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1.
PLoS Pathog ; 16(12): e1008893, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33326490

RESUMO

Bacterial bloodstream infections (BSI) are a major health concern and can cause up to 40% mortality. Pseudomonas aeruginosa BSI is often of nosocomial origin and is associated with a particularly poor prognosis. The mechanism of bacterial persistence in blood is still largely unknown. Here, we analyzed the behavior of a cohort of clinical and laboratory Pseudomonas aeruginosa strains in human blood. In this specific environment, complement was the main defensive mechanism, acting either by direct bacterial lysis or by opsonophagocytosis, which required recognition by immune cells. We found highly variable survival rates for different strains in blood, whatever their origin, serotype, or the nature of their secreted toxins (ExoS, ExoU or ExlA) and despite their detection by immune cells. We identified and characterized a complement-tolerant subpopulation of bacterial cells that we named "evaders". Evaders shared some features with bacterial persisters, which tolerate antibiotic treatment. Notably, in bi-phasic killing curves, the evaders represented 0.1-0.001% of the initial bacterial load and displayed transient tolerance. However, the evaders are not dormant and require active metabolism to persist in blood. We detected the evaders for five other major human pathogens: Acinetobacter baumannii, Burkholderia multivorans, enteroaggregative Escherichia coli, Klebsiella pneumoniae, and Yersinia enterocolitica. Thus, the evaders could allow the pathogen to persist within the bloodstream, and may be the cause of fatal bacteremia or dissemination, in particular in the absence of effective antibiotic treatments.


Assuntos
Infecções Bacterianas/sangue , Infecções Bacterianas/imunologia , Ativação do Complemento/imunologia , Acinetobacter baumannii/crescimento & desenvolvimento , Acinetobacter baumannii/patogenicidade , Bacteriemia/sangue , Bacteriemia/imunologia , Bacteriemia/microbiologia , Bactérias , Burkholderia/crescimento & desenvolvimento , Burkholderia/patogenicidade , Proteínas do Sistema Complemento/imunologia , Escherichia coli/crescimento & desenvolvimento , Escherichia coli/patogenicidade , Humanos , Klebsiella pneumoniae/crescimento & desenvolvimento , Klebsiella pneumoniae/patogenicidade , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/sangue , Infecções por Pseudomonas/imunologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/crescimento & desenvolvimento , Pseudomonas aeruginosa/patogenicidade , Yersinia enterocolitica/crescimento & desenvolvimento , Yersinia enterocolitica/patogenicidade
2.
Front Immunol ; 11: 598404, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33329592

RESUMO

Background: Bacterial sepsis has been used as a prototype to understand the pathogenesis of severe coronavirus disease 2019 (COVID-19). In addition, some management programs for critically ill COVID-19 patients are also based on experience with bacterial sepsis. However, some differences may exist between these two types of sepsis. Methods: This retrospective study investigated whether there are differences in the immune system status of these two types of sepsis. A total of 64 bacterial sepsis patients and 43 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sepsis were included in this study. Demographic data were obtained from medical records. Laboratory results within 24 h after the diagnosis of sepsis were provided by the clinical laboratory. Results: The results of blood routine (neutrophil, lymphocyte, and monocyte counts), infection biomarkers (C-reactive protein, ferritin, and procalcitonin levels), lymphocyte subset counts (total T lymphocyte, CD4+ T cell, CD8+ T cell, B cell, and NK cell counts), and lymphocyte subset functions (the proportions of PMA/ionomycin-stimulated IFN-γ positive cells in CD4+, CD8+ T cells, and NK cells) were similar in bacterial sepsis patients and SARS-CoV-2 sepsis patients. Cytokine storm was milder, and immunoglobulin and complement protein levels were higher in SARS-CoV-2 sepsis patients. Conclusions: There are both similarities and differences in the immune system status of bacterial sepsis and SARS-CoV-2 sepsis. Our findings do not support blocking the cytokine storm or supplementing immunoglobulins in SARS-CoV-2 sepsis, at least in the early stages of the disease. Treatments for overactivation of the complement system and lymphocyte depletion may be worth exploring further.


