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1.
Medicine (Baltimore) ; 100(7): e24847, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607856

RESUMO

ABSTRACT: The objective of this study was to evaluate the risk factors, pathogenic bacteria and drug sensitivity of maternal sepsis, and provide evidence for clinical prevention and treatment.A retrospective investigation of pregnant women with full-term maternal sepsis was performed to analyze the risk factors, pathogenic bacteria, and drug sensitivity of maternal sepsis.Univariate analysis showed that temperature, serum procalcitonin (PCT) and C-reactive protein (CRP) at admission, white blood cell count (WBC), PCT, CRP and neutrophilic granulocyte percentage (N%) during fever, premature rupture of membranes (PROM), antibiotic use within 1 week, mode of production, onset and duration of fever, between groups were statistically significant (P < .05). Logistic regression analysis showed that cesarean section was an independent risk factor for sepsis (OR = 11.839, 95%CI: 3.121-44.906). Apparent increase was found in body temperature (OR = 3.664, 95%CI: 1.722-7.795), duration of fever (OR = 1.953, 95%CI: 1.242-3.071), and PCT (OR = 1.080, 95%CI: 1.002-1.163). Also, increasing neutrophil ratio (OR = 1.180, 95%CI: 1.073-1.297) indicated a high possibility of maternal sepsis. The organism Escherichia coli (E. coli) was the most common pathogenic bacteria in the positive blood culture group (90%), and the sensitivity to carbapenems (meropenem and imipenem/cilastatin) was 100%, that to piperacillin-tazobactam and amoxicillin sulbactam was over 90%, and that to ceftazidime was 95%.Cesarean section was an independent risk factor for maternal sepsis in term pregnant women with positive blood culture. Besides, the E. coli was the most common pathogenic bacteria in the positive blood culture group. Antibiotics should be used in time and reasonably when the temperature was significantly increased with elevated PCT and N% after a cesarean section.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/patogenicidade , Hospitalização/estatística & dados numéricos , Complicações Infecciosas na Gravidez/microbiologia , Adulto , Antibacterianos/normas , Bactérias/efeitos dos fármacos , Hemocultura/métodos , Hemocultura/estatística & dados numéricos , Proteína C-Reativa/análise , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , China/epidemiologia , Escherichia coli/patogenicidade , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Febre , Humanos , Contagem de Leucócitos/métodos , Contagem de Leucócitos/estatística & dados numéricos , Testes de Sensibilidade Microbiana/métodos , Neutrófilos/citologia , Neutrófilos/patologia , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Gestantes , Pró-Calcitonina/sangue , Estudos Retrospectivos , Fatores de Risco
2.
BMC Infect Dis ; 21(1): 182, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33596842

RESUMO

BACKGROUND: The association between blood culture status and mortality among sepsis patients remains controversial hence we conducted a tri-center retrospective cohort study to compare the early and late mortality of culture-negative versus culture-positive sepsis using the inverse probability of treatment weighting (IPTW) method. METHODS: Adult patients with suspected sepsis who completed the blood culture and procalcitonin tests in the emergency department or hospital floor were eligible for inclusion. Early mortality was defined as 30-day mortality, and late mortality was defined as 30- to 90-day mortality. IPTW was calculated from propensity score and was employed to create two equal-sized hypothetical cohorts with similar covariates for outcome comparison. RESULTS: A total of 1405 patients met the inclusion criteria, of which 216 (15.4%) yielded positive culture results and 46 (21.3%) died before hospital discharge. The propensity score model showed that diabetes mellitus, urinary tract infection, and hepatobiliary infection were independently associated with positive blood culture results. There was no significant difference in early mortality between patients with positive or negative blood culture results. However, culture-positive patients had increased late mortality as compared with culture-negative patients in the full cohort (IPTW-OR, 1.95, 95%CI: 1.14-3.32) and in patients with severe sepsis or septic shock (IPTW-OR, 1.92, 95%CI: 1.10-3.33). After excluding Staphylococcal bacteremia patients, late mortality difference became nonsignificant (IPTW-OR, 1.78, 95%CI: 0.87-3.62). CONCLUSIONS: Culture-positive sepsis patients had comparable early mortality but worse late mortality than culture-negative sepsis patients in this cohort. Persistent Staphylococcal bacteremia may have contributed to the increased late mortality.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Sepse/diagnóstico , Choque Séptico/diagnóstico , Idoso , Bacteriemia/microbiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pró-Calcitonina/análise , Estudos Retrospectivos , Sepse/microbiologia , Sepse/mortalidade , Choque Séptico/microbiologia , Choque Séptico/mortalidade
3.
BMC Infect Dis ; 21(1): 62, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33435894

