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1.
J Med Microbiol ; 69(2): 249-255, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32003712

RESUMO

Introduction. Among the causative agents of bloodstream infections (BSIs), methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) are the key causative pathogens. Their rapid detection directly from Gram-positive cocci-positive blood culture specimens will promote timely treatment and help to implement effective infection control measures.Aim. We aim to develop a PCR-dipstick technique for the rapid detection of MRSA and VRE directly from positive blood culture specimens.Methodology. PCR-dipstick is a PCR-based multiplex detection technique where DNA-DNA hybridization is employed, and the results are interpreted with the naked eye. It was designed to target three drug resistance genes: mecA in MRSA and vanA/vanB in VRE from positive blood culture specimens. A total of 120 clinical isolates were used to evaluate the sensitivity and specificity of PCR-dipstick. Then, PCR-dipstick was examined for MRSA and VRE detection directly from positive blood cultures.Results. PCR-dipstick showed 100 % sensitivity and specificity in detecting mecA, vanA and vanB genes directly from bacterial colonies in comparison with multiplex PCR for genomic DNA followed by agarose gel electrophoresis. Further, it could differentially detect multiple resistant genes in pooled bacterial colonies (n=10). Ultimately, PCR-dipstick could detect MRSA and VRE in positive blood cultures in ~3 h.Conclusion. The results of the current study substantiate that PCR-dipstick can be used as an efficient detection system for MRSA and VRE directly from Gram-positive cocci-positive blood cultures. Its affordability and rapidity indicate that PCR-dipstick can be an effective tool for controlling nosocomial pathogens.


Assuntos
Proteínas de Bactérias/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/genética , Reação em Cadeia da Polimerase Multiplex/métodos , Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Sangue/microbiologia , Hemocultura , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/diagnóstico , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/isolamento & purificação , Humanos , Reação em Cadeia da Polimerase Multiplex/instrumentação
2.
Rev Esp Quimioter ; 32(4): 365-369, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31293114

RESUMO

OBJECTIVE: Matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry (MALDI-TOF MS) is widely used for fast identification of bacteria from blood cultures (BC). We compared the performance of two procedures, one including a pre-enrichment step in brain heart infusion and the other a direct method using vacutainer separator gel tubes (DI), for identification of bacteria from blood cultures by MALDI-TOF MS. METHODS: We first prepared a training set of 20 simulated bacteremia specimens, including 10 Gram-negative and 10 Gram-positive species. A total of 145 non-consecutive BCs flagged as positive (68 Gram-negative rods, and 77 Gram-positive cocci) were prospectively analyzed (validation set). RESULTS: A total of 82% and 49% of isolates were correctly identified to the species level by the respective methods. CONCLUSIONS: The pre-enrichment method outperformed the DI method for identification of virtually all bacterial species included in the panels.


Assuntos
Bacteriemia/microbiologia , Hemocultura/métodos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Técnicas de Tipagem Bacteriana/métodos , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/isolamento & purificação , Humanos , Estudos Prospectivos
3.
BMC Pulm Med ; 19(1): 132, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319825

RESUMO

BACKGROUND: Culturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia. However, the sensitivity is low, especially in patients pre-treated with anti-infective agents. The early detection of a pathogen is crucial for the outcome of respiratory tract infections. For bloodstream infections, a multiplex polymerase chain reaction (PCR) assay (SeptiFast®, SF) is available for improved pathogen detection from blood. OBJECTIVE: The aim of the present study was to determine whether the SF assay is applicable to the BAL of children with pulmonary infections and whether the frequency of pathogen detection is enhanced by the use of this multiplex PCR method. METHODS: We investigated 70 BAL samples of 70 children simultaneously by culture and multiplex PCR. The frequency of pathogen detection was compared. RESULTS: Pathogens were detected more frequently by SF than by culture (83% vs. 31%; p < 0.001). This advantage was shown for immunocompetent patients (p = 0.001) as well as for immunocompromised patients (p = 0.003). The majority (38/44; 86%) of the Gram positive cocci were only detected by SF. Fungal organisms were detected in 7/70 patients (10%) by SF and in 2/70 (3%) by culture (p = 0.125). CONCLUSION: Compared to conventional culture, the use of the SF assay on the BAL of children with pneumonia increases pathogen detection rates and therefore adds important information to guide anti-infective therapy.