Assuntos
Infecções Bacterianas , Síndrome da Liberação de Citocina , Subpopulações de Linfócitos , Sepse , Adulto , Idoso , Infecções Bacterianas/sangue , Infecções Bacterianas/imunologia , /imunologia , Síndrome da Liberação de Citocina/sangue , Síndrome da Liberação de Citocina/imunologia , Feminino , Humanos , Contagem de Linfócitos , Subpopulações de Linfócitos/imunologia , Subpopulações de Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , /metabolismo , Sepse/sangue , Sepse/imunologia
3.
Medicine (Baltimore) ; 99(42): e22551, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080689

RESUMO

A first C-reactive protein (CRP) test, as often performed by clinicians during the presentation of patients with an acute bacterial infection, might be misleading. The aim of our study was to explore the dynamic between a second CRP test taken within 12 hours from admission CRP test in a cohort of patients diagnosed with acute bacterial infection in comparison to CRP in a control group of apparently healthy individuals.This was a historical cohort study comprised of all patients admitted to the Sourasky Tel-Aviv Medical Center, Israel, between July 2007 and March 2016. The study cohort included adult patients who were diagnosed as having an infection, assumed to be of bacterial etiology (cellulitis and erysipelas, pneumonia, cholecystitis, pyelonephritis, or septicemia), who had a CRP test during the first 6 hours of hospital admission (baseline CRP), and a successive CRP test up to 12 hours from the first one (recurrent CRP). The control group was of healthy subjects who attended our medical center for a routine annual check-up.The study included 950 patients. Baseline CRP ranged from 0.04 to 454 mg/L. The median CRP velocity was 0.53 mg/L/h. Patients were grouped by baseline CRP into 4 groups (CRP < 10, 10-74.9, 75-199.9, ≥200). There was an increase in median CRP velocity between the first (0.48 mg/L/h) and the second (0.93 mg/L/h) groups, which then was decreased in the next 2 groups (0.46 and -2.58 mg/L/h, respectively). In 45 of 103 (44%) patients of the group of baseline CRP concentration less than 10 mg/dL with bacterial diagnosis, there was a complete overlap with CRP values of apparently healthy individuals during their routine annual checkup.A first single low CRP result cannot exclude the presence of a significant bacterial infection. Patients with acute bacterial infection might present with a relatively low CRP value that at times correspond to normal limit CRP concentrations. A second test, obtained within 12 hours of admission, might serve as an important tool to identify patient with an evolving inflammatory burst commonly seen during acute bacterial infection.


Assuntos
Infecções Bacterianas/sangue , Proteína C-Reativa/metabolismo , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
4.
Medicine (Baltimore) ; 99(39): e22424, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991476

RESUMO

Hypercoagulable is an important pathological state in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). Fibrinogen (FIB) is the main protein in coagulation process. In this study, we aimed to investigate the clinical significance and influencing factors of FIB in AAV from Southwest China.A retrospective study was performed on AAV patients from Peoples Hospital of Deyang City from January 2007 to December 2018. Demographic and clinical characteristics were collected.A total of 463 AAV patients were included. In Wilcoxon rank sum test, FIB was significantly higher in AAV active group than inactive group (P = .005). FIB was also higher in bacterial infection group than in non-infection group both in active group (P = .008) and inactive group (P = .017). In receiver operating characteristic (ROC) curve analysis, the critical value of FIB for diagnosis of bacterial infection between AAV active and inactive groups was 3.385 g/L (P = .030), with sensitivity of 70.2% and specificity of 52.9%. In the multivariate analysis of variance (MANOVA), estimated glomerular filtration rate (eGFR) was shown to be an independent factor for FIB (P = .001). Least-significant difference showed the concentration of FIB (P < .05) increased with renal impairment, especially in endstage kidney disease (ESKD).FIB identified a certain reference value in distinguishing AAV activity from bacterial infection. ESKD had a statistical effect on it. Influencing factors of FIB should be evaluated based on the renal function impairment of patients.


Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/sangue , Infecções Bacterianas/sangue , Fibrinogênio/metabolismo , Adulto , Idoso , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/epidemiologia , Infecções Bacterianas/complicações , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
BMC Infect Dis ; 20(1): 515, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32677903

RESUMO

BACKGROUND: Procalcitonin is an inflammatory biomarker that is sensitive for bacterial infections and a promising clinical decision aid in antimicrobial stewardship programs. However, there are few studies of physicians' experiences concerning the use of PCT. The objective of this study was to investigate whether hospital physicians' experience with procalcitonin after 18 months of use can inform the PCT implementation in antimicrobial stewardship programs. MATERIALS/METHODS: We deployed a qualitative approach using semi-structured interviews with 14 hospital physicians who had experience with procalcitonin in clinical practice. Interviews were audio-taped, transcribed verbatim and analysed using thematic analysis. RESULTS: Physicians reported a knowledge gap, which made them uncertain about the appropriate procalcitonin use, interpretation, and trustworthiness. Simultaneously, the physicians experienced procalcitonin as a useful clinical decision aid but emphasised that their clinical evaluation of the patient was the most important factor when deciding on antibiotic treatment. CONCLUSIONS: Procalcitonin was regarded a helpful clinical tool, but the physicians called for more knowledge about its appropriate uses. Active implementation of unambiguous procalcitonin algorithms and physician education may enhance the utility of the test as an antimicrobial stewardship adjunct.


