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1.
Medicine (Baltimore) ; 99(50): e23410, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327265

RESUMO

Carbapenemase-producing organisms (CPO) have been identified as an urgent healthcare threat. Various methods have been used for the detection of CPO using rectal swabs. Recently, an on-demand polymerase chain reaction (PCR) assay, namely, the Xpert Carba-R assay, that requires less than an hour of turnaround time, had been developed for CPO detection in clinical samples. This study focused on the use of this assay to determine the intestinal colonization rate of CPO in patients admitted to emergency rooms (ERs).A retrospective review of medical records was conducted at a tertiary hospital between July 2017 and June 2018. CPO screening using rectal swabs was performed for patients transferred from other hospitals or for those who tested positive in CPO culture tests in the previous three months. The Xpert Carba-R assay and culture tests were used as the CPO screening methods, and the results of both tests were compared.Medical records of 705 patients admitted to our hospital during the study period were reviewed. Of these, 31 (4.4%) showed positive results for CPO using the Xpert Carba-R assay, and these patients were then transferred from the ERs to isolation rooms. Fifteen of the Xpert Carba-R assay-positive patients were also positive for the culture test; hence, early detection enabled the rapid isolation of CPO-infected patients and prevented the spread of the CPO.The Xpert Carba-R assay is a rapid test to identify and guide infection control programs to contain the spread of the rectal colonization of CPO within a hospital.


Assuntos
Técnicas Bacteriológicas/métodos , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Enterococos Resistentes à Vancomicina/isolamento & purificação , Serviço Hospitalar de Emergência , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Isolamento de Pacientes , Prevalência , Reto/microbiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
2.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370929

RESUMO

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.


Assuntos
Infecções por HIV , Obstrução Intestinal , Penicilinas/administração & dosagem , Proctite/diagnóstico , Neoplasias Retais/diagnóstico , Reto , Treponema pallidum , Idoso , Antibacterianos/administração & dosagem , Diagnóstico Diferencial , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Masculino , Proctite/etiologia , Proctite/fisiopatologia , Proctite/terapia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia , Sigmoidoscopia/métodos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/terapia , Tomografia Computadorizada por Raios X/métodos , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação
3.
PLoS One ; 15(11): e0241971, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33201906

RESUMO

BACKGROUND: Fecal colonization by carbapenem-resistant Enterobacteriaceae (CRE) can be the main reservoir for transmission of these resistant organisms especially in the Intensive Care Units (ICUs). AIM: This study was conducted to evaluate the rate of rectal carriage and molecular characterization of CRE in patients hospitalized in the ICUs of 2 major hospitals (Adan and Mubarak Al Kabeer Hospitals) in Kuwait. MATERIALS AND METHODS: Rectal swabs were collected from all patients at admission, 48 h after admission and once weekly from April 2017- March 2018. Initial CRE screening was carried out on MacConkey agar on which meropenem disc 10µg was placed. Identification of isolates was by API 20E. Susceptibility testing was performed using the E-test method. Polymerase chain reaction (PCR) was used to detect the carbapenemase-encoding genes. Clonal relationship was investigated by pulsed-field electrophoresis (PFGE). Genes of blaOXA-181 and blaNDM-5-carrying plasmids were detected in some strains. RESULTS: A total of 590 patients were recruited into the study. Of these, 58 were positive for CRE, giving a prevalence of 9.8%; 25/320 (7.8%) in Adan and 33/270 (12.2%) in Mubarak Al Kabeer Hospitals. All isolates were resistant to multiple antibiotics. Resistance rates to colistin and tigecycline were 17% and 83%, respectively. Single genes of blaOXA-181 were detected in isolates from 38 (65.5%) out of 58 patients and in 5 patients colonized by blaOXA-48-positive CRE. A combination of 2 genes was detected in 12 isolates; 5 blaKPC-2 and blaOXA-181, 4 blaVIM-1 and blaOXA-181, and 3 blaNDM-5 and blaOXA-181. PFGE showed an overall level of similarity of 38%. Southern hybridization studies localized the blaOXA-181 and blaNDM-5 genes to a large plasmid of 200kb in 3 K. pneumoniae isolates and a small plasmid of 80kb in 2 E. coli isolates, respectively. CONCLUSION: The prevalence of CRE colonization in the 2 hospital ICUs was relatively high and the emergence of blaOXA-181-mediated CRE is a cause for concern as there is the possibility of rapid horizontal spread among hospital patients in Kuwait. Active surveillance of CRE in the ICUs is highly recommended to stem its spread.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/crescimento & desenvolvimento , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Reto/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Carbapenêmicos/uso terapêutico , Colistina/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/crescimento & desenvolvimento , Feminino , Hospitais , Humanos , Unidades de Terapia Intensiva , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/crescimento & desenvolvimento , Kuweit , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Plasmídeos/genética , Prevalência , Adulto Jovem , beta-Lactamases/genética
4.
PLoS One ; 15(11): e0242544, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237921

