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2.
BMC Infect Dis ; 20(1): 680, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32942993

RESUMO

BACKGROUND: Although the risk factors for positive follow-up blood cultures (FUBCs) in gram-negative bacteremia (GNB) have not been investigated extensively, FUBC has been routinely carried out in many acute care hospitals. We attempted to identify the risk factors and develop a predictive scoring model for positive FUBC in GNB cases. METHODS: All adults with GNB in a tertiary care hospital were retrospectively identified during a 2-year period, and GNB cases were assigned to eradicable and non-eradicable groups based on whether removal of the source of infection was possible. We performed multivariate logistic analyses to identify risk factors for positive FUBC and built predictive scoring models accordingly. RESULTS: Out of 1473 GNB cases, FUBCs were carried out in 1268 cases, and the results were positive in 122 cases. In case of eradicable source of infection, we assigned points according to the coefficients from the multivariate logistic regression analysis: Extended spectrum beta-lactamase-producing microorganism (+ 1 point), catheter-related bloodstream infection (+ 1), unfavorable treatment response (+ 1), quick sequential organ failure assessment score of 2 points or more (+ 1), administration of effective antibiotics (- 1), and adequate source control (- 2). In case of non-eradicable source of infection, the assigned points were end-stage renal disease on hemodialysis (+ 1), unfavorable treatment response (+ 1), and the administration of effective antibiotics (- 2). The areas under the curves were 0.861 (95% confidence interval [95CI] 0.806-0.916) and 0.792 (95CI, 0.724-0.861), respectively. When we applied a cut-off of 0, the specificities and negative predictive values (NPVs) in the eradicable and non-eradicable sources of infection groups were 95.6/92.6% and 95.5/95.0%, respectively. CONCLUSIONS: FUBC is commonly carried out in GNB cases, but the rate of positive results is less than 10%. In our simple predictive scoring model, zero scores-which were easily achieved following the administration of effective antibiotics and/or adequate source control in both groups-had high NPVs. We expect that the model reported herein will reduce the necessity for FUBCs in GNB cases.


Assuntos
Bacteriemia/etiologia , Bacteriemia/microbiologia , Hemocultura , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Feminino , Seguimentos , Bactérias Gram-Negativas/metabolismo , Infecções por Bactérias Gram-Negativas/complicações , Humanos , Falência Renal Crônica/microbiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , beta-Lactamases/metabolismo
3.
PLoS One ; 15(8): e0237260, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857755

RESUMO

OBJECTIVE: Infections caused by multidrug-resistant Gram-negative bacilli (MDR-GNB) are a major issue in intensive care. The intestinal and oropharyngeal microbiota being the reservoir of MDR-GNB. Our main objective was to assess the link between the composition of the intestinal microbiota and the tracheal and intestinal colonization by MDR-GNB, and also by Enterococcus spp. and yeasts. METHODS: We performed a 2-month prospective, monocentric cohort study in the medical intensive care unit of our hospital. Patients ventilated >3 days and spontaneously passing feces were included. A fecal sample and an endotracheal aspiration (EA) were collected twice a week. MDR-GNB but also Enterococcus faecium and yeasts (as potential dysbiosis surrogate markers) were detected by culture methods. The composition of the intestinal microbiota was assessed by 16S profiling. RESULTS: We collected 62 couples of feces and EA from 31 patients, including 18 feces and 9 EA positive for MDR-GNB. Forty-eight fecal samples were considered for 16S profiling. We did not observe a link between the diversity and the richness of the intestinal microbiota and the MDR-GNB intestinal relative abundance (RA). Conversely, we observed a negative link between the intestinal diversity and richness and the RA of Enterococcus spp. (p<0.001). CONCLUSION: The fecal MDR-GNB RA was not associated to the diversity nor the richness of the intestinal microbiota, but that of Enterococcus spp. was.


Assuntos
Enterococcus faecium/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Intestinos/microbiologia , Traqueia/microbiologia , Adulto , Idoso , Cuidados Críticos , Enterococcus faecium/genética , Face/microbiologia , Feminino , Microbioma Gastrointestinal , Bactérias Gram-Negativas/genética , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Leveduras/genética , Leveduras/isolamento & purificação , Adulto Jovem
4.
PLoS Pathog ; 16(8): e1008794, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32813725

