, death, and dissemination, each of which can vary across organs. Quantifying the contribution of each these processes is required to interpret and understand experimental phenotypes. Here, we leveraged STAMPR, a new barcoding framework, to investigate the population dynamics of extraintestinal pathogenic Escherichia coli, a common cause of bacteremia, during murine systemic infection. We show that while bacteria are largely cleared by most organs, organ-specific clearance failures are pervasive and result from dramatic expansions of clones representing less than 0.0001% of the inoculum. Clonal expansion underlies the variability in bacterial burden between animals, and stochastic dissemination of clones profoundly alters the pathogen population structure within organs. Despite variable pathogen expansion events, host bottlenecks are consistent yet highly sensitive to infection variables, including inoculum size and macrophage depletion. We adapted our barcoding methodology to facilitate multiplexed validation of bacterial fitness determinants identified with transposon mutagenesis and confirmed the importance of bacterial hexose metabolism and cell envelope homeostasis pathways for organ-specific pathogen survival. Collectively, our findings provide a comprehensive map of the population biology that underlies bacterial systemic infection and a framework for barcode-based high-resolution mapping of infection dynamics.


Assuntos
Bacteriemia/patologia , Infecções por Escherichia coli/patologia , Animais , Bacteriemia/microbiologia , Escherichia coli/fisiologia , Infecções por Escherichia coli/microbiologia , Camundongos , Modelos Animais
7.
APMIS ; 129(11): 653-662, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34580927

RESUMO

Infective endocarditis (IE) is a heart valve infection with high mortality rates. IE results from epithelial lesions, inducing sterile healing vegetations consisting of platelets, leucocytes, and fibrin that are susceptible for colonization by temporary bacteremia. Clinical testing of new treatments for IE is difficult and fast models sparse. The present study aimed at establishing an in vitro vegetation simulation IE model for fast screening of novel treatment strategies. A healing promoting platelet and leucocyte-rich fibrin patch was used to establish an IE organoid-like model by colonization with IE-associated bacterial isolates Staphylococcus aureus, Streptococcus spp (S. mitis group), and Enterococcus faecalis. The patch was subsequently exposed to tobramycin, ciprofloxacin, or penicillin. Bacterial colonization was evaluated by microscopy and quantitative bacteriology. We achieved stable bacterial colonization on the patch, comparable to clinical IE vegetations. Microscopy revealed uneven, biofilm-like colonization of the patch. The surface-associated bacteria displayed increased tolerance to antibiotics compared to planktonic bacteria. The present study succeeded in establishing an IE simulation model with the relevant pathogens S. aureus, S. mitis group, and E. faecalis. The findings indicate that the IE model mirrors the natural IE process and has the potential for fast screening of treatment candidates.


Assuntos
Endocardite Bacteriana/microbiologia , Modelos Biológicos , Antibacterianos/farmacologia , Bacteriemia/microbiologia , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Contagem de Colônia Microbiana , Tolerância a Medicamentos , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/patologia , Humanos , Organoides/citologia , Organoides/efeitos dos fármacos , Organoides/microbiologia
8.
PLoS One ; 16(9): e0257449, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529734

RESUMO

Despite the formation of biofilms on catheters for extracorporeal membrane oxygenation (ECMO), some patients do not show bacteremia. To elucidate the specific linkage between biofilms and bacteremia in patients with ECMO, an improved understanding of the microbial community within catheter biofilms is necessary. Hence, we aimed to evaluate the biofilm microbiome of ECMO catheters from adults with (n = 6) and without (n = 15) bacteremia. The microbiomes of the catheter biofilms were evaluated by profiling the V3 and V4 regions of bacterial 16s rRNA genes using the Illumina MiSeq sequencing platform. In total, 2,548,172 reads, with an average of 121,341 reads per sample, were generated. Although alpha diversity was slightly higher in the non-bacteremic group, the difference was not statistically significant. In addition, there was no difference in beta diversity between the two groups. We found 367 different genera, of which 8 were present in all samples regardless of group; Limnohabitans, Flavobacterium, Delftia, Massilia, Bacillus, Candidatus, Xiphinematobacter, and CL0-1 showed an abundance of more than 1% in the sample. In particular, Arthrobacter, SMB53, Neisseria, Ortrobactrum, Candidatus Rhabdochlamydia, Deefgae, Dyella, Paracoccus, and Pedobacter were highly abundant in the bacteremic group. Network analysis indicated that the microbiome of the bacteremic group was more complex than that of the non-bacteremic group. Flavobacterium and CL0.1, which were abundant in the bacteremic group, were considered important genera because they connected different subnetworks. Biofilm characteristics in ECMO catheters varied according to the presence or absence of bacteremia. There were no significant differences in diversity between the two groups, but there were significant differences in the community composition of the biofilms. The biofilm-associated community was dynamic, with the bacteremic group showing very complex network connections within the microbiome.