Assuntos
Infecções Bacterianas/diagnóstico , Líquido da Lavagem Broncoalveolar/microbiologia , Micoses/diagnóstico , Adolescente , Adulto , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Feminino , Fungos/isolamento & purificação , Fungos/patogenicidade , Cocos Gram-Positivos/isolamento & purificação , Cocos Gram-Positivos/patogenicidade , Humanos , Hospedeiro Imunocomprometido , Lactente , Recém-Nascido , Masculino , Reação em Cadeia da Polimerase Multiplex , Micoses/microbiologia , Pneumonia/diagnóstico , Pneumonia/microbiologia , Sensibilidade e Especificidade , Adulto Jovem
4.
Eur J Clin Microbiol Infect Dis ; 38(8): 1471-1479, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31079314

RESUMO

For patients with a single-positive blood culture growing gram-positive cocci, organism identification can provide supportive information for differentiating contamination from infection. We investigated the effect of a rapid blood culture identification panel (BCID) on vancomycin-prescribing patterns and patient outcomes for single positive blood culture (PBC) growing gram-positive cocci. Adult patients with single-positive blood culture growing gram-positive cocci with conventional organism identification (pre-BCID) were compared with organism identification by BCID (post-BCID). Antimicrobial Stewardship Program (ASP) review of PBC was performed in both study groups. Vancomycin prescribing patterns were studied. Secondary endpoints were the incidence of nephrotoxicity, length of stay (LOS), readmission rate, mortality, and hospital costs. A total of 188 patients (86 pre-BCID, 102 post-BCID) were included. Organism identification was known 21 h sooner in the post-BCID group (P < 0.001). Coagulase-negative staphylococci were the most commonly isolated organisms (73%). In patients where vancomycin was deemed unnecessary (n = 133), vancomycin use (51% pre-BCID vs 36% post-BCID; P = 0.09) and time from culture positivity to vancomycin discontinuation (1.5 vs. 1.7 days; P = 0.92) did not differ between groups. We found no differences in the development of nephrotoxicity, LOS, readmission, mortality, or hospital costs. Earlier identification of single positive blood culture growing gram-positive cocci did not significantly influence prescribing patterns of vancomycin. However, baseline antimicrobial stewardship review of single positive blood culture growing gram-positive cocci may have lessened the opportunity for detectable differences. Larger studies, accounting for the impact of ASP intervention, should be performed to determine the value of each individual component.


Assuntos
Bacteriemia/diagnóstico , Hemocultura , Cocos Gram-Positivos/genética , Cocos Gram-Positivos/isolamento & purificação , Reação em Cadeia da Polimerase , Adulto , Idoso , Gestão de Antimicrobianos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Padrões de Prática Médica , Staphylococcus/isolamento & purificação , Fatores de Tempo , Estados Unidos , Vancomicina/uso terapêutico
5.
Enferm Infecc Microbiol Clin ; 37(2): 140-141, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29631929
6.
Clin Microbiol Infect ; 25(6): 760.e1-760.e6, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30217761

RESUMO

OBJECTIVES: Gram-positive, anaerobic cocci (GPAC) can cause infections in humans. Only a few cases of bacteraemia with GPAC have been reported. We describe the clinical and microbiological characteristics of GPAC bacteraemia. METHODS: A retrospective population-based study of GPAC bacteraemia 2012-2016 in southern Sweden was performed. GPAC were identified using matrix-associated laser desorption ionization time-of-flight mass spectrometry or 16S rRNA gene sequencing. Etests were used to determine antibiotic susceptibilities. Data on patient and infection characteristics, treatment, and outcome were collected from the medical records. RESULTS: A total of 226 episodes of GPAC bacteraemia in adults were studied; this corresponds to an annual incidence of 3.4 cases per 100,000 persons per year. The bacteria identified were Anaerococcus spp. (n = 43), Atopobium spp. (n = 7), Blautia spp. (n = 1), Finegoldia spp. (n = 15), Parvimonas spp. (n = 100), Peptoniphilus spp. (n = 52), Peptostreptococcus spp. (n = 2), and Ruminococcus spp. (n = 9) of which 200 isolates were identified to the species level. Resistance to imipenem and piperacillin was not identified, whereas resistance among the 229 isolates to penicillin was detected in four, to metronidazole in six, and clindamycin in 16 isolates. The median age of patients was 73 years (55-83, IQR), 57% were male and comorbidities were common. Fifty-one per cent of infections were polymicrobial. In 60% of cases a focus of infection was identified. Forty per cent of patients had either organ dysfunction or shock. The 30-day mortality was 11%, and nosocomial infections were over-represented among the deceased. CONCLUSIONS: GPAC bacteraemia is much more common than previously reported. GPAC-bacteraemia is a condition with significant mortality mainly affecting elderly persons with comorbidities.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bactérias Anaeróbias/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Bacteriemia/patologia , Bactérias Anaeróbias/classificação , Bactérias Anaeróbias/efeitos dos fármacos , Bactérias Anaeróbias/genética , Criança , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Feminino , Infecções por Bactérias Gram-Positivas/patologia , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/genética , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico 16S/genética , Estudos Retrospectivos , Análise de Sequência de DNA , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Suécia/epidemiologia , Adulto Jovem
7.
BMC Infect Dis ; 18(1): 490, 2018 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-30268097