RESUMO

Wolbachia are the world's most common, maternally-inherited, arthropod endosymbionts. Their worldwide distribution is due, in part, to a selfish drive system termed cytoplasmic incompatibility (CI) that confers a relative fitness advantage to females that transmit Wolbachia to their offspring. CI results in embryonic death when infected males mate with uninfected females but not infected females. Under the Two-by-One genetic model of CI, males expressing the two phage WO proteins CifA and CifB cause CI, and females expressing CifA rescue CI. While each protein is predicted to harbor three functional domains, there is no knowledge on how sites across these Cif domains, rather than in any one particular domain, contribute to CI and rescue. Here, we use evolution-guided, substitution mutagenesis of conserved amino acids across the Cif proteins, coupled with transgenic expression in uninfected Drosophila melanogaster, to determine the functional impacts of conserved residues evolving mostly under purifying selection. We report that amino acids in CifA's N-terminal unannotated region and annotated catalase-related domain are important for both complete CI and rescue, whereas C-terminal residues in CifA's putative domain of unknown function are solely important for CI. Moreover, conserved CifB amino acids in the predicted nucleases, peptidase, and unannotated regions are essential for CI. Taken together, these findings indicate that (i) all CifA amino acids determined to be crucial in rescue are correspondingly crucial in CI, (ii) an additional set of CifA amino acids are uniquely important in CI, and (iii) CifB amino acids across the protein, rather than in one particular domain, are all crucial for CI. We discuss how these findings advance an expanded view of Cif protein evolution and function, inform the mechanistic and biochemical bases of Cif-induced CI/rescue, and continue to substantiate the Two-by-One genetic model of CI.


Assuntos
Proteínas de Bactérias/metabolismo , Evolução Biológica , Citoplasma/metabolismo , Drosophila melanogaster/microbiologia , Infecções por Bactérias Gram-Negativas/metabolismo , Mutação , Wolbachia/fisiologia , Animais , Animais Geneticamente Modificados/microbiologia , Animais Geneticamente Modificados/fisiologia , Proteínas de Bactérias/genética , Citoplasma/microbiologia , Drosophila melanogaster/fisiologia , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/patologia , Masculino
5.
BMC Infect Dis ; 20(1): 604, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32807092

RESUMO

BACKGROUND: Infectious Diseases Society of America (IDSA) guidelines suggest 7-14 days' duration of antibiotic treatment for uncomplicated Gram-negative bacteria (GNB) catheter-related bloodstream infection (CRBSI). The objectives of this study were to review microbial epidemiology, to determine rate and risk factors for relapse, and to compare clinical outcomes in patients receiving long- versus short-duration antibiotic therapy. METHODS: A retrospective phase 1 study was conducted between January 2010 and October 2016 to review microbial epidemiology and to determine the incidence of and risk factors for relapse in patients with GNB CRBSI, according to the IDSA guidelines diagnostic criteria. In phase 2 of the study, patients without risk factors for relapse between November 2016 and October 2017 were prospectively recruited to receive antibiotic therapy for 7 days after catheter removal. Matched patients from the retrospective phase 1 study who had received antibiotic therapy for ≥14 days were selected as a phase 2 control group to compare outcomes. RESULTS: In phase 1, three most common pathogens identified among 174 cases were Pseudomonas aeruginosa (22.0%), Klebsiella pneumoniae (16.7%), and Stenotrophomonas maltophilia (13.4%). Eighty-nine episodes of infection occurred while patients were receiving antibiotic therapy. Of 140 cases, the relapse rate was 6.4%. Catheter retention was the only risk factor strongly associated with relapse (odds ratio = 145.32; 95% confidence interval 12.66-1667.37, P < 0.001). In phase 2, 11 patients with catheter removal were prospectively recruited to receive short-duration therapy. The number of patients with relapse receiving long- or short-duration therapy was 1 (3%) and 0 (0%), respectively (P = 1.000). CONCLUSIONS: For the management of patients with uncomplicated GNB CRBSI, empiric broad-spectrum antibiotic therapy with adequate coverage of P. aeruginosa should be chosen. Catheter removal should be performed to prevent relapse and shortening the duration of treatment could be considered. TRIAL REGISTRATION: Thai Clinical Trial Registry: TCTR20190914001 . Retrospectively registered on 13 September 2019.