Assuntos
Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Oxigenação por Membrana Extracorpórea/instrumentação , Microbiota , Arthrobacter/genética , Arthrobacter/isolamento & purificação , Arthrobacter/fisiologia , Bacteriemia/patologia , Bactérias/genética , Bactérias/isolamento & purificação , Biofilmes , Infecções Relacionadas a Cateter/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neisseria/genética , Neisseria/isolamento & purificação , Neisseria/fisiologia , RNA Ribossômico 16S/análise , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Estudos Retrospectivos
9.
J Korean Acad Nurs ; 51(4): 414-429, 2021 Aug.
Artigo em Coreano | MEDLINE | ID: mdl-34497251

RESUMO

PURPOSE: This systematic review and meta-analysis analyzed the effects of 2% chlorhexidine bathing on the incidence of hospital-acquired infection (HAI) and multidrug-resistant organisms (MDRO) in adult intensive care units. METHODS: PubMed, CINAHL, Cochrane library, and RISS database were systematically searched, and 12 randomized studies were included in the analysis. Comprehensive Meta-Analysis version 3.0 was used to calculate the effect size using the odds ratio (OR) and a 95% confidence interval (CI). Subgroup analysis was performed according to the specific infection and intervention types. RESULTS: In general, 2% chlorhexidine bathing has a significant effect on the incidence of HAI (OR, 0.59; 95% CI, 0.40~0.86) and MDRO (OR, 0.52; 95% CI, 0.34~0.79). Subgroup analyses show 2% chlorhexidine bathing is effective in bloodstream infections (OR, 0.51; 95% CI, 0.39~0.66) but not for urinary tract infections, ventilator-associated pneumonia infections, and Clostridium difficile infections. Moreover, 2% chlorhexidine bathing alone or its combination with other interventions has a significant effect on the incidence of HAI and MDRO (OR, 0.59; 95% CI, 0.38~0.92). CONCLUSION: This meta-analysis reveals that 2% chlorhexidine bathing significantly reduces the incidence of HAI and MDRO in intensive care units. The effect of 2% chlorhexidine bathing on pediatric patients or patients at general wards should be further assessed as a cost-effective intervention for infection control.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Bacteriemia/prevenção & controle , Clorexidina/uso terapêutico , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Unidades de Terapia Intensiva , Adulto , Bacteriemia/microbiologia , Banhos , Hospitais , Humanos
10.
PLoS One ; 16(9): e0257596, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34543323

RESUMO

BACKGROUND: To describe factors associated with severe sepsis in diarrheal adults and their outcomes and offender in blood and stool to understand their interplay as clinical features of sepsis and severe diarrhea often overlap. METHODS AND RESULTS: We used this retrospective chart analysis employing an unmatched case-control design to study critically ill diarrheal adults aged ≥18 years treated in ICU of Dhaka hospital, icddr,b between January 2011 to December 2015. Of 8,863 in-patient diarrheal adults, 350 having severe sepsis were cases and an equal number of randomly selected non-septic patients were the controls. Cases died significantly more (14.9% vs 4.6%, p = <0.001) than controls. 69% of the cases progressed to septic shock. In logistic regression analysis, steroid intake, ileus, acute kidney injury (AKI), metabolic acidosis, and hypocalcemia were significantly associated with severe sepsis in diarrheal adults (all, p<0.05). 12% of cases (40/335) had bacteremia. Streptococcus pneumoniae [9 (22.5%)] was the single most common pathogen and gram-negatives [27 (67.5%)] were prevailing as a group. CONCLUSION: Diarrheal adults who had ileus, AKI, metabolic acidosis, hypocalcemia, and also took steroids were found to have an association with severe sepsis. Strikingly, gram-negative were the predominant bacteria among the diarrheal adults having severe sepsis.