Assuntos
Gestão de Antimicrobianos , Infecções Bacterianas/diagnóstico , Biomarcadores/sangue , Hospitais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pró-Calcitonina/sangue , Adulto , Idoso , Algoritmos , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/organização & administração , Gestão de Antimicrobianos/normas , Infecções Bacterianas/sangue , Infecções Bacterianas/tratamento farmacológico , Bioensaio/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Médicos/normas , Médicos/estatística & dados numéricos , Padrões de Prática Médica/normas , Pró-Calcitonina/análise , Pesquisa Qualitativa , Inquéritos e Questionários
6.
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
7.
Transfusion ; 60(5): 974-985, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32357261

RESUMO

BACKGROUND: The high incidence of septic transfusion reactions (STRs) led to testing being mandated by AABB from 2004. This was implemented by primary culture of single-donor apheresis platelets (APs) from 2004 and prestorage pooled platelets (PSPPs) from 2007. STUDY DESIGN/METHODS: Platelet (PLT) aliquots were cultured at issue and transfusion reactions evaluated at our hospital. Bacterial contamination and STR rates (shown as rates per million transfusions in Results) were evaluated before and after introduction of primary culture by blood centers that used a microbial detection system (BacT/ALERT, bioMerieux) or enhanced bacterial detection system (eBDS, Haemonetics). RESULTS: A total of 28,457 PLTs were cultured during pre-primary culture periods (44.7% APs; 55.3% at-issue pooled PLTs [AIPPs]) and 97,595 during post-primary culture periods (79.3% APs; 20.7% PSPPs). Forty-three contaminated units were identified in preculture and 34 in postculture periods (rates, 1511 vs. 348; p < 0.0001). Contamination rates of APs were significantly lower than AIPPs in the preculture (393 vs. 2415; p < 0.0001) but not postculture period compared to PSPPs (387 vs. 198; p = 0.9). STR rates (79 vs. 90; p = 0.98) were unchanged with APs but decreased considerably with pooled PLTs (826 vs. 50; p = 0.0006). Contamination (299 vs. 324; p = 0.84) and STR rates (25 vs. 116; p = 0.22) were similar for PLTs tested by BacT/ALERT and eBDS primary culture methods. A change in donor skin preparation method in 2012 was associated with decreased contamination and STR rates. CONCLUSION: Primary culture significantly reduced bacterial contamination and STR associated with pooled but not AP PLTs. Measures such as secondary testing near time of use or pathogen reduction are needed to further reduce STRs.


Assuntos
Infecções Bacterianas/epidemiologia , Contaminação de Medicamentos/estatística & dados numéricos , Transfusão de Plaquetas , Cultura Primária de Células , Sepse/epidemiologia , Reação Transfusional/epidemiologia , Centros Médicos Acadêmicos , Adulto , Infecções Bacterianas/sangue , Infecções Bacterianas/transmissão , Remoção de Componentes Sanguíneos/efeitos adversos , Remoção de Componentes Sanguíneos/história , Remoção de Componentes Sanguíneos/normas , Remoção de Componentes Sanguíneos/estatística & dados numéricos , Plaquetas/citologia , Plaquetas/microbiologia , Segurança do Sangue/efeitos adversos , Segurança do Sangue/história , Segurança do Sangue/estatística & dados numéricos , Transfusão de Sangue/história , Transfusão de Sangue/estatística & dados numéricos , Células Cultivadas , Criança , História do Século XX , História do Século XXI , Humanos , Incidência , Transfusão de Plaquetas/efeitos adversos , Transfusão de Plaquetas/história , Transfusão de Plaquetas/estatística & dados numéricos , Cultura Primária de Células/história , Cultura Primária de Células/normas , Cultura Primária de Células/estatística & dados numéricos , Estudos Retrospectivos , Sepse/sangue , Sepse/etiologia , Reação Transfusional/microbiologia , Estados Unidos/epidemiologia
8.
Epidemiol Infect ; 148: e86, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32228723

RESUMO

Chills and vomiting have traditionally been associated with severe bacterial infections and bacteremia. However, few modern studies have in a prospective way evaluated the association of these signs with bacteremia, which is the aim of this prospective, multicenter study. Patients presenting to the emergency department with at least one affected vital sign (increased respiratory rate, increased heart rate, altered mental status, decreased blood pressure or decreased oxygen saturation) were included. A total of 479 patients were prospectively enrolled. Blood cultures were obtained from 197 patients. Of the 32 patients with a positive blood culture 11 patients (34%) had experienced shaking chills compared with 23 (14%) of the 165 patients with a negative blood culture, P = 0.009. A logistic regression was fitted to show the estimated odds ratio (OR) for a positive blood culture according to shaking chills. In a univariate model shaking chills had an OR of 3.23 (95% CI 1.35-7.52) and in a multivariate model the OR was 5.9 (95% CI 2.05-17.17) for those without prior antibiotics adjusted for age, sex, and prior antibiotics. The presence of vomiting was also addressed, but neither a univariate nor a multivariate logistic regression showed any association between vomiting and bacteremia. In conclusion, among patients at the emergency department with at least one affected vital sign, shaking chills but not vomiting were associated with bacteremia.