Assuntos
Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Projetos Piloto , Estudos Prospectivos , Pseudomonas aeruginosa/isolamento & purificação , Recidiva , Fatores de Risco , Stenotrophomonas maltophilia/isolamento & purificação , Tailândia/epidemiologia , Adulto Jovem
6.
J Med Microbiol ; 69(9): 1132-1144, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32812863

RESUMO

Introduction. While colonization by Staphylococcus aureus in haemodialysis patients has been assessed, knowledge about colonization by beta-lactam-resistant Gram-negative bacilli is still limited.Aim. To describe clinical and molecular characteristics in haemodialysis patients colonized by S. aureus (MSSA-MRSA) and beta-lactam-resistant Gram-negative bacilli in an ambulatory renal unit.Methodology. The study included patients with central venous catheters in an outpatient haemodialysis facility in Medellín, Colombia (October 2017-October 2018). Swab specimens were collected from the nostrils and skin around vascular access to assess colonization by S. aureus (MSSA-MRSA). Stool samples were collected from each patient to evaluate beta-lactam-resistant Gram-negative bacilli colonization. Molecular typing included PFGE, multilocus sequence typing (MLST), spa typing and enterobacterial repetitive intergenic consensus-PCR (ERIC). Clinical information was obtained from medical records and personal interview.Results. A total of 210 patients were included in the study. S. aureus colonization was observed in 33.8 % (n=71) of the patients, 4.8 % (n=10) of which were colonized by methicillin-resistant S. aureus. Stool samples were collected from 165 patients and of these 41.2 % (n=68) and 11.5 % (n=19) were colonized by extended-spectrum-beta-lactamase-producing (ESBL) and carbapenem-resistant bacilli, respectively. Typing methods revealed high genetic diversity among S. aureus and ESBL-producing Gram-negative bacilli (ESBL-GNB). Antibiotic use and hospitalization in the previous 6 months were observed in more than half of the studied population.Conclusion. The high colonization by ESBL-GNB in haemodialysis patients shows evidence for the need for stronger surveillance, not only for S. aureus but also for multidrug-resistant bacilli in order to avoid their spread. Additionally, the high genetic diversity suggests other sources of transmission outside the renal unit instead of horizontal transmission between patients.


Assuntos
Antibacterianos/farmacologia , Infecção Hospitalar/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/microbiologia , Lactamas/farmacologia , Resistência beta-Lactâmica , Idoso , Fezes/microbiologia , Feminino , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/genética , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus aureus/isolamento & purificação
7.
Proc Natl Acad Sci U S A ; 117(30): 17984-17991, 2020 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-32661164

RESUMO

Cellular differentiation is a fundamental strategy used by cells to generate specialized functions at specific stages of development. The bacterium Caulobacter crescentus employs a specialized dimorphic life cycle consisting of two differentiated cell types. How environmental cues, including mechanical inputs such as contact with a surface, regulate this cell cycle remain unclear. Here, we find that surface sensing by the physical perturbation of retracting extracellular pilus filaments accelerates cell-cycle progression and cellular differentiation. We show that physical obstruction of dynamic pilus activity by chemical perturbation or by a mutation in the outer-membrane pilus secretin CpaC stimulates early initiation of chromosome replication. In addition, we find that surface contact stimulates cell-cycle progression by demonstrating that surface-stimulated cells initiate early chromosome replication to the same extent as planktonic cells with obstructed pilus activity. Finally, we show that obstruction of pilus retraction stimulates the synthesis of the cell-cycle regulator cyclic diguanylate monophosphate (c-di-GMP) through changes in the activity and localization of two key regulatory histidine kinases that control cell fate and differentiation. Together, these results demonstrate that surface contact and sensing by alterations in pilus activity stimulate C. crescentus to bypass its developmentally programmed temporal delay in cell differentiation to more quickly adapt to a surface-associated lifestyle.


Assuntos
Fenômenos Fisiológicos Bacterianos , Caulobacter crescentus/fisiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Ciclo Celular , GMP Cíclico/análogos & derivados , GMP Cíclico/metabolismo , Replicação do DNA , Fímbrias Bacterianas/fisiologia , Modelos Biológicos , Mutação
8.
Mikrobiyol Bul ; 54(2): 235-245, 2020 Apr.
Artigo em Turco | MEDLINE | ID: mdl-32723279