RESUMO

OBJECTIVES: Multidrug-resistant organisms (MDRO) are considered an emerging threat worldwide. Data covering the clinical impact of MDRO colonization in patients with solid malignancies, however, is widely missing. We sought to determine the impact of MDRO colonization in patients who have been diagnosed with Non-small cell lung cancer (NSCLC) who are at known high-risk for invasive infections. MATERIALS AND METHODS: Patients who were screened for MDRO colonization within a 90-day period after NSCLC diagnosis of all stages were included in this single-center retrospective study. RESULTS: Two hundred and ninety-five patients were included of whom 24 patients (8.1%) were screened positive for MDRO colonization (MDROpos) at first diagnosis. Enterobacterales were by far the most frequent MDRO detected with a proportion of 79.2% (19/24). MDRO colonization was present across all disease stages and more present in patients with concomitant diabetes mellitus. Median overall survival was significantly inferior in the MDROpos study group with a median OS of 7.8 months (95% CI, 0.0-19.9 months) compared to a median OS of 23.9 months (95% CI, 17.6-30.1 months) in the MDROneg group in univariate (p = 0.036) and multivariate analysis (P = 0.02). Exploratory analyses suggest a higher rate of non-cancer-related-mortality in MDROpos patients compared to MDROneg patients (p = 0.002) with an increased rate of fatal infections in MDROpos patients (p = 0.0002). CONCLUSIONS: MDRO colonization is an independent risk factor for inferior OS in patients diagnosed with NSCLC due to a higher rate of fatal infections. Empirical antibiotic treatment approaches should cover formerly detected MDR commensals in cases of (suspected) invasive infections.


Assuntos
Bactérias/isolamento & purificação , Carcinoma Pulmonar de Células não Pequenas/microbiologia , Farmacorresistência Bacteriana Múltipla , Neoplasias Pulmonares/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/efeitos dos fármacos , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/terapia , Causas de Morte , Comorbidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Nariz/microbiologia , Admissão do Paciente/estatística & dados numéricos , Faringe/microbiologia , Reto/microbiologia , Estudos Retrospectivos , Fatores de Risco
5.
Obstet Gynecol ; 136(4): 756-764, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925625

RESUMO

OBJECTIVE: To compare maternal and cord blood penicillin concentrations in women with and without obesity who are receiving intrapartum group B streptococcus (GBS) prophylaxis. METHODS: We performed a prospective cohort study of term women receiving intrapartum penicillin prophylaxis for GBS colonization (determined by antenatal rectovaginal culture). The following outcomes were compared between obese (body mass index [BMI] 35 or higher at delivery) and nonobese (BMI less than 30 at delivery) groups: penicillin concentration in maternal blood (after two penicillin doses) and umbilical cord blood, GBS rectovaginal colonization status on admission and after two completed doses, and neonatal GBS colonization (using a postnatal ear swab). Fifty-five women were needed to detect a 0.75 SD difference in cord blood penicillin concentrations. RESULTS: Fifty-five women were enrolled and had all specimens collected; 49 had complete data for analysis (obese n=25, nonobese n=24). There was no difference in the median maternal penicillin concentration between groups (obese 4.2 micrograms/mL vs nonobese 4.0 micrograms/mL, P=.58). There was, however, a 60% lower median cord blood penicillin concentration in the obese compared with the nonobese group (2.7 micrograms/mL vs 6.7 micrograms/mL, respectively, P<.01), with no significant difference in time from last penicillin dose to delivery (obese 2.9 hours vs nonobese 1.7 hours, P=.07). The difference in cord blood concentrations remained significant after adjustment for nulliparity, hypertensive disorders, and time from last penicillin dose to delivery. Only 59.6% of women tested positive for GBS by rectovaginal culture on admission (obese 60.9% vs nonobese 58.3%, P=.86). CONCLUSION: The median cord blood penicillin concentration was 60% lower in neonates born to women with obesity compared with those born to women without obesity. However, all concentrations exceeded the minimum inhibitory concentration. Maternal penicillin levels were not significantly different between groups. More than 40% of women who previously tested positive for GBS by antenatal culture tested negative for GBS on admission for delivery.