RESUMO

BACKGROUND: Although traditional diagnostic techniques of infection are mature and price favorable at present, most of them are time-consuming and with a low positivity. Metagenomic next⁃generation sequencing (mNGS) was studied widely because of identification and typing of all pathogens not rely on culture and retrieving all DNA without bias. Based on this background, we aim to detect the difference between mNGS and traditional culture method, and to explore the relationship between mNGS results and the severity, prognosis of infectious patients. METHODS: 109 adult patients were enrolled in our study in Shanghai Tenth People's Hospital from October 2018 to December 2019. The diagnostic results, negative predictive values, positive predictive values, false positive rate, false negative rate, pathogen and sample types were analyzed by using both traditional culture and mNGS methods. Then, the samples and clinical information of 93 patients in the infected group (ID) were collected. According to whether mNGS detected pathogens, the patients in ID group were divided into the positive group of 67 cases and the negative group of 26 cases. Peripheral blood leukocytes, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil counts were measured, and the concentrations of IL-2, IL-4, IL-6, TNF-α, IL-17A, IL-10 and INF-γ in the serum were determined by ELISA. The correlation between the positive detection of pathogens by mNGS and the severity of illness, hospitalization days, and mortality were analyzed. RESULTS: 109 samples were assigned into infected group (ID, 92/109, 84.4%), non-infected group (NID, 16/109, 14.7%), and unknown group (1/109, 0.9%). Blood was the most abundant type of samples with 37 cases, followed by bronchoalveolar lavage fluid in 36 cases, tissue, sputum, pleural effusion, cerebrospinal fluid (CSF), pus, bone marrow and nasal swab. In the ID group, the majority of patients were diagnosed with lower respiratory system infections (73/109, 67%), followed by bloodstream infections, pleural effusion and central nervous system infections. The sensitivity of mNGS was significantly higher than that of culture method (67.4% vs 23.6%; P < 0.001), especially in sample types of bronchoalveolar lavage fluid (P = 0.002), blood (P < 0.001) and sputum (P = 0.037), while the specificity of mNGS was not significantly different from culture method (68.8% vs 81.3%; P = 0.41). The number of hospitals stays and 28-day-motality in the positive mNGS group were significantly higher than those in the negative group, and the difference was statistically significant (P < 0.05). Age was significant in multivariate logistic analyses of positive results of mNGS. CONCLUSIONS: The study found that mNGS had a higher sensitivity than the traditional method, especially in blood, bronchoalveolar lavage fluid and sputum samples. And positive mNGS group had a higher hospital stay, 28-day-mortality, which means the positive of pathogen nucleic acid sequences detection may be a potential high-risk factor for poor prognosis of adult patients and has significant clinical value. MNGS should be used more in early pathogen diagnosis in the future.


Assuntos
Doenças Transmissíveis/diagnóstico , Testes Diagnósticos de Rotina/métodos , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Metagenômica/métodos , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemocultura/métodos , Líquido da Lavagem Broncoalveolar/microbiologia , China , Doenças Transmissíveis/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Escarro/microbiologia
4.
J Med Microbiol ; 70(3)2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33331811

RESUMO

Introduction. Blood culture (BC) remains the gold standard for the diagnosis of bloodstream infection. Clinical microbiology laboratories must ensure the quality of their BC process from receipt to definitive results.Aim. In this study, we followed the evolution of different quality indicators for BCs over the first year of implementation of the BacT/Alert Virtuo system in a French hospital.Methodology. In our laboratory, we instituted regular monitoring of several quality indicators to track (i) delays in sample registration, (ii) delays in loading BC bottles in our incubating system (BacT/Alert Virtuo) after registration, (iii) the volume of blood in bottles and (iv) the contamination rates.Results. For 53 892 BC bottles loaded in the BacT/Alert Virtuo from 23 January to 31 December 2019, the delays in sample registration, loading and unloading were respectively 3.5 h±0.016, 44 min±0.209 and 5.8 h±0.0727. Intriguingly, the automated process performed by the BacT/Alert Virtuo system to check the blood volume in bottles was only performed for 60 % of the loaded bottles. Among these, 30 % contained the recommended volume of blood (between 7 and 13 ml). Finally, the contamination rate was found to be 27.2 % for samples at our institution.Conclusions. The delays in sample registration, loading and unloading were found to be acceptable, even though they could be improved by ensuring a continuous service during the night duty period. Furthermore, the percentage of volumes measured is insufficient and must be improved and the majority of bottles do not contain the recommended blood volume.


Assuntos
Bactérias/isolamento & purificação , Hemocultura/métodos , Indicadores de Qualidade em Assistência à Saúde , Sepse , Manejo de Espécimes/métodos , França , Humanos , Sepse/diagnóstico , Sepse/microbiologia , Fatores de Tempo
5.
APMIS ; 129(4): 178-185, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33368673

RESUMO

Bloodstream infections (BSIs) are related to high mortality and morbidity. Rapid administration of effective antimicrobial treatment is crucial for patient survival. Recently developed rapid methods to identify pathogens directly from blood culture bottles speed up diagnosis of BSIs. The present study compares the performance of two rapid identification methods, FilmArray and direct MALDI-TOF MS, on identifying microorganisms directly from positive blood culture bottles with polymicrobial growth. FilmArray and direct MALDI-TOF MS were performed directly on positive clinical and simulated polymicrobial blood culture bottles. Assay results were compared with standard culture methods. In total, 110 polymicrobial blood culture samples, of which 96 samples contained two microorganisms while 14 samples contained three microorganisms, were studied. FilmArray was able to identify 215/234 (92.0%) of isolates detected by the standard culture method and successfully identified all microorganisms in 88/110 (80.0%) of blood culture bottles. In contrast, direct MALDI-TOF MS was only able to identify 65/234 (27.8%) of isolates and managed to identify all microoganisms in 2/110 (2.1%) of blood culture bottles. FilmArray is a rapid method for direct identification of polymicrobial blood culture samples that can complement the conventional identification methods. Direct MALDI-TOF MS has low performance with polymicrobial samples.