RESUMO

Rhizobium radiobacter, which is found in nature and causes tumorigenic plant diseases can lead to opportunistic infections, especially in people with underlying diseases. In our study, endophthalmitis that observed in ten patients caused by R.radiobacter bacteria after intravitreal ranibizumab injection in Ophthalmology Clinic were examined microbiologically. Vitreous fluid samples of 13 patients who received intravitreal ranibizumab injection were sent to the Microbiology Laboratory from Van Yuzuncu Yil University Faculty of Medicine's Ophthalmology Clinic for microbiological examination in December 21, 2016. Samples were examined under microscope after staining with Gram and cultured with 5% sheep blood agar and Eosin Methylene Blue (EMB) agar. The culture plates were incubated for 18-24 hours at 37°C in 5% CO2. At the end of this period, catalase, oxidase, and urease tests were performed on the colonies. The identification and antibiotic susceptibility tests of microorganisms growing in vitreous fluid samples were performed using BD Phoenix (Becton Dickinson, USA), Vitek 2 Compact (BioMerieux, France), and Vitek MS (BioMerieux, France) systems. In addition, 16S rDNA sequence analysis was performed and the pulsed field gel electrophoresis (PFGE) method was used to determine the clonal relationship between the isolates. After growing in cultures (one day after the procedure), culture samples were collected from the objects, medical tools and equipment, hands of healthcare staff and a new injection solution in the area where the procedure was performed. R.radiobacter was isolated in 10 of the vitreous fluid samples of 13 patients, and no bacterial growth was detected in 3. The microorganisms were found to be gram-negative bacilli, non-fermenter, motile, catalase/oxidase/urease positive, in compliance with R.radiobacter. All isolates were identified as R.radiobacter by BD Phoenix (Becton Dickinson, USA), Vitek 2 Compact (BioMerieux, France), and Vitek MS (BioMerieux, France) (database v2.0) systems. R.radiobacter isolates were found to be resistant to ampicillin, amoxicillin/clavulanate, trimethoprim/ sulfamethoxazole, cefotaxime and ceftazidime; susceptible to cefuroxime, cefepime, amikacin, gentamicin, imipenem, meropenem, ciprofloxacin, levofloxacin and piperacillin/tazobactam. The isolates were identified as R.radiobacter by 16S rDNA sequence analysis. PFGE showed that all isolates had the same band profile. R.radiobacter isolates with the same band profile likely revealed that the contamination was from the same source. However, the growth of R.radiobacter was not detected in the cultures made from the objects, medical instruments and supplies, the hands of healthcare professionals and the new injection solution in the area where the procedure was performed, and the source of the agent could not be determined. The results have shown that intravitreal injection procedure carries a risk for R.radiobacter infection. Disinfection and antisepsis conditions, before and during the procedure, is important for the prevention of such infections. This study is the first epidemic outbreak report of endophthalmitis caused by the same strain of R.radiobacter and the second article in which R.radiobacter was reported as the cause of endophthalmitis after intravitreal injection.


Assuntos
Agrobacterium tumefaciens , Antibacterianos , Surtos de Doenças , Infecções por Bactérias Gram-Negativas , Injeções Intravítreas , Agrobacterium tumefaciens/classificação , Agrobacterium tumefaciens/efeitos dos fármacos , Agrobacterium tumefaciens/genética , Agrobacterium tumefaciens/isolamento & purificação , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Eletroforese em Gel de Campo Pulsado , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Injeções Intravítreas/efeitos adversos , Testes de Sensibilidade Microbiana , RNA Ribossômico 16S/genética , Ranibizumab/administração & dosagem , Turquia/epidemiologia
9.
Biomed Environ Sci ; 33(6): 385-395, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32641201

RESUMO

Objective: This study aimed to evaluate the genetic diversity, virulence, and antimicrobial resistance of Aeromonas isolates from clinical patients, tap water systems, and food. Methods: Ninety Aeromonas isolates were obtained from Ma'anshan, Anhui province, China, and subjected to multi-locus sequence typing (MLST) with six housekeeping genes. Their taxonomy was investigated using concatenated gyrB-cpn60 sequences, while their resistance to 12 antibiotics was evaluated. Ten putative virulence factors and several resistance genes were identified by PCR and sequencing. Results: The 90 Aeromonas isolates were divided into 84 sequence types, 80 of which were novel, indicating high genetic diversity. The Aeromonas isolates were classified into eight different species. PCR assays identified virulence genes in the isolates, with the enterotoxin and hemolysin genes act, aerA, alt, and ast found in 47 (52.2%), 13 (14.4%), 22 (24.4%), and 12 (13.3%) of the isolates, respectively. The majority of the isolates (≥ 90%) were susceptible to aztreonam, imipenem, cefepime, chloramphenicol, gentamicin, tetracycline, and ciprofloxacin. However, several resistance genes were detected in the isolates, as well as a new mcr-3 variant. Conclusions: Sequence type, virulence properties, and antibiotic resistance vary in Aeromonas isolates from clinical patients, tap water systems, and food.