Assuntos
Bacteriemia/epidemiologia , Calafrios , Vômito , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/sangue , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Estações do Ano , Viroses/sangue
9.
Transplant Proc ; 52(5): 1593-1600, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32305204

RESUMO

INTRODUCTION: Presepsin (or sCD14) has been identified as a protein whose levels increase specifically in the blood of patients with bacterial infections. In this study, we evaluated the clinical performance of sCD14 and its usefulness in the early diagnosis of bacterial infection in decompensated cirrhotic patients. MATERIALS: Seventy patients were enrolled in this study. The mean age of patients was 49.5 years, and 21 were women and 49 men. The heparinized whole blood for the PATHFAST test was used in the evaluation of bacterial infection (T0). The test was repeated after 48 hours (T1); at 96 hours (T2); at 144 hours (T3); then at 15 days (T4) to monitor the clinical responses to therapeutic interventions. RESULTS: Forty-nine patients tested positive for sCD14. The mean sCD14 level was 1854 ± 1744 pg/mL. Microbiological findings confirmed the presence of bacterial infections within 84 ± 4.8 h from enrollment in all 49 positive patients. Thirty-eight patients were considered responders to empirical antibiotic therapy with a decrease of presepsin at the different time points, while an increased level of sCD14 was highlighted in 11 patients. When the test was performed, 45% of the patients showed no signs or symptoms of bacterial infection. At 30 days of follow-up 43 patients survived, and 6 patients died from septic shock. CONCLUSIONS: The PATHFAST test highlighted the presence of infection in a very short time (15 minutes), and the presepsin could be considered an early biomarker in patients with cirrhosis. A greater number of patients are necessary to confirm these data.


Assuntos
Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Receptores de Lipopolissacarídeos/sangue , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Fragmentos de Peptídeos/sangue , Adulto , Infecções Bacterianas/complicações , Biomarcadores/sangue , Diagnóstico Precoce , Feminino , Humanos , Cirrose Hepática/microbiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sensibilidade e Especificidade , Choque Séptico
10.
Transfusion ; 60(5): 986-996, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32181889

RESUMO

BACKGROUND: Platelets have the highest bacterial contamination risk of all blood components, and septic transfusion reactions remain a problem. A good estimate of contamination rates could provide information about residual risk and inform optimal testing strategies. We performed a systematic review and meta-analysis of platelet contamination rates by primary culture. STUDY DESIGN AND METHODS: A literature search in December 2019 identified articles on platelet contamination rates using primary culture. We used meta-analysis to estimate the overall rate of contamination and meta-regression to identify heterogeneity. We studied the following sources of heterogeneity: collection method, sample volume, positivity criteria, and study date. Contamination rate estimates were obtained for apheresis (AP), platelet rich plasma (PRP), and buffy coat (BC) collection methods. RESULTS: The search identified 6102 studies, and 22 were included for meta-analysis. Among these 22 studies, there were 21 AP cohorts (4,072,022 components), 4 PRP cohorts (138,869 components), and 15 BC cohorts (1,474,679 components). The overall mean contamination rate per 1000 components was 0.51 (95% CI: 0.38-0.67) including AP (0.23, 95% CI: 0.18-0.28), PRP, (0.38, 95% CI: 0.15-0.70), and BC (1.12, 95% CI: 0.51-1.96). There was considerable variability within each collection method. Sample volume, positivity criteria, and publication year were significant sources of heterogeneity. CONCLUSION: The bacterial contamination rate of platelets by primary culture is 1 in 1961. AP and PRP components showed a lower contamination rate than BC components. There is clinically significant between-study variability for each method. Larger sample volumes increased sensitivity, and bacterial contamination rates have decreased over time.