Assuntos
Hemocultura/métodos , Reação em Cadeia da Polimerase/métodos , Sepse/diagnóstico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Humanos , Sensibilidade e Especificidade
7.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 38(8): 375-378, oct. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-201024

RESUMO

OBJECTIVE: The aim was to evaluate a rapid method which would combine identification and susceptibility testing directly from positive blood cultures for Gram-negative bacilli of the Enterobacterales. MATERIAL AND METHODS: Gram-negative rods from blood cultures were directly identified by MALDI-TOF. Samples with Enterobacterales were selected for direct antimicrobial susceptibility testing by Vitek 2. The results were compared to those obtained with our laboratory's standard method. RESULTS: MALDI-TOF directly from blood cultures identified correctly 83% of the samples. Enterobacterales (n = 68) were identified at gender and species level in 85% of blood cultures with a score >1.7. In general, MICs were obtained after 7 h. MICs of amoxicillin-clavulanate, amikacin and ciprofloxacin showed in almost 50% of the cases after 5 h. CONCLUSIONS: A simple procedure with low cost and reduced working time makes it possible to integrate both identification and susceptibility testing directly from blood cultures. Thus, this protocol could offer advantages when it comes to selection and cost of treatment and patients' clinical outcomes


OBJETIVO: Evaluar un método rápido de identificación y estudio de sensibilidad directamente desde hemocultivos positivos para bacilos gramnegativos del orden Enterobacterales. MATERIAL Y MÉTODOS: Los hemocultivos con bacilos gramnegativos fueron utilizados para identificación mediante MALDI-TOF, seleccionándose aquellos con Enterobacterales para estudio de sensibilidad con Vitek 2. Los resultados fueron comparados con el método estándar del laboratorio. RESULTADOS: MALDI-TOF identificó correctamente el 83% de las muestras obtenidas directamente de hemocultivos. En caso de Enterobacterales (n = 68), el 85% se identificaron a nivel de género y especie con un score > 1,7. El tiempo necesario para la obtención de CMIs fue de 7 horas, reduciéndose a 5 en amoxicilina-clavulánico, amicacina y ciprofloxacino, casi en el 50% de los casos. CONCLUSIONES: Un protocolo simplificado, con bajo coste y reducido tiempo de trabajo, combinando identificación y estudio de sensibilidad directamente desde hemocultivos, podría proporcionar beneficios en la elección y coste del tratamiento, y mejora clínica del paciente


Assuntos
Humanos , Bacteriemia/microbiologia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Testes de Sensibilidade Microbiana/métodos , Diagnóstico Precoce , Hemocultura/métodos , Bactérias Gram-Positivas/isolamento & purificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/classificação , Bactérias Gram-Negativas/classificação , Antibacterianos/farmacologia
8.
BMC Infect Dis ; 20(1): 619, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831055

RESUMO

BACKGROUND: Neisseria macacae was discovered in the oral cavity of monkeys in 1983. In humans, it has been isolated from the upper respiratory tract of neutropenic patients. However, only two cases of N. macacae bacteremia have been reported in a 65-year-old man with infective endocarditis and a 5-month-old child with fever and petechiae. There are no reports of infections in cancer patients. Here, we present two cases of N. macacae bacteremia in cancer patients. CASE PRESENTATION: In the first case, a 42-year-old woman who underwent ovarian cancer surgery presented with duodenal invasion associated with multiple lymph node metastasis. N. macacae was isolated from her blood culture and identified using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). In the second case, a 69-year-old woman with a long-standing history of esophagogastric junction cancer presented with fever. She had stage IVB cancer with lung, bone, and multiple lymph node metastasis. The last chemotherapy was administered 5 weeks before N. macacae was detected using MALDI-TOF MS and nitrate test negative. In both cases, transthoracic echography showed no vegetation. Antibiotics were administered for 14 and 13 days in the first and second cases, respectively. In both cases, fever alleviated on day 4 of antibiotic administration. Both patients were discharged after their conditions improved. CONCLUSIONS: This, to our knowledge, is the first report of N. macacae bacteremia in cancer patients. Both patients, mucosal damage was observed in the upper gastrointestinal tract. Therefore, exclusion diagnosis suggested that bacteremia invasion was caused by mucosal rupture in both cases. Both cases responded well to treatment with ß-lactam antibiotics and improved after 2 weeks. Modifying the treatment based on the source of the infection may shorten the treatment period. Therefore, further research on N. macacae bacteremia is necessary. Immunocompromised patients such as those with cancer are susceptible to mucosal damage by unusual bacterial species such as N. macacae despite not having contact with monkeys.