Assuntos
Aeromonas , Água Potável/microbiologia , Farmacorresistência Bacteriana , Microbiologia de Alimentos , Variação Genética , Infecções por Bactérias Gram-Negativas/microbiologia , Aeromonas/efeitos dos fármacos , Aeromonas/genética , Aeromonas/isolamento & purificação , Aeromonas/patogenicidade , Antibacterianos/farmacologia , China , Especificidade da Espécie , Virulência
10.
Rev Col Bras Cir ; 47: e20202471, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32667581

RESUMO

PURPOSE: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. METHODS: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. RESULTS: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. CONCLUSIONS: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.


Assuntos
Antibacterianos/uso terapêutico , Pé Diabético/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Bactérias Gram-Positivas/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Dermatopatias Bacterianas/microbiologia , Idoso , Antibacterianos/farmacologia , Complicações do Diabetes , Diabetes Mellitus , Pé Diabético/tratamento farmacológico , Resistência Microbiana a Medicamentos , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Infecções , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Dermatopatias Bacterianas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/epidemiologia , Infecções Cutâneas Estafilocócicas/microbiologia
11.
Ann Hematol ; 99(8): 1925-1932, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32564194

RESUMO

Antimicrobial stewardship is of major importance in patients with febrile neutropenia (FN). In this study, we aimed to investigate the trends in resistance and the relationship with mortality rates in patients with FN. The single-center surveillance data of inpatients with FN and diagnosed as microbiologically confirmed bloodstream infections (BSIs) between 2006 and 2016 were reviewed retrospectively. A total of 950 episodes in 552 patients with BSIs were analyzed. Of whom, 55.9% were male, the median age was 43 years, and 35.6% had acute myeloid leukemia. In total, 1016 microorganisms were isolated from blood cultures. Gram-negatives accounted for 42.4% (n = 403) of the episodes. Among Gram-negatives, Enterobacteriaceae accounted for 346 (86%) (E. coli, n = 197; 34% extended-spectrum ß-lactamases (ESBL) producers, and Klebsiella spp., n = 120; 48.3% ESBL producers). Also, 24 (20.0%) of Klebsiella spp. had carbapenemase activity. There were 6 (5.0%) colistin-resistant Klebsiella spp. Thirteen (26.5%) of Pseudomonas spp. and 17 (60.7%) of Acinetobacter spp. had carbapenemase activity. There were 2 (5.6%) colistin-resistant Acinetobacter spp. The 30-day mortality rates were 12.0%, 21.5%, 34.6%, and 29.0% in BSIs due to Gram-positive, Gram-negative bacterial, fungal, and polymicrobial etiology respectively (p = 0.001). BSIs with ESBL-producing (p = 0.001) isolates, carbapenem (p < 0.001), and colistin-resistant isolates (p < 0.001) were associated with increased mortality risk. The tremendous rise in resistance rates among Gram-negatives is dreadfully related to increasing mortality and leads to sharp shifts toward extreme restrictions of unnecessary antibiotic uses. Antimicrobial stewardship in patients with FN requires vigilance and tailoring of treatment upon local surveillance data.


Assuntos
Farmacorresistência Bacteriana , Neutropenia Febril , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas , Leucemia Mieloide Aguda , Adulto , Idoso , Antibacterianos/administração & dosagem , Intervalo Livre de Doença , Neutropenia Febril/sangue , Neutropenia Febril/tratamento farmacológico , Neutropenia Febril/microbiologia , Neutropenia Febril/mortalidade , Feminino , Seguimentos , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Humanos , Leucemia Mieloide Aguda/sangue , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/microbiologia , Leucemia Mieloide Aguda/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Taxa de Sobrevida
12.
BMC Infect Dis ; 20(1): 408, 2020 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527246

RESUMO

BACKGROUND: To compare the efficacy and safety of double-carbapenem therapy (DCT) with other antibiotics for the treatment of multidrug resistant (MDR) Gram-negative bacterial infections. METHODS: Cochrane Library, PubMed, Embase and Web of Science as well as Chinese databases were searched from database establishment to February 2019. All types of studies were included if they had evaluated efficacy and safety of DCT regimens in patients with MDR Gram-negative bacterial infections. Clinical response, microbiological response, adverse events and mortality were the main outcomes. The protocol was registered with PROSPERO No. CRD42019129979. RESULTS: Three cohort or case-control studies consisting of 235 patients and 18 case series or case reports consisting of 90 patients were included. The clinical and microbiological responses were similar between DCT and other regimens in patients with carbapenem-resistant Enterobacteriaceae (CRE) infection. DCT achieved a lower mortality than comparators in patients with CRE infection (OR = 0.44, 95% CI = 0.24-0.82, P = 0.009). Ertapenem was the most reported antibiotic in DCT regimens in case series or case reports. Moreover, clinical and microbiological improvements were found in 59 (65.6%) and 63 (70%) in total 90 cases, respectively. CONCLUSIONS: DCT was as effective as other antibiotics in treating MDR Gram-negative bacterial infections, with similar efficacy response and lower mortality. DCT could be an alternative therapeutic option in the treatment of MDR Gram-negative bacterial infections. High-quality randomized controlled trials were required to confirm the beneficial effects of DCT.