Assuntos
Diarreia/patologia , Sepse/complicações , Injúria Renal Aguda/complicações , Injúria Renal Aguda/patologia , Adulto , Bacteriemia/complicações , Bacteriemia/microbiologia , Bacteriemia/patologia , Bangladesh , Diarreia/complicações , Feminino , Hospitais Urbanos , Humanos , Unidades de Terapia Intensiva , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Streptococcus pneumoniae/isolamento & purificação
11.
Diagn Microbiol Infect Dis ; 101(3): 115416, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34391076

RESUMO

BACKGROUND: COVID19 is the novel respiratory illness caused by SARS-CoV-2. The presence of other potentially pathogenic microorganisms could worsen the prognosis of these patients. AIM: The study aims to describe coinfections in COVID-19 patients and contrast it between standard ward and critical care patients at Hospital Central de la Defensa Gómez Ulla (HCDGU). METHODS: A retrospective study was carried out of patients with COVID-19 confirmed with RTPCR admitted to the HCDGU from March 5, 2020 to May 7 of 2020. FINDINGS: Of a total of 703 patients with COVID-19, 75(10.7%) had other microbiologically confirmed infections: 9% (58/648) in standard ward patients and 31.5%(17/54) in critical care patients. In total 86 samples of the 75 patients presented some microorganism; clinically relevant bacteraemias, 50%, respiratory cultures, 32.6% and pneumococcal positive antigens, 17.4%. CONCLUSIONS: We found a low frequency of microorganism coinfection in COVID-19 patients, however in critical care these coinfections increased considerably.


Assuntos
Infecções Bacterianas/complicações , COVID-19/complicações , Coinfecção/diagnóstico , Pacientes Internados , SARS-CoV-2 , Idoso , Bacteriemia/complicações , Bacteriemia/microbiologia , Bactérias/classificação , Bactérias/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Sci Rep ; 11(1): 15882, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34354138

RESUMO

Bacterial bloodstream infections are of great concern globally. Of late, the emergence of drug resistant bacteria worsen the related morbidity and mortality. This study was aimed to determine the bacterial profile, antimicrobial susceptibility patterns, and associated factors among the blood stream infection (BSI) suspected patients attending the Arba Minch General Hospital (AMGH), southern Ethiopia, from 01 June through 31st August, 2020. A cross-sectional study was conducted among 225 BSI suspected patients. Systematic random sampling method was used to select patients. Blood culture was done to isolate bacterial pathogens. Antimicrobial susceptibility test was performed by employing the Kirby-Bauer disc diffusion method. Descriptive statistics and multivariable logistic regression analysis were done by Statistical Package for Social Service (SPSS) version 22. The rate of prevalence of bacteriologically confirmed cases was 22/225 (9.8%). Majority of BSI were caused by Gram-positive cocci, 13/22 (59.1%), particularly the isolates of S. aureus, 7/22 (31.8%) followed by Enterococci species, 4/22 (18.2%) and coagulase-negative Staphylococci (CoNS), 2/22 (9.1%). Among the Gram-negative bacteria 9/22 (41.1%), Klebsiella species 4/22 (18.2%) was the prominent one followed by Escherichia coli 2/22 (9.1%), Pseudomonas aeruginosa 2/22 (9.1%), and Enterobacter species 1/22 (4.5%). All the isolates of Gram-negative bacteria were susceptible to meropenem whereas 69.2% of the isolates of Gram-positive counterparts were susceptible to erythromycin. Slightly above two third (68.2%) of the total isolates were multidrug resistant. Insertion of a peripheral intravenous line was significantly associated with BSI [p = 0.03; Adjusted Odds Ratio = 4.82; (Confidence Interval: 1.08-21.46)]. Overall results revealed that eventhough the prevalence of BSI in Arba Minch is comparatively lower (9.8%), multidrug resistance is alarmingly on the rise, which is to be addressed through effective surveillance and control strategies.