RESUMO

BACKGROUND: Staphylococcus aureus bacteraemia is a common and significant infection, associated with high rates of mortality. Therefore, early identification is important for the initiation of appropriate treatment. The objective of this study was to evaluate the accuracy of blood culture Gram staining along with the finding of an 'oozing sign' to diagnose either Staphylococcus aureus or coagulase-negative staphylococci. METHODS: This single-centre, prospective observational study was performed from May 2017 to November 2017. We used routine blood culture bottles (BacT/ALERT FA and BacT/ALERT SN; bioMérieux, Inc., Durham, NC). Bacterial species were identified and the minimum inhibitory concentration was determined by using the MicroScan WalkAway 96 SI system (Beckman Coulter, Tokyo, Japan). Bottles showing growth were removed, and Gram staining was performed. RESULTS: A total of 118 samples, including 55 aerobic and 63 anaerobic bottle samples, were analysed. The overall sensitivity of Gram staining was 78.7% (95% CI: 65.8-94.3%), and the specificity was 95.0% (95% CI: 84.7-98.4%). CONCLUSION: The 'oozing sign' observed in Gram staining may be useful for the rapid prediction of S. aureus in BacT/ALERT blood culture bottles.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Cocos Gram-Positivos/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Antibacterianos/farmacologia , Bacteriemia/microbiologia , Violeta Genciana/química , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/crescimento & desenvolvimento , Humanos , Testes de Sensibilidade Microbiana , Fenazinas/química , Estudos Prospectivos , Sensibilidade e Especificidade , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/crescimento & desenvolvimento
8.
BMC Infect Dis ; 18(1): 401, 2018 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-30107836

RESUMO

BACKGROUND: Helcococcus ovis, belonging to the genus of Helcococcu in Peptostreptococcaceae, is one kind of facultative anaerobic and gram-positive cocci, which was first isolated from a mixed infection in sheep in 1999. To our knowledge, it's known as an invasive pathogen in animals, and never been reported as a human pathogen in published literature. The aims of this work are to describe the first report of H. ovis which was recovered from the artificial eye of human case and perform a literature review. CASE PRESENTATION: A 26 year-old man reporting pyogenic infection with an artificial eye attended ophthalmic ward in Tongji hospital. After physical examination, clinical and laboratory investigations, the diagnosis of eye infection caused by Helcococcus ovis and Staphylococcus aureus was established. Receiving a medico-surgical approach, the patient was successfully treated. The treatment consisted in intravenous cefotaxime and ornidazole, levofloxacin eye drops during two weeks and removing of right artificial eye with debridement. CONCLUSIONS: We describe here the first known case of H. ovis which was recovered from human artificial eye. This report different from previous data found in the literature emphasizes the invasive potential of this bacterial species as a pathogen in human. Prospectively, the application of next generation sequencing tools would contribute to a more accurate classification of clinical strains.


Assuntos
Infecções por Bactérias Gram-Positivas/diagnóstico , Cocos Gram-Positivos/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Olho/diagnóstico por imagem , Olho Artificial , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/efeitos dos fármacos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Imagem por Ressonância Magnética , Masculino , Soluções Oftálmicas/farmacologia , Soluções Oftálmicas/uso terapêutico , Staphylococcus aureus/isolamento & purificação
9.
Artigo em Inglês | MEDLINE | ID: mdl-30150472

RESUMO

In community hospitals, antimicrobial stewardship team notification of rapid diagnostic testing (RDT) results may not be feasible. A retrospective quasi-experimental study was conducted evaluating 252 adult inpatients with blood cultures positive for Gram-positive cocci in clusters (pre-RDT, n = 143; post-RDT, n = 109). The median time to appropriate therapy was significantly shorter in the post-RDT group (15 versus 0 h, P < 0.001), and the mean length of stay for patients with coagulase-negative staphylococcus was significantly shorter (10.5 versus 7.7 days; P = 0.015).