Assuntos
Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Neisseria/patogenicidade , Adulto , Idoso , Antibacterianos/uso terapêutico , Hemocultura/métodos , Endocardite Bacteriana/microbiologia , Neoplasias Esofágicas/microbiologia , Junção Esofagogástrica/patologia , Feminino , Humanos , Masculino , Neisseria/genética , Neisseria/isolamento & purificação , Neoplasias Ovarianas/microbiologia , RNA Ribossômico 16S , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos
9.
J Med Microbiol ; 69(8): 1095-1099, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32639226

RESUMO

Introduction. Empirical vancomycin (VAN) treatment failure for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia, with significantly higher mortality, has been reported for MRSA strains with reduced VAN susceptibility.Aim. Our goal was to study the effect of sub-culture on VAN minimum inhibitory concentration (MIC) values compared to direct susceptibility of MRSA-positive blood cultures.Methodology. Using 19 MRSA-positive blood cultures and 19 seeded MRSA-positive blood cultures, we compared the VAN MICs from direct susceptibility testing of MRSA-positive blood cultures and MRSA sub-cultured from positive blood cultures.Results. In comparing direct VAN MICs from MRSA-positive blood cultures and standard agar dilution, nearly half of the MICs from agar dilution were lower, with one sample decreasing from 1.5 to 0.75 µg ml-1. Furthermore, in seeded blood cultures, 80 % or more showed lower values from standard agar dilution compared to direct VAN MICs.Conclusion. Our results reveal a trend towards lower MICs after positive blood culture isolates are sub-cultured. Some clinical failures among MRSA infections treated with VAN may result from this phenomenon.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Hemocultura/métodos , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Infecções Estafilocócicas/microbiologia , Vancomicina/farmacologia , Animais , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Ovinos
10.
J Med Microbiol ; 69(6): 806-811, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32490793

RESUMO

Introduction. Bloodstream infections (BSI) are growing in incidence and present a serious health threat. Most patients wait up to 48 h before microbiological cultures can confirm a diagnosis. Low numbers of circulating bacteria in patients with BSI mean we need to develop new methods and optimize current methods to facilitate efficient recovery of bacteria from the bloodstream. This will allow detection of positive blood cultures in a more clinically useful timeframe. Many bacterial blood recovery methods are available and usually include a combination of techniques such as centrifugation, filtration, serum separation or lysis treatment. Here, we evaluate nine different bacteria recovery methods performed directly from blood culture.Aim. We sought to identify a bacterial recovery method that would allow for a cost-effective and efficient recovery of common BSI pathogens directly from blood culture.Methods. Simulated E. coli ATCC 25922 blood culture was used as a model system to evaluate nine different bacteria recovery methods. Each method was assessed on recovery yield, cost, hands-on time, risk of contamination and ease of use. The highest scoring recovery method was further evaluated using simulated blood cultures spiked with seven of the most frequently occurring bloodstream pathogens. The recovery yield was calculated based on c.f.u. count before and after each recovery method. Independent t-tests were performed to determine if the recovery methods evaluated were significantly different based on c.f.u. ml-1 log recovery.Results. All nine methods evaluated successfully recovered E. coli ATCC 25922 from simulated blood cultures although the bacterial yield differed significantly. The MALDI-TOF intact cell method offered the poorest recovery with a mean loss of 2.94±0.37 log c.f.u. ml-1. In contrast, a method developed by Bio-Rad achieved the greatest bacterial yield with a mean bacteria loss of 0.27±0.013 log c.f.u. ml-1. Overall, a low-speed serum-separation method was demonstrated to be the most efficient method in terms of time, cost and recovery efficiency and successfully recovered seven of the most frequent BSI pathogens with a mean bacteria loss of 0.717±0.18 log c.f.u. ml-1.Conclusion. The efficiency of bacterial recovery can vary significantly between different methods and thereby can have a critical impact on downstream analysis. The low-speed serum-separation method offered a simple and effective means of recovering common BSI pathogens from blood culture and will be further investigated for use in the rapid detection of bacteraemia and susceptibility testing in clinical practice.


Assuntos
Bactérias/isolamento & purificação , Técnicas Bacteriológicas/métodos , Hemocultura/métodos , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Bacteriemia/diagnóstico , Escherichia coli/isolamento & purificação , Humanos
11.
J Med Microbiol ; 69(7): 944-948, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32490795