Assuntos
Sepse/tratamento farmacológico , Sepse/etiologia , Sepse/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Bacteriemia/microbiologia , Bactérias/classificação , Infecções Bacterianas/tratamento farmacológico , Doenças Transmissíveis/tratamento farmacológico , Estudos Transversais , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Etiópia/epidemiologia , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Cocos Gram-Positivos/efeitos dos fármacos , Hospitais Gerais , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade
13.
Diagn Microbiol Infect Dis ; 101(2): 115485, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34365091

RESUMO

Antimicrobial Susceptibility Testing is mandatory for Bloodstream Infections management in order to establish appropriate antimicrobial therapy. Herein we evaluated new approach based on AST results directly from positive blood cultures, using Microscan WA to carry out rapid phenotypical profile of antibiotic resistance. Our investigations allow to reduce time versus traditional results.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Bactérias/efeitos dos fármacos , Farmacorresistência Bacteriana , Hemocultura , Diagnóstico Precoce , Humanos , Fenótipo , Fatores de Tempo
14.
Sci Rep ; 11(1): 15677, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344954

RESUMO

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of infection. We conducted a longitudinal study to evaluate changes in clinical and microbiological characteristics as well as outcomes of sequence type (ST) 72 MRSA bacteremia. We reviewed adult patients enrolled in a prospective cohort with ST72 MRSA bacteremia from August 2008 to December 2018 at Asan Medical Center, Seoul, South Korea. Changes in clinical characteristics, outcomes, and microbiological characteristics of patients over time were evaluated. Generalized linear and linear regression models were used to evaluate changes. Of the 1,760 isolates, 915 (62%) were MRSA bacteremia and 292 (31.9%) were ST72 MRSA. During the study period, the relative risk (RR) of MRSA bacteremia decreased annually by 3.7%; however, among MRSA bacteremia, RR of ST72 MRSA increased annually by 8.5%. Vancomycin minimum inhibitory concentration (MIC) decreased over the study period. Metastatic infection, persistent bacteremia, and recurrence of bacteremia within 12 weeks decreased significantly. There were no significant changes in 30-d and 12-week mortality. Antibiotic susceptibility of ST72 MRSA was evaluated, and the resistance rate to erythromycin decreased significantly. ST72 MRSA incidence increased annually; its vancomycin MIC and erythromycin resistance rate decreased over the 11 years.


Assuntos
Bacteriemia/microbiologia , Toxinas Bacterianas , Exotoxinas , Leucocidinas , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Idoso , Antibacterianos/farmacologia , Toxinas Bacterianas/genética , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Exotoxinas/genética , Feminino , História do Século XXI , Humanos , Leucocidinas/genética , Masculino , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Vigilância em Saúde Pública , República da Coreia/epidemiologia , Infecções Estafilocócicas/história
15.
BMC Infect Dis ; 21(1): 636, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215207