Assuntos
Sangue Fetal/química , Triagem Neonatal/métodos , Obesidade , Penicilinas , Complicações Infecciosas na Gravidez , Infecções Estreptocócicas , Streptococcus agalactiae/isolamento & purificação , Adulto , Antibacterianos/sangue , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Índice de Massa Corporal , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Obesidade/sangue , Obesidade/complicações , Obesidade/diagnóstico , Avaliação de Processos e Resultados em Cuidados de Saúde , Penicilinas/sangue , Penicilinas/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/tratamento farmacológico , Reto/microbiologia , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Vagina/microbiologia
6.
Am J Surg Pathol ; 44(9): 1274-1281, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32568824

RESUMO

Syphilis is a sexually transmitted disease caused by the spirochetal bacterium Treponema pallidum that has been of public health concern for centuries. In the United States, it is currently a reportable disease and one which is recently generating increasing case numbers especially in at risk populations of immune deficiency and men who have sex with men. The present series examines biopsies from 13 patients collected over a 12-year period from a general hospital network in north suburban Cook County, Illinois. There were 13 patients (11 male: 2 female) with varied presentations, including primary ulcerated anogenital chancres, mucosal lesions, peculiar rashes, and alopecia. The reason(s) for biopsy were not clear from the clinical record, as a clinical consideration of syphilis was recorded in only 3 cases. Histologic examination of the mucocutaneous lesions encompassed a spectrum of findings including ulceration, psoriasiform hyperplasia, intense mixed band-like inflammation at the dermal-epidermal junction with a prominent plasma cell component. The contemporary availability of an effective immunostain is a valuable diagnostic adjunct. The organisms generally parallel the intensity of the inflammatory infiltrate but the distribution may vary and rarely, organisms may be absent despite serologic confirmation. Previous corkscrew morphology of the organism described ultrastructurally is reflected in the immunostained representation. Although the diagnosis of syphilis remains a clinical one in most cases, some patients will have unusual presentations and biopsies will be done. The awareness of the pathologist will facilitate prompt and effective treatment.


Assuntos
Cancro/patologia , Mucosa Intestinal/patologia , Mucosa Bucal/patologia , Reto/patologia , Pele/patologia , Sífilis Cutânea/patologia , Treponema pallidum/patogenicidade , Adulto , Alopecia/microbiologia , Biópsia , Cancro/microbiologia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Illinois , Mucosa Intestinal/microbiologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/microbiologia , Valor Preditivo dos Testes , Reto/microbiologia , Pele/microbiologia , Sífilis Cutânea/microbiologia , Adulto Jovem
7.
Sex Transm Infect ; 96(6): 417-421, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32404400

RESUMO

OBJECTIVES: As Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most commonly reported STIs in Belgium and the majority of women infected are asymptomatic, targeted screening of patients in specified risk groups is indicated. To prevent long-term complications and interrupt transmission, extragenital samples should be included. As this comes with a substantial extra cost, analysis of a pooled sample from vaginal and extragenital sites could be a solution. In this study, we evaluated the feasibility of molecular testing for CT and NG in pooled versus single-site samples in a large cohort of female sex workers. METHODS: Women were sampled from three anatomical sites: a pharyngeal, a vaginal and a rectal swab. Each sample was vortexed, and 400 µL of transport medium from each sample site was pooled into an empty tube. NAAT was performed using the Abbott RealTime CT/NG assay on the m2000sp/rt system. RESULTS: We included 489 patients: 5.1% were positive for CT; 2.0% were positive for NG and 1.4% were coinfected, resulting in an overall prevalence of 6.5% (95% CI 4.5% to 9.1%) for CT and 3.5% (95% CI 2.0% to 5.5%) for NG. From the 42 patients positive on at least one non-pooled sample, only 5 gave a negative result on the pooled sample, resulting in a sensitivity of 94% (95% CI 79% to 99%) for CT and 82% (95% CI 57% to 96%) for NG. The missed pooled samples were all derived from single-site infections with low bacterial loads. The possibility of inadequate self-sampling as a cause of false negativity was excluded, as 4/5 were collected by the physician. Testing only vaginal samples would have led to missing 40% of CT infections and 60% of NG infections. CONCLUSIONS: Pooling of samples is a cost-saving strategy for the detection of CT and NG in women, with minimal decrease in sensitivity. By reducing costs, more patients and more extragenital samples can be tested, resulting in higher detection rates.