RESUMO

Introduction. Polymicrobial infections including yeasts and bacteria are not rare and patients with polymicrobial bloodstream infection have higher early and overall case fatality rates. The diagnosis of invasive fungal and bacterial infections is mainly based on blood culture.Aim. The aim was to reveal the effect of concomitant bacteraemia on the detection of fungi from blood cultures in the presence of polymicrobial bloodstream infections involving Candida and non-Candida fungi and to show the superiority of blood culture bottles including selective fungal media in such situations.Methodology. Twenty-four polymicrobial bloodstream infection models - involving one fungus and one bacterium - were constituted by using clinical blood culture isolates (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Candida glabrata, Fusarium solani and Trichosporon asahii). The Plus Aerobic/F (PAF) and Mycosis IC/F (MICF) culture bottles were used with the BACTEC 9240 device. After a bottle signalled positive, direct microscopic examination and subcultures on agar plates were performed.Results. All of fungi that were inoculated alone and in combination were detected by both direct microscopic examination and subcultures on agar plates from MICF bottles, whereas direct microscopic examination only revealed the bacterial agents from PAF bottles including combinations. Furthermore, fungal growth was hidden by bacterial growth on blood agar subcultures from PAF bottles including combinations of F. solani, C. glabrata or T. asahii with bacteria.Conclusion. Blood culture bottles including selective fungal media that can allow selective growth of fungi and earlier detection of some species should be preferred in addition to non-selective blood culture bottles, especially in specific patient populations. Further, the use of selective agar plates such as inhibitory mould agar may contribute to the solution of this problem in clinical laboratories.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Bacteriemia/sangue , Bacteriemia/microbiologia , Bactérias/crescimento & desenvolvimento , Bactérias/isolamento & purificação , Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Candida/isolamento & purificação , Candidemia/sangue , Candidemia/diagnóstico , Candidemia/microbiologia , Meios de Cultura , Fungos/crescimento & desenvolvimento , Fungos/isolamento & purificação , Humanos , Técnicas Microbiológicas/métodos , Micoses/sangue , Micoses/diagnóstico
12.
Rev. esp. quimioter ; 33(3): 200-206, jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-197878

RESUMO

INTRODUCTION: Bloodstream Infections has become in one of the priorities for the antimicrobial stewardship teams due to their high mortality and morbidity rates. Usually, the first antibiotic treatment for this pathology must be empirical, without microbiology data about the microorganism involved. For this reason, the population studies about the etiology of bacteremia are a key factor to improve the selection of the empirical treatment, because they describe the main microorganisms associated to this pathology in each area, and this data could facilitate the selection of correct antibiotic therapy. MATERIAL AND METHODS: This study describes the etiology of bloodstream infections in the Southeast of Spain. The etiology of bacteremia was analysed by a retrospective review of all age-ranged patients from every public hospital in the Autonomous Community of Valencia (approximately 5,000,000 inhabitants) for five years. RESULTS: A total of 92,097 isolates were obtained, 44.5% of them were coagulase-negative staphylococci. Enterobacteriales was the most prevalent group and an increase in frequency was observed along the time. Streptococcus spp. were the second microorganisms more frequently isolated. Next, the most prevalent were Staphylococcus aureus and Enterococcus spp., both with a stable incidence along the study. Finally, Pseudomonas aeruginosa was the fifth microorganism more frequently solated. CONCLUSIONS: These data constitute a useful tool that can help in the choice of empirical treatment for bloodstream infections, since the knowledge of local epidemiology is key to prescribe a fast and appropriate antibiotic therapy, aspect capital to improve survival


INTRODUCCIÓN: Las bacteriemias se han convertido en una de las prioridades de los Programas de Optimización de uso de Antimicrobianos (PROA) debido a sus altas tasas de morbimortalidad. Normalmente, el tratamiento antibiótico tiene que ser pautado de forma empírica, sin datos del microorganismo implicado. Por esto, los estudios poblacionales sobre la etiología de las bacteriemias son un factor clave para mejorar la elección del tratamiento empírico, ya que describen los principales microorganismos asociados a esta patología en cada área, lo que facilita en gran medida la selección del antibiótico correcto. MATERIAL Y MÉTODOS: Este estudio describe la etiología de las bacteriemias en el sureste de España durante los años 2013-2017. La etología fue analizada de forma retrospectiva estudiando los microorganismos implicados en todas las bacteriemias diagnosticadas en la Comunidad Valenciana (5.000.000 de habitantes). RESULTADOS: Se obtuvieron un total de 92.097 aislados clínicos, de los cuales un 44,5% fueron Staphylococcus coagulasa negativos. Las enterobacterias fueron el grupo más prevalente, su frecuencia se incrementó durante el estudio. Los cocos grampositivos, tipo Streptococcus, fueron los siguientes microorganismos que se aislaron de forma más frecuente, su frecuencia disminuyó a lo largo del periodo estudiado. A continuación, Staphylococcus aureus y Enterococcus spp. les siguieron en prevalencia, manteniéndose sus tasas estables a lo largo del estudio. Por último, el quinto microorganismo más prevalente fue Pseudomonas aeruginosa. CONCLUSIONES: Los datos obtenidos en este estudio constituyen una herramienta que puede facilitar la elección correcta del tratamiento empírico inicial que debe aplicarse en estos procesos


Assuntos
Humanos , Bacteriemia/epidemiologia , Sangue/microbiologia , Hemocultura/métodos , Infecções Bacterianas/epidemiologia , Staphylococcus/isolamento & purificação , Contagem de Colônia Microbiana/métodos , Espanha/epidemiologia , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia
13.
Sci Rep ; 10(1): 7622, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32376847