RESUMO

BACKGROUND: This study aimed to investigate the epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance bacterial bloodstream infections (BSIs) among adult cancer patients in Shiraz, Iran. We also report a four-year trend of antimicrobial resistance patterns of BSIs. METHODS: We conducted a retrospective study at a referral oncology hospital from July 2015 to August 2019, which included all adults with confirmed BSI. RESULTS: 2393 blood cultures tested during the four-year study period; 414 positive cultures were included. The mean age of our patients was 47.57 ± 17.46 years old. Central Line-Associated BSI (CLABSI) was more common in solid tumors than patients with hematological malignancies. Gram-negative (GN) bacteria were more detected (63.3%, 262) than gram-positive bacteria (36.7%, 152). Escherichia coli was the most common gram-negative organism (123/262, 47%), followed by Pseudomonas spp. (82/262, 31%) and Klebsiella pneumoniae (38/262, 14.5%). Coagulase-negative staphylococci (CoNS) was the most frequently isolated pathogen among gram-positive bacteria (83/152, 54.6%). Acinetobacter spp., Pseudomonas spp., E. coli, and K. pneumoniae were the most common Extended-Spectrum Beta-Lactamase (ESBL) producers (100, 96.2, 66.7%, and 60.7, respectively). Acinetobacter spp., Pseudomonas spp., Enterobacter spp., E. coli, and K. pneumoniae were the most common carbapenem-resistant (CR) isolates (77.8, 70.7, 33.3, 24.4, and 13.2%, respectively). Out of 257 Enterobacterales and non-fermenter gram-negative BSIs, 39.3% (101/257) were carbapenem-resistant. Although the incidence of multi-drug resistance (MDR) gram-negative BSI increased annually during 2015-2018, the mortality rate of gram-negative BSI remains unchanged at about 20% (p-value = 0.55); however, the mortality rate was significantly greater (35.4%) in those with resistant gram-positive BSI (p-value = 0.001). The overall mortality rate was 21.5%. Early (7-day mortality) and late mortality rate (30-day mortality) were 10 and 3.4%, respectively. CONCLUSIONS: The emergence of MDR gram-negative BSI is a significant healthcare problem in oncology centers. The high proportion of the most frequently isolated pathogens were CR and ESBL-producing Enterobacterales and Pseudomonas spp. We have few effective choices against MDRGN BSI, especially in high-risk cancer patients, which necessitate newer treatment options.


Assuntos
Bacteriemia/complicações , Bactérias/patogenicidade , Farmacorresistência Bacteriana , Resistência a Múltiplos Medicamentos , Neoplasias/mortalidade , Sepse/complicações , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Terapia Combinada , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/patologia , Estudos Retrospectivos , Fatores de Risco , Sepse/microbiologia
16.
Biomed Res Int ; 2021: 6619911, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239928

RESUMO

Background: Polymicrobial Klebsiella pneumoniae bloodstream infection (KP-BSI) has been reported to account for more than 10% of all KP-BSI, but few studies have characterized polymicrobial KP-BSI. Our study investigated the clinical characteristics, risk factors, and outcomes of polymicrobial KP-BSI by comparing with monomicrobial KP-BSI. Methods: We conducted a single-center retrospective cohort study of patients with KP-BSI from 1 January 2013 to 31 December 2018 and collected the clinical data by reviewing electronic medical records. Results: Of the 818 patients with KP-BSI recruited, 13.9% (114/818) were polymicrobial KP-BSI. The severity of illness in polymicrobial and monomicrobial KP-BSI was similar, while the rate of resistance to carbapenems was obviously higher in polymicrobial KP-BSI (78.1% vs. 65.6%, p = 0.009). On multivariate analysis, hospitalization in burn ward (odds ratio (OR) 6.13, 95% confidence interval (CI) 2.00-18.76, p = 0.001) and intensive care unit (OR 2.39, 95% CI 1.05-5.43, p = 0.038) was independently associated with polymicrobial KP-BSI. Gram-negative bacteria accounted for the highest proportion (68.9%) among copathogens of polymicrobial KP-BSI, whereas gram-positive bacteria (22.9%) and Candida (8.2%) ranked the second and the third, respectively, with Acinetobacter baumannii being the most common (23.0%). Patients with polymicrobial KP-BSI had longer hospital days after BSI onset and total hospital days than patients with monomicrobial KP-BSI (median (interquartile range (IQR)), 19 (5, 39) vs. 12 (6, 25), 37 (21, 67) vs. 29 (16, 53), respectively, p < 0.05). The mortality did not differ between polymicrobial KP-BSI and monomicrobial KP-BSI (all p > 0.05). Conclusions: It was observed that polymicrobial KP-BSI accounted for a significant proportion among all KP-BSI in the current study. Hospitalization in burn ward and intensive care unit was an independent risk factor for the development of polymicrobial KP-BSI. The patients with polymicrobial KP-BSI had a higher rate of carbapenem-resistant K. pneumoniae and might have poor outcomes compared to monomicrobial KP-BSI.