Assuntos
Infecções Bacterianas/sangue , Remoção de Componentes Sanguíneos/estatística & dados numéricos , Plaquetas/microbiologia , Contaminação de Medicamentos/estatística & dados numéricos , Transfusão de Plaquetas/estatística & dados numéricos , Cultura Primária de Células/estatística & dados numéricos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/transmissão , Técnicas Bacteriológicas , Remoção de Componentes Sanguíneos/efeitos adversos , Transfusão de Componentes Sanguíneos/efeitos adversos , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Plaquetas/citologia , Células Cultivadas , Humanos , Transfusão de Plaquetas/efeitos adversos , Plasma Rico em Plaquetas/microbiologia , Cultura Primária de Células/métodos , Cultura Primária de Células/normas , Reação Transfusional/epidemiologia , Reação Transfusional/microbiologia
11.
PLoS One ; 15(3): e0220424, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130227

RESUMO

BACKGROUND: Bloodstream infections (BSI) are serious and life-threatening, associated with high mortality and morbidity. In resource-limited settings, there is a paucity of data on predictors of outcome in patients with BSI. This study aimed at examining the predictors of mortality in patients with BSI as well as bacteria causing BSI. METHODS AND MATERIALS: This was a cross-sectional study conducted at Muhimbili National Hospital between April and May 2018. Blood culture results from all inpatients at the clinical microbiology laboratory were recorded and clinical information was retrieved retrospectively from the files. Bacteria from positive blood culture were identified and antimicrobial susceptibility was performed. RESULTS: The overall prevalence of BSI was, 46/402 (11.4% 95% CI 8.6-15), with a case fatality rate of 37%. There was a significantly high rate of BSI in patients who had died (19.5%) compared to those who survived (9.2%) p = 0.008. Gram-negative bacteria (74%) were the common cause of BSI, with a predominance of Enterobacteriaceae (22), followed by Pseudomonas aeruginosa (11). The majority of bacteria (70.5%) isolated from patients with BSI were Multi-drug resistant (MDR). Forty-six percent of Pseudomonas aeruginosa were resistant to meropenem while 68% (15/22) of Enterobacteriaceae were extended-spectrum ß lactamase producers. Carbapenemase production was detected in 27% (3/11) of Pseudomonas aeruginosa and one Proteus mirabilis. Forty percent of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus. Positive blood culture (aOR 2.24, 95%CI 1.12-4.47, p 0.02) and admission to the intensive care unit (aOR 3.88, 95%CI 1.60-9.41, p = 0.003) were independent factors for mortality in suspected BSI. Isolation of MDR bacteria was an independent predictor for mortality in confirmed BSI (aOR 15.62, 95%CI 1.24-161.38, p = 0.02). CONCLUSION: The prevalence of BSI was 11.4%, with the majority of bacteria in BSI were MDR. Positive blood culture, admission to the ICU and MDR were predictors for mortality.


Assuntos
Infecções Bacterianas/sangue , Infecções Bacterianas/mortalidade , Farmacorresistência Bacteriana Múltipla , Centros de Atenção Terciária , Adolescente , Adulto , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tanzânia/epidemiologia , Adulto Jovem
12.
J Immunoassay Immunochem ; 41(2): 152-157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32028862

RESUMO

Q fever, caused by Coxiella burnetii, is an important zoonosis worldwide. Q fever is documented in many parts of the world; however, information on the disease in Ghana is scanty. This study was therefore conducted to provide evidence of exposure of sheep and goats slaughtered at the Kumasi Abattoir to Coxiella burnetii. A total of 350 serum samples collected from 175 sheep and 175 goats were analyzed for the presence of C. burnetii antibodies using a commercial ELISA kit (ID Vet). Results of the study established a seroprevalence of 28.57% in goats, 16.57% in sheep and an overall seroprevalence of 22.29% in sheep and goats; 20.57% for male sheep, 23.86% for female sheep, 26.44% for male goats and 30.68% for female goats. Results showed that goats are more at risk to the infection than sheep however sex is not a risk factor. This study confirms the existence of Q fever in sheep and goats in Ghana hence, the disease should be considered as a public health risk to workers at the abattoir and other stakeholders in the sheep and goat production chain.


Assuntos
Infecções Bacterianas/imunologia , Coxiella burnetii/imunologia , Doenças das Cabras/imunologia , Doenças dos Ovinos/imunologia , Animais , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Gana , Doenças das Cabras/sangue , Doenças das Cabras/microbiologia , Cabras , Masculino , Fatores de Risco , Ovinos , Doenças dos Ovinos/sangue , Doenças dos Ovinos/microbiologia
13.
PLoS One ; 15(1): e0227967, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945114