RESUMO

Bloodstream infections (BSI) and sepsis are major causes of morbidity and mortality worldwide. Blood culture-based diagnostics usually requires 1-2 days for identification of bacterial agent and an additional 2-3 days for phenotypic determination of antibiotic susceptibility pattern. With the escalating burden of antimicrobial resistance (AMR) rapid diagnostics becomes increasingly important to secure adequate antibiotic therapy. Real-time whole genome sequencing represents a genotypic diagnostic approach with the ability to rapidly identify pathogens and AMR-encoding genes. Here we have used nanopore sequencing of bacterial DNA extracted from positive blood cultures for identification of pathogens, detection of plasmids and AMR-encoding genes. To our knowledge, this is the first study to gather the above-mentioned information from nanopore sequencing and conduct a comprehensive analysis for diagnostic purposes in real-time. Identification of pathogens was possible after 10 minutes of sequencing and all predefined AMR-encoding genes and plasmids from monoculture experiments were detected within one hour using raw nanopore sequencing data. Furthermore, we demonstrate the correct identification of plasmids and blaCTX-M subtypes using de novo assembled nanopore contigs. Results from this study hold great promise for future applications in clinical microbiology and for health care surveillance purposes.


Assuntos
Hemocultura/métodos , Resistência Microbiana a Medicamentos/genética , Sequenciamento por Nanoporos/métodos , Plasmídeos/genética , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Escherichia coli/genética , Transferência Genética Horizontal , Salmonella/genética , Fatores de Tempo
14.
J Infect Chemother ; 26(8): 813-817, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32312620

RESUMO

The time to positivity (TTP) of blood culture has significant value for clinicians. However, almost all subjects of previous studies regarding TTP were adults and early infants. Therefore, careful attention is required when referring to previously published data, which might differ according to the age of subjects, as the tendency of infectious focus and pathogens identified from culture vary with age. In this study, we compared the TTP between two pediatric age groups (≤12 months and 13 months to 15 years [>12 months]) at a teaching hospital during a 5-year period. Of the 95 subjects, 41 and 54 were aged ≤12 and > 12 months, among whom true pathogenic bacteria were identified in 12 (29.3%) and 19 (35.2%), respectively. The median TTP for the younger group with pathogenic bacteria was 11.2 (interquartile range, 10.0-11.9) hours, which was significantly shorter than that for the older group (12.6 [interquartile range, 11.9-16.9] hours) (P = 0.01). At 12 h after the initiation of culture, the younger group with pathogenic bacteria had a significantly higher positivity rate (83.3%) than the older group (26.3%) (P < 0.01). The times required for the positivity to exceed 90% were 13.4 and 20.1 h for the younger and older pathogenic groups and 30.4 and 67.8 h for the younger and older contaminant groups, respectively. The range of TTP could be assessed more accurately by considering the effect of age on the infectious background.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Hemocultura/métodos , Adolescente , Fatores Etários , Bacteriemia/diagnóstico , Bactérias/isolamento & purificação , Técnicas Bacteriológicas , Sangue/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Tempo
15.
Sci Rep ; 10(1): 6737, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32317653

RESUMO

Bacteriophages are abundant in human biomes and therefore in human clinical samples. Although this is usually not considered, they might interfere with the recovery of bacterial pathogens at two levels: 1) by propagating in the enrichment cultures used to isolate the infectious agent, causing the lysis of the bacterial host and 2) by the detection of bacterial genes inside the phage capsids that mislead the presence of the bacterial pathogen. To unravel these interferences, human samples (n = 271) were analyzed and infectious phages were observed in 11% of blood culture, 28% of serum, 45% of ascitic fluid, 14% of cerebrospinal fluid and 23% of urine samples. The genetic content of phage particles from a pool of urine and ascitic fluid samples corresponded to bacteriophages infecting different bacterial genera. In addition, many bacterial genes packaged in the phage capsids, including antibiotic resistance genes and 16S rRNA genes, were detected in the viromes. Phage interference can be minimized applying a simple procedure that reduced the content of phages up to 3 logs while maintaining the bacterial load. This method reduced the detection of phage genes avoiding the interference with molecular detection of bacteria and reduced the phage propagation in the cultures, enhancing the recovery of bacteria up to 6 logs.


Assuntos
Bactérias/virologia , Inoviridae/classificação , Myoviridae/classificação , Podoviridae/classificação , RNA Ribossômico 16S/genética , Siphoviridae/classificação , Líquido Ascítico/microbiologia , Líquido Ascítico/virologia , Bactérias/classificação , Bactérias/genética , Hemocultura/métodos , Capsídeo/química , Líquido Cefalorraquidiano/microbiologia , Líquido Cefalorraquidiano/virologia , Filtração/métodos , Humanos , Inoviridae/genética , Inoviridae/isolamento & purificação , Lisogenia/fisiologia , Tipagem Molecular/métodos , Myoviridae/genética , Myoviridae/isolamento & purificação , Podoviridae/genética , Podoviridae/isolamento & purificação , Soro/microbiologia , Soro/virologia , Siphoviridae/genética , Siphoviridae/isolamento & purificação , Urina/microbiologia , Urina/virologia
16.
J Infect Chemother ; 26(8): 785-789, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32249163