Assuntos
Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Antibacterianos/farmacologia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Carbapenêmicos/farmacologia , Quimioterapia Combinada , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Resultado do Tratamento
13.
Khirurgiia (Mosk) ; (5): 34-41, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500687

RESUMO

OBJECTIVE: To evaluate bacterial flora in patients with deep sternal wound infection and the effect of negative pressure wound therapy on eradication of the pathogen. MATERIAL AND METHODS: There were 102 patients with deep wound infection after cardiac surgery. Mean age was 66.9±9.9 years. Diabetes mellitus was detected in 21 (20.5%) cases, chronic obstructive pulmonary disease - in 15 (14.7%). Wound debridement via daily dressings was performed in 64 patients; vacuum-assisted dressings were applied in 38 patients. Bacteriological analysis of discharge was carried out every week.Results. Mixed infection was observed in 38 (37.3%) patients. S.aureus was the most common pathogen (n=51, 50%), Gram negative bacteria were found in 36 (35.3%) patients. Negative pressure wound therapy ensured eradication of S.aureus within 3 weeks while dressings were associated with only 40% decrease of the incidence of positive analyses (p<0.05). Effectiveness of the method was not obtained for Gram negative bacteria. CONCLUSION: Negative pressure wound therapy accelerates eradication of Gram positive pathogens but does not affect eradication of Gram negative microbes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa , Infecções Estafilocócicas/terapia , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/terapia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Desbridamento , Resistência Microbiana a Medicamentos , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Pessoa de Meia-Idade , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Esterno/microbiologia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/etiologia
14.
BMC Infect Dis ; 20(1): 404, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517658

RESUMO

BACKGROUND: Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Consequently, appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. Here, we explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy. METHODS: We reviewed all GNB bacteremia cases that occurred during induction or consolidation chemotherapy, over a 15-year period, in a tertiary-care hospital. RESULTS: Among 489 GNB bacteremia cases from 324 patients, 45 (9.2%) were carba-NS and 444 (90.8%) were carbapenem susceptible GNB. Independent risk factors for carba-NS GNB bacteremia were: carbapenem use at bacteremia onset (adjusted odds ratio [aOR]: 91.2; 95% confidence interval [95%CI]: 29.3-284.1; P < 0.001); isolation of carbapenem-resistant Acinetobacter baumannii (aOR: 19.4, 95%CI: 3.4-112.5; P = 0.001) in the prior year; and days from chemotherapy to GNB bacteremia (aOR: 1.1 per day, 95%CI: 1.1-1.2; P < 0.001). Carba-NS bacteremia was independently associated with in-hospital mortality (aOR: 6.6, 95%CI: 3.0-14.8; P < 0.001). CONSLUSION: Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors.


Assuntos
Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/diagnóstico , Leucemia Mieloide Aguda/patologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Adulto , Idoso , Antibacterianos/farmacologia , Antineoplásicos/uso terapêutico , Carbapenêmicos/farmacologia , Estudos de Casos e Controles , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Mortalidade Hospitalar , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Resultado do Tratamento
15.
Vet Res Commun ; 44(2): 61-72, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32472344

RESUMO

Aeromonas salmonicida is one of the most important pathogens in salmonids and non-salmonids species. Nevertheless, very little was reported in cyprinids about A. salmonicida infection. Hence, a pathogenic A. salmonicida subsp. salmonicida, namely isolate GCA-518, was isolated from diseased crucian carp Carassius auratus. Its optimal growth conditions were at 28 °C, pH 7.0 and 1.5% NaCl. Furthermore, the quantitative real-time PCR (qPCR) targeting serine protease (aspA) gene was established for rapid detection of the lowest limit of 5.6 × 102 copies per reaction. The pathogenicity was confirmed in crucian carp by intraperitoneal infection. Histopathologic examination displayed multifocal necrosis and infiltration of inflammatory cells in gill, liver, kidney and intestine. This is the first report on typical A. salmonicida infection in cultured crucian carp.