Assuntos
Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Técnicas de Amplificação de Ácido Nucleico/métodos , Faringe/microbiologia , Reto/microbiologia , Profissionais do Sexo , Vagina/microbiologia , Infecções Assintomáticas/epidemiologia , Bélgica/epidemiologia , Infecções por Chlamydia/epidemiologia , Chlamydia trachomatis , Feminino , Gonorreia/epidemiologia , Humanos , Sensibilidade e Especificidade , Manejo de Espécimes/métodos
8.
Int J Syst Evol Microbiol ; 70(5): 2998-3003, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32375941

RESUMO

Nine independent Gram-negative bacterial strains were isolated from rectal swabs or stool samples of immunocompromised patients from two different wards of a university hospital. All isolates were phylogenetically analysed based on their 16S rRNA gene sequence, housekeeping gene recN, multilocus sequence analysis of concatenated partial fusA, leuS, pyrG and rpoB sequences, and by whole genome sequencing data. The analysed strains of the new species cluster together and form a separate branch with Citrobacter werkmanii NBRC105721T as the most closely related species. An average nucleotide identity value of 95.9-96% and computation of digital DNA-DNA hybridization values separate the new species from all other type strains of the genus Citrobacter. Biochemical characteristics further delimit the isolates from closely related Citrobacter type strains. As a result of the described data, a new Citrobacter species is introduced, for which the name Citrobacter cronae sp. nov. is proposed. The type strain is Tue2-1T with a G+C DNA content of 52.2 mol%.


Assuntos
Citrobacter/classificação , Fezes/microbiologia , Filogenia , Reto/microbiologia , Técnicas de Tipagem Bacteriana , Composição de Bases , Citrobacter/isolamento & purificação , DNA Bacteriano/genética , Ácidos Graxos/química , Genes Bacterianos , Alemanha , Humanos , Hospedeiro Imunocomprometido , Tipagem de Sequências Multilocus , Hibridização de Ácido Nucleico , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
10.
BMC Infect Dis ; 20(1): 302, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321444

RESUMO

BACKGROUND: Estimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS. METHODS: We evaluated the prevalence, antimicrobial susceptibility patterns, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017. Consenting pregnant women between 12 and 40 weeks of gestation were enrolled. Interview-administered questionnaires were used to assess risk factors associated with GBS colonization. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin using the disk diffusion method. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization. RESULTS: A total of 292 women were enrolled. Median age was 30 years (Interquartile range {IQR} 26-35) and a median gestational age of 35 weeks (IQR 30-37). Overall GBS was identified in 60/292 (20.5%) of participants. Among the positive isolates, resistance was detected for penicillin G in 42/58 (72.4%) isolates, ampicillin in 32/58 (55.2%) isolates, clindamycin in 14/46 (30.4%) isolates, and vancomycin in 14/58 (24.1%) isolates. All ten GBS serotypes were isolated, and 37/53 (69.8%) of GBS positive participants were colonized by more than one serotype. None of the risk factors was associated with GBS colonization. CONCLUSION: The prevalence of GBS colonization was high among antenatal women at KNH. In addition, a high proportion of GBS isolates were resistant to commonly prescribed intrapartum antibiotics. Hence, other measures like GBS vaccination is a potentially useful approaches to GBS prevention and control in this population. Screening of pregnant mothers for GBS colonization should be introduced and antimicrobial susceptibility test performed on GBS positive samples to guide antibiotic prophylaxis.