RESUMO

BACKGROUND: To prevent contamination when taking blood culture, there are various effective interventions. Whether there is greater efficacy by using a combination of these interventions has not been widely evaluated. METHODS: Our six-element intervention bundle aimed to prevent contamination of blood culture in our emergency department (ED). Elements were: use of 1% chlorhexidine alcohol, alcohol wiping, hand hygiene, using sterile gloves, using holed sterile cover, and selection of upper extremities as the site of venipuncture. We compared the contamination rate of blood culture between the pre- and the post-intervention periods among all cases with two or more blood cultures taken in our ED. We also evaluated the rate of patients receiving vancomycin among all those transferred to the hospital from the ED. RESULTS: During the pre- and post-intervention periods, 460 and 450 cases were included in analysis, respectively. Contamination of blood culture occurred in 29 pre-intervention cases (6.3%) and five post-interventional cases (1.1%) (relative risk 0.18, 95% confidence interval 0.07 to 0.45; P < 0.001). After bundle implementation, there was significant increase in adherence to using 1% chlorhexidine alcohol, alcohol wiping, hand hygiene, and using holed sterile covers. Among patients admitted to hospital, fewer patients received vancomycin during the post-intervention period than in the pre-intervention period (5.4% vs. 3.2%, P = 0.03). CONCLUSIONS: Our intervention bundle dramatically reduced the contamination rate when drawing blood culture in our ED.


Assuntos
Sangue/microbiologia , Serviço Hospitalar de Emergência , Contaminação de Equipamentos/prevenção & controle , Flebotomia/métodos , Anti-Infecciosos Locais/uso terapêutico , Hemocultura/métodos , Clorexidina/uso terapêutico , Desinfetantes/uso terapêutico , Higiene das Mãos , Humanos
17.
Emergencias (Sant Vicenç dels Horts) ; 32(2): 81-89, abr. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188155

RESUMO

Objetivo: Diseñar un modelo sencillo de riesgo para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el servicio de urgencias hospitalario (SUH). Métodos: Estudio observacional, de cohortes retrospectivo, de todos los hemocultivos (SUH) extraídos en un SU en los pacientes adultos ($18 años) atendidos por infección desde el 1 de julio de 2018 hasta el 31 de marzo de 2019. Se analizaron 38 variables independientes (demográficas, comorbilidad, funcionales, clínicas y analíticas) que pudieran predecir la existencia de bacteriemia. Se realizó un estudio univariado y multivariable, mediante regresión logística, y después se construyó una escala de puntuación de riesgo. Resultados: Se incluyeron 2.181 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 262 (12%) y como HC negativos 1.919 (88%). Entre los negativos, 1.755 (80,5%) no tuvieron crecimiento y 164 (7,5%) se consideraron contaminados. Se definió un modelo predictivo de bacteriemia con 5 variables (5MPB-Toledo). El modelo incluyó la temperatura > 38,3°C (1 punto), un índice de Charlson $ 3 (1 punto), la frecuencia respiratoria $ 22 respiraciones por minuto (1 punto), leucocitos > 12.000/mm3 (1 punto) y procalcitonina $ 0,51 ng/ml (4 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,1%, 10,5% y 77%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,946 (IC 95%: 0,922-0,969). Conclusiones: El Modelo 5MPB-Toledo podría ser de utilidad para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el SUH


Objectives: To develop a simple risk score to predict bacteremia in patients in our hospital emergency department for infection. Methods: Retrospective observational short study of all blood cultures ordered in the emergency department for adults (aged 18 or older) from July 1, 2018, to March 31, 2019. We gathered data on 38 independent variables (demographic, comorbidity, functional status, and laboratory findings) that might predict bacteremia. Univariate and multiple logistic regression analyses were applied to the data and a risk scale was developed. Results: A total of 2181 blood samples were cultured. True cases of bacteremia were confirmed in 262 (12%). The remaining 1919 cultures (88%) were negative. No growth was observed in 1755 (80.5%) of the negative cultures, and 164 (7.5%) were judged to be contaminated. The 5MPB-Toledo model identified 5 predictors of bacteremia: temperature higher than 38.3°C (1 point), a Charlson comorbidity index of 3 or more (1 point), respiratory frequency of at least 22 breaths/min (1 point), leukocyte count greater than 12 000/mm3 (1 point), and procalcitonin concentration of 0.51 ng/mL or higher (4 points). Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.1%, 10.5%, and 77%, respectively. The model's area under the receiver operating characteristic curve was 0.946 (95% CI, 0.922-0.969). Conclusion: The 5MPB-Toledo score could be useful for predicting bacteremia in patients attended in hospital emergency departments for infection


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/diagnóstico , Infecções/epidemiologia , Serviços Médicos de Emergência , Estudos de Coortes , Prognóstico , Medição de Risco/métodos , Valor Preditivo dos Testes , Bacteriemia/epidemiologia , Estudos Retrospectivos , Hemocultura/métodos , Modelos Logísticos , Bactérias/isolamento & purificação , Análise Estatística
18.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 38(4): 170-173, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-200683