RESUMO

Neonates are at high risk for central line associated bloodstream infections (CLABSI). Biofilm formation is universal on indwelling catheters but why some biofilms seed the bloodstream to cause CLABSI is not clearly understood. With the objective to test the hypothesis that catheter biofilm microbiome in neonates with CLABSI differs than those without infection, we prospectively enrolled neonates (n = 30) with infected and uninfected indwelling central catheters. Catheters were collected at the time of removal, along with blood samples and skin swabs at the catheter insertion sites. Microbiomes of catheter biofilms, skin swabs and blood were evaluated by profiling the V4 region of the bacterial 16S rRNA gene using Illumina MiSeq sequencing platform. The microbial DNA load was higher from catheter biofilms of CLABSI patients without differences in alpha diversity when compared to that of the non-CLABSI neonates. Proteus and unclassified Staphylococcaceae were more abundant in infected catheter biofilms while Bradyrhizobium, Cloacibacterium, and Sphingomonas were more abundant in the uninfected catheters. A blood microbiome was detected in uninfected samples. The blood microbiome in CLABSI neonates clustered separately from the uninfected blood samples in beta diversity plots. We found that the microbiome signature in catheter biofilm and blood of neonates with CLABSI is different than the microbiomes of non-CLABSI neonates.


Assuntos
Infecções Bacterianas/genética , Infecções Relacionadas a Cateter/genética , Flavobacteriaceae/genética , Microbiota/genética , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Infecções Bacterianas/patologia , Biofilmes/crescimento & desenvolvimento , Bradyrhizobium/genética , Bradyrhizobium/patogenicidade , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Feminino , Flavobacteriaceae/patogenicidade , Humanos , Recém-Nascido , Masculino , RNA Ribossômico 16S/genética , Estudos Retrospectivos , Staphylococcaceae/genética , Staphylococcaceae/patogenicidade
14.
J Trop Pediatr ; 66(1): 29-37, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31062031

RESUMO

Serum procalcitonin (PCT) was measured in 228 children aged 1 month to 15 years at an emergency department of a hospital located in an area without local malaria transmission in children with suspected infections; 21% (49) children had a clinical syndrome for suspected bacterial infections (Syndrome+ve). In children with Syndrome+ve criteria, 27/49 (55.1%) had PCT ≥0.5 µg/l but only 59/179 (32.9%) of those Syndrome-ve had abnormal PCT, χ2 = 8.0, p = 0.005; positive likelihood ratio = 2.0 [95% confidence interval (CI) 1.2-3.3]; negative likelihood ratio = 0.8 (95% CI 0.7-1.0). In patients with pneumonia, 9/15 (60%) with severe pneumonia had PCT ≥0.5 µg/l compared to 11/21 (52.4%) with non-severe pneumonia, χ2 = 0.2, p = 0.65. Children with clinical signs of pneumonia or clinical signs suggestive of bacterial infections fulfilling clinical syndromic definitions for suspected bacterial infections commonly have elevated PCT level. PCT levels are associated with disease severity and antibiotic trials guided by PCT levels may be needed where cultures are not available.


Assuntos
Infecções Bacterianas/sangue , Pneumonia/sangue , Pró-Calcitonina/sangue , Adolescente , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Quênia , Masculino , Gravidade do Paciente , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Sepse/sangue , Sepse/tratamento farmacológico
15.
J Matern Fetal Neonatal Med ; 33(2): 184-190, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886779

RESUMO

Objective: To investigate whether intact umbilical cord milking (I-UCM) can aggravate infection or result in other undesirable complications in preterm infants with premature prolonged rupture of membranes (PPROM).Methods: Neonates vaginally delivered between 28 and 37 weeks' gestation and complicated by PPROM before birth were randomly divided into two groups according to the cord clamping procedure: I-UCM before clamping and immediate cord clamping (ICC). Various parameters of the study participants were compared between the two groups.Results: Of 102 preterm infants, 48 and 54 were randomly allocated to the I-UCM and ICC groups, respectively. There were no significant differences between the two groups regarding hematological parameters (platelet count, white blood count, neutrophil ratio, and C-reactive protein) or neonatal outcomes (probable or certain neonatal infection, respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage) (p > .05). However, preterm neonates in the I-UCM group had higher serum hemoglobin and hematocrit levels (p < .05) and received fewer blood transfusions (p < .05) than those in the ICC group.Conclusion: Milking the umbilical cord to a preterm neonate with PPROM will not aggravate neonatal infection or result in other undesirable complications. This simple procedure will improve hemoglobin values and hematocrit levels and may lessen the need for transfusion during the neonatal period.