Assuntos
Testes de Sensibilidade Microbiana , Complicações Infecciosas na Gravidez/epidemiologia , Reto/microbiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/classificação , Streptococcus agalactiae/isolamento & purificação , Vagina/microbiologia , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Quênia/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Prevalência , Fatores de Risco , Sorogrupo , Sorotipagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/efeitos dos fármacos
11.
PLoS One ; 15(4): e0230976, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240218

RESUMO

Acinetobacter baumannii is an opportunistic pathogen of intensive care unit (ICU) patients. A. baumannii colonizes many parts of the body including the gastrointestinal tract. Endemic and epidemic strains are polyclonal. There is no clarity on the origin of polyclonality of A. baumannii. The objective of the study was to define the genetic relatedness of serial isolates and the origin of polyclonality. Serial rectal isolates from ICU patients whose rectum was colonized on ≥5 sampling occasions were selected. From a total of 32 eligible colonized patients, isolates from a subgroup of 13 patients (a total of 108 isolates) showing different patterns of colonization as revealed by pulsed-field gel electrophoresis (PFGE) were studied. The isolates were analyzed by PFGE pulsotypes, sequence types (STs) by multi-locus sequence typing (MLST) and clonal complex (CC) by eBURST analysis. Serial isolates constituted a mixture of identical, related and unrelated pulsotypes. Analysis by STs and CCs were less discriminatory. The data suggest a combination of an initial colonizing isolate undergoing mutation as well as colonization by independent isolates. Further clarity on the origin of diversity should be better obtained by whole-genome sequencing.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Mutação/genética , Reto/microbiologia , Técnicas de Tipagem Bacteriana/métodos , Infecção Hospitalar/microbiologia , Eletroforese em Gel de Campo Pulsado , Humanos , Unidades de Terapia Intensiva , Kuweit , Centros de Atenção Terciária
13.
R I Med J (2013) ; 103(2): 28-30, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122097

RESUMO

The rate of nosocomial C. difficile in Rhode Island is among the highest in the country. Colonization with C. difficile is uncommon but can lead to falsely identifying a patient as having C. difficile infection. Additionally, unrecognized C. difficile colonization may act as a reservoir in the hospital. During a 19-day period, rectal swabs obtained for routine VRE surveillance were cultured for C. difficile. Overall, 51 (7.9%) of 649 patients had C. difficile by culture. The majority (n=36, 71%) of patients from whom a rectal swab grew C. difficile did not have a sample sent to the clinical laboratory. Hence, at least 5.5% of the 649 patients were colonized. One patient was classified as having hospital-acquired C. difficile since the clinical specimen was sent to the clinical laboratory on hospital day 4. This patient was culture positive on admission and hence misclassified as having hospital- acquired C. difficile.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Pacientes Internados/estatística & dados numéricos , Adulto , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Hospitais , Humanos , Tempo de Internação , Reto/microbiologia , Rhode Island
15.
J Anim Sci ; 98(3)2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32076715

RESUMO

The in vitro gas production technique (IVGPT) has been a valuable tool in ruminant nutrition research for decades and has more recently been used in horse nutrition studies to investigate fermentation activities of the equine hindgut though primarily using feces as inoculum. This study was conducted to evaluate the use of equine rectal content in the IVGPT system as a viable inoculum that can be considered representative of the activities throughout the equine hindgut. Additionally, the study was conducted to measure the effects on fermentation kinetics and end-product production using inoculum from horses fed supplemental levels of coated sodium butyrate in an IVGPT system. Eight warmblood horses were fed a diet consisting of haylage (1% DM intake based on ideal body weight [BW]) and a mash concentrate formulated to provide 2.5 g nonstructural carbohydrate (NSC)/kg BW per meal. The diet was intended to create a NSC challenge to the microbial populations of the hindgut. The horses were randomly assigned to treatment or control group and after a 1-wk diet-adaptation period, the treatment group received 0.4 g/kg BW per day of a coated sodium butyrate supplement, while the control group received a placebo (coating only). After a 3-wk treatment period, the animals were sacrificed and digesta from the cecum, left ventral colon, right dorsal colon, and the rectum were collected within 30 min postmortem and used as inocula for the IVGPT trial. Haylage and concentrates fed to the test animals were also used as substrates in vitro. Sodium butyrate supplementation was not significant for gas production parameters or VFA measured suggesting no effect of sodium butyrate supplementation on the extent or kinetics of gas production or microbial end-product production (P ≥ 0.073). Differences in inocula were significant for organic matter corrected cumulative gas production (P = 0.0001), asymptotic gas production of the second phase (A2) (P < 0.0001); and maximal rate of OM degradation of the second phase (Rmax2) (P = 0.002). Inocula had a significant effect on total VFA (P = 0.0002), butyrate (Bu) (P = 0.015), branched chain fatty acids (P < 0.0001), pH (P < 0.0001), and ammonia (NH3) (P = 0.0024). In conclusion, based on observed results from this study, total tract digestibility may be overestimated if using rectal content inoculum to evaluate forage-based feeds in an IVGPT system.