Assuntos
Infecções por Bactérias Gram-Positivas/diagnóstico , Cocos Gram-Positivos/isolamento & purificação , Adulto , Gestão de Antimicrobianos/métodos , Bacteriemia/sangue , Bacteriemia/diagnóstico , Bacteriemia/metabolismo , Bacteriemia/microbiologia , Hemocultura/métodos , Coagulase/metabolismo , Feminino , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/metabolismo , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais Comunitários/métodos , Hospitais de Ensino/métodos , Humanos , Tempo de Internação , Masculino , Estudos Retrospectivos , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação
10.
Acta Microbiol Immunol Hung ; 65(4): 501-513, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30010391

RESUMO

Dissemination of pathogenic multiresistant bacteria is of public health concern. Reliable data can be difficult to obtain, especially in developing countries. This work aimed to characterize the skin and oropharyngeal microbiota, as well as their antimicrobial resistance profiles, of East-Timor populations to identify potentially pathogenic Gram-positive cocci. In order to assess the prevalence of pathogenic bacteria in East-Timor, the oropharyngeal and skin microbiota of 74 individuals was characterized. Gram-positive cocci were evaluated and their antimicrobial resistance profiles were determined. A total of 228 oropharyngeal and 278 skin samples were obtained. The population consisted of 36.5% of asymptomatic carriers of Gram-positive cocci. Kocuria rosea (n = 7, 19.4%), Staphylococcus spp. (n = 6, 16.7%), and Micrococcus luteus (n = 6, 16.7%) were isolated, among others. Antimicrobial resistance levels ranged between 0% and 36.1%, and a multiresistance profile was observed in one third of the isolates. Gram-positive cocci colonization was associated with age group. Prevalence of multiresistant isolates was higher in males who were sampled at the refugee camp. Results show that the prevalence of antimicrobial resistance on East Timor may be underestimated. This study represents the first step toward the full characterization of potential pathogenic Gram-positive cocci present in the populations from East Timor.


Assuntos
Portador Sadio/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/isolamento & purificação , Adolescente , Adulto , Fatores Etários , Antibacterianos/farmacologia , Portador Sadio/microbiologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Orofaringe/microbiologia , Prevalência , Pele/microbiologia , Timor-Leste/epidemiologia , Adulto Jovem
11.
J Antimicrob Chemother ; 73(10): 2748-2756, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29982565

RESUMO

Background: Many infections due to Gram-positive cocci (GPC; staphylococci, streptococci and enterococci) regularly involve prolonged systemic antibiotic use. Dalbavancin has demonstrated activity against GPC isolates and has been approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) in adults. Objectives: To evaluate the activity of dalbavancin against GPC isolated from a variety of infection types in the USA and Europe. Methods: A total of 14 319 Staphylococcus aureus, 1992 CoNS, 3269 ß-haemolytic streptococci (BHS), 2071 Enterococcus faecalis, 936 Enterococcus faecium, 71 Enterococcus gallinarum/casseliflavus and other Enterococcus spp., 3487 Streptococcus pneumoniae and 1063 viridans group streptococci (VGS) causing clinical infections were consecutively collected (2015-16) and tested for susceptibility by broth microdilution methods. Results: All S. aureus (36.4% MRSA) isolates were susceptible to dalbavancin, teicoplanin and vancomycin, while daptomycin and linezolid showed susceptibility rates of >99.9% (according to CLSI criteria). Dalbavancin MIC results were at least 16-fold lower than these comparators against all S. aureus. Dalbavancin was the most potent agent against CoNS [62.2%/59.6% methicillin-resistant (CLSI/EUCAST)], followed by daptomycin, linezolid and vancomycin. All vancomycin-susceptible E. faecalis isolates were inhibited by dalbavancin at ≤0.25 mg/L (FDA susceptible breakpoint). Dalbavancin was very active against BHS (MIC90 0.03 mg/L) and the most active agent against S. pneumoniae and VGS (highest MIC 0.25 mg/L). Ceftriaxone, daptomycin, levofloxacin and vancomycin were also active (93.5%-100.0% susceptible) against VGS, whereas clindamycin, erythromycin, penicillin and tetracycline had lower activity. Conclusions: Dalbavancin appears to be a viable candidate for treating serious infections caused by GPC.