RESUMO

INTRODUCTION: The objective of this study was to assess the performance of a technique (S. PneumoStrip test) based on PCR followed by reverse strip hybridisation for the detection of Streptococcus pneumoniae serotypes directly in blood culture vials. METHODS: One hundred and ten (110) pairs of isolated strains and their corresponding original blood cultures vials were studied in parallel. Pure isolated strains were conventionally serotyped using latex agglutination and the Quellung reaction. The S. PneumoStrip test was carried out directly in the original blood culture samples. RESULTS: In 102 cases (92.7%), results of the serotype obtained by Quellung coincided with their corresponding original blood cultures typed by S. PneumoStrip. CONCLUSIONS: S. PneumoStrip test is a good alternative technique for direct pneumococcal serotyping in blood culture clinical simples


INTRODUCCIÓN: El objetivo de este estudio fue evaluar el rendimiento de una técnica de PCR seguida de hibridación reversa (S. PneumoStrip test) para su aplicación directa en muestras de frasco de hemocultivo. MÉTODOS: Se estudiaron 110 cepas aisladas en sangre y sus correspondientes muestras de frasco de hemocultivo. Las cepas fueron serotipadas convencionalmente mediante aglutinación por látex y reacción de Quellung. El test de S. PneumoStrip se realizó directamente en las muestras originales de hemocultivo. RESULTADOS: En 102 casos (92,7%) el serotipado por Quellung coincidió con el obtenido directamente en su original frasco de hemocultivo. CONCLUSIONES: S. PneumoStrip constituye una buena alternativa para el serotipado directo en muestras de frasco de hemocultivo


Assuntos
Humanos , Animais , Streptococcus pneumoniae/isolamento & purificação , Sorotipagem/métodos , Hemocultura/métodos , Técnicas de Hibridização Subtrativa , Reação em Cadeia da Polimerase
19.
J Med Microbiol ; 69(4): 552-557, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32141812

RESUMO

Introduction. Staphylococcus aureus bacteraemia (SAB) causes significant morbidity and mortality. Standard diagnostic methods require 24-48 h to provide results, during which time management is guideline-based and may be suboptimal.Aim. Evaluate the impact of rapid molecular detection of S. aureus in positive blood culture bottle fluid on patient management.Methodology. Samples were tested prospectively at two clinical centres. Positive blood cultures with Gram-positive cocci in clusters on microscopy were tested with the Xpert MRSA/SA blood culture assay (Cepheid), as well as standard culture-based identification and antimicrobial sensitivity tests. Results were passed to clinical microbiologists in real time and used for patient management.Results. Of 264 blood cultures tested (184 and 80 from each centre), S. aureus was grown from 39 (14.8 %) with one identified as methicillin-resistant S. aureus; all Xpert results agreed with culture results. Median turnaround time from culture flagging positive to result reporting for Xpert was 1.7 h, compared to 25.7 h for species identification by culture. Xpert results allowed early changes to management in 40 (16.8 %) patients, with Xpert positive patients starting specific therapy for SAB and Xpert negative patients stopping or avoiding empiric antimicrobials for SAB.Conclusion. Rapid and accurate detection of S. aureus with the Xpert MRSA/SA BC assay in positive blood culture bottles allowed earlier targeted patient management. Negative Xpert results are suggestive of coagulase negative staphylococci, allowing de-escalation of antimicrobial therapy if clinically appropriate.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Bacteriemia/sangue , Bacteriemia/microbiologia , Sangue/microbiologia , Humanos , Estudos Prospectivos , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética
20.
Klin Lab Diagn ; 65(3): 185-190, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32163694

RESUMO

Diagnosing of bloodstream infection (BSI) in outpatients is essential. A large blood volume is required to obtain blood culture (CLSI): 2 sets, 40ml of blood for diagnosing in 95% cases of bacteremia. Molecular-genetic methods can not replace blood culture method, but they accelerate the identification of any pathogen. Culturomics gives a combination of different conditions for isolating microorganisms from a sample and along with their genetic identification. We used the patent method for direct inoculation of buffy-coat from 4,5ml of a venous blood sample and MALDI-ToF identification method. In 382 outpatients examined there were received 183 blood cultures (48,0%), more often among women (65,6%) and young people (74,9%). The causative agents of community-acquired bloodstream infection were aerobes (73,4%), anaerobes (24,2%), fungi (2,4%). The gram-positive cocci were prevailing (51,4%) and the gram-negative rods were isolated rather seldom (9,6%). BSI was monomicrobial (66,5%) and polymicrobial (33,5%). Polymicrobial blood cultures had 2, 3, 4 agents in one blood sample (75,4%, 18,8%, 5,8%, respectively). There were also found combinations of different species of aerobes (47,8%), aerobes with anaerobes (42%). BSI caused complications of the primary disease of the respiratory system, urogenital system and in 100% of cases after plastic surgery. A small blood volume is required for buffy-coat inoculation, the direct agar culture reduces the response time to 2 days, so it makes genetic identification possible on the 2nd day from the moment of blood collection.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Adolescente , Bactérias , Feminino , Fungos , Bactérias Gram-Negativas , Humanos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
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