Assuntos
Infecções por Klebsiella/sangue , Klebsiella pneumoniae/metabolismo , Adulto , Idoso , Bacteriemia/microbiologia , Carbapenêmicos/farmacologia , Ertapenem/farmacologia , Feminino , Hospitalização , Humanos , Imipenem/farmacologia , Unidades de Terapia Intensiva , Masculino , Meropeném/farmacologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Br J Anaesth ; 127(3): 405-414, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34229832

RESUMO

BACKGROUND: Allogeneic red blood cell (RBC) transfusion can induce immunosuppression, which can then increase the susceptibility to postoperative infection. However, studies in different types of surgery show conflicting results regarding this effect. METHODS: In this retrospective cohort study conducted in a tertiary referral centre, we included adult patients undergoing clean-contaminated surgery from 2014 to 2018. Patients who received allogeneic RBC transfusion from preoperative Day 30 to postoperative Day 30 were included into the transfusion group. The control group was matched for the type of surgery in a 1:1 ratio. The primary outcome was infection within 30 days after surgery, which was defined by healthcare-associated infection, and identified mainly based on antibiotic regimens, microbiology tests, and medical notes. RESULTS: Among the 8098 included patients, 1525 (18.8%) developed 1904 episodes of postoperative infection. Perioperative RBC transfusion was associated with an increased risk of postoperative infection after controlling for 27 confounders by multivariable regression analysis (odds ratio [OR]: 1.60; 95% confidence interval [CI]: 1.39-1.84; P<0.001) and propensity score weighing (OR: 1.64; 95% CI: 1.45-1.85; P<0.001) and matching (OR: 1.70; 95% CI: 1.43-2.01; P<0.001), and a dose-response relationship was observed. The transfusion group also showed higher risks of surgical site infection, pneumonia, bloodstream infection, multiple infections, intensive care admission, unplanned reoperation, prolonged postoperative length of hospital stay, and all-cause death. CONCLUSIONS: Perioperative allogeneic RBC transfusion is associated with an increased risk of infection after clean-contaminated surgery in a dose-response manner. Close monitoring of infections and enhanced prophylactic strategies should be considered after transfusion.


Assuntos
Infecções Bacterianas/microbiologia , Transfusão de Eritrócitos/efeitos adversos , Hospedeiro Imunocomprometido , Assistência Perioperatória/efeitos adversos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Antibacterianos/uso terapêutico , Bacteriemia/imunologia , Bacteriemia/microbiologia , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/imunologia , Infecções Bacterianas/mortalidade , Cuidados Críticos , Transfusão de Eritrócitos/mortalidade , Humanos , Tempo de Internação , Readmissão do Paciente , Assistência Perioperatória/mortalidade , Pneumonia Bacteriana/imunologia , Pneumonia Bacteriana/microbiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/mortalidade , Infecção da Ferida Cirúrgica/imunologia , Infecção da Ferida Cirúrgica/microbiologia , Fatores de Tempo , Transplante Homólogo/efeitos adversos , Resultado do Tratamento
18.
Infect Immun ; 89(10): e0017721, 2021 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-34280035

RESUMO

Proteus mirabilis is a leading uropathogen of catheter-associated urinary tract infections (CAUTIs), which are among the most common health care-associated infections worldwide. A key factor that contributes to P. mirabilis pathogenesis and persistence during CAUTI is the formation of catheter biofilms, which provide increased resistance to antibiotic treatment and host defense mechanisms. Another factor that is important for bacterial persistence during CAUTI is the ability to resist reactive oxygen species (ROS), such as through the action of the catalase enzyme. Potent catalase activity is one of the defining biochemical characteristics of P. mirabilis, and the single catalase (katA) gene in strain HI4320 was recently identified as a candidate fitness factor for UTI, CAUTI, and bacteremia. Here, we show that disruption of katA results in increased ROS levels, increased sensitivity to peroxide, and decreased biofilm biomass. The biomass defect was due to a decrease in the production of extracellular polymeric substances (EPS) by the ΔkatA mutant and specifically due to reduced carbohydrate content. Importantly, the biofilm defect resulted in decreased antibiotic resistance in vitro and a colonization defect during experimental CAUTI. The ΔkatA mutant also exhibited decreased fitness in a bacteremia model, supporting a dual role for catalase in P. mirabilis biofilm development and immune evasion.