Assuntos
Antibacterianos/farmacologia , Cocos Gram-Positivos/efeitos dos fármacos , Teicoplanina/análogos & derivados , Daptomicina/farmacologia , Enterococcus/efeitos dos fármacos , Enterococcus/isolamento & purificação , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/isolamento & purificação , Europa (Continente)/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Teicoplanina/farmacologia , Estados Unidos/epidemiologia , Vancomicina/farmacologia , Estreptococos Viridans/efeitos dos fármacos , Estreptococos Viridans/isolamento & purificação
12.
Microbiologyopen ; 7(3): e00570, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29745065

RESUMO

Strain Marseille-P2341T , a nonmotile, nonspore-forming, Gram-stain-positive anaerobic coccus, was isolated in the vaginal specimen of a patient with bacterial vaginosis using culturomics. Its growth occurred at temperatures ranging from 25 to 42°C, with pH between 6.5 and 8.5, and at NaCl concentrations lower than 5%. The major fatty acids were C18:1n9 (27.7%) and C16:0 (24.4%). Its genome is 1,671,491 bp long with 49.48 mol% of G+C content. It is composed of 1,501 genes: 1,446 were protein-coding genes and 55 were RNAs. Strain Marseille-P2341T shared 97.3% of 16S rRNA gene sequence similarity with Murdochiella asaccharolytica, the phylogenetically closest species. These results enabled the classification of strain Marseille-P2341T as a new species of the genus Murdochiella for which we proposed the name Murdochiella vaginalis sp. nov. The type strain is strain Marseille-P2341T (=DSM 102237, =CSUR P2341).


Assuntos
Bactérias Anaeróbias/classificação , Bactérias Anaeróbias/isolamento & purificação , Firmicutes/classificação , Firmicutes/isolamento & purificação , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/isolamento & purificação , Vaginose Bacteriana/microbiologia , Adulto , Anaerobiose , Bactérias Anaeróbias/genética , Bactérias Anaeróbias/fisiologia , Composição de Bases , Análise por Conglomerados , Citosol/química , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Ácidos Graxos/análise , Feminino , Firmicutes/genética , Firmicutes/fisiologia , Cocos Gram-Positivos/genética , Cocos Gram-Positivos/fisiologia , Humanos , Concentração de Íons de Hidrogênio , Filogenia , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Cloreto de Sódio/metabolismo , Temperatura Ambiente , Vagina/microbiologia
13.
World J Urol ; 36(5): 775-781, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29372354

RESUMO

OBJECTIVE: To investigate the incidence and microbiology of urinary tract infection (UTI) within 90 days following radical cystectomy (RC) and urinary diversion. METHODS: We reviewed 1133 patients who underwent RC for bladder cancer at our institution between 2003 and 2013; 815 patients (72%) underwent orthotopic diversion, 274 (24%) ileal conduit, and 44 (4%) continent cutaneous diversion. 90-day postoperative UTI incidence, culture results, antibiotic sensitivity/resistance and treatment were recorded through retrospective review. Fisher's exact test, Kruskal-Wallis test, and multivariable analysis were performed. RESULTS: A total of 151 urinary tract infections were recorded in 123 patients (11%) during the first 90 days postoperatively. 21/123 (17%) had multiple infections and 25 (20%) had urosepsis in this time span. Gram-negative rods were the most common etiology (54% of positive cultures). 52% of UTI episodes led to readmission. There was no significant difference in UTI rate, etiologic microbiology (Gram-negative rods, Gram-positive cocci, fungi), or antibiotic sensitivity and resistance patterns between diversion groups. Resistance to quinolones was evident in 87.5% of Gram-positive and 35% of Gram-negative bacteria. In multivariable analysis, Charlson Comorbidity Index > 2 was associated with higher 90-day UTI rate (OR = 1.8, 95% CI 1.1-2.9, p = 0.05) and Candida UTI (OR 5.6, 95% CI 1.6-26.5, p = 0.04). CONCLUSIONS: UTI is a common complication and cause of readmission following radical cystectomy and urinary diversion. These infections are commonly caused by Gram-negative rods. High comorbidity index is an independent risk factor for postoperative UTI, but diversion type is not.