Assuntos
Ácidos Graxos Voláteis/metabolismo , Microbioma Gastrointestinal/fisiologia , Cavalos/microbiologia , Animais , Ácido Butírico/análise , Dieta/veterinária , Suplementos Nutricionais/análise , Digestão , Ácidos Graxos Voláteis/análise , Fezes/microbiologia , Fermentação , Trato Gastrointestinal/metabolismo , Trato Gastrointestinal/microbiologia , Cavalos/metabolismo , Técnicas In Vitro/veterinária , Distribuição Aleatória , Reto/metabolismo , Reto/microbiologia
16.
Gastroenterology ; 158(6): 1546-1547, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32017908

Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Coinfecção/diagnóstico , Granuloma/diagnóstico , Proctite/diagnóstico , Doenças Sexualmente Transmissíveis/diagnóstico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/imunologia , Antibacterianos/administração & dosagem , Antivirais/administração & dosagem , Ceftriaxona/administração & dosagem , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Coinfecção/tratamento farmacológico , Coinfecção/imunologia , Coinfecção/microbiologia , Colonoscopia , Citomegalovirus/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Doxiciclina/administração & dosagem , Quimioterapia Combinada/métodos , Granuloma/tratamento farmacológico , Granuloma/imunologia , Granuloma/microbiologia , Humanos , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Proctite/tratamento farmacológico , Proctite/imunologia , Proctite/microbiologia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/imunologia , Doenças Sexualmente Transmissíveis/microbiologia , Resultado do Tratamento , Valganciclovir/administração & dosagem
17.
Int J Med Microbiol ; 310(3): 151401, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32037036

RESUMO

Whole-genome sequencing has enabled detailed studies on bacterial evolution during infection, but there is limited knowledge on intraclonal variation. In this study, we sought to provide a snapshot of the intraclonal diversity of Escherichia coli as both commensal in the faecal environment and pathogen during urinary tract infection, respectively. This was performed by whole-genome sequencing and analyses of single nucleotide polymorphisms (SNPs) and gene-content variation in ten isolates belonging to the same clone and isolated from rectal swabs or urine samples. We identified only one clone in eight of the nine urines sampled (89 %). In both the commensal and pathogenic state, the within-host diversity was limited with intraclonal SNP diversity of 0-2 non-synonymous SNPs for each clone. The genetic diversity showed variation in gene content in a range of 2-15 genes in total for all clones, including genes positioned on plasmids, and in the K- and O-antigen cluster. The observed SNP- and gene variation shows that sampling of one colony would be enough for surveillance, outbreak investigations and clonal evolution. However, for studies of adaptation during or between colonization and infection, this variation is relevant to consider.


Assuntos
Infecções por Escherichia coli/microbiologia , Escherichia coli/genética , Variação Genética , Genoma Bacteriano , Simbiose , Escherichia coli/patogenicidade , Escherichia coli/fisiologia , Infecções por Escherichia coli/urina , Fezes/microbiologia , Feminino , Genótipo , Humanos , Filogenia , Polimorfismo de Nucleotídeo Único , Reto/microbiologia , Infecções Urinárias/microbiologia , Sequenciamento Completo do Genoma
18.
Dan Med J ; 67(2)2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32053485