Assuntos
Aeromonas salmonicida/fisiologia , Carpas , Doenças dos Peixes/diagnóstico , Doenças dos Peixes/microbiologia , Infecções por Bactérias Gram-Negativas/veterinária , Aeromonas salmonicida/genética , Aeromonas salmonicida/isolamento & purificação , Aeromonas salmonicida/patogenicidade , Animais , Proteínas de Bactérias/genética , Doenças dos Peixes/patologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/patologia , Limite de Detecção , Reação em Cadeia da Polimerase em Tempo Real , Serina Endopeptidases/genética
16.
Aquat Toxicol ; 224: 105494, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32422488

RESUMO

Little is known about the impacts of dietary exposure to inorganic mercury (Hg) for a long duration on the health indicators, growth, and disease resistance in Oreochromis niloticus. Accordingly, the current study was designed to assess the effects of Hg contaminated diets on blood biochemistry, growth, chemical composition, Hg bioaccumulation in the tissues, histopathology of liver and head kidneys, and disease resistance to Aeromonas hydrophila of O. niloticus. Also, the efficiency of citronella oil, geranium oil (GO), curcumin (CUR), Bacillus toyonensis (BT), and Bacillus subtilis (BS) as dietary supplements on reversing the negative impacts of Hg were assessed. A total of 240 tilapia fingerlings were assigned to eight dietary treatments fed on the basal diet (G1), G1 diet contaminated with 50 ppm Hg (G2), whereas the other groups fed the G2 diet and enriched with 400 mg CO (G3), 400 mg GO (G4), 200 mg CUR (G5), 7 × 107 cells BT (G6), 7 × 107 cells BS (G7), and 7 × 107 BT + BS/ kg diet (G8) for 16 weeks. The obtained results showed that fish fed on the G2 diet had significantly impaired growth performance indicators, blood parameters, and resistance to bacterial infection compared with fish in the control group. Additionally, distinct pathological perturbations in liver and head kidneys were observed. In contrast, fish groups G3 to G8 had a significant enhancement in the growth performance, Hg bioaccumulation in fish tissues, blood biochemistry, and resistance against A. hydrophila infection compared with fish in the G2 group. Maximum improvement was recorded in G5, G6, and G8. Conclusively, from both health and an economic point of view, these results suggested that several benefits might be gained by adding these additives, especially CUR, BT, and BT + BS, on growth enhancement and ameliorating Hg negative impacts in O. niloticus.


Assuntos
Ração Animal/análise , Bioacumulação , Ciclídeos/crescimento & desenvolvimento , Resistência à Doença/efeitos dos fármacos , Doenças dos Peixes/prevenção & controle , Infecções por Bactérias Gram-Negativas/veterinária , Mercúrio/toxicidade , Poluentes Químicos da Água/toxicidade , Aeromonas hydrophila/patogenicidade , Animais , Ciclídeos/imunologia , Ciclídeos/microbiologia , Dieta , Suplementos Nutricionais , Resistência à Doença/imunologia , Doenças dos Peixes/imunologia , Doenças dos Peixes/microbiologia , Infecções por Bactérias Gram-Negativas/imunologia , Infecções por Bactérias Gram-Negativas/microbiologia , Rim Cefálico/efeitos dos fármacos , Rim Cefálico/metabolismo , Rim Cefálico/patologia , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Mercúrio/metabolismo , Poluentes Químicos da Água/metabolismo
17.
BMC Infect Dis ; 20(1): 351, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423417

RESUMO

BACKGROUND: Eikenella corrodens and Streptococcus anginosus, which are primary colonization bacteria of the normal flora of the oropharynx, are infrequent bacteria, especially the former. Here, we report a case of lung abscess with a coinfection of Eikenella corrodens and Streptococcus anginosus in a lung cancer patient. CASE PRESENTATION: A 66-year-old Chinese man with lung cancer was admitted to the hospital, complaining of a cough and expectoration for five months and fever for two months. After a series of inspections to differentiate a cancer-related fever from an infectious fever, he was diagnosed with lung abscess. Draining pus culture demonstrated Eikenella corrodens and Streptococcus anginosus. After more than 1 month of antibiotic therapy and draining in total, he gradually recovered to fight against lung cancer. CONCLUSION: This report highlights the increased pathogenicity of Eikenella corrodens and Streptococcus anginosus in an immunocompromised cancer patient, especially after a few invasive operations. Additionally, even though a patient has been diagnosed with cancerous fever, strong vigilance is needed in case an infection arises.