Assuntos
Cistectomia/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos , Infecções Urinárias , Idoso , Cistectomia/métodos , Resistência Microbiana a Medicamentos , Feminino , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/isolamento & purificação , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Estados Unidos/epidemiologia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/patologia , Derivação Urinária/métodos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia
14.
J Food Sci ; 83(2): 377-385, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29337343

RESUMO

Although most Brazilian dairy products meet high technological standards, there are quality issues regarding milk production, which may reduce the final product quality. Several microbial species may contaminate milk during manufacture and handling. If antimicrobial usage remains uncontrolled in dairy cattle, the horizontal transfer of antimicrobial resistance genes in foodstuffs may be of particular concern for both food producers and dairy industry. This study focused on the evaluation of putative Gram positive cocci in Minas cheese and of antimicrobial and biocide resistance genes among the isolated bacteria. Representative samples of 7 different industrially trademarked Minas cheeses (n = 35) were processed for selective culture and isolation of Gram positive cocci. All isolated bacteria were identified by DNA sequencing of the 16S rRNA gene. Antimicrobial resistance genes were screened by PCR. Overall, 208 strains were isolated and identified as follows: Enterococcus faecalis (47.6%), Macrococcus caseolyticus (18.3%), Enterococcus faecium (11.5%), Enterococcus caseliflavus (7.7%), Staphylococcus haemolyticus (7.2%), Staphylococcus aureus (4.3%), Staphylococcus epidermidis (2.9%), and Enterococcus hirae (0.5%). The genetic markers mecA (78.0%) and smr (71.4%) were the most prevalent, but others were also detected, such as blaZ (65.2%), msrA (60.9%), msrB (46.6%), linA (54.7%), and aacA-aphD (47.6%). The occurrence of opportunist pathogenic bacteria harboring antimicrobial resistance markers in the cheese samples are of special concern, since these bacteria are not considered harmful contaminating agents according to the Brazilian sanitary regulations. However, they are potentially pathogenic bacteria and the cheese may be considered a reservoir for antimicrobial resistance genes available for horizontal transfer through the food chain, manufacturing personnel and consumers.


Assuntos
Queijo/microbiologia , Farmacorresistência Bacteriana/genética , Cocos Gram-Positivos/genética , Cocos Gram-Positivos/isolamento & purificação , Animais , Antibacterianos , Brasil , Bovinos , DNA Bacteriano/análise , Enterococcus/genética , Enterococcus/isolamento & purificação , Microbiologia de Alimentos , Marcadores Genéticos , Cocos Gram-Positivos/efeitos dos fármacos , Leite/microbiologia , RNA Ribossômico 16S/genética , Staphylococcus/genética , Staphylococcus/isolamento & purificação
15.
J Int Med Res ; 46(1): 225-233, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28789605

RESUMO

Objective This study aimed to investigate the epidemiology and changes in antibacterial susceptibility of children in Shenmu City, northern Shaanxi, and provide a basis for rational drug use. Methods The distribution and drug resistance pattern of pathogenic bacteria isolated from children were retrospectively analysed. Results A total of 573 strains of pathogens were cultivated. A total of 201 (35.07%) strains of Gram-positive cocci and 183 (31.93%) strains of Gram-negative cocci were detected. A total of 189 (32.98%) strains of fungi were detected. The resistance rate of Staphylococcus to penicillin was 100% and that to erythromycin was 90.69%. There were varying degrees of resistance to other drugs, but no single strain had vancomycin resistance. Gram-negative bacilli were generally resistant to ampicillin, but had low resistance to the combined preparation of enzyme inhibitors, quinolones, and aminoglycosides, and were highly sensitive to imipenem and meropenem. Conclusion Gram-negative bacilli are the main pathogens of bacterial infection in the paediatric ward. Strengthening clinical monitoring of bacterial distribution in paediatric clinical isolates and understanding changes in drug resistance are important for guiding the rational use of antibiotics. These measures could also prevent emergence and spreading of resistant strains.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Fungos/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Cocos Gram-Positivos/efeitos dos fármacos , Ampicilina/uso terapêutico , Antifúngicos/uso terapêutico , Criança , Pré-Escolar , Eritromicina/uso terapêutico , Feminino , Fungos/crescimento & desenvolvimento , Fungos/isolamento & purificação , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Cocos Gram-Positivos/crescimento & desenvolvimento , Cocos Gram-Positivos/isolamento & purificação , Humanos , Imipenem/uso terapêutico , Lactente , Recém-Nascido , Masculino , Meropeném , Testes de Sensibilidade Microbiana , Micoses/tratamento farmacológico , Micoses/microbiologia , Penicilinas/uso terapêutico , Estudos Retrospectivos , Tienamicinas/uso terapêutico , Vancomicina/uso terapêutico
17.
J Med Microbiol ; 66(12): 1752-1758, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29134938