RESUMO

INTRODUCTION: In pregnant women, bacteriuria with group B streptococci (GBS) may be associated with a high degree of recto-vaginal GBS colonisation and therefore an increased risk of early-onset GBS disease. The aim of this study was to assess the performance of routine use of dipstick urine analysis during pregnancy for prediction of recto-vaginal GBS colonisation at the time of labour. METHODS: Among 902 unselected Danish pregnant women, we obtained results from 1) dipstick urine analysis, 2) urine culture carried out during pregnancy, if indicated, and 3) recto-vaginal culture at labour. The inclusion criteria were age > 18 years and gestational age ≥ 37 weeks. RESULTS: Intrapartum recto-vaginal GBS colonisation was predicted by a positive urine dipstick with 5% sensitivity only. CONCLUSION: Dipstick urine analysis had a low sensitivity for predicting intrapartum recto-vaginal colonisation with GBS. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Bacteriúria/microbiologia , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/isolamento & purificação , Urinálise , Adolescente , Adulto , Contagem de Colônia Microbiana , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações Infecciosas na Gravidez/urina , Reto/microbiologia , Infecções Estreptocócicas/urina , Vagina/microbiologia , Adulto Jovem
19.
Reprod Sci ; 27(4): 1064-1073, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32046455

RESUMO

Endometriosis remains a challenge to understand and to diagnose. This is an observational cross-sectional pilot study to characterize the gut and vaginal microbiome profiles among endometriosis patients and control subjects without the disease and to explore their potential use as a less-invasive diagnostic tool for endometriosis. Overall, 59 women were included, n = 35 with endometriosis and n = 24 controls. Rectal and vaginal samples were collected in two different periods of the menstrual cycle from all subjects. Gut and vaginal microbiomes from patients with different rASRM (revised American Society for Reproductive Medicine) endometriosis stages and controls were analyzed. Illumina sequencing libraries were constructed using a two-step 16S rRNA gene PCR amplicon approach. Correlations of 16S rRNA gene amplicon data with clinical metadata were conducted using a random forest-based machine-learning classification analysis. Distribution of vaginal CSTs (community state types) significantly differed between follicular and menstrual phases of the menstrual cycle (p = 0.021, Fisher's exact test). Vaginal and rectal microbiome profiles and their association to severity of endometriosis (according to rASRM stages) were evaluated. Classification models built with machine-learning methods on the microbiota composition during follicular and menstrual phases of the cycle were built, and it was possible to accurately predict rASRM stages 1-2 verses rASRM stages 3-4 endometriosis. The feature contributing the most to this prediction was an OTU (operational taxonomic unit) from the genus Anaerococcus. Gut and vaginal microbiomes of women with endometriosis have been investigated. Our findings suggest for the first time that vaginal microbiome may predict stage of disease when endometriosis is present.


Assuntos
Endometriose/diagnóstico , Endometriose/microbiologia , Microbiota , Vagina/microbiologia , Adulto , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Ciclo Menstrual , Pessoa de Meia-Idade , Projetos Piloto , Curva ROC , Reto/microbiologia , Adulto Jovem
20.
Int J Infect Dis ; 92: 81-88, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31935535

RESUMO

OBJECTIVES: We present an updated picture (1/1/2017-31/08/2019) of the frequency of carbapenemase producing Klebsiella pneumoniae (CPKP) in surveillance rectal swabs (SRS) and in clinical samples (CS) of patients admitted to a tertiary level hospital, focusing on longitudinal evolution of CPKP detected in SRS and on colistin resistant strains. METHODS: Retrospective longitudinal analysis. Only the first positive CPKP strain isolated from each patient was included. RESULTS: 638 CPKP strains were identified (471 in SRS and 167 in CS). SRS frequency increased over time in the medical department, remained high in the surgical department (SD) and decreased in the intensive care department. Most SRS-71.3%-and 49.1% of CS had nosocomial origin; about half of the SRS were identified in the SD. Regarding SRS evolution, carriage was confirmed in 39.5% of patients, no more testing in 25.5%, clinical involvement in 24.8 %, and negative result in 10.2%. Rates of colistin resistance were 20.1% in 2017, 31.2% in 2018 and 26.9% in 2019. CONCLUSIONS: CPKP diffusion is still an important issue despite the surveillance program. It is vital to enhance medical staff's awareness on this because most CPKP first detections in SRS occurred during hospital stay due to a nosocomial acquisition with a comparable picture over time. Colistin resistance is increasing.


Assuntos
Proteínas de Bactérias/metabolismo , Infecção Hospitalar/microbiologia , Hospitais de Ensino , Infecções por Klebsiella/transmissão , Klebsiella pneumoniae/metabolismo , Centros de Atenção Terciária , beta-Lactamases/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Colistina/farmacologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Farmacorresistência Bacteriana , Monitoramento Epidemiológico , Feminino , Humanos , Itália/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Reto/microbiologia , Estudos Retrospectivos
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