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2.
Zhonghua Nei Ke Za Zhi ; 58(8): 566-571, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31365977

RESUMO

Objective: To evaluate the efficacy and safety of different antimicrobial regimens in patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods: The clinical date of patients with CRKP bloodstream infections were retrospectively analyzed at the First Affiliated Hospital of Zhejiang University Medical College between January 2017 and January 2018. All subjects were separated into three groups based on antibiotics regimens over 72 hours, including meropenem 2.0 g every 8 hours, tigecycline 200 mg as initial dose and 100 mg every 12 hours, and polymyxin B 1.25 mg/kg every 12 hours as salvage treatment of tigecycline. Results: A total of 86 patients were finally recruited, including 14, 52 and 20 patients in groups of meropenem, tigecycline and polymyxin B salvage, respectively. All of the strains were resistant to meropenem and susceptible to tigecycline and polymyxin B initially, while 2 of them became resistant to tigecycline during treatment. The 28-day mortality was significantly higher in meropenem group (13/14) than that in tigecycline group and polymyxin B salvage group (61.5%, 32/52) and (12/20), respectively (P<0.01), while as no significant difference was seen in the last two groups (χ(2)=0.014, P>0.05). The incidences of hepatic impairment [3.8%(2/52) vs. 1/20] and renal dysfunction (0 vs. 1/20) between tigecycline group and polymyxin B salvage group were both comparable (P>0.05). Conclusion: The meropenem-based therapy is not recommended for CRKP-related bloodstream infections. Tigecycline-based therapy is still disappointing despite salvage use of polymyxin B after 72 hours. Hepatic and nephretic toxicities caused by additional polymyxin B are acceptable.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Meropeném/uso terapêutico , Polimixinas/uso terapêutico , Tigeciclina/uso terapêutico , Antibacterianos/administração & dosagem , Bacteriemia/mortalidade , China/epidemiologia , Farmacorresistência Bacteriana Múltipla , Humanos , Infecções por Klebsiella/diagnóstico , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Resultado do Tratamento , Resistência beta-Lactâmica
3.
BMC Infect Dis ; 19(1): 678, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370804

RESUMO

BACKGROUND: Fecal colonization with carbapenem-resistant Enterobacteriaceae (CRE) is a risk factor for bacterial translocation resulting in subsequent endogenous infections. The purpose of this study is to investigate the prevalence of CRE strains colonization in stool samples of outpatient in a tertiary pediatric hospital of Shanghai, China. METHODS: In a retrospective study, fecal samples were consecutively obtained from patients in 2016 and screening test for CRE was conducted by using home-made MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and ß-lactamases were characterized by polymerase chain reaction (PCR) assays and DNA sequencing. Multilocus sequence typing (MLST) was performed for the genetic relationships of the isolates. RESULTS: A total of 880 fecal samples were included for this screening test and 32 CRE strains were identified in 32 non-duplicate fecal samples from 32 children (1.3 ± 1.5 years), with a carriage rate of 3.6%. These strains mainly distributed in Klebsiella pnuemoniae (37.5%) and Escherichia coli (37.5%). All CRE strains showed high resistance to most of the routinely used antibiotics (> 90%) except for polymyxin B and tigecycline. The blaNDM gene was the major carbapenemase gene harbored by gastrointestinal CRE strains, followed by blaKPC-2, blaIMP-26, and blaIMP-4. Other ß-Lactamase genes including blaCTX-M, blaSHV, blaTEM-1, and blaDHA-1 were also detected. MLST analysis revealed that various sequence types (STs) were detected in these strains, with ST11 and ST37 being more prevalent in K.pneumoniae and ST101 in E.coli. CONCLUSIONS: This study revealed the prevalence of CRE fecal carriage in children from outpatient and urgent implementation of infection control measure should be conducted to limit the spread of CRE strains.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/patogenicidade , Infecções por Enterobacteriaceae/epidemiologia , Fezes/microbiologia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Pré-Escolar , China/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Escherichia coli/genética , Feminino , Humanos , Lactente , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Pacientes Ambulatoriais/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , beta-Lactamases/genética
4.
Stud Health Technol Inform ; 262: 180-183, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349296

RESUMO

Optimal antibiotic use for the treatment of nosocomial infections plays a central role in the effort to control the rapidly increasing prevalence of multidrug-resistant bacteria. Antibiotic selection should be based on accurate knowledge of local susceptibility rates. Traditional methods of resistance reporting, which are in routine use by microbiology laboratories could be enhanced by using statistically significant results. We present a method of reporting based on antibiotic susceptibility data analysis which offers an accurate tool that reduces clinician uncertainty and enables optimization of the antibiotic selection process.