RESUMO

PURPOSE: Fast identification of bacteria directly from positive blood cultures (BCs) by matrix-assisted laser desorption/ionization time-of-flight mass-spectrometry (MALDI-TOF MS) can be achieved either using the MALDI Sepsityper kit (protein extraction method) or after a short-term pre-cultivation step on solid medium. We developed a new method that involves short-term enrichment of positive BCs in brain-heart infusion broth (BHI) prior to MALDI-TOF MS analysis. METHODOLOGY: Eighty-four BCs flagged as positive were included in this study; these were processed in parallel either directly using the MALDI Sepsityper kit or following a short-term culture either in BHI or on Columbia blood agar with 5 % sheep blood (CBA). RESULTS: Bacterial species were successfully identified in 91.6, 89.2 and 65.4 % of cases after pre-cultivation for 4 h in BHI, on CBA, or by using the MALDI Sepsityper kit, respectively. Overall, the mean incubation time to correct identification was shorter when pre-cultures were performed in BHI; the mean time for Gram-negative rods was 78.2 min in BHI and 108.2 min on CBA (P=0.045), and the mean time for Gram-positive cocci was 128.5 min in BHI and 169.6 min on CBA (P=0.013). CONCLUSION: Short-term enrichment of BCs in BHI accelerates identification of a number of bacterial species by MALDI-TOF MS. Further prospective studies are needed to validate our method and gauge its potential clinical impact on the management of bloodstream bacterial infections.


Assuntos
Hemocultura , Meios de Cultura/química , Bactérias Gram-Negativas/isolamento & purificação , Cocos Gram-Positivos/isolamento & purificação , Infecções Bacterianas/diagnóstico , Técnicas Bacteriológicas , Humanos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
18.
BMC Vet Res ; 13(1): 357, 2017 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-29178882

RESUMO

BACKGROUND: The present investigation was an endeavor into the elucidation of the disease-causing pathogen of streptococcosis in Nile tilapia (Oreochromis niloticus) in Egypt affecting adult fish cultured and wild fish in the Nile river. Fish were obtained from commercial fishermen, collected as part of their routine fishing activities. The researchers observed the routine fishing process and selected fish for use in the study, at the point of purchase from the fisherman. RESULTS: Diseased fish showed exophthalmia with accumulation of purulent and haemorrhagic fluid around eyes, and ventral petechial haemorrhages. The Post mortem examination revealed, abdominal fat haemorrhage, pericarditis and enlargement of the liver, spleen and kidney. Gram-stained smears revealed the presence of Gram-positive cocci, ß-hemolytic, oxidase and catalase negative. Analysis of the 16S rRNA gene confirmed that the 17 tilapia isolates studied were 6/17 Enterococcus faecalis, 2/17 Enterococcus gallinarum, 3/17 Streptococcus pluranimalium, 2/17 Aerococcus viridans, 1/17 isolate of each Streptococcus dysgalactiae, Streptococcus anginosus, Lactococcus garvieae and Granulicetella elegans/Leuconostoc mesenteroides cremoris. It should be noted that there was no mixed infection. Multiple resistance was observed and the most frequent antibiotic combination was penicillin, ampicillin, vancomycin, chloramphenicol, rifampicin, ofloxacin, clindamycin, erythromycin and tetracycline representing eight classes. CONCLUSIONS: Consequently, we concluded that Streptococcus species are an emerging pathogen for Nile tilapia aquaculture in Egypt and to be considered as a new candidate in the warm water fish diseases in Egypt with special reference to L. garvieae, S. dysgalactiae in addition to L. mesenteroides cremoris which was not reported before from tilapia and taking into consideration their zoonotic implications for public health.