Assuntos
Infecções Bacterianas/etiologia , Parto Obstétrico/métodos , Doenças do Prematuro/etiologia , Recém-Nascido Prematuro/sangue , Cordão Umbilical/irrigação sanguínea , Adulto , Infecções Bacterianas/sangue , Infecções Bacterianas/prevenção & controle , Transfusão de Sangue , Feminino , Ruptura Prematura de Membranas Fetais/sangue , Humanos , Recém-Nascido , Doenças do Prematuro/prevenção & controle , Gravidez
16.
Clin Biochem ; 75: 23-29, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31672644

RESUMO

BACKGROUND: Human neutrophil lipocalin (HNL) is used as a novel biomarker for infections. However, only a few studies have focused on the usefulness of HNL. The purpose of this study was to evaluate the diagnostic efficiency of HNL for identifying bacterial infections and to compare HNL with procalcitonin (PCT) and C-reactive protein (CRP). METHODS: Hospital patients with acute infections of bacterial origin (n = 439), viral origin (n = 71), and healthy volunteers (n = 67) were included in the study. The infection status of each patient was verified using microbiological, serological, and PCR testing. Additionally, CRP, HNL, and PCT levels were measured by established methods. RESULTS: In distinguishing bacterial and viral infections, area under the curve (AUC) analysis showed that, with a value of 0.81 (95% CI, 0.76-0.86), HNL was superior to CRP at 0.73 (0.68-0.79) and PCT at 0.64 (0.58-0.70). Interestingly, the combination of HNL, PCT, and CRP improved the diagnostic potential significantly with an AUC of 0.86 (0.82-0.90, P < 0.05). Furthermore, when comparing different infection site subgroups with healthy patients, HNL levels were higher in all bacterial groups, albeit to widely varying degrees (P < 0.0001), and HNL reached a higher level in bloodstream and abdominal infections. CRP levels showed the same trend as HNL levels. PCT levels were significantly increased in bloodstream infections, abdominal infections, and in bacterial pneumonia (P < 0.0001), while no significant differences were found in soft tissue (P = 0.4378) or urinary tract infections (P = 0.423). There was no difference in HNL and CRP levels between patients with Gram-negative bacterial (GNB) or Gram-positive bacterial infections. However, compared with controls, PCT was only increased in GNB-infected patients. CONCLUSION: HNL detection can help diagnose patients with infectious diseases, and the diagnostic efficacy of HNL is not affected by the infected site or by pathogenic bacterial species. The combination of HNL, PCT, and CRP has a superior performance at identifying bacterial infections compared with traditional biomarkers.


Assuntos
Infecções Bacterianas , Proteína C-Reativa/metabolismo , Lipocalinas/sangue , Pró-Calcitonina/sangue , Viroses , Adolescente , Adulto , Idoso , Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Viroses/sangue , Viroses/diagnóstico , Adulto Jovem
17.
Trop Med Int Health ; 25(3): 291-300, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31808588

RESUMO

OBJECTIVE: Identifying febrile patients requiring antibacterial treatment is challenging, particularly in low-resource settings. In South-East Asia, C-reactive protein (CRP) has been demonstrated to be highly sensitive and moderately specific in detecting bacterial infections and to safely reduce unnecessary antibacterial prescriptions in primary care. As evidence is scant in sub-Saharan Africa, we assessed the sensitivity of CRP in identifying serious bacterial infections in Tanzania. METHODS: Samples were obtained from inpatients and outpatients in a prospective febrile illness study at two hospitals in Moshi, Tanzania, 2011-2014. Bacterial bloodstream infections (BSI) were established by blood culture, and bacterial zoonotic infections were defined by ≥4 fold rise in antibody titre between acute and convalescent sera. The sensitivity of CRP in identifying bacterial infections was estimated using thresholds of 10, 20 and 40 mg/l. Specificity was not assessed because determining false-positive CRP results was limited by the lack of diagnostic testing to confirm non-bacterial aetiologies and because ascertaining true-negative cases was limited by the imperfect sensitivity of the diagnostic tests used to identify bacterial infections. RESULTS: Among 235 febrile outpatients and 569 febrile inpatients evaluated, 31 (3.9%) had a bacterial BSI and 61 (7.6%) had a bacterial zoonosis. Median (interquartile range) CRP values were 173 (80-315) mg/l in bacterial BSI, and 108 (31-208) mg/l in bacterial zoonoses. The sensitivity (95% confidence intervals) of CRP was 97% (83%-99%), 94% (79%-98%) and 90% (74%-97%) for identifying bacterial BSI, and 87% (76%-93%), 82% (71%-90%) and 72% (60%-82%) for bacterial zoonoses, using thresholds of 10, 20 and 40 mg/l, respectively. CONCLUSION: C-reactive protein was moderately sensitive for bacterial zoonoses and highly sensitive for identifying BSIs. Based on these results, operational studies are warranted to assess the safety and clinical utility of CRP for the management of non-malaria febrile illness at first-level health facilities in sub-Saharan Africa.