Assuntos
Coinfecção/diagnóstico , Eikenella corrodens/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Abscesso Pulmonar/microbiologia , Neoplasias Pulmonares/complicações , Infecções Estreptocócicas/diagnóstico , Streptococcus anginosus/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Coinfecção/tratamento farmacológico , Drenagem , Febre/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Abscesso Pulmonar/tratamento farmacológico , Masculino , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Resultado do Tratamento
18.
J Fish Dis ; 43(5): 519-529, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32285473

RESUMO

Vibrio vulnificus, Edwardsiella anguillarum and Aeromonas hydrophila are three common bacterial pathogens in cultivated eels. To protect farming eels from infection by these pathogens, a trivalent outer membrane protein (OMP) containing partial sequences of OmpU from V. vulnificus, OmpA from E. anguillarum and OmpII from A. hydrophila was expressed and purified; then, the OMP was used as a vaccine to immunize Japanese eels (Anguilla japonica). Whole-blood cell proliferation, antibody titres and complement and lysozyme activities were detected at different days post-immunization (dpi), and the relative per cent survival (RPS) was determined after eels were infected with V. vulnificus, E. anguillarum or A. hydrophila at 28 dpi. The results showed that the OMP significantly stimulates the antibody titres. At 14 days after the challenge (i.e. at 28 dpi), the RPS of OMP against V. vulnificus, E. anguillarum and A. hydrophila was 20%, 70% and 11.1%, respectively. The construction, expression and immunogenicity of a trivalent Omp were reported for the first time, and this study will provide a valuable reference for the development of fish multiplex vaccines.


Assuntos
Aeromonas hydrophila/genética , Proteínas da Membrana Bacteriana Externa/genética , Edwardsiella/genética , Doenças dos Peixes/microbiologia , Infecções por Bactérias Gram-Negativas/veterinária , Vibrio vulnificus/genética , Aeromonas hydrophila/metabolismo , Anguilla , Animais , Proteínas da Membrana Bacteriana Externa/imunologia , Edwardsiella/metabolismo , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/veterinária , Infecções por Bactérias Gram-Negativas/microbiologia , Vibrioses/microbiologia , Vibrioses/veterinária , Vibrio vulnificus/imunologia
19.
Nat Commun ; 11(1): 2044, 2020 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-32341346

RESUMO

Recent studies portend a rising global spread and adaptation of human- or healthcare-associated pathogens. Here, we analyse an international collection of the emerging, multidrug-resistant, opportunistic pathogen Stenotrophomonas maltophilia from 22 countries to infer population structure and clonality at a global level. We show that the S. maltophilia complex is divided into 23 monophyletic lineages, most of which harbour strains of all degrees of human virulence. Lineage Sm6 comprises the highest rate of human-associated strains, linked to key virulence and resistance genes. Transmission analysis identifies potential outbreak events of genetically closely related strains isolated within days or weeks in the same hospitals.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Stenotrophomonas maltophilia/genética , Alelos , Análise por Conglomerados , Infecção Hospitalar/microbiologia , Genoma Bacteriano , Geografia , Humanos , Infecções Oportunistas/microbiologia , Filogenia , Stenotrophomonas maltophilia/efeitos dos fármacos , Virulência
20.
J Infect Chemother ; 26(8): 802-806, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32265107

RESUMO

Roseomonas, a genus of pink-pigmented glucose non-fermentative bacteria, has been associated with various primary and hospital-acquired human infections; however, to our knowledge, its nosocomial transmission has never been reported. Clinical and epidemiological investigations were carried out after two cases of R. mucosa bacteremia occurred in our hospital in 2018. Environmental samples were taken of environmental surfaces prone to water contamination in the wards and cultured. The two clinical isolates and all environmental isolates that showed growth of pink colonies were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry and 16S rRNA gene sequencing. Pulse-field gel electrophoresis (PFGE) was performed and fingerprinting software was used to analyze the DNA restriction patterns and determine their similarity. Two patients who developed R. mucosa bacteremia had received care from the same treatment team. Of 126 environmental samples, five showed growth of R. mucosa. Using 80% similarity as the cut-off, PFGE analysis revealed that the isolates from the two patients' blood cultures and three environmental isolates belonged to the same clone. The hospital water environment was contaminated with the same clone of R. mucosa that caused bacteremia in the two patients, suggesting nosocomial transmission linked to contaminated environment. Increased vigilance is needed to monitor the emergence of Roseomonas in healthcare settings.


Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Methylobacteriaceae/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Hospitais , Humanos , Methylobacteriaceae/genética , RNA Ribossômico 16S , Análise de Sequência de RNA , Resultado do Tratamento , Doenças Transmitidas pela Água/epidemiologia , Doenças Transmitidas pela Água/microbiologia
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