Assuntos
Ciclídeos/microbiologia , Doenças dos Peixes/microbiologia , Infecções por Bactérias Gram-Positivas/veterinária , Cocos Gram-Positivos/isolamento & purificação , Animais , Aquicultura , Farmacorresistência Bacteriana , Egito , Doenças dos Peixes/patologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/patologia , Cocos Gram-Positivos/classificação , Cocos Gram-Positivos/genética , RNA Ribossômico 16S , Sepse/microbiologia , Sepse/veterinária
19.
J Antimicrob Chemother ; 72(11): 3191-3198, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28961942

RESUMO

Objectives: To compare antibiotic optimization and outcomes of patients before implementation of the Verigene Gram-Positive Blood Culture (Verigene BC-GP) nucleic acid microarray assay to after implementation with antimicrobial stewardship (AS) interventions and after discontinuation of AS interventions. Methods: A retrospective pre-post-post quasi-experimental study was conducted to compare the three periods. AS interventions consisted of real-time guidance to clinicians on antibiotic selection. The primary outcome was median time from Gram stain to optimal therapy. Secondary outcomes included median time to effective therapy, median duration of therapy for contaminant organisms, median length of stay after blood cultures were collected, and all-cause in-hospital mortality. Results: Out of a total of 923 patients, 390 (125 baseline, 134 intervention, 131 post-intervention) who were not on optimal therapy at the time of Gram stain or had contaminated blood cultures were assessed. Compared with baseline, only the median time to optimal therapy for MSSA bacteraemia was reduced in both the intervention and post-intervention periods (17 versus 17 versus 50 h; P < 0.001), respectively. In an analysis adjusted for baseline differences among the groups using quantile regression models, use of the Verigene BC-GP assay in both periods significantly reduced time to optimal therapy by 14-22 h in patients who would achieve optimal therapy at ≥ 26 h without the assay. There were no differences in in-hospital mortality or hospital length of stay between study periods. Conclusions: A real-time AS intervention implemented alongside introduction of the Verigene BC-GP assay led to improvements in antibiotic therapy for patients with bacteraemia due to Gram-positive cocci, even after the AS intervention was discontinued.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Bacteriemia/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Adulto , Idoso , Antibacterianos/efeitos adversos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Hemocultura , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/genética , Cocos Gram-Positivos/isolamento & purificação , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Estudos Retrospectivos , Resultado do Tratamento
20.
Urologiia ; (2): 66-70, 2017 Jun.
Artigo em Russo | MEDLINE | ID: mdl-28631909

RESUMO

INTRODUCTION: In the structure of tuberculosis morbidity, urogenital tuberculosis (UGT) ranks second or third only to pulmonary tuberculosis. Every fourth patient has the stage of cavern formation at first presentation. Seventy five percent of nephrotuberculosis cases co-occur with nonspecific pyelonephritis, which excludes "sterile pyuria". We aimed to determine the microbial spectrum of urine and gonadal appendages in patients with suspected UGT and to investigate the susceptibility of the isolated microorganisms to the main antibacterial drugs. MATERIAL AND METHODS: The study investigated the spectrum of pathogenic microflora isolated from patients admitted to the urogenital clinic of the TB Research Institute from January 1, 2012 to September 30, 2016 to rule out UGT. Microorganism species were identified by time-of-flight mass spectrometry using the microbiological analyzer Phoenix 100 (Becton Dickinson, USA). Antibiotic resistance was determined using the Phoenix 100 microbiological analyzer (Becton Dickinson, USA). RESULTS: A total of 3004 bacteriological tests for nonspecific microflora were performed during the analyzed period. In the structure of pathogens, E. coli comprised about half of the cases thus confirming its role as the leading uropathogen. Only piperacillin/tazobactam and nitrofurantoin provided relatively plausible antimicrobial resistance rates, for other antibacterial drugs the rates of susceptible strains progressively decreased and by 2016 dropped to 40% and lower. CONCLUSION: Our findings cannot be extrapolated to the entire population since patients presenting for differential diagnosis receive multiple courses of treatment with various antibacterial drugs, which led to the selection of resistant strains. The findings emphasize the need for a strict selection of antibiotics for urogenital infection empirical therapy. In the absence of response, the patient should be immediately examined for tuberculosis using molecular and genetic diagnostic techniques.


Assuntos
Resistência Microbiana a Medicamentos , Fungos/classificação , Bactérias Gram-Negativas/classificação , Cocos Gram-Positivos/classificação , Tuberculose Urogenital/microbiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/isolamento & purificação , Humanos , Espectrometria de Massas , Testes de Sensibilidade Microbiana , Federação Russa , Tuberculose Urogenital/tratamento farmacológico
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