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1.
J Med Microbiol ; 69(2): 228-232, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31922949

RESUMO

Introduction. Rapid and reliable detection of carbapenemase-producing Enterobacterales (CPE) from surveillance cultures is critical in supporting a good infection control programme. We implemented a new algorithm for CPE detection incorporating the NG Test CARBA 5 in January 2019.Aim. Our goals were to compare turnaround time (TAT), costs and staff requirements between the old and new algorithm, and to evaluate the performance of the CARBA 5 test directly on colonies grown on CARBA Smart agar.Methodology. We analysed and compared the TAT of CPE surveillance cultures processed using the old and new CPE screening algorithm. The total actual reagent costs and staff requirements for the new CPE algorithm were compared with the estimated costs and staff requirements of the old CPE algorithm.Results. Of 197 isolates included in the evaluation of the new algorithm, 64 were positive for carbapenemases by both CARBA 5 and Xpert Carba-R assay. Of the 133 that were negative, two were found to harbour NDM and IMI genotypes. Significant improvements in TAT were achieved with 88.7 % of cultures with CPE, reported on the same day as growth was observed on CARBA Smart agar compared to none in the old algorithm. The new algorithm incurred lower costs and, based on our workload, the new algorithm is estimated to save 28.9 man-hours annually.Conclusion. CARBA 5 performs well on colonies growing on CARBA Smart agar and significant improvements in TAT can be achieved without incurring additional costs or staff requirements.


Assuntos
Proteínas de Bactérias/metabolismo , Técnicas de Laboratório Clínico/métodos , Contagem de Colônia Microbiana/métodos , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/crescimento & desenvolvimento , Enterobacteriaceae/isolamento & purificação , Ensaios Enzimáticos/métodos , Algoritmos , Proteínas de Bactérias/genética , Técnicas de Laboratório Clínico/economia , Contagem de Colônia Microbiana/economia , Enterobacteriaceae/enzimologia , Enterobacteriaceae/genética , Infecções por Enterobacteriaceae/diagnóstico , Ensaios Enzimáticos/economia , Humanos , Sensibilidade e Especificidade , beta-Lactamases/genética , beta-Lactamases/metabolismo
2.
mSphere ; 4(5)2019 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511372

RESUMO

An Enterobacter hormaechei isolate harboring bla VIM-4 and mcr-9 was recovered from a pediatric patient in a U.S. hospital. The bla VIM-4 and mcr-9 genes are carried on the same IncH12 plasmid, pME-1a. The isolate tested susceptible to colistin, without observed induction of colistin resistance. The mcr-9 gene is located between two insertion elements, IS903 and IS1, but lacks the downstream regulatory genes (qseC and qseB) found in other isolates that harbor mcr-9 IMPORTANCE We describe the complete genome assembly and sequence of a clinical Enterobacter isolate harboring both bla VIM-4 and mcr-9 recovered from a pediatric patient in the United States with a history of travel to Egypt. Moreover, to the best of our knowledge, this is the first report of an Enterobacter isolate harboring both bla VIM-4 and mcr-9 from the United States. The bla VIM-4 and mcr-9 genes are carried on the same IncH12 plasmid, pME-1a. The isolate tested susceptible to colistin, without observed induction of colistin resistance. The mcr-9 gene is located between two insertion elements, IS903 and IS1, but lacks the downstream regulatory genes (qseC and qseB) found in other isolates that harbor mcr-9.


Assuntos
Enterobacter/genética , Enterobacter/isolamento & purificação , Genoma Bacteriano , beta-Lactamases/genética , Pré-Escolar , Egito , Enterobacter/enzimologia , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Humanos , Masculino , Plasmídeos/genética , Análise de Sequência de DNA , Doença Relacionada a Viagens , Estados Unidos
3.
BMJ Case Rep ; 12(9)2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31492731

RESUMO

A 72-year-old gentleman with significant cardiac history and a pacemaker in situ initially presented to the emergency department 5 days after he had his pacemaker-unit batteries changed. He had deranged vital signs, productive cough and fever. His chest plain radiograph did not show evidence of infection; however, he had right basal crackles on auscultation, which suggested a lower respiratory tract infection. He was treated with intravenous co-amoxiclav and supportive therapy, which led to his improvement. The patient was discharged but had to be readmitted a total of four times over the span of 4 months due to recurrent fever and associated symptoms. Transthoracic and transoesophageal echocardiograms and CT of the neck/thorax/abdomen/pelvis were done to look for endocarditis, pacemaker-unit infection and other sources of infection. However, these did not show any evidence of infection. He did have persistent raised inflammatory markers and two blood cultures growing Enterobacter cloacae. A fluorodeoxyglucose positron emission tomography scan was done, which showed evidence of pacemaker lead infection. His pacemaker unit was removed, which led to cessation of his symptoms and normalisation of his inflammatory markers. He had no further hospital admissions to date and has been regularly followed up in an outpatient cardiology clinic.


Assuntos
Infecções por Enterobacteriaceae/diagnóstico , Marca-Passo Artificial , Infecções Relacionadas à Prótese/diagnóstico , Idoso , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Hemocultura , Remoção de Dispositivo , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/terapia , Febre de Causa Desconhecida/etiologia , Fluordesoxiglucose F18 , Hospitalização , Humanos , Masculino , Readmissão do Paciente , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Compostos Radiofarmacêuticos
4.
Int J Low Extrem Wounds ; 18(3): 269-278, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31379224

RESUMO

The use of an antimicrobial dressing instead of a non-antimicrobial dressing may increase the number of diabetic foot ulcers healed over a medium-term follow-up period. The study aim was to evaluate the clinical and microbiological efficacy of a silver foam dressing in the management of diabetic foot ulcers. We conducted a single-center, prospective, open, noncontrolled study involving 21 outpatients with diabetic foot ulcers with mild infection. All patients received standard of care for their wounds and a silver foam dressing with silicone adhesive was applied twice per week for wound management during a 6-week treatment period. Soft tissue punch biopsies were taken every second week for qualitative and quantitative microbiological analysis. Wounds were assessed at patient admission, and wound bed tissue was evaluated for presence, quality, and consistency of granulation tissue. Clinical evaluation revealed improvements in wound conditions as a result of treatment with the silver dressing. Wollina wound scores improved significantly, from a mean score of 3.9 ± 1.6 points at inclusion to 6.1 ± 1.3 points at the end of the study (n = 19, P < .001). Treatment with the silver dressing resulted in significant decreases in the bioburden of classically considered diabetic foot ulcer pathogenic organisms such as Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, Enterobacteriaceae species, Pseudomonas aeruginosa, and other nonfermenting gram-negative bacilli. Findings revealed that the use of silver foam dressing significantly reduced the pathogenic bacterial load and markedly improved the clinical outcome in patients with diabetic foot ulcer with mild infection over a 6-week treatment period.


Assuntos
Pé Diabético , Silicones/administração & dosagem , Compostos de Prata/administração & dosagem , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos , Adesivos/administração & dosagem , Antibacterianos/administração & dosagem , Carga Bacteriana/efeitos dos fármacos , Bandagens , Pé Diabético/diagnóstico , Pé Diabético/microbiologia , Pé Diabético/terapia , Monitoramento de Medicamentos/métodos , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Resultado do Tratamento , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/terapia
5.
Eur J Clin Microbiol Infect Dis ; 38(11): 2029-2036, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31385145

RESUMO

Carbapenemase-producing microorganisms are increasingly isolated and often associated with treatment failures and outbreaks. The need for reliable and timely detection and/or confirmation of carbapenemase production is paramount; therefore, a real-time PCR assay targeting IMP, NDM, VIM, KPC and OXA-48-like carbapenemases was designed and validated. All available allele variants of the above carbapenemases were downloaded from the Beta-Lactamase DataBase ( http://bldb.eu/ ), aligned with Clustal Omega and primers designed using Primer-BLAST. Real-time PCR monoplexes were optimized for the QuantStudio 6-Flex (Applied Biosystems) using the PowerUp SYBR Green Master Mix (Life Technologies) and validated using a panel of 204 characterised strains carrying a wide range of beta-lactamases, sometimes in combination. Melt-curve analysis was used to confirm positive results. The in silico approach allowed primers to be designed in conserved regions of the KPC and NDM alignments, while three primer sets for IMP and two for VIM were necessary to ensure amplification of the different variants. One primer set was designed for OXA-48-like; however, it is unlikely to detect all variants. Expected results were obtained for all 204 tested strains, with 100% sensitivity and specificity. Melt-curve analysis showed consistent Tm results for KPC, NDM, and OXA-48-like; differences were instead noted for IMP and VIM as likely consequence of higher variability in the PCR target regions. Inhibition was not observed. The assay is rapid, easy to perform and implement. It enables unequivocal detection of IMP, NDM, VIM, KPC and OXA-48-like carbapenemases even when more than one type is present simultaneously.


Assuntos
Proteínas de Bactérias/genética , Técnicas Bacteriológicas/métodos , Bactérias Gram-Negativas/enzimologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real , beta-Lactamases/genética , Testes Diagnósticos de Rotina , Enterobacteriaceae/enzimologia , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Bactérias Gram-Negativas/genética , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Sensibilidade e Especificidade
6.
Eur J Obstet Gynecol Reprod Biol ; 241: 24-29, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31437621

RESUMO

OBJECTIVE: To compare the detection rates of vaginal-perineal cultures for group B streptococci (GBS) with the standard vaginal and rectal cultures and evaluate the diagnostic yield of vaginal-perineal vs. rectal swabs for extended spectrum ß-lactamase producing Enterobacterales (ESBL-E) during the third trimester of pregnancy. STUDY DESIGN: Vagino-perineal and rectal swabs were collected cross-sectionally from pregnant women between 35-37 weeks gestation and tested for the presence of GBS and ESBL-E. Accuracy of the vagino-perineal swab was compared to the combined vagino-perineal/rectal swab. Risk factors for ESBL carriage were examined. Degrees of pain, discomfort and stress related to the rectal swab were analyzed on visual analogue scales. RESULTS: 48 out of 250 participants (19.2%) were GBS positive. The vagino-perineal swab was positive in 44 of 48 women (91.7%) yielding a negative predictive value of 98.1%. Agreement (kappa) between the two methods was 0.95. Six out of 190 women with additional ESBL-E screening (3.2%) tested positive by rectal swab. Of these, only two had also a positive vagino-perineal swab. The rectal swab caused overall little subjective discomfort, pain or stress, as indicated by low scores indicated on the visual scales. CONCLUSIONS: The GBS detection rate of the vagino-perineal swab was lower compared to the reference standard. However, agreement between the two screening methods was high and there were no cases of GBS neonatal sepsis in the recruited population, supporting this less invasive screening strategy. In contrast, the vaginal-perineal swab was inferior to the rectal swab for detecting ESBL-E, indicating that this less invasive method for detecting antibiotic resistant bacteria that may be potentially transferred to the neonate during labor and delivery would be inappropriate for ESBL-E screening in pregnant women. The low ESBL-E carriage rate among pregnant women likely reflects the prevalence in the general population.


Assuntos
Infecções por Enterobacteriaceae/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Manejo de Espécimes/métodos , Infecções Estreptocócicas/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Prevalência , Infecções Estreptocócicas/epidemiologia , Suíça/epidemiologia
7.
J Coll Physicians Surg Pak ; 29(9): 878-881, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31455486

RESUMO

OBJECTIVE: To determine the molecular characterisation of carbapenem-resistant enterobacteriaceae (CRE) from patients admitted in intensive care units (ICUs) of a tertiary care hospital. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Pathology and Microbiology, Pakistan Institute of Medical Sciences (PIMS), SZABMU, Islamabad, Pakistan, from July 2015 to March 2016. METHODOLOGY: Fifty isolates of CRE from intensive care units samples were processed, collected through samples coming from ICUs. Specimens were cultured on blood and Mac Conkey agar, and organisms were identified. Resistant organisms to imipenem and meropenem were preserved in glycerol broth at -80oC. Their molecular characterisation was done using the conventional PCR targeting NDM, KPC, VIM and IMP genes. RESULTS: Out of 50 samples, 13 (26%) were from urine, 13 (26%) from endotracheal tube tip, 7 (14%) from blood, 7 (14%) from pus, 7 (14%) from tracheal secretions, 2 (4%) from fluids, and 1 (2%) from catheter tip. NDM genes was isolated in 56% isolates. VIM, KPC, and IMP genes were not found in any isolates. NDM positive isolates included 86% Klebsiella pneumonia, 10% Escherichia coli, and 4% Klebsiella oxytoca. CONCLUSION: NDM gene was present in 28 (56%) samples. Whereas, VIM gene, KPC gene, and IMP genes were not detected in the CRE samples.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Paquistão , Adulto Jovem
8.
Artigo em Chinês | MEDLINE | ID: mdl-31446714

RESUMO

Summary A 29-year-old negro woman was admitted with external nasal pain and swelling for 5 weeks. The incision and drainage was done and a few of pus were drained out. CT scan showed the possibility of infectious lesions with nasal soft tissue swelling and increased density. The diagnosis was external nasal cellulitis, and the causative bacteria were enterobacter cloacae.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Nariz/microbiologia , Adulto , Celulite (Flegmão)/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos
9.
Diagn Microbiol Infect Dis ; 95(2): 119-124, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31272742

RESUMO

Many Escherichia albertii isolates, an emerging pathogen of human and birds, might have been misidentified due to the difficulty of differentiating this bacterium from Escherichia coli and Shigella spp. by routine biochemical tests, resulting in underestimation of E. albertii infections. We have developed a polymerase chain reaction (PCR) assay that targets E. albertii cytolethal distending toxin (Eacdt) genes, which include the genes previously identified as Escherichia coli cdt-II. This assay could generate a single 449-bp PCR product in each of 67 confirmed E. albertii strains but failed to produce PCR product from any of the tested non-E. albertii enteric strains belonging to 37 different species, indicating 100% sensitivity and specificity of the PCR assay. The detection limit was 10 CFU per PCR tube and could detect 105 CFU E. albertii per gram of spiked healthy human stool. The Eacdt gene-based PCR could be useful for simple, rapid, and accurate detection and identification of E. albertii.


Assuntos
Toxinas Bacterianas/genética , Infecções por Enterobacteriaceae/diagnóstico , Escherichia/isolamento & purificação , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase , DNA Bacteriano/genética , Infecções por Enterobacteriaceae/microbiologia , Escherichia/genética , Fezes/microbiologia , Humanos , Limite de Detecção , Sensibilidade e Especificidade
10.
Braz J Microbiol ; 50(3): 657-662, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31270693

RESUMO

The emergence of carbapenem-resistant Enterobacterales (CRE) is a matter of public health concern. Carbapenemases are the main mechanism of resistance among CRE, and its rapid detection is essential. The detection of carbapenemases usually requires culture-based methods and molecular assays, which may be costly and need long turnaround times. Recently, an easy and rapid immunochromatographic assay for carbapenemases (OXA-48, KPC, and NDM) detection based in lateral flow immunoassay with specific monoclonal antibodies on a nitrocellulose membrane has been developed. We aimed to evaluate the RESIST-3 O.K.N. in colonies from pure culture as well as in spiked blood cultures with Enterobacterales. All carbapenemase producers (CP) presenting the OXA-48-like, KPC, and NDM enzymes presented positive results in both pure colonies and spiked blood cultures. None of the carbapenemase non-producers (CNP) presented positive results in the tests. A total of 97% CP isolates presented positive results in pure colonies in less than 5 min. For CP directly from blood culture, the mean time to positivity for OXA-48-like and KPC was 1 min, whereas it was 25 min for NDM. Our results indicate that this immunoassay can be used to detect carbapenemases directly from blood culture bottles in a routine diagnostic laboratory, which would reduce the turnaround time of CP detection.


Assuntos
Proteínas de Bactérias/sangue , Infecções por Enterobacteriaceae/sangue , Enterobacteriaceae/enzimologia , Imunoensaio/métodos , beta-Lactamases/sangue , Antibacterianos/farmacologia , Hemocultura , Brasil , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/genética , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Humanos
11.
BMJ Case Rep ; 12(7)2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31300600

RESUMO

A late preterm male infant of 36 weeks gestation and a birth weight of 2100 g was admitted on day 35 of life with complaints of respiratory distress and lethargy. He was diagnosed as a case of sepsis screen positive culture negative sepsis and was managed with respiratory support and intravenous antibiotics for 10 days. The infant improved clinically and was on spoon feeds by day 14 of admission. On day 14 of admission, he developed new-onset respiratory distress and was diagnosed as a case of nosocomial pneumonia based on chest radiography findings. The blood culture grew a rare organism Cedecea lapagei and a diagnosis of sepsis was also made. The antibiotics were tailored as per the blood culture sensitivity pattern and the infant had clinical improvement in the next 72 hours.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/isolamento & purificação , Combinação Piperacilina e Tazobactam/uso terapêutico , Respiração Artificial , Síndrome do Desconforto Respiratório do Recém-Nascido/microbiologia , Sepse/diagnóstico , Enterobacteriaceae/classificação , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/fisiopatologia , Humanos , Lactente , Letargia , Masculino , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Sepse/tratamento farmacológico , Punção Espinal , Resultado do Tratamento
12.
J Hosp Infect ; 103(2): 115-120, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279758

RESUMO

BACKGROUND: Detection of faecal carriers of carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant Enterococci (VRE) has become a routine medical practice in many countries. In an outbreak setting, several public health organizations recommend three-weekly rectal screenings to rule-out acquisition in contact patients. This strategy, associated with bed closures and reduction of medical activity for a relatively long time, seems costly. AIM: The objective of this study was to test the positive and negative predictive values of reverse transcription polymerase chain reaction (RT-PCR; GeneXpert®) carried-out at Day 0, compared with conventional three-weekly culture-based rectal screenings, in identifying, among contact patients, those who acquired CPE/VRE. METHODS: A multicentre retrospective study was conducted from January2015 to October2018. All contact patients (CPs) were included identified from index patients (IPs) colonized or infected with CPE/VRE, incidentally discovered. Each CP was investigated at Day 0 by PCR (GeneXpert®), and by the recommended three-weekly screenings. FINDINGS: Twenty-two IPs and 159 CPs were included. An average of 0.77 secondary cases per patient was noted, with a mean duration of contact of 10 days (range 1-64). Among the 159 CPs, 16 (10%) had a CPE/VRE-positive culture during the monitoring period. Rectal screenings were positive at Day 0 (10 patients), Day 7 (two patients), Day 14 (four patients). Thirteen of 16 patients with positive culture had a positive PCR at Day 0. Overall, a concordance of 97.5% (155/159) was observed between the three-weekly screenings and Day 0 PCR results. When performed on CPs at Day 0 of the identification of an IP, PCR (GeneXpert®) allowed the reduction in turnaround time by five to 27 days, compared to three-weekly screenings. Positive predictive value and negative predictive value were 100% and 98%, respectively. CONCLUSIONS: The use of RT-PCR (GeneXpert®) can avoid the three-weekly rectal samplings needed to rule-out acquisition of CPE/VRE.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Monitoramento Epidemiológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Fechamento de Instituições de Saúde/estatística & dados numéricos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Enterococos Resistentes à Vancomicina/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Enterobacteriaceae/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-31316917

RESUMO

Fast dissemination of the mobilized colistin resistance (mcr) gene mcr-1 in Enterobacteriaceae causes a huge threat to the treatment of severe infection. In the current report, a multiple cross displacement amplification (MCDA) coupled with the detection of amplified products by gold nanoparticles-based lateral flow biosensor (LFB) assay (MCDA-LFB) was established to identify the mcr-1 gene with simpleness, rapidity, specificity, and sensitivity. The MCDA-LFB assay was performed at a isothermal temperature (63°C) for only 30 min during the amplification stage, and the reaction products were directly identified by using LFB which obtained the result within 2 min. The entire process of experiments, from templates extraction to result judging, was accomplished in <60 min. For the analytical specificity of this method, all of the 16 mcr-1-producing strains were positive, and all of the non-mcr-1 isolates produced the negative results. The sensitivity of mcr-1-MCDA-LFB assay was as little as 600 fg of plasmid DNA per reaction in pure culture, and approximately 4.5 × 103 CFU/mL (~4.5 CFU/reaction) in spiked fecal samples. Therefore, this technique established in the present study is suitable for the surveillance of mcr-1 gene in clinic and livestock industry.


Assuntos
Técnicas Biossensoriais/métodos , Farmacorresistência Bacteriana/genética , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Ouro/química , Nanopartículas Metálicas/química , Técnicas de Amplificação de Ácido Nucleico/métodos , Proteínas de Bactérias/genética , Técnicas Bacteriológicas/métodos , Colistina/farmacologia , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Genes Bacterianos/genética , Sensibilidade e Especificidade , Temperatura Ambiente , Fatores de Tempo
15.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352398

RESUMO

We present an elderly diabetic man with left hallux pain and drainage who was initially diagnosed with acute gouty arthritis using the diagnostic rule for acute gout and monosodium urate crystals presented on synovial fluid analysis. Further investigation with surgical debridement, plain X-ray, MRI and wound culture revealed concomitant Citrobacter koseri septic arthritis with osteomyelitis. C. koseri is considered an opportunistic infection that rarely causes musculoskeletal infections. Acute gouty arthritis and septic arthritis are rarely seen occurring concomitantly in the same joint and are often difficult to differentiate due to similar findings on exam and imaging. The present case illustrates that osteomyelitis with an opportunistic organism can present concomitantly with acute gouty arthritis, and the diagnosis of one should not exclude the other.


Assuntos
Antibacterianos/uso terapêutico , Artrite Gotosa/microbiologia , Citrobacter koseri/patogenicidade , Pé Diabético/fisiopatologia , Infecções por Enterobacteriaceae/diagnóstico , Ertapenem/uso terapêutico , Osteomielite/diagnóstico , Idoso de 80 Anos ou mais , Artrite Gotosa/terapia , Desbridamento , Pé Diabético/microbiologia , Infecções por Enterobacteriaceae/fisiopatologia , Infecções por Enterobacteriaceae/terapia , Humanos , Masculino , Osteomielite/fisiopatologia , Osteomielite/terapia , Combinação Piperacilina e Tazobactam/uso terapêutico , Resultado do Tratamento , Vancomicina/uso terapêutico
17.
Wilderness Environ Med ; 30(3): 291-294, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31221600

RESUMO

Although catfish are found worldwide and commonly consumed in the southern United States, fatal infections from catfish are rare. Edwardsiella tarda is a bacterium known to cause gastrointestinal distress most commonly, but extraintestinal infections are a rarely considered danger for those acquiring, preparing, and consuming aquatic animals. Susceptible to all gram-negative active antibiotics, it is easily treated except in immunocompromised hosts, such as those with malignancy, diabetes, and hepatic dysfunction.


Assuntos
Mordeduras e Picadas/terapia , Peixes-Gato/microbiologia , Edwardsiella tarda/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Animais , Mordeduras e Picadas/microbiologia , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/patologia , Infecções por Enterobacteriaceae/fisiopatologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Choque Séptico/microbiologia
18.
J Clin Nurs ; 28(21-22): 3890-3900, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31240778

RESUMO

AIM: To explore patients' accounts of screening and being managed for colonisation with the antimicrobial resistant organism, carbapenemase-producing Enterobacteriaceae (CPE), when in hospital. BACKGROUND: Antimicrobial resistance (AMR) has been identified as one of the biggest global health challenges of the 21st Century. As the threat from AMR grows, screening to identify patients who are colonised with resistant organisms such as CPE is becoming an increasingly important aspect of nursing practice, in order to reduce risk of transmission of infection within hospitals. There is currently little research evidence on the patient experience of hospital management of CPE colonisation. METHODS: Qualitative semi-structured telephone interviews were undertaken, using a topic guide. Nine patients participated in the study. The data were analysed thematically, and rigour was maintained through peer review. The COREQ checklist was used. RESULTS: Two main themes were identified: "I can't make sense of CPE," illustrating limitations in patients' understandings of CPE; and, "I feel as if they are saying it is my fault," indicating the feelings of responsibility and blame which patients experienced. CONCLUSIONS: This paper contributes original evidence to the limited literature on patients' experiences of being colonised with CPE. The findings suggest that support and information provided for patients by healthcare professionals needs to be based on current evidence-based guidance on the nature of CPE and its implications for patient care, as well as being responsive to patients' emotional needs. RELEVANCE TO CLINICAL PRACTICE: This study has international relevance for nursing practice. As the global threat of AMR grows, the demands on healthcare providers to manage resistant organisms and their implications for patient care within healthcare settings are increasing. Enabling healthcare professionals to engage sensitively with patients being managed for colonisation with CPE is paramount to providing patient-centred care.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/psicologia , Programas de Rastreamento/enfermagem , Infecções por Enterobacteriaceae/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Educação de Pacientes como Assunto/métodos , Pesquisa Qualitativa
19.
Diagn Microbiol Infect Dis ; 95(2): 107-112, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31171396

RESUMO

The recently released CHROMagar™ ESBL/CHROMagar™ mSuperCARBA bi-plate medium was evaluated for the detection of ESBL- and carbapenemase-producing Enterobacteriaceae. Spiked stools were used to mimic in vivo stool colonization. Two-hundred enterobacterial isolates were tested. Respective sensitivities of 93.9% and 97.8% were obtained for the detection of ESBL and carbapenemase producers.


Assuntos
Técnicas Bacteriológicas/métodos , Meios de Cultura/química , Infecções por Enterobacteriaceae/diagnóstico , Enterobacteriaceae/isolamento & purificação , Proteínas de Bactérias/análise , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Enterobacteriaceae/enzimologia , Infecções por Enterobacteriaceae/microbiologia , Fezes/microbiologia , Humanos , Sensibilidade e Especificidade , beta-Lactamases/análise , beta-Lactamases/genética , beta-Lactamases/metabolismo
20.
J Hosp Infect ; 103(2): 156-159, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31039383

RESUMO

Carbapenemase-producing Enterobacteriaceae (CPE) are a growing problem in UK hospitals. Preventing transmission requires early detection. This study evaluates a new screening policy for patients with a history of blaKPC-associated CPE (KPC-CPE) in a higher incidence hospital. Previous policy assumed 'once positive always positive'. New policy uses rapid screening and risk assessment. Results show that most (76.5%) patients with a history of KPC-CPE do not have detectable KPC-CPE on readmission or during their subsequent hospital stay but that repeat screening after an initial negative result is required. The new policy takes a risk-based approach while prioritizing isolation facilities in a higher incidence trust.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Transmissão de Doença Infecciosa/prevenção & controle , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Testes Diagnósticos de Rotina , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/transmissão , Política de Saúde , Humanos , Incidência , Programas de Rastreamento , Readmissão do Paciente , Reino Unido/epidemiologia
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