Assuntos
Infecções Bacterianas/diagnóstico , Proteína C-Reativa/metabolismo , Adolescente , Adulto , Infecções Bacterianas/sangue , Infecções Bacterianas/epidemiologia , Biomarcadores/sangue , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Sensibilidade e Especificidade , Tanzânia/epidemiologia , Adulto Jovem
18.
Nat Microbiol ; 5(1): 93-101, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31659298

RESUMO

To revitalize the antibiotic pipeline, it is critical to identify and validate new antimicrobial targets1. In Mycobacteria tuberculosis and Francisella tularensis, biotin biosynthesis is a key fitness determinant during infection2-5, making it a high-priority target. However, biotin biosynthesis has been overlooked for priority pathogens such as Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. This can be attributed to the lack of attenuation observed for biotin biosynthesis genes during transposon mutagenesis studies in mouse infection models6-9. Previous studies did not consider the 40-fold higher concentration of biotin in mouse plasma compared to human plasma. Here, we leveraged the unique affinity of streptavidin to develop a mouse infection model with human levels of biotin. Our model suggests that biotin biosynthesis is essential during infection with A. baumannii, K. pneumoniae and P. aeruginosa. Encouragingly, we establish the capacity of our model to uncover in vivo activity for the biotin biosynthesis inhibitor MAC13772. Our model addresses the disconnect in biotin levels between humans and mice, and explains the failure of potent biotin biosynthesis inhibitors in standard mouse infection models.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Infecções Bacterianas/tratamento farmacológico , Biotina/biossíntese , Farmacorresistência Bacteriana/efeitos dos fármacos , Animais , Antibacterianos/química , Antibacterianos/uso terapêutico , Bactérias/genética , Bactérias/crescimento & desenvolvimento , Infecções Bacterianas/sangue , Proteínas de Bactérias/antagonistas & inibidores , Proteínas de Bactérias/química , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Biotina/sangue , Modelos Animais de Doenças , Farmacorresistência Bacteriana/genética , Humanos , Camundongos , Testes de Sensibilidade Microbiana , Modelos Moleculares , Mutação , Especificidade da Espécie , Estreptavidina/administração & dosagem , Transaminases/antagonistas & inibidores , Transaminases/química , Transaminases/genética , Transaminases/metabolismo
19.
Arch Microbiol ; 202(3): 519-523, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31712863

RESUMO

A rod-shaped microorganism with unknown type of flagellation has been accidentally discovered during phase-contrast microscopy of a sample of contaminated human donor blood. The flagellum consists of three fragments that form a complex locomotor device attached to bacterial body. The device provides bacterial motility by rotating around longitudinal axis of bacterial body and so this type of flagellation has been named "rototrichous." This newly discovered bacterial flagellation should be included in the classification of bacterial flagellations.


Assuntos
Bactérias/citologia , Flagelos/química , Bactérias/química , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Sangue/microbiologia , Humanos , Microscopia de Contraste de Fase
20.
Infection ; 48(2): 241-248, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31873850

RESUMO

PURPOSE: Differential diagnosis between acute viral and bacterial infection is an emerging common challenge for a physician in the emergency department. Serum C-reactive protein (CRP) is used to support diagnosis of bacterial infection, but in patients admitted with low CRP, its ability to discriminate between viral and bacterial infections is limited. We aimed to use two consecutive CRP measurements in order to improve differential diagnosis between bacterial and viral infection. METHODS: A single-center retrospective cohort (n = 1629) study of adult patients admitted to the emergency department with a subsequent microbiological confirmation of either viral or bacterial infection. Trend of CRP was defined as the absolute difference between the first two measurements of CRP divided by the time between them, and we investigated the ability of this parameter to differentiate between viral and bacterial infection. RESULTS: In patients with relatively low initial CRP concentration (< 60 mg/L, n = 634 patients), where the uncertainty regarding the type of infection is the highest, the trend improved diagnosis accuracy (AUC 0.83 compared to 0.57 for the first CRP measurement). Trend values above 3.47 mg/L/h discriminated bacterial from viral infection with 93.8% specificity and 50% sensitivity. CONCLUSIONS: The proposed approach for using the kinetics of CRP in patients whose first CRP measurement is low can assist in differential diagnosis between acute bacterial and viral infection.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Infecções Bacterianas/diagnóstico , Proteínas de Transporte/metabolismo , Proteínas com Domínio LIM/metabolismo , Viroses/diagnóstico , Doença Aguda , Proteínas Adaptadoras de Transdução de Sinal/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Infecções Bacterianas/sangue , Proteínas de Transporte/sangue , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Proteínas com Domínio LIM/sangue , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Viroses/sangue
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