Assuntos
Biofilmes/crescimento & desenvolvimento , Catalase/metabolismo , Infecções Relacionadas a Cateter/microbiologia , Matriz Extracelular de Substâncias Poliméricas/metabolismo , Infecções por Proteus/microbiologia , Proteus mirabilis/enzimologia , Infecções Urinárias/microbiologia , Animais , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Biofilmes/efeitos dos fármacos , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateteres/microbiologia , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Feminino , Humanos , Camundongos , Camundongos Endogâmicos CBA , Infecções por Proteus/tratamento farmacológico , Proteus mirabilis/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico
19.
Anaerobe ; 71: 102420, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34314865

RESUMO

A 42-year-old man was referred to the Department of Orthopedic Surgery with pain over his right greater trochanter and signs of systemic infection. CT showed an enhanced mass in his gluteus maximus as well as gas in the biceps femoris over the underlying hip joint. Tissue biopsy yielded Fusobacterium nucleatum and Actinomyces turicensis. The patient was successfully treated for 6 weeks with amoxicillin/clavulanic acid 875mg/125mg and metronidazole 500mg.


Assuntos
Actinomycetaceae/isolamento & purificação , Infecções por Actinomycetales/microbiologia , Bacteriemia/microbiologia , COVID-19/imunologia , Infecções por Fusobacterium/microbiologia , Fusobacterium nucleatum/isolamento & purificação , Quadril/microbiologia , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Actinomycetaceae/efeitos dos fármacos , Actinomycetaceae/genética , Infecções por Actinomycetales/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , COVID-19/virologia , Infecções por Fusobacterium/tratamento farmacológico , Fusobacterium nucleatum/efeitos dos fármacos , Fusobacterium nucleatum/genética , Humanos , Hospedeiro Imunocomprometido , Masculino , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação
20.
Acta Med Indones ; 53(2): 169-176, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34251345

RESUMO

BACKGROUND: multidrug-resistant organisms (MDRO) caused pneumonia has become a crucial case. MDRO infection has been a problem concern to community-acquired pneumonia (CAP). A lot of factors play roles in CAP with MDRO infection. This study aimed to analyze MDRO as the etiology of hospitalized patients with CAP along with its risk factors in Dr. Soetomo Hospital as one of the top referral hospitals in east Indonesia. METHODS: this retrospective cohort study was conducted from January 2016 to December 2018. Data were collected from patients' medical records. Automatic Rapid Diagnosis (Phoenix TM) was used as a standard method for culture and susceptibility test. Various risk factors were analyzed for MDRO infection. RESULTS: five most common pathogens in hospitalized patients with CAP were Acinetobacter baumannii 244/1364 (17.9%), Klebsiella pneumoniae 134/1364 (9.8%), Pseudomonas aeruginosa 91/1364 (6.7%), Escherichia coli 58/1364 (4.3%), and Enterobacter cloacae 45/1364 (3.3%). There were 294/1364 (21.5%) MDROs isolated from patients with CAP. MDRO infection was linked to previous hospitalization, malignancy, cardiovascular disease, and structural lung disease with p values of 0.002, <0.001, 0.024, and <0.001, respectively. CONCLUSION: the incidence of MDRO in CAP is high (21.5%). The risk factors related were previous hospitalization, malignancy, cardiovascular disease, and structural lung disease.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Farmacorresistência Bacteriana Múltipla , Pneumonia/epidemiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bactérias/classificação , Doenças Cardiovasculares/epidemiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Indonésia/epidemiologia , Modelos Logísticos , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/epidemiologia , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , Estudos Retrospectivos , Fatores de Risco
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