Assuntos
Infecção Hospitalar , Análise de Dados , Farmacorresistência Bacteriana , Klebsiella pneumoniae , Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Humanos , Klebsiella pneumoniae/efeitos dos fármacos
5.
Rev Soc Bras Med Trop ; 52: e20180502, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31271619

RESUMO

INTRODUCTION: Plant products are sources for drug development against multidrug resistant bacteria. METHODS: The antimicrobial activity of Origanum vulgare L. essential oil (OVeo) against carbapenem-resistant strains was assessed by disk-diffusion, microdilution (REMA-Resazurin Microtiter Assay), and time kill assays. RESULTS: Carbapenemase production was confirmed for all strains. OVeo exhibited a minimum inhibitory concentration of 0.059% v/v for Klebsiella pneumoniae and Serratia marcescens, and of 0.015 % v/v for Acinetobacter baumannii. A decrease in cell count was observed after a 4 h treatment. CONCLUSIONS: OVeo antimicrobial effect was rapid and consistent, making it a candidate for developing alternative therapeutic options against carbapenem-resistant strains.


Assuntos
Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/farmacologia , Bactérias Gram-Negativas/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacos , Óleos Voláteis/farmacologia , Origanum/química , Serratia marcescens/efeitos dos fármacos , Acinetobacter baumannii/crescimento & desenvolvimento , Antibacterianos/classificação , Proteínas de Bactérias , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/crescimento & desenvolvimento , Humanos , Klebsiella pneumoniae/crescimento & desenvolvimento , Testes de Sensibilidade Microbiana , Serratia marcescens/crescimento & desenvolvimento , beta-Lactamases
7.
Photochem Photobiol Sci ; 18(8): 1923-1932, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31147667

RESUMO

Drug-resistant pathogens, particularly those that result in hospital acquired infections (HAIs), have emerged as a critical priority for the World Health Organization. To address the need for self-disinfecting materials to counter the threat posed by the transmission of these pathogens from surfaces to new hosts, here we investigated if a cationic BODIPY photosensitizer, embedded via electrospinning into nylon and polyacrylonitrile (PAN) nanofibers, was capable of inactivating both bacteria and viruses via antimicrobial photodynamic inactivation (aPDI). Materials characterization, including fiber morphology and the degree of photosensitizer loading, was assessed by scanning electron microscopy (SEM), thermal gravimetric analysis (TGA), and UV-visible diffuse reflectance spectroscopy (UV-Vis DRS), and demonstrated that the materials were comprised of nanofibers (125-215 nm avg. diameter) that were thermostable to >300 °C. The antimicrobial potencies of the resultant Nylon-BODIPY(+) and PAN-BODIPY(+) nanofiber materials were evaluated against four strains of bacteria recognized by the World Health Organization as either critical or high priority pathogens: Gram-positive strains methicillin-resistant S. aureus (MRSA; ATCC BAA-44) and vancomycin-resistant E. faecium (VRE; ATCC BAA-2320), and Gram-negative strains multidrug-resistant A. baumannii (MDRAB; ATCC BAA-1605) and NDM-1 positive K. pneumoniae (KP; ATCC BAA-2146). Our results demonstrated the detection limit (99.9999%; 6 log units reduction in CFU mL-1) photodynamic inactivation of three strains upon illumination (30-60 min; 40-65 ± 5 mW cm-2; 400-700 nm): MRSA, VRE, and MDRAB, but only minimal inactivation (47-75%) of KP. Antiviral studies employing PAN-BODIPY(+) against vesicular stomatitis virus (VSV), a model enveloped virus, revealed complete inactivation. Taken together, the results demonstrate the potential for electrospun BODIPY(+)-embedded nanofiber materials as the basis for pathogen-specific anti-infective materials, even at low photosensitizer loadings.


Assuntos
Resinas Acrílicas/farmacologia , Antibacterianos/farmacologia , Compostos de Boro/farmacologia , Nylons/farmacologia , Fotoquimioterapia , Fármacos Fotossensibilizantes/farmacologia , Acinetobacter baumannii/efeitos dos fármacos , Resinas Acrílicas/química , Antibacterianos/química , Compostos de Boro/química , Klebsiella pneumoniae/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Nanofibras/química , Nylons/química , Tamanho da Partícula , Fármacos Fotossensibilizantes/química , Enterococos Resistentes à Vancomicina/efeitos dos fármacos
8.
Int J Nanomedicine ; 14: 3983-3993, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213810

RESUMO

Background: Infections caused by drug resistant bacteria are a major health concern worldwide and have prompted scientists to carry out efforts to overcome this challenge. Researchers and pharmaceutical companies are trying to develop new kinds of antimicrobial agents by using different physical and chemical methods to overcome these problems. Materials and methods: In the present study, rifampicin conjugated silver (Rif-Ag) nanoparticles have successfully been synthesized using a chemical method. Characterization of the nanoparticles was performed using a UV-Vis spectrophotometer, FTIR, SEM, TEM, and AFM. Results: The AFM, SEM, and TEM results showed that the average particle size of Rif-Ag nanoparticles was about 15-18±4 nm. The FTIR spectra revealed the conjugation of -NH2 and -OH functional moiety with silver nanoparticles surface. Considering the penetrating power of rifampicin, the free drug is compared with synthesized nanoparticle for antimicrobial, biofilm inhibition, and eradication potential. Synthesized nanoparticles were found to be significantly active as compared to drug alone. Conclusion: This study has shown greater biofilm inhibitory and eradicating potential against methicillin resistant Staphylococcus aureus and Klebsiella pneumoniae, as evident by crystal violet, MTT staining, and microscopic analysis. So, it will be further modified, and studies for the mechanism of action are needed.


Assuntos
Biofilmes/efeitos dos fármacos , Klebsiella pneumoniae/fisiologia , Nanopartículas Metálicas/química , Staphylococcus aureus Resistente à Meticilina/fisiologia , Rifampina/farmacologia , Prata/farmacologia , Antibacterianos/farmacologia , Temperatura Alta , Humanos , Concentração de Íons de Hidrogênio , Klebsiella pneumoniae/efeitos dos fármacos , Nanopartículas Metálicas/ultraestrutura , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Rifampina/química , Sais , Prata/química , Espectroscopia de Infravermelho com Transformada de Fourier
9.
Future Microbiol ; 14: 691-704, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31148474

RESUMO

Aim: To determine the prevalence of New Delhi metallo-ß-lactamase (NDM)-producing Gram-negative pathogens isolated from children's samples. Materials & methods: Carbapenem-resistant clinical isolates (n = 117) were confirmed by VITEK® 2 compact system, matrix-assisted laser desorption ionization-time of flight and multilocus sequence typing. MIC (µg/ml) of various antibiotics was determined by VITEK 2 compact system. Molecular characterization of the isolates was performed by PCR, DNA sequencing, PFGE and DNA hybridization. Results: Out of 117 carbapenemase producers, 37 (31.6%) and 29 (24.7%) were Klebsiella pneumoniae and Acinetobacter baumannii, respectively. 72 (61.5%) isolates were NDM positive and among these 60, 9 and 3 were NDM-1, -5 and -7, respectively. Majority of the NDM-producing K. pneumoniae belonged to ST11 and ST273 while most of the Escherichia coli belonged to ST405 and ST101. blaNDM were mainly located on 150kb plasmids. MIC displayed high resistance against ß-lactams drugs including carbapenems, and the most sensitive drugs were tigecycline and colistin. Conclusion: Dissemination of blaNDM-producing pathogens, particularly in children clinical settings, is a matter of great public health concern.


Assuntos
Bactérias Gram-Negativas/enzimologia , Bactérias Gram-Negativas/genética , beta-Lactamases/biossíntese , beta-Lactamases/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/enzimologia , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Antibacterianos/farmacologia , Proteínas de Bactérias/biossíntese , Proteínas de Bactérias/genética , Criança , DNA Bacteriano/análise , Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Feminino , Perfilação da Expressão Gênica , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Paquistão/epidemiologia , Plasmídeos , Análise de Sequência de DNA
10.
Rev Inst Med Trop Sao Paulo ; 61: e29, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31241658

RESUMO

Increased resistance to polymyxin in Klebsiella pneumoniae (ColRKP) has been observed. Molecular epidemiology, as well as the clinical impact of these difficult to treat pathogens need to be better characterized. We present the clinical outcomes of 28 patients infected by ColRKP in a tertiary hospital. Isolates with MIC >2 by Vitek 2 were confirmed by the microdilution broth test. Polymerase chain reaction (PCR) was performed for blaKPC, blaNDM, blaOXA-48 and blamcr-1 genes in the isolates, and Whole Genome Sequencing (WGS) was performed in six isolates. Seventeen (61%) patients were female and the mean age was 50 years old. In-hospital and 30-day mortality were 64% (18/28) and 53% (15/28), respectively. Central line-associated bloodstream infection in addition to bacteremia episodes due to other sources were the most frequent (61%). Mean APACHE and Charlson comorbidity index were 16 and 5, respectively. Twenty patients (71%) received at least one active drug and ten (35%) received two drugs: tigecycline 46% (13/28); amikacin 21% (6/28) and fosfomycin 3% (1 case). Twenty-six out of 28 tested cases were positive for blaKPC. Eight different clusters were identified. Four STs were detected (ST11, ST23, ST340, and ST437). Mutations on pmrA, arnB, udg, and yciM genes were present in all six isolates submitted to WGS; lpxMand mgrB mutations were also detected in all but one isolate. In conclusion, we observed resistance to polymyxin in severely ill patients mostly from intensive care units and/or immunosuppressed patients with high mortality rates in whom a diversity of ColRKP clusters was identified and might indicate selective pressure.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Polimixinas/farmacologia , Adolescente , Brasil , Feminino , Humanos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Centros de Atenção Terciária
11.
Rev Soc Bras Med Trop ; 52: e20190089B, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31038624

RESUMO

INTRODUCTION: The relationships between phagocytosis, and mucoid phenotype, plasmid profile and virulence, and resistance genetic characteristics of Klebsiella pneumoniae clinical isolates were evaluated. METHODS: Thirty isolates were used to determine the mucoid aspect. Four were selected for analysis of phagocytosis by alveolar macrophages. RESULTS: Thirty percent of the samples presented the mucoid phenotype. The phagocytosis rate ranged from 21.5% to 43.43%. Phagocytosis was not correlated with the plasmid profile, but was apparently correlated with mucoid phenotype and antibiotic susceptibility. CONCLUSIONS: Several virulence factors act in parallel in K. pneumoniae to impair host defense.


Assuntos
Antibacterianos/farmacologia , Resistência Microbiana a Medicamentos/genética , Klebsiella pneumoniae/genética , Fagocitose/genética , Fatores de Virulência/genética , Virulência/genética , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/patogenicidade , Fagocitose/fisiologia , Fenótipo , Plasmídeos
12.
Zhonghua Nei Ke Za Zhi ; 58(5): 361-365, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31060144

RESUMO

Objective: To describe the clinical characteristics of hypervirulent Klebsiella pneumoniae (hvKP) infection. To analyze the antibiotic susceptibility of hvKP to provide the empiric antibiotic options. To investigate capsule serotype and sequence type (ST) of hvKP and their correlation with clinical profiles. Methods: hvKP was defined as bacteria isolated from patients with community-acquired pyogenic liver abscess (CA-PLA) with co-infection sites outside liver or a bloodstream infection in a host without underlying biliary tract diseases. Patients with CA-PLA hospitalized in the First Hospital of China Medical University were retrospectively analyzed from January 2011 to December 2017. Antibiotic susceptibility was detected by automatic bacterial identification and antibiotic susceptibility analysis system in vitro. Polymerase chain reaction method and gene sequencing were used to detect the main capsule serotype and ST. Results: A total of 140 cases with hvKP infection were enrolled. The co-infections outside liver abscess included 98 bloodstream infections, 53 pneumonia, 11 perianal abscess, 10 urinary system infections, 3 subphrenic abscess, 3 endophthalmitis, 2 spleen abscess, and other miscellaneous infections including 1 peritonitis, 1 skin and soft tissue infection, 1 myelitis, 1 colitis, 1 psoas major abscess and 1 myocardial abscess. Among the 140 cases, 106 presented with single co-infection site, 32 with 2 sites, and 2 with 3 sites. HvKP manifested high antibiotic susceptibility up to 80% for most commonly used antibiotics. Capsule serotyping of 43 revived isolates indicated that K1 serotype accounted for 53.49% (23/43), K2 34.88 (15/43), K54 2.33% (1/43), K57 2.33% (1/43), and other serotypes 6.98%(3/43). There was no significant distribution among K1, K2, K54 and K57 of hvKP capsule serotypes in patients with or without diabetes mellitus (P>0.05). Multilocus sequence typing (MLST) suggested that ST23 and ST65 were predominant accounting for 39.53% (17/43) and 25.58% (11/43) respectively. No serotype or ST predominance was seen in any of the clinical infections. Conclusion: HvKP is related to a wide spectrum of infectious diseases, including multiple extrahepatic sites and bloodstream infections besides CA-PLA with high antibiotic susceptibility. K1 and K2 are the predominant capsule serotypes, and ST 23 and ST65 are the predominant sequence types.


Assuntos
Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/patogenicidade , Virulência/efeitos dos fármacos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , China , Humanos , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Tipagem de Sequências Multilocus , Estudos Retrospectivos , Sorogrupo
13.
Nat Commun ; 10(1): 1979, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040286

RESUMO

Hospital acquired infections (HAIs) and the emergence of antibiotic resistant strains are major threats to human health. Copper is well known for its high antimicrobial efficacy, including the ability to kill superbugs and the notorious ESKAPE group of pathogens. We sought a material that maintains the antimicrobial efficacy of copper while minimizing the downsides - cost, appearance and metallic properties - that limit application. Here we describe a copper-glass ceramic powder as an additive for antimicrobial surfaces; its mechanism is based on the controlled release of copper (I) ions (Cu1+) from cuprite nanocrystals that form in situ in the water labile phase of the biphasic glass ceramic. Latex paints containing copper-glass ceramic powder exhibit ≥99.9% reduction in S. aureus, P. aeruginosa, K. aerogenes and E. Coli colony counts when evaluated by the US EPA test method for efficacy of copper-alloy surfaces as sanitizer, approaching that of benchmark metallic copper.


Assuntos
Anti-Infecciosos/química , Anti-Infecciosos/farmacologia , Cerâmica/química , Cobre/química , Nanopartículas/química , Klebsiella pneumoniae/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos
14.
J Med Microbiol ; 68(6): 882-889, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31050634

RESUMO

PURPOSE: The aim of the present study was to investigate the dissemination of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates in integrated intensive care units (IICUs) and emergency ICUs (EICUs) for controlling the spread of CRKP in different ICUs of the hospital. METHODOLOGY: From January 2016 to April 2017, a total of 46 non-duplicate CRKP isolates were consecutively isolated from a tertiary hospital. The production of carbapenemases was determined by the modified carbapenem inactivation method (mCIM) test. The resistance and virulence-associated genes were detected by PCR and DNA sequencing. A hypermucoviscosity phenotype was identified by the string test. Bacterial clonal relatedness of the CRKP isolates tested was determined by multi-locus sequence typing (MLST) and PFGE. RESULTS: All CRKP isolates showed multiple drug resistance. All CRKP isolates harboured blaKPC-2-encoding carbapenemase and at least one of the other ß-lactamase genes tested, with positive rates of 89.1  % (41/46) for blaCTX-M-65. qnrS was found among 76.1  % (35/46) of the CRKP isolates. A hypermucoviscosity phenotype was found in only two (4.3 %, 2/46) CRKP isolates. The virulence-associated genes with positive rates of more than 90  % among the 46 isolates tested included wabG (100 %, 46/46), ycf (100 %, 46/46), ureA (95.6 %, 44/46) and fim H (95.6 %, 44/46). MLST results showed that 46 CRKP isolates belonged to ST11 (95.6 %, 44/46) and ST86 (4.4 %, 2/46). PFGE patterns showed four clusters. CONCLUSION: The CRKP ST11 clone with co-production of CTX-M-65 and KPC-2 disseminated in ICUs of this tertiary teaching hospital in central China. The emergence of CRKP with a hypermucoviscosity phenotype in ICUs should be of particular concern.


Assuntos
Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos , Carbapenêmicos/farmacologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Tipagem Bacteriana , China/epidemiologia , Serviços Médicos de Emergência , Feminino , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Centros de Atenção Terciária , Adulto Jovem
15.
J Med Microbiol ; 68(6): 837-847, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084700

RESUMO

INTRODUCTION: The last few years have seen the emergence of multi-drug resistant (MDR) Gram-negative infections, which are associated with high morbidity and mortality. The indiscriminate use of colistin has led to the development of resistance, which can be diagnosed effectively by broth microdilution. Studies from India are limited, and this study was conducted in order to determine the prevalence and risk factors associated with colistin resistance. METHODS: Urine samples from patients admitted with urinary tract infection (UTI), growing MDR Escherichia coli and Klebsiella pneumoniae, were tested for the minimum inhibitory concentration (MIC) of colistin by broth microdilution. Isolates with an MIC >2 µg ml-1 (resistant) were subjected to polymerase chain reaction (PCR) for the mcr1, mcr2 and mgrB genes. A case-control study with 21 cases (resistant) and 42 matched controls (sensitive) was designed to evaluate risk factors and outcomes (recurrent UTI, readmission and hospital stay >2 weeks). RESULTS: Two hundred and fifty MDR isolates (E. coli=142/2319 and K.pneumoniae=108/775) from 216 patients were selected from the 25 046 isolates screened. Twenty-five isolates (20 K.pneumoniae and 5 E. coli) were resistant to colistin, with a prevalence of 3.52  % in E. coli and 18.5  % in K. pneumoniae among the MDR isolates. PCR for the mcr1 and mcr2 genes was negative. Multivariate regression showed that multiple episodes of hospitalization, hospital stay >2 weeks, exposure to >three antibiotic classes and abnormality/surgery of the lower urinary tract were the significant risk factors for colistin resistance. Previous use of colistin and colistin resistance had a significant effect on all outcomes. CONCLUSIONS: K. pneumoniae show six times higher prevalence of colistin resistance than E. coli, and the emergence of resistant organisms has led to an increase in morbidity in infected patients.


Assuntos
Antibacterianos/farmacologia , Colistina/farmacologia , Infecções por Escherichia coli/epidemiologia , Escherichia coli/genética , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Infecções Urinárias/epidemiologia , Adulto , Proteínas de Bactérias/genética , Estudos de Casos e Controles , Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Índia/epidemiologia , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Adulto Jovem
16.
BMC Res Notes ; 12(1): 244, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036061

RESUMO

OBJECTIVES: Diabetic foot ulcers (DFUs) often lead to hospital admissions, amputations and deaths; however, there is no up-to-date information on microbial isolates from DFUs and no mention of utilization of molecular techniques in Sub-Saharan Africa. We conducted a cross-sectional study among 83 adult patients at a tertiary hospital in Kenya over 12 months. The study aimed to isolate, identify bacteria, their antibiotic susceptibility patterns in active DFUs, and to compare standard microbiological methods versus a real-time PCR commercial kit in the detection of Staphylococcus aureus DNA and methicillin-resistant S. aureus (MRSA) DNA. RESULTS: Eighty swabs (94%) were culture-positive; 29% were Gram-positive and 65% were Gram-negative. The main organisms isolated were S. aureus (16%), Escherichia coli (15%), Proteus mirabilis (11%), Klebsiella pneumoniae (7%) and Pseudomonas aeruginosa (7%). The bacterial isolates showed resistance to commonly used antibiotics such as ampicillin, amoxicillin, cefepime, ceftazidime, cefuroxime, clindamycin, erythromycin, piperacillin-tazobactam, tetracycline and trimethoprim-sulphamethoxazole (TMPSMX). Thirty-one percent of the S. aureus isolated and 40% of the Gram-negatives were multi-drug resistant organisms (MDROs). There was a high prevalence of nosocomial bacteria. MRSA were not identified using culture methods but were identified using PCR. PCR was more sensitive but less specific than culture-based methods to identify S. aureus.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Pé Diabético/diagnóstico , Farmacorresistência Bacteriana Múltipla , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus/efeitos dos fármacos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Técnicas de Tipagem Bacteriana , Cefalosporinas/uso terapêutico , Clindamicina/uso terapêutico , Estudos Transversais , Pé Diabético/tratamento farmacológico , Pé Diabético/epidemiologia , Pé Diabético/microbiologia , Escherichia coli/classificação , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Humanos , Quênia/epidemiologia , Klebsiella pneumoniae/classificação , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Macrolídeos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Penicilinas/uso terapêutico , Proteus mirabilis/classificação , Proteus mirabilis/efeitos dos fármacos , Proteus mirabilis/genética , Proteus mirabilis/isolamento & purificação , Pseudomonas aeruginosa/classificação , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Sulfanilamidas/uso terapêutico
17.
Rev Soc Bras Med Trop ; 52: e20180352, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31141048

RESUMO

INTRODUCTION: The emergence of New Delhi metallo-ß-lactamase (NDM) is concernig because it reduces the antibiotic therapy options for bacterial infections. METHODS: Resistant and virulent genes from an isolate of Klebsiella pneumoniae derived from a patient with sepsis in a hospital in Recife-PE, Brazil, were investigated using PCR and DNA sequencing. RESULTS: bla NDM-1, aac(6')-Ib-cr and acrB resistance genes, and cps and mrkD virulence genes were detected. CONCLUSIONS: To our knowledge, this is the first report on bla NDM-1 in Recife-PE. This detection alerts researchers to the need to control the spread of bla NDM-1 resistance gene by this bacterium in Brazil.


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana Múltipla/genética , Klebsiella pneumoniae/genética , Virulência/genética , beta-Lactamases/genética , Feminino , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Sepse/microbiologia , Análise de Sequência de DNA
18.
Mem Inst Oswaldo Cruz ; 114: e180555, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31116243

RESUMO

BACKGROUND: Polymyxins are currently used as a "last-line" treatment for multidrug-resistant Gram-negative infections. OBJECTIVES: To identify the major mechanisms of resistance to polymyxin and compare the genetic similarity between multi-drug resistant Klebsiella pneumoniae strains recovered from inpatients of public hospitals in the Mid-West of Brazil. METHODS: 97 carbapenems non-susceptible K. pneumoniae were studied. ß-lactamases (bla OXA-48, bla KPC, bla NDM, bla CTX-M, bla SHV, bla TEM, bla IMP, bla VIM) and mcr-1 to mcr-5 genes were investigated by polymerase chain reaction (PCR). Mutations in chromosomal genes (pmrA, pmrB, phoP, phoQ, and mgrB) were screened by PCR and DNA sequencing. Clonal relatedness was established by using pulsed-field gel electrophoresis and multilocus sequence typing. FINDINGS: K. pneumoniae isolates harbored bla KPC (93.3%), bla SHV (86.6%), bla TEM (80.0%), bla CTX-M (60%) genes. Of 15 K. pneumoniae resistant to polymyxin B the authors identified deleterious mutations in pmrB gene, mainly in T157P. None K. pneumoniae presented mcr gene variants. Genetic polymorphism analyses revealed 12 different pulsotypes. MAIN CONCLUSIONS: Deleterious mutations in pmrB gene is the main chromosomal target for induction of polymyxin resistance in carbapenem-resistant K. pneumoniae in public hospitals in the Mid-West of Brazil.


Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Mutação/genética , Polimixinas/farmacologia , Biodiversidade , Farmacorresistência Bacteriana Múltipla/genética , Humanos , Klebsiella pneumoniae/genética , Reação em Cadeia da Polimerase
19.
Int J Infect Dis ; 84: 109-115, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31077804

RESUMO

OBJECTIVES: Urinary tract infection (UTI) is a common medical complication experienced by patients with neurologic diseases. In this study, we established the microbial etiologies of UTI, and resistances to antibiotics in UTI as well as determining which appropriate empirical antibiotics should be used to treat UTI in neurological patients. DESIGNS AND METHODS: We retrospectively reviewed microbial etiologies and antimicrobial resistance among patients experiencing UTI events in the neurology ward of Seoul National University Hospital from 2007 to 2016. RESULTS: The total number of UTI events observed was 301, and Klebsiella pneumoniae was the most common pathogen observed in UTIs. But in catheter-associated UTI (CAUTI), Enterococcus species were the most prevalent pathogens. Susceptibility to commonly-prescribed antibiotics decreased over 10 years, indicating increased antibiotic resistance in pathogens associated with UTI. ESBL-producing K. pneumoniae increased significantly, while increases of MDR K. pneumoniae, ESBL-producing E. coli, and VRE were not observed. CONCLUSIONS: The worldwide trend of increasing drug-resistant pathogens should be considered, and further studies on antibiotics resistance in UTI are needed. These data will greatly assist physicians when they select antibiotics to treat UTIs in neurological patients.


Assuntos
Antibacterianos/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Farmacorresistência Bacteriana , Feminino , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Seul , Fatores de Tempo , Adulto Jovem
20.
Microb Pathog ; 132: 369-373, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31075430

RESUMO

Present study evaluates the protective effect of mollugin against Klebsiella pneumonia (KP) and also postulates the possible mechanism of its action. Klebsiella pneumoniae (2.4 × 108 CFU/ml) was used for the induction of KP. PMNs and WBC count was determined in the blood and bronchoalveolar lavage fluid (BALF) of Klebsiella pneumonia rat. Level of inflammatory cytokines in the blood of Klebsiella pneumonia rat was determined by ELISA methods. Moreover effect of mollugin was estimated by Western blot assay and RT-PCR method. Result of the study suggests that water content in lung was reduced in the mollugin treated group compared to pneumonia control group of rats. Count of PMNs and WBC were found to be reduced in mollugin treated group compared to pneumonia control group of rats. Level of inflammatory cytokines was also found to be reduced in the blood of mollugin treated group than pneumonia control group. Moreover treatment with mollugin attenuates the altered expression of p-MAPK, p-JNK and p-ERK protein and mRNA expression of NF-κB in the lung tissues of Klebsiella pneumonia rat. In conclusion, data of the study reveals that treatment with mollugin ameliorates Klebsiella pneumonia rat by reducing the lung inflammation. Inflammation of lung tissue was reduced by regulating the NF-κB/MAPK signaling pathway in mollugin treated group.


Assuntos
Klebsiella pneumoniae/efeitos dos fármacos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , NF-kappa B/efeitos dos fármacos , Pneumonia/tratamento farmacológico , Piranos/farmacologia , Transdução de Sinais/efeitos dos fármacos , Animais , Líquido da Lavagem Broncoalveolar/microbiologia , Citocinas/sangue , Citocinas/metabolismo , Modelos Animais de Doenças , Feminino , Infecções por Klebsiella/sangue , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/patogenicidade , Pulmão/metabolismo , Pulmão/patologia , Masculino , Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo , NF-kappa B/metabolismo , Pneumonia/microbiologia , Piranos/uso terapêutico